Sample records for unicuspid aortic valve

  1. Unicuspid Unicommissural Aortic Valve: An Extremely Rare Congenital Anomaly

    PubMed Central

    Singh, Sukhjeet; Ghayal, Puneet; Mathur, Atish; Mysliwiec, Margaret; Lovoulos, Constantinos; Solanki, Pallavi; Klapholz, Marc

    2015-01-01

    Unicuspid aortic valve is a rare congenital malformation that usually presents in the 3rd to 5th decade of life—and usually with severe aortic stenosis or regurgitation. It often requires surgical correction. Diagnosis can be made with 2- or 3-dimensional transthoracic or transesophageal echocardiography, cardiac computed tomography, or cardiac magnetic resonance imaging. We report the case of a 31-year-old man who presented with dyspnea on exertion due to severe aortic stenosis secondary to a unicuspid unicommissural aortic valve. After aortic valve replacement, this patient experienced complete heart block that required the placement of a permanent pacemaker. PMID:26175647

  2. Tricuspidization and reimplantation procedure for unicuspid aortic valve with annuloaortic ectasia.

    PubMed

    Abe, Kohei; Kawazoe, Kohei; Ito, Joji; Yamasaki, Manabu; Kuwauchi, Shintaro; Misumi, Hiroyasu

    2015-03-01

    Unicuspid aortic valve is a rare anomaly. We report 2 cases of successfully treated unicuspid valves with aortic dilatations by using a tricuspidization and reimplantation procedure. Two men, 35 and 39 years old, with severe aortic regurgitation and stenosis received this procedure. The sclerotic portion of a unicuspid valve, including 2 rudimentary commissures, was resected and reconstructed with autologous pericardium to create a tricuspid valve. An aortic root was replaced with a prosthetic graft. Postoperative echocardiogram showed trivial aortic regurgitation and minimal pressure gradient. Follow-up was 32 and 34 months, respectively. These valves remained stable in these periods. Tricuspidization and reimplantation is a promising procedure. PMID:25742847

  3. Unicuspid aortic valve presenting with cardiac arrest in an adolescent.

    PubMed

    Connelly, Tara; Kolcow, Walenty; Smyth, Yvonne; Veerasingham, David

    2015-01-01

    Unicuspid aortic valve (UAV) is a rare congenital anomaly typically affecting patients in their fourth and fifth decades and presenting with signs of heart failure. Our case is one of a previously asymptomatic teenage girl with a UAV, who presented with cardiac arrest and was successfully treated. Only two other similar cases have been reported in the literature, both were of slightly older male patients. Our case highlights the morbidity associated with the anomaly supporting the need for careful assessment of the valve in cases where UAV is suspected. PMID:26178230

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

    PubMed

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

    2011-05-19

    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

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

    PubMed

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

    2012-09-01

    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

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

    PubMed

    Dandes, Eric; Kirsch, Jacobo; Novaro, Gian

    2012-03-01

    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

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

    Microsoft Academic Search

    Eric Dandes; Jacobo Kirsch; Gian Novaro

    Cardiac CT angiography (CTA) is an ideal tool to investigate possible cardiac malformations. In this case, careful planning\\u000a of the CTA acquisition and reconstruction provided high resolution images of cardiac anatomy revealing 2 extremely rare coexisting\\u000a congenital defects; a unicuspid aortic valve (UAV) and sinus of Valsalva aneurysm (SVA). Detailed planning of CTA acquisition\\u000a reconstruction protocols is essential in obtaining

  8. Aortic Valve

    MedlinePLUS

    ... disease requiring surgery is called " senile aortic calcification ," meaning that the valve has worn out with age. ... valve of the left side of the heart, meaning that it opens during systole (when the ventricle ...

  9. Aortic valve repair leads to a low incidence of valve-related complications

    Microsoft Academic Search

    Diana Aicher; Roland Fries; Svetlana Rodionycheva; Kathrin Schmidt; Frank Langer; Hans-Joachim Schäfers

    2010-01-01

    Objective: Aortic valve replacement for aortic regurgitation (AR) has been established as a standard treatment but implies prosthesis-related complications. Aortic valve repair is an alternative approach, but its mid- to long-term results still need to be defined. Methods: Over a 12-year period, 640 patients underwent aortic valve repair for regurgitation of a unicuspid (n=21), bicuspid (n=205), tricuspid (n=411) or quadricuspid

  10. Aortic Valve

    MedlinePLUS

    ... Replacement of Artificial Valves? Are There Differences Between Mechanical and Biological Replacement Valves? Why is Surgery Necessary? ... are two types of artificial valves or prostheses: mechanical valves and biological valves . Examples of the valves ...

  11. Sutureless aortic valve replacement

    PubMed Central

    Phan, Kevin

    2015-01-01

    The increasing incidence of aortic stenosis and greater co-morbidities and risk profiles of the contemporary patient population has driven the development of minimally invasive aortic valve surgery and percutaneous transcatheter aortic valve implantation (TAVI) techniques to reduce surgical trauma. Recent technological developments have led to an alternative minimally invasive option which avoids the placement and tying of sutures, known as “sutureless” or rapid deployment aortic valves. Potential advantages for sutureless aortic prostheses include reducing cross-clamp and cardiopulmonary bypass (CPB) duration, facilitating minimally invasive surgery and complex cardiac interventions, whilst maintaining satisfactory hemodynamic outcomes and low paravalvular leak rates. However, given its recent developments, the majority of evidence regarding sutureless aortic valve replacement (SU-AVR) is limited to observational studies and there is a paucity of adequately-powered randomized studies. Recently, the International Valvular Surgery Study Group (IVSSG) has formulated to conduct the Sutureless Projects, set to be the largest international collaborative group to investigate this technology. This keynote lecture will overview the use, the potential advantages, the caveats, and current evidence of sutureless and rapid deployment aortic valve replacement (AVR). PMID:25870807

  12. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra

    ClinicalTrials.gov

    2014-08-08

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

  13. Aortic valve rupture during isometric muscle contraction.

    PubMed

    Payne, Darrin M; Richards, Tammy; Hamilton, Andrew

    2015-05-01

    Aortic valve rupture has been previously reported in association with blunt chest trauma as well as spontaneously in the setting of abnormal valves. We present a case of a patient who required emergent aortic valve replacement following rupture of his aortic valve during an isometric muscle contraction. PMID:25728450

  14. Association between congenitally quadricuspid aortic valve and mitral valve prolapse

    PubMed Central

    George, Betsy Ann; O'Hayre, Tayler Ann

    2013-01-01

    We describe transthoracic echocardiograms in three patients with combined quadricuspid aortic valve and prolapsing mitral valve. None had symptoms of cardiac dysfunction. Two patients had precordial murmurs. A third patient was referred for evaluation of infective endocarditis. The fact that a quadricuspid aortic valve is clearly a congenital anomaly supports the view that mitral valve prolapse is a congenital anomaly that may be more strongly associated with quadricuspid aortic valves than once thought. PMID:23814388

  15. Association between congenitally quadricuspid aortic valve and mitral valve prolapse.

    PubMed

    George, Betsy Ann; O'Hayre, Tayler Ann; Schussler, Jeffrey M

    2013-07-01

    We describe transthoracic echocardiograms in three patients with combined quadricuspid aortic valve and prolapsing mitral valve. None had symptoms of cardiac dysfunction. Two patients had precordial murmurs. A third patient was referred for evaluation of infective endocarditis. The fact that a quadricuspid aortic valve is clearly a congenital anomaly supports the view that mitral valve prolapse is a congenital anomaly that may be more strongly associated with quadricuspid aortic valves than once thought. PMID:23814388

  16. Aortic valve surgery - open

    MedlinePLUS

    ... There are two main types of new valves: Mechanical -- made of man-made materials, such as titanium ... Mechanical heart valves do not fail often. However, blood clots can develop on them. If a blood ...

  17. Bicuspid aortic valve is heritable

    Microsoft Academic Search

    Linda Cripe; Gregor Andelfinger; Lisa J. Martin; Kerry Shooner; D. Woodrow Benson

    2004-01-01

    ObjectivesPrevious studies have established familial clustering of bicuspid aortic valve (BAV), presumably indicating genetic inheritance. Our objective was to statistically test whether the segregation pattern of BAV is consistent with genetic inheritance and to obtain an estimate of the size of the genetic effect (heritability).

  18. Aortic Valve Injury Following Blunt Chest Trauma

    PubMed Central

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

    2014-01-01

    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

  19. Late surgical explantation and aortic valve replacement after transcatheter aortic valve implantation.

    PubMed

    Wang, Louis W; Granger, Emily K; McCourt, Jennifer A; Pye, Roger; Kaplan, Jason M; Muller, David W M

    2015-04-01

    Transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve disease is associated with higher rates of paravalvular aortic regurgitation, which may require subsequent surgical correction. We report a case of successful late surgical CoreValve explantation 1,389 days after TAVI in a patient with bicuspid aortic valve stenosis and McArdle's disease who developed severe paravalvular aortic regurgitation. We confirm that neoendothelialization and incorporation of the nitinol cage into the aortic wall had occurred at nearly 4 years postimplantation, although explantation with careful endarterectomy could still be performed without requiring simultaneous aortic root replacement. PMID:25841830

  20. Aortic root replacement with a valve-sparing technique for quadricuspid aortic valve.

    PubMed

    Yamanaka, Katsuhiro; Okada, Kenji; Okita, Yutaka

    2015-04-01

    A 67-year old man with ascending aortic aneurysm was referred because of a quadricuspid aortic valve. He underwent aortic root replacement with a valve-sparing technique. Under deep hypothermic circulatory arrest, replacement of the ascending aorta was successfully performed. The postoperative course was uneventful without recurrence of aortic regurgitation. PMID:24898609

  1. Transcatheter aortic valve implantation in Jehovah's Witness patients with symptomatic severe aortic valve stenosis

    PubMed Central

    Buz, Semih; Pasic, Miralem; Unbehaun, Axel; Hetzer, Roland

    2012-01-01

    Transcatheter aortic valve implantation (TAVI) is currently reserved for high or prohibitive surgical-risk patients with aortic valve stenosis. We report on successful TAVI in two Jehovah's witness patients. It offers a simple and effective treatment of severe aortic valve stenosis in high-risk patients who refuse the use of allogeneic blood and blood products. PMID:22753437

  2. Current approach to transfemoral aortic valve replacement.

    PubMed

    Kleczy?ski, Pawe?; Sorysz, Danuta; Rzeszutko, ?ukasz; Tr?bacz, Jaros?aw; Tomala, Marek; Sobczy?ski, Robert; Bagie?ski, Maciej; Bobrowska, Beata; Sadowski, Jerzy; Dudek, Dariusz

    2013-01-01

    We present a case of a 73 year-old male with severe aortic stenosis and high perioperative risk who was considered as candidate for percutaneous valve treatment. After precise clinical assessment, the subject underwent successful transfemoral aortic valve replacement with 29 mm device in analgosedation. PMID:23575719

  3. The natural history of aortic valve disease after mitral valve surgery

    Microsoft Academic Search

    Mordehay Vaturi; Avital Porter; Yehuda Adler; Yaron Shapira; Gideon Sahar; Bernardo Vidne; Alex Sagie

    1999-01-01

    OBJECTIVESThe present study evaluates the long-term course of aortic valve disease and the need for aortic valve surgery in patients with rheumatic mitral valve disease who underwent mitral valve surgery.BACKGROUNDLittle is known about the natural history of aortic valve disease in patients undergoing mitral valve surgery for rheumatic mitral valve disease. In addition there is no firm policy regarding the

  4. Replacement of ascending aorta with aortic valve reimplantation: midterm results

    Microsoft Academic Search

    Wolfgang Harringer; Klaus Pethig; Christian Hagl; Thorsten Wahlers; Jochen Cremer; Axel Haverich

    1999-01-01

    Objective: Aneurysms of the aortic root lead to aortic valve incompetence due to dilatation of the sinotubular junction and annuloaortic ectasia. Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft corrects annular ectasia as well as dilatation of sinotubular junction and aortic sinuses. Durability of this valve repair with respect to increased mechanical stress on valve

  5. Replacement of ascending aorta with aortic valve reimplantation: midterm resultsq

    Microsoft Academic Search

    Wolfgang Harringer; Klaus Pethig; Christian Hagl; Thorsten Wahlers; Jochen Cremer; Axel Haverich

    Objective: Aneurysms of the aortic root lead to aortic valve incompetence due to dilatation of the sinotubular junction and annuloaortic ectasia. Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft corrects annular ectasia as well as dilatation of sinotubular junction and aortic sinuses. Durability of this valve repair with respect to increased mechanical stress on valve

  6. Incidental necropsy finding of a quadricuspid aortic valve.

    PubMed

    van Rijswijk, Jan Willem; Willemink, Martin J; Kluin, Jolanda; Vink, Aryan

    2015-01-01

    Quadricuspid aortic valve is a rare congenital cardiac malformation often associated with abnormal valve function. In this article, we present a case of quadricuspid aortic valve only diagnosed at the time of post-mortem examination. PMID:25754175

  7. Geometry of aortic heart valves. [prosthetic design

    NASA Technical Reports Server (NTRS)

    Karara, H. M.

    1975-01-01

    Photogrammetric measurements of the surface topography of the aortic valves obtained from silicon rubber molds of freshly excised human aortic valves are presented. The data are part of an investigation into the design of a new prosthetic valve which will be a central-flow device, like the real valve and unlike previous central-occluding prostheses. Since the maximum stress on the heart valve is induced when the valve is closed and subject to diastolic back-pressure, it was decided to determine the valve geometry during diastole. That is, the molds were formed by pouring the rubber down the excised aortas, causing the valves to close. The molds were made under different pressures (20-120 torr); photogrammetry served as a vehicle for the assessment of the mold topography through the following outputs: digital models, surface profiles, and contour maps.

  8. Recellularization of aortic valves in pigs

    Microsoft Academic Search

    Jesper Langhoff Honge; Jonas Funder; Erik Hansen; Pascal Maria Dohmen; Wolfgang Konertz; John Michael Hasenkam

    2011-01-01

    Objectives: Decellularized porcine heart valves treated with deoxycholic acid (DOA) have demonstrated complete recellularization and absence of calcification when implanted into the pulmonary position in sheep. We studied recellularization and calcification in stented DOA-treated heart valves compared with conventional stented glutaraldehyde-treated valves in the aortic position in juvenile pigs 6 months after implantation. Methods: DOA heart valves (n=12) and glutaraldehyde-treated

  9. Prosthesis-preserving aortic root repair after aortic valve replacement.

    PubMed

    Hamamoto, Masaki; Kobayashi, Taira; Kodama, Hiroshi

    2015-07-01

    We describe a new technique of prosthesis-preserving aortic root replacement for patients who have previously undergone aortic valve replacement. With preservation of the mechanical prosthesis, we implant a Gelweave Valsalva graft using double suture lines. The first suture line is made between the sewing cuff of the mechanical valve and the graft, with mattress sutures of 2/0 braided polyester with pledgets. After the first sutures are tied, the second suture line is created between the graft collar and the aortic root remnant with continuous 4/0 polypropylene sutures. PMID:25186426

  10. Towards new therapies for calcific aortic valve disease

    Microsoft Academic Search

    P. W. Riem Vis

    2011-01-01

    Calcific aortic valve disease (CAVD) is characterized by progressive calcification of the aortic valve cusps. The end-stage (stenosis), can lead to heart failure and death. Approximately 2-3% of adults over 65 years of age are thought to suffer from valve stenosis, requiring aortic valve replacement. This amounts to a total number of approximately 300,000 aortic valve replacements worldwide and this

  11. Transcatheter aortic valve-in-valve implantation for patients with degenerative surgical bioprosthetic valves.

    PubMed

    Dvir, Danny; Barbanti, Marco; Tan, John; Webb, John G

    2014-01-01

    Most surgical heart valves currently implanted are bioprosthetic tissue valves. Such valves deteriorate with time, eventually presenting with either stenosis or regurgitation. Reoperation, the current standard of care for failed valves, carries significant risk in terms of both morbidity and mortality. Implantation of a transcatheter valve inside a failed surgical valve (valve-in-valve procedure) has recently emerged as an alternative, less-invasive option. Although the procedure is similar in some aspects to transcatheter aortic valve implantation in the setting of native aortic valve stenosis, there are many differences that deserve special consideration. We review the potential and challenges of valve-in-valve implantation in patients with failing surgical aortic bioprostheses. PMID:24331437

  12. Available transcatheter aortic valve replacement technology.

    PubMed

    Weiss, Dillon; Ruiz, Carlos E; Pirelli, Luigi; Jelnin, Vladimir; Fontana, Gregory P; Kliger, Chad

    2015-03-01

    Transcatheter aortic valve replacement (TAVR) is an alternative and now recommended therapy for patients who meet indications for surgical valve replacement and are high or prohibitive surgical risk. Available TAVR technologies are rapidly emerging to treat this complex patient population. This review discusses the specific valve designs of the transcatheter heart valves currently used, newer generation modifications to overcome limitations of earlier valve designs, and novel imaging modalities, such as computed tomographic angiography-fluoroscopy and echocardiography-fluoroscopy fusion imaging, available for pre-procedural planning and intra-procedural guidance. PMID:25651785

  13. Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic valve

    Microsoft Academic Search

    Matthias Bauer; Miralem Pasic; Rudolf Meyer; Nadine Goetze; Ulrike Bauer; Henryk Siniawski; Roland Hetzer

    2002-01-01

    Background. Patients with bicuspid aortic valves tend to develop dilatation of the ascending aorta. The aim of this study was to analyze whether or not there is any histologic difference in the aortic media of patients with a bicuspid aortic valve or a tricuspid aortic valve.Methods. A morphometric analysis of the wall of the ascending aorta was performed in 107

  14. Review Article The aortic valve microenvironment and its role in calcific aortic

    E-print Network

    Simmons, Craig A.

    Review Article The aortic valve microenvironment and its role in calcific aortic valve disease 21 November 2010; accepted 1 December 2010 Abstract In calcific aortic valve disease, fibrotic and calcific lesions form focally in the fibrosa layer of the valve leaflets. Layer

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

    PubMed

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

    2014-10-01

    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

  16. Role of transcatheter aortic valve implantation (TAVI) versus conventional aortic valve replacement in the treatment of aortic valve disease.

    PubMed

    Lawrie, Gerald M

    2012-01-01

    Conventional aortic valve replacement (AVR) surgery has been in clinical use since 1960. Results, particularly in high-risk populations such as the very elderly and frail, continue to improve in response to the challenges posed by this growing segment of the patient population. Transcatheter aortic valve implantation (TAVI) is a fairly recent development, performed for the first time in 2002. The last decade has seen an exponential growth in the application of this technology in higher-risk populations. Results of recent randomized prospective trials demonstrate both the future promise and current problems of the TAVI approach. Many patients deemed inoperable for AVR have been treated successfully by TAVI. However, elevated procedural and late mortality rates, excessive early and late stroke, and a significant incidence of periprosthetic aortic valve insufficiency and patient-prosthesis mismatch all suggest caution in extending this technology to patients able to undergo conventional AVR with a low risk of early or late complications. PMID:22891120

  17. Aortic valve replacement in elderly patients with aortic stenosis.

    PubMed Central

    Straumann, E.; Kiowski, W.; Langer, I.; Grädel, E.; Stulz, P.; Burckhardt, D.; Pfisterer, M.; Burkart, F.

    1994-01-01

    OBJECTIVE--To assess the risk of aortic valve replacement and long-term follow-up in elderly patients with dominant aortic stenosis. DESIGN--Retrospective analysis of patients who had aortic valve replacement over a 10 year period and were routinely seen in an outpatient clinic. SETTING--University hospital. PATIENTS--93 patients aged > or = 60 and 47 patients > or = 70 years with symptomatic aortic stenosis undergoing aortic valve replacement. MAIN OUTCOME MEASURES--Early and late mortality in different age groups. Influence of preoperative signs and symptoms on overall outcome. RESULTS--The proportion of patients older than 70 years increased from 11% in 1978 to 54% in 1986. Perioperative mortality was 3.6% and mortality after 2 and 5 years was 9% and 13% respectively. Survival was similar (85% and 83%, respectively) in patients aged 60-69 years (group 1, n = 93, mean age 64.5 (2.7) and patients aged > or = 70 years (group 2, n = 47, mean age 72.6 (2.5)). Additional coronary artery disease and coronary bypass grafting did not significantly affect survival. The cardiothoracic ratio was inversely related to survival (Cox regression, p < 0.05). Preoperative symptoms (syncope, angina pectoris, and dyspnoea) were similar in both patient groups. After a mean (SD) follow up of 51 (33) months 96% of surviving patients were in NYHA functional class I or II with no difference between the two age groups. Similarly, the cardiothoracic ratio and Sokolow index decreased to near normal values in both age groups. CONCLUSION--The risk of aortic valve replacement in patients with dominant aortic stenosis is low and not significantly influenced by age. Therefore replacement may be performed without increased risk in elderly patients and with a good long-term outcome. PMID:8011409

  18. Transcatheter aortic valve implantation: status and challenges.

    PubMed

    Fishbein, Gregory A; Schoen, Frederick J; Fishbein, Michael C

    2014-01-01

    Calcific aortic valve disease of the elderly is the most prevalent hemodynamically-significant valvular disease, and the most common lesion requiring valve replacement in industrialized countries. Transcatheter aortic valve implantation is a less invasive alternative to classical aortic valve replacement that can provide a therapeutic option for high-risk or inoperable patients with aortic stenosis. These devices must be biocompatible, have excellent hemodynamic performance, be easy to insert, be securely anchored without sutures, and be durable, without increased risk of thrombosis or infection. To date, complications are related to the site of entry for insertion, the site of implantation (aorta, coronary ostia, base of left ventricle), and to the structure and design of the inserted device. However, as with any novel technology unanticipated complications will develop. Goals for future development will be to make the devices more effective, more durable, safer, and easier to implant, so as to further improve outcome for patients with severe aortic stenosis. The pathologist participating in research and development, and examination of excised devices will have a critical role in improving outcome for these patients. PMID:24183003

  19. Mitral valve prolapse and occult aortic coarctation.

    PubMed Central

    Ludman, P.; Yacoub, M.; Dancy, M.

    1990-01-01

    A 22 year old man developed symptoms of left ventricular failure secondary to atrial fibrillation and congenital mitral regurgitation. After operation for mitral valve repair he was unable to be successfully weaned from cardiopulmonary bypass and this was ascribed to poor left ventricular function. He therefore underwent emergency cardiac transplantation but again was unable to be weaned from bypass. At post-mortem examination a previously undiagnosed aortic coarctation was revealed. The presentation of occult aortic coarctation is discussed, and its association with congenital mitral valve abnormalities reviewed. Images Figure 2 PMID:2099423

  20. Early aortic valve cusp rupture in relapsing polychondritis

    Microsoft Academic Search

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

    1992-01-01

    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

  1. Transcatheter aortic valve implantation: anesthetic considerations.

    PubMed

    Billings, Frederic T; Kodali, Susheel K; Shanewise, Jack S

    2009-05-01

    Aortic valvular stenosis remains the most common debilitating valvular heart lesion. Despite the benefit of aortic valve (AV) replacement, many high-risk patients cannot tolerate surgery. AV implantation treats aortic stenosis without subjecting patients to sternotomy, cardiopulmonary bypass (CPB), and aorta cross-clamping. This transcatheter procedure is performed via puncture of the left ventricular (LV) apex or percutaneously, via the femoral artery or vein. Patients undergo general anesthesia, intense hemodynamic manipulation, and transesophageal echocardiography (TEE). To elucidate the role of the anesthesiologist in the management of transcatheter AV implantation, we review the literature and provide our experience, focusing on anesthetic care, intraoperative events, TEE, and perioperative complications. Two approaches to the aortic annulus are performed today: transfemoral retrograde and transapical antegrade. Iliac artery size and tortuosity, aortic arch atheroma, and pathology in the area of the (LV) apex help determine the preferred approach in each patient. A general anesthetic is tailored to achieve extubation after procedure completion, whereas IV access and pharmacological support allow for emergent sternotomy and initiation of CPB. Rapid ventricular pacing and cessation of mechanical ventilation interrupts cardiac ejection and minimizes heart translocation during valvuloplasty and prosthesis implantation. Although these maneuvers facilitate exact prosthesis positioning within the native annulus, they promote hypotension and arrhythmia. Vasopressor administration before pacing and cardioversion may restore adequate hemodynamics. TEE determines annulus size, aortic pathology, ventricular function, and mitral regurgitation. TEE and fluoroscopy are used for positioning the introducer catheter within the aortic annulus. The prosthesis, crimped on a valvuloplasty balloon catheter, is implanted by inflation. TEE immediately measures aortic regurgitation and assesses for aortic dissection. After repair of femoral vessels or LV apex, patients are allowed to emerge and assessed for extubation. Observed and published complications include aortic regurgitation, prosthesis embolization, mitral valve disruption, hemorrhage, aortic dissection, CPB, stroke, and death. Transcatheter AV implantation relies on intraoperative hemodynamic manipulation for success. Transfemoral and transapical approaches pose unique management challenges, but both require rapid ventricular pacing, the management of hypotension and arrhythmias during beating-heart valve implantation, and TEE. Anesthesiologists will care for debilitated patients with aortic stenosis receiving transcatheter AV implantation. PMID:19372319

  2. Transcatheter, valve-in-valve transapical aortic and mitral valve implantation, in a high risk patient with aortic and mitral prosthetic valve stenoses.

    PubMed

    Ramakrishna, Harish; DeValeria, Patrick A; Sweeney, John P; Mookaram, Farouk

    2015-01-01

    Transcatheter valve implantation continues to grow worldwide and has been used principally for the nonsurgical management of native aortic valvular disease-as a potentially less invasive method of valve replacement in high-risk and inoperable patients with severe aortic valve stenosis. Given the burden of valvular heart disease in the general population and the increasing numbers of patients who have had previous valve operations, we are now seeing a growing number of high-risk patients presenting with prosthetic valve stenosis, who are not potential surgical candidates. For this high-risk subset transcatheter valve delivery may be the only option. Here, we present an inoperable patient with severe, prosthetic valve aortic and mitral stenosis who was successfully treated with a trans catheter based approach, with a valve-in-valve implantation procedure of both aortic and mitral valves. PMID:25849702

  3. Coronary Ostial Stenosis after Aortic Valve Replacement

    PubMed Central

    Ziakas, Antonios G.; Economou, Fotios I.; Charokopos, Nicholas A.; Pitsis, Antonios A.; Parharidou, Despina G.; Papadopoulos, Thomas I.; Parharidis, Georgios E.

    2010-01-01

    Coronary ostial stenosis is a rare but potentially serious sequela after aortic valve replacement. It occurs in the left main or right coronary artery after 1% to 5% of aortic valve replacement procedures. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Although the typical treatment is coronary artery bypass grafting, patients have been successfully treated by means of percutaneous coronary intervention. Herein, we present the cases of 2 patients in whom coronary ostial stenosis developed after aortic valve replacement. In the 1st case, a 72-year-old man underwent aortic valve replacement and bypass grafting of the saphenous vein to the left anterior descending coronary artery. Six months later, he experienced a non-ST-segment-elevation myocardial infarction. Coronary angiography revealed a critical stenosis of the right coronary artery ostium. In the 2nd case, a 78-year-old woman underwent aortic valve replacement and grafting of the saphenous vein to an occluded right coronary artery. Four months later, she experienced unstable angina. Coronary angiography showed a critical left main coronary artery ostial stenosis and occlusion of the right coronary artery venous graft. In each patient, we performed percutaneous coronary intervention and deployed a drug-eluting stent. Both patients were asymptomatic on 6-to 12-month follow-up. We attribute the coronary ostial stenosis to the selective ostial administration of cardioplegic solution during surgery. We conclude that retrograde administration of cardioplegic solution through the coronary sinus may reduce the incidence of postoperative coronary ostial stenosis, and that stenting may be an efficient treatment option. PMID:20844624

  4. Staged biventricular repair for absent aortic valve in a neonate.

    PubMed

    Iwaki, Ryuma; Oshima, Yoshihiro; Maruo, Ayako; Hasegawa, Tomomi; Matsuhisa, Hironori; Noda, Rei; Matsushima, Shunsuke

    2015-05-01

    Congenitally absent aortic valve is an extremely rare and fatal cardiac malformation. We report the case of a neonate with absent aortic valve, an interrupted aortic arch, and a normal-sized left ventricle. At age 9 hours, emergency aortic valve closure and a Norwood procedure were performed to maintain coronary circulation. The patient's postoperative course was complicated because of tracheomalacia and a severely dilated aorta that were treated with reduction aortoplasty at age 4 months. Finally, a staged Yasui procedure was performed at 26 months. To our knowledge, this is the first report of a successful biventricular repair for absent aortic valve. PMID:25952245

  5. CT in transcatheter aortic valve replacement.

    PubMed

    Blanke, Philipp; Schoepf, U Joseph; Leipsic, Jonathon A

    2013-12-01

    Transcatheter aortic valve replacement is a new method to treat patients with symptomatic, severe aortic stenosis who are at high surgical risk. Short- and midterm results have been encouraging, with more than 90,000 procedures performed worldwide. Patient selection, prosthesis sizing, and access strategies heavily rely on noninvasive imaging. Computed tomographic (CT) angiography is increasingly used for peri-interventional evaluation, as this modality allows for objective three-dimensional assessment of the aortic root, evaluation of the iliofemoral access route, and prediction of appropriate projection angles for prosthesis deployment. Compared with two-dimensional imaging techniques, CT provides comprehensive information about aortic annulus anatomy and geometry, supporting appropriate patient selection and prosthesis sizing. Recently, integration of CT measurements into sizing algorithms has been demonstrated to significantly reduce the incidence of paravalvular regurgitation, compared with prosthesis sizing with two-dimensional echocardiography. In addition, CT-based vascular access planning has been shown to reduce vascular access complications. Postprocedural CT imaging allows for the documentation of procedural success, evaluation of prosthesis positioning, and identification of asymptomatic complications. In this article, the rapidly emerging role of CT in the context of transcatheter aortic valve replacement will be described. Online supplemental material is available for this article. PMID:24261496

  6. Left Ventricular Dynamics after Aortic Valve Replacement

    PubMed Central

    Masotti, Claudio S.; Bonfranceschi, Paola; Rusticali, Guido; Rusticali, Franco; Pierangeli, Angelo

    1992-01-01

    Between January 1985 and July 1990, we studied 71 patients at our institution who underwent aortic valve replacement for either aortic valve regurgitation (40 patients) or stenosis (31 patients). The following prostheses were implanted: 25 St. Jude Medical valves (bileaflet), 16 Björk-Shiley (monoleaflet, tilting disc, 60° convexo-concave), 16 Medtronic-Hall (monoleaflet, tilting disc), and 14 Starr-Edwards (caged ball). The patients were evaluated pre-and postoperatively by means of gated blood-pool scintigraphy and Doppler echocardiography. Postoperatively, each patient was studied at 6 months, 1 year, and then annually. The evaluations focused upon 1) scintigraphically assessed left ventricular performance indicators (end-diastolic and end-systolic volume, as well as resting and exercise ejection fraction) and 2) Doppler-derived hemodynamic indexes (peak and mean transvalvular pressure gradient, effective orifice area, regurgitant flow, and systolic wall stress). Early after aortic valve replacement, 55 (77.5%) of the patients had substantial symptomatic relief, with normal hemodynamic values both at rest and during exercise (New York Heart Association functional class I or II); another 6 patients (8.5%) maintained their preoperative status in those classes. Within a year after surgery, a majority of patients showed a significant reduction in left ventricular dimensions. The patients with preoperative aortic valve stenosis had a significantly reduced end-diastolic and end-systolic volume (p<0.05), a moderately reduced left ventricular mass index (p<0.01), and a significantly increased exercise ejection fraction (p<0.05); moreover, in all 31 of these cases, systolic wall stress returned to normal or lower-than-control values (p<0.005). The patients with preoperative aortic valve regurgitation had a significant reduction in end-diastolic and end-systolic volume (p<0.005), diastolic wall stress (p<0.005), and a significant increase in exercise ejection fraction (p<0.01); however, their left ventricular mass index was not significantly reduced. Optimal long-term survival was afforded by the St. Jude valve in the small size (21 mm) and the Starr-Edwards valve in the large size (27 mm). This study represents the first reported use of a serial, combined radionuclide and echocardiographic procedure for the follow-up of patients undergoing aortic valve replacement. During the 5½-year follow-up period, this combined technique proved highly accurate for collecting follow-up data, often complementing or correcting simple ultrasound results. This diagnostic approach enabled us to 1) obtain information comparable to or better than that provided by cardiac catheterization, 2) identify complications early, 3) differentiate between valvular and ventricular failure, and 4) suggest the valve of choice (not always that with the best hemodynamic performance) in patients with different cardiac variables. Further research is needed to confirm this study, the results of which could change many medical and surgical strategies for clinical management of the diseased aortic valve. (Texas Heart Institute Journal 1992; 19:97-106) Images PMID:15227421

  7. Mechanobiology of the Aortic Heart Valve Jonathan T. Butcher1

    E-print Network

    Simmons, Craig A.

    Review: Mechanobiology of the Aortic Heart Valve Jonathan T. Butcher1 , Craig A. Simmons2 , James N valve, positioned between the left ventri- cle and aortic root, prevents retrograde flow of blood into the ventricle during diastole. Opening and closing of the valve occurs passively in response to inertial forces

  8. Collagen Bundle Orientation Explains Aortic Valve Leaflet Coaptation

    E-print Network

    Collagen Bundle Orientation Explains Aortic Valve Leaflet Coaptation Peter E. Hammer1 , Christina A. The aortic valve owes its strength and durability to a network of collagen fibers within the leaflets. However, the pattern of these fibers and their role in valve function is not well understood. We imaged

  9. Minimally Invasive Aortic Valve Replacement

    MedlinePLUS Videos and Cool Tools

    ... lot of turbulent flow, as represented by the red and the blue color. Typically, blood flowing through ... t supposed to happen, is bright blue and red. And so this valve has two problems. It's ...

  10. Aortic Valve Conservation in Acute Type A Dissection

    Microsoft Academic Search

    Stephen Westaby; Takahiro Katsumata; Edward Freitas

    1997-01-01

    Background. We consider operative survival as the primary objective in acute type A dissection and believe that virtually all native aortic valves can be conserved. We sought to answer the question: “Does glue repair improve the long-term stability of proximal aortic repair?”Methods. We retrospectively studied 64 patients with an acute type A dissection, an ascending aortic tear, and aortic regurgitation

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

    PubMed Central

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

    2013-01-01

    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

  12. Hemodynamic Changes following Aortic Valve Bypass: A Mathematical Approach

    E-print Network

    Benevento, Emilia

    Aortic valve bypass (AVB) has been shown to be a viable solution for patients with severe aortic stenosis (AS). Under this circumstance, the left ventricle (LV) has a double outlet. The objective was to develop a mathematical ...

  13. Urgent transcatheter aortic valve replacement for severe aortic valve stenosis with acute decompensated heart failure: report of a case.

    PubMed

    Kashiyama, Noriyuki; Kuratani, Toru; Torikai, Kei; Maeda, Koichi; Toda, Koichi; Miyagawa, Shigeru; Nishi, Hiroyuki; Yoshikawa, Yasushi; Fukushima, Satsuki; Yoshioka, Daisuke; Saito, Tetsuya; Sawa, Yoshiki

    2015-07-01

    Recent evidence suggests that transcatheter aortic valve replacement (TAVR) is feasible for treating severe aortic valve stenosis (AS) in patients who are considered high risk for elective surgery. However, it is still unclear whether TAVR is a better option than surgical aortic valve replacement for severe AS with acute decompensated heart failure. We report a case of severe AS with acute heart failure, which was treated successfully by urgent TAVR, with cardiopulmonary support. PMID:25358893

  14. Combined congenitally bicuspid aortic valve and mitral valve prolapse causing pure regurgitation

    PubMed Central

    Roberts, William C.; Zafar, Saleha; Ko, Jong Mi; Carry, Melissa M.; Hebeler, Robert F.

    2013-01-01

    Described herein is a patient with a purely regurgitant congenitally bicuspid aortic valve and a purely regurgitant prolapsing mitral valve. Although it is well established that the bicuspid aortic valve is a congenital anomaly, it is less well appreciated that mitral valve prolapse is almost certainly also a congenital anomaly. The two occurring in the same patient provides support that mitral valve prolapse is also a congenital anomaly. PMID:23382607

  15. Combined congenitally bicuspid aortic valve and mitral valve prolapse causing pure regurgitation.

    PubMed

    Roberts, William C; Zafar, Saleha; Ko, Jong Mi; Carry, Melissa M; Hebeler, Robert F

    2013-01-01

    Described herein is a patient with a purely regurgitant congenitally bicuspid aortic valve and a purely regurgitant prolapsing mitral valve. Although it is well established that the bicuspid aortic valve is a congenital anomaly, it is less well appreciated that mitral valve prolapse is almost certainly also a congenital anomaly. The two occurring in the same patient provides support that mitral valve prolapse is also a congenital anomaly. PMID:23382607

  16. Surgical treatment of infective endocarditis with aortic and tricuspid valve involvement using cryopreserved aortic and mitral valve allografts.

    PubMed

    Ostrovsky, Yury; Spirydonau, Siarhei; Shchatsinka, Mikalai; Shket, Aliaksandr

    2015-05-01

    Surgical treatment of infective and prosthetic endocarditis using allografts gives good results. Aortic allograft implantation is a common technique, while tricuspid valve replacement with a mitral allograft is very rare. Multiple valve disease in case of infective endocarditis is a surgical challenge as such patients are usually in a grave condition and results of surgical treatment are often unsatisfactory. In this article we describe a clinical case of successful surgical treatment in a patient with active infective endocarditis of aortic and tricuspid valve, complicated by an aortic-right ventricular fistula. The aortic valve and ascending aorta were replaced with a cryopreserved aortic allograft; the tricuspid valve was replaced with a cryopreserved mitral allograft. PMID:25697982

  17. Thalassemia and heart surgery: aortic valve repair after endocarditis.

    PubMed

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

    2015-01-01

    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

  18. Innate and Adaptive Immunity in Calcific Aortic Valve Disease

    PubMed Central

    Mathieu, Patrick; Bouchareb, Rihab

    2015-01-01

    Calcific aortic valve disease (CAVD) is the most common heart valve disorder. CAVD is a chronic process characterized by a pathologic mineralization of valve leaflets. Ectopic mineralization of the aortic valve involves complex relationships with immunity. Studies have highlighted that both innate and adaptive immunity play a role in the development of CAVD. In this regard, accumulating evidence indicates that fibrocalcific remodelling of the aortic valve is associated with activation of the NF-?B pathway. The expression of TNF-? and IL-6 is increased in human mineralized aortic valves and promotes an osteogenic program as well as the mineralization of valve interstitial cells (VICs), the main cellular component of the aortic valve. Different factors, including oxidized lipid species, activate the innate immune response through the Toll-like receptors. Moreover, VICs express 5-lipoxygenase and therefore produce leukotrienes, which may amplify the inflammatory response in the aortic valve. More recently, studies have emphasized that an adaptive immune response is triggered during CAVD. Herein, we are reviewing the link between the immune response and the development of CAVD and we have tried, whenever possible, to keep a translational approach.

  19. What is the best approach in a patient with a failed aortic bioprosthetic valve: transcatheter aortic valve replacement or redo aortic valve replacement?

    PubMed

    Tourmousoglou, Christos; Rao, Vivek; Lalos, Spiros; Dougenis, Dimitrios

    2015-06-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether transcatheter aortic valve-in-valve replacement (viv-TAVR) or redo aortic valve replacement (rAVR) is the best strategy in a patient with a degenerative bioprosthetic aortic valve. Altogether, 162 papers were found using the reported search, of which 12 represented the best evidence to answer the question. The authors, journal, date, country of publication, patient group, study type, outcomes and results of papers are tabulated. The results of the studies provided interesting results. All the studies are retrospective. Four papers reported the results of redo aortic valve replacement in patients with failed aortic bioprosthetic valve, six papers demonstrated their results with transcatheter aortic valve-in-valve replacement for the same indication and two papers reported their propensity-matched analysis of outcomes between viv-TAVR and rAVR in patients with previous cardiac surgery. Thirty-day mortality for rAVR was 2.3-15.5% and 0-17% for viv-TAVR. For rAVR, survival rate at 30 days was 83.6%, 76.1% at 1 year, 70.8% at 3 years, at 51.3-66% at 5 years, 61% at 8 years and 61.5% at 10 years. For viv-TAVR, the overall Kaplan-Meier survival rate at 1 year was 83.2%. After viv-TAVR at 1 year, 86.2% of surviving patients were at New York Heart Association (NYHA) class I/II. The complications after rAVR were stroke (4.6-5.8%), reoperation for bleeding (6.9-9.7%), low-cardiac output syndrome (9.9%) whereas complications after viv-TAVR at 30 days were major stroke (1.7%), aortic regurgitation of at least moderate degree (25%), new permanent pacemaker implantation rate (0-11%), ostial coronary obstruction (2%), need for implantation of a second device (5.7%) and major vascular complications (9.2%). It is noteworthy to mention that there is a valve-in-valve application that provides information to surgeons for choosing the correct size of the TAVR valve. Transcatheter aortic valve-in-valve procedures are clinically effective, at least in the short term, and could be an acceptable approach in selected high-risk patients with degenerative bioprosthetic valves. Redo AVR achieves acceptable medium and long-term results. Both techniques could be seen as complementary approaches for high-risk patients. PMID:25754372

  20. Anaesthetic management of transcatheter aortic valve implantation.

    PubMed

    Franco, Annalisa; Gerli, Chiara; Ruggeri, Laura; Monaco, Fabrizio

    2012-01-01

    Transcatheter aortic valve implantation (TAVI) is an emergent technique for high-risk patients with aortic stenosis. TAVI poses significant challenges about its management because of the procedure itself and the population who undergo the implantation. Two devices are currently available and marketed in Europe and several other technologies are being developed. The retrograde transfemoral approach is the most popular procedure; nevertheless, it may not be feasible in patients with signi?cant aortic or ileo-femoral arterial disease. Alternatives include a transaxillary approach, transapical approach, open surgical access to the retroperitoneal iliac artery and the ascending aorta. A complementary approach using both devices and alternative routes tailored to the anatomy and the comorbidities of the single patient is a main component for the successful implementation of a TAVI program. Anaesthetic strategies vary in different centers. Local anaesthesia or general anaesthesia are both valid alternatives and can be applied according to the patient's characteristics and procedural instances. General anaesthesia offers many advantages, mainly regarding the possibility of an early diagnosis and treatment of possible complications through the use of transesophageal echocardiography. However, after the initial experiences, many groups began to employ, routinely, sedation plus local anaesthesia for TAVI, and their procedural and periprocedural success demonstrates that it is feasible. TAVI is burdened with potential important complications: vascular injuries, arrhythmias, renal impairment, neurological complications, cardiac tamponade, prosthesis malpositioning and embolization and left main coronary artery occlusion. The aim of this work is to review the anaesthetic management of TAVI based on the available literature. PMID:22234024

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

    PubMed Central

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

    2013-01-01

    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

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

    Microsoft Academic Search

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

    1998-01-01

    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

  3. Aortic valve and ascending aortic root modeling from 3D and 3D+t CT

    NASA Astrophysics Data System (ADS)

    Grbic, Saša; Ionasec, Razvan I.; Zäuner, Dominik; Zheng, Yefeng; Georgescu, Bogdan; Comaniciu, Dorin

    2010-02-01

    Aortic valve disorders are the most frequent form of valvular heart disorders (VHD) affecting nearly 3% of the global population. A large fraction among them are aortic root diseases, such as aortic root aneurysm, often requiring surgical procedures (valve-sparing) as a treatment. Visual non-invasive assessment techniques could assist during pre-selection of adequate patients, planning procedures and afterward evaluation of the same. However state of the art approaches try to model a rather short part of the aortic root, insufficient to assist the physician during intervention planning. In this paper we propose a novel approach for morphological and functional quantification of both the aortic valve and the ascending aortic root. A novel physiological shape model is introduced, consisting of the aortic valve root, leaflets and the ascending aortic root. The model parameters are hierarchically estimated using robust and fast learning-based methods. Experiments performed on 63 CT sequences (630 Volumes) and 20 single phase CT volumes demonstrated an accuracy of 1.45mm and an performance of 30 seconds (3D+t) for this approach. To the best of our knowledge this is the first time a complete model of the aortic valve (including leaflets) and the ascending aortic root, estimated from CT, has been proposed.

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

    PubMed Central

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

    2013-01-01

    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

  5. Aortic Valve Replacement for Patients With Severe Aortic Stenosis: Risk Factors and Their Impact on 30Month Mortality

    Microsoft Academic Search

    Edward L. Hannan; Zaza Samadashvili; Stephen J. Lahey; Craig R. Smith; Alfred T. Culliford; Robert S. D. Higgins; Jeffrey P. Gold; Robert H. Jones

    2009-01-01

    Background. Few studies have reported population- based outcomes for aortic valve replacement patients. Methods. Patients with severe aortic valve stenosis who underwent aortic valve replacement with or without concomitant coronary artery bypass graft surgery from January 1, 2003, to December 31, 2005, were included in the study. Statistical models were developed to identify significant risk factors for mortality, to compare

  6. Comparison of aortic media changes in patients with bicuspid aortic valve stenosis versus bicuspid valve insufficiency and proximal aortic aneurysm

    PubMed Central

    Girdauskas, Evaldas; Rouman, Mina; Borger, Michael A.; Kuntze, Thomas

    2013-01-01

    OBJECTIVES The aim of this study was to evaluate aortic media changes in bicuspid aortic valve (BAV) patients who underwent aortic valve replacement (AVR) and simultaneous replacement of the proximal aorta for BAV stenosis vs BAV insufficiency. METHODS Review of our institutional BAV database identified a subgroup of 79 consecutive BAV patients (mean age 52.3 ± 13 years, 81% men) with BAV stenosis or insufficiency and concomitant proximal aortic dilatation of ?50 mm who underwent AVR and simultaneous replacement of proximal aorta from 1995 through 2005. All cases of BAV disease and concomitant ascending aortic dilatation of 40–50 mm underwent isolated AVR and therefore were excluded from this analysis. Proximal aortic media elastic fibre loss (EFL) was assessed (graded 0 to 3+) and compared between patients with BAV stenosis (Group I, n = 44) vs BAV insufficiency (Group II, n = 35). Follow-up (690 patient-years) was 100% complete and 9.1 ± 4.6 years long. RESULTS Mean aortic media EFL was 1.3 ± 0.7 in Group I vs 2.5 ± 0.8 in Group II (P = 0.03). Moderate/severe EFL (i.e. defined as grade 2+/3+) was found in 13 patients (29%) in Group I vs 28 patients (80%) in Group II (P < 0.001). Logistic regression identified BAV insufficiency as the strongest predictor of moderate/severe EFL (OR 9.3; 95% CI 3.2–29.8, P < 0.001). Valve-related event-free survival was 64 ± 8% in Group I vs 93% ± 5% in Group II at 10 years postoperatively (P = 0.05). A total of 4 patients (5%, 3 from Group I and 1 from Group II) underwent redo aortic root surgery for prosthetic valve endocarditis during follow-up. CONCLUSIONS Patients with BAV insufficiency and a proximal aorta of ?50 mm have a significantly higher rate of moderate/severe EFL as compared to their counterparts with BAV stenosis. PMID:24006478

  7. Percutaneous transluminal alcohol septal myocardial ablation after aortic valve replacement

    NASA Technical Reports Server (NTRS)

    Sitges, M.; Kapadia, S.; Rubin, D. N.; Thomas, J. D.; Tuzcu, M. E.; Lever, H. M.

    2001-01-01

    When left ventricular outflow tract obstruction develops after aortic valve replacement, few treatment choices have been available until now. We present a patient with prior aortic valve replacement who developed left ventricle outflow tract obstruction that was successfully treated with a percutaneous transcoronary myocardial septal alcohol ablation. This technique is a useful tool for the treatment of obstructive hypertrophic cardiomyopathy, especially in those patients with prior heart surgery. Copyright 2001 Wiley-Liss, Inc.

  8. Insights into degenerative aortic valve disease.

    PubMed

    Goldbarg, Seth H; Elmariah, Sammy; Miller, Marc A; Fuster, Valentin

    2007-09-25

    Despite the dramatic decline of rheumatic heart disease over the past 5 decades, there has not been a concordant decline in the prevalence of valvular heart disease. Degenerative aortic valve disease (DAVD) has become the most common cause of valvular heart disease in the Western world, causing significant morbidity and mortality. No longer considered a benign consequence of aging, valve calcification is the result of an active process that, much like atherosclerotic vascular disease, is preceded by basement membrane disruption, inflammatory cell infiltration, and lipid deposition and is associated with diabetes, hypercholesterolemia, hypertension, and tobacco use. These realizations, in addition to pathological insights gained from emerging imaging modalities, have lead to the exploration of a variety of therapeutic interventions to delay or prevent the progression of DAVD. Inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, angiotensin-converting enzyme, and matrix metalloproteinase have all been studied as potential disease modifiers. Moreover, tissue engineering, aided by emerging stem cell technology, holds immense potential for the treatment of valvular heart disease as adjuncts to surgical interventions. Here we review the epidemiology and pathophysiology of DAVD, in addition to highlighting emerging therapeutic interventions for this growing problem. PMID:17888836

  9. Transcatheter Aortic Valve Implantation Despite Challenging Vascular Access

    PubMed Central

    Nascimbene, Angelo; Azpurua, Federico; Livesay, James J.; Fish, R. David

    2015-01-01

    We describe transcatheter aortic valve implantation in a patient who had severe peripheral artery disease. The patient's vascular condition required additional preliminary peripheral intervention to enable adequate vascular access. A 78-year-old man with severe aortic stenosis, substantial comorbidities, and severe heart failure symptoms was referred for aortic valve replacement. The patient's 20-mm aortic annulus necessitated the use of a 23-mm Edwards Sapien valve inserted through a 22F sheath, which itself needed a vessel diameter of at least 7 mm for percutaneous delivery. The left common femoral artery was selected for valve delivery. The left iliac artery and infrarenal aorta underwent extensive intervention to achieve an intraluminal diameter larger than 7 mm. After aortic valvuloplasty, valve deployment was successful, and the transaortic gradient decreased from 40 mmHg to less than 5 mmHg. The patient was discharged from the hospital 4 days postoperatively. We conclude that transcatheter aortic valve implantation can be successfully performed in patients with obstructed vascular access, including stenosis of the infrarenal aorta and the subclavian and coronary arteries. PMID:25873826

  10. The living aortic valve: From molecules to function

    PubMed Central

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

    2014-01-01

    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

  11. Aortic valve perforation during aortic valvuloplasty: Identification and strategies for prevention.

    PubMed

    Ussia, Gian Paolo; Sarkar, Kunal; Tamburino, Corrado

    2011-05-01

    Balloon aortic valvuloplasty has seen a revival in interest because of its role in predilation and preparation of the annulus before trans catheter aortic valve implantation. Aortic valve cusp perforation is a serious complication that needs early recognition and prompt corrective measures to prevent a poor procedural outcome or conversion to emergent surgery. A number of useful angiographic and technical findings can alert the operator about the possibility of this complication. Failure to recognize cusp perforation can lead to serious procedural complications like severe aortic regurgitation, suboptimal prosthesis deployment, and function that can necessitate emergent open cardiac surgery. PMID:21413122

  12. Elective valve-in-valve implantation for migration of a corevalve in a patient with bicuspid aortic valve stenosis.

    PubMed

    Tanaka, Yutaka; Tanaka, Masashi; Saito, Shigeru

    2015-08-01

    Transcatheter aortic valve implantation for bicuspid aortic valve stenosis (BAVS) is controversial, as its unfavorable anatomy may lead to device dislocation or malfunctioning. If device failure occurs, the bailout intervention can be more complex and technically challenging. We here report a unique case of late migration of a CoreValve (Medtronic, MN) implanted in a patient with BAVS, who was successfully treated with elective valve-in-valve implantation using the first valve as a firm scaffold after waiting for it to adhere at the migrated position. This new strategy may represent a useful salvage option for some patients with prosthesis migration. © 2015 Wiley Periodicals, Inc. PMID:25545068

  13. Opening and Closing Characteristics of the Aortic Valve After Different Types of Valve-Preserving Surgery

    Microsoft Academic Search

    Rainer G. Leyh; Claudia Schmidtke; Hans-Hinrich Sievers; Magdi H. Yacoub

    Background—The surgical approach to aortic root aneurysm and\\/or dissection remains controversial. The use of valve-sparing operations, which are thought to have many advantages, is increasing. We hypothesized that the particular technique and type of surgery could influence valve motion characteristics and function. Therefore, we studied the instantaneous opening and closing characteristics of the aortic valve after the main 2 types

  14. Significant transaortic gradient after direct flow aortic valve implantation.

    PubMed

    Hernandez-Antolín, Rosa-Ana; Salido, Luisa; Zamorano, José Luis

    2015-08-01

    A patient with severe aortic valve disease and high surgical risk underwent Direct Flow (DF) valve implantation. Anatomical assessment (Trans-esophageal echocardiography (TEE) and CT scan) revealed a 3-leaflet aortic valve (annulus diameter 23.4 mm) that was functionally bicuspid because of complete and linearly calcified fusion of noncoronary and right cusps. The valve had severe stenosis (peak/mean gradients of 70/45 mm Hg) and moderate to severe regurgitation. A balloon valvuloplasty (semicompliant 23 mm × 45 mm balloon, 2 inflations) was performed with persistence of balloon waist. A 25 DF valve was positioned in the aortic annulus, with both rings well expanded. A mild deformity in the vertical supporting tubes was observed but considered nonrelevant because valve function (peak/mean gradients of 25/12 mm Hg respectively and no aortic regurgitation) was acceptable. Then the polymer was injected and the valve released from its attachments. Postoperative course was uneventful without clinical complications; nevertheless 3 days later Doppler peak/mean transaortic gradients were 80/45 mm Hg. These high gradients were confirmed by direct invasive measurements while CT scan documented a severe geometrical deformation of the valve cuff. Since patient was in good clinical condition, a conservative strategy was adopted. Eight months later, patient functional status had improved (NYHA class II), left ventricular dimensions decreased, left ventricular ejection fraction (LVEF) increased, and valve gradients remained unchanged; therefore surgical aortic valve replacement has been deferred until clinical indication. Such a favorable course can be explained by disappearance of aortic regurgitation. Patient anatomical and procedural features that conditioned this very rare phenomenon are discussed as well as clues to prevent it. © 2015 Wiley Periodicals, Inc. PMID:25545173

  15. Doppler transesophageal echocardiographic determination of aortic valve area in adults with aortic stenosis.

    PubMed

    Stoddard, M F; Hammons, R T; Longaker, R A

    1996-08-01

    Two-dimensional transesophageal echocardiography has been shown to be an accurate method of measuring aortic valve area in patients with aortic stenosis. The accuracy of Doppler transesophageal echocardiography for this purpose is unknown. Thus 86 consecutive adult patients (mean age 68 +/- 11 years) with calcific (n = 79) or congenital bicuspid (n = 7) AS were studied by biplane or multiplane transesophageal echocardiography. From the transgastric long-axis view, continuous wave Doppler of peak aortic valve velocity and pulsed Doppler of left ventricular outflow tract velocity were determined. Left ventricular outflow tract diameter was measured from a transesophageal echocardiography long-axis view, and cross-sectional area was calculated. Aortic valve area was calculated by the continuity equation. Two-dimensional transesophageal echocardiography was used to directly measure aortic valve area by planimetry of the minimal orifice from a short-axis view. Aortic valve area determination was less feasible by Doppler (62 of 86 patients, or 72%) versus two-dimensional transesophageal echocardiography (81 of 86 patients, or 94%; p < 0.0025) because of the inability to align the continuous wave Doppler beam with the aorta in 24 patients. The feasibility of obtaining aortic valve area by Doppler transesophageal echocardiography improved from the first 43 patients (24 of 43 patients, or 56%) to the latter 43 patients (38 of 43 patients, or 88%; p < 0.0025) and suggests a significant learning curve. In 62 patients, aortic valve area by Doppler and two-dimensional transesophageal echocardiography did not differ (1.30 +/- 0.54 cm2 vs 1.23 +/- 0.46 cm2, p = not significant) and correlated well (r = 0.88; standard error of the estimate = 0.26 cm2; intercept = 0.02 cm2; slope = 1.04; p = 0.0001). Absolute and percent differences between aortic valve area measured by Doppler and two-dimensional transesophageal echocardiography were small (0.18 +/- 0.20 cm2 and 15% +/- 15%, respectively). Mild, moderate, and severe aortic stenosis by two-dimensional transesophageal echocardiography was correctly identified in 93% (28 of 30), 79% (15 of 19), and 77% (10 of 13) of patients by Doppler transesophageal echocardiography, respectively. Doppler transesophageal echocardiography is an accurate method to measure aortic valve area in patients with aortic stenosis and should complement two-dimensional transesophageal echocardiography. The feasibility of Doppler transesophageal echocardiography for aortic valve area determination has a significant learning curve. PMID:8701895

  16. Assessment of left ventricular and aortic valve function after aortic balloon valvuloplasty in adult patients with critical aortic stenosis

    SciTech Connect

    McKay, R.G.; Safian, R.D.; Lock, J.E.; Diver, D.J.; Berman, A.D.; Warren, S.E.; Come, P.C.; Baim, D.S.; Mandell, V.E.; Royal, H.D.

    1987-01-01

    Preliminary reports have documented the utility of balloon aortic valvuloplasty as a palliative treatment for high-risk patients with critical aortic stenosis, but the effect of this procedure on cardiac performance has not been studied in detail. Accordingly, 32 patients (mean age 79 years) with long-standing, calcific aortic stenosis were treated at the time of cardiac catheterization with balloon dilatation of the aortic valve, and serial changes in left ventricular and valvular function were followed before and after valvuloplasty by radionuclide ventriculography, determination of systolic time intervals, and Doppler echocardiography. Prevalvuloplasty examination revealed heavily calcified aortic valves in all patients, a mean peak-to-peak aortic valve gradient of 77 +/- 27 mm Hg, a mean Fick cardiac output of 4.6 +/- 1.4 liters/min, and a mean calculated aortic valve area of 0.6 +/- 0.2 cm2. Subsequent balloon dilatation with 12 to 23 mm valvuloplasty balloons resulted in a fall in aortic valve gradient to 39 +/- 15 mm Hg, an increase in cardiac output to 5.2 +/- 1.8 liters/min, and an increase in calculated aortic valve area to 0.9 +/- 0.3 cm2. Individual hemodynamic responses varied considerably, with some patients showing major increases in valve area, while others demonstrated only small increases. In no case was balloon dilatation accompanied by evidence of embolic phenomena. Supravalvular aortography obtained in 13 patients demonstrated no or a mild increase in aortic insufficiency. Serial radionuclide ventriculography in patients with a depressed left ventricular ejection fraction revealed a small increase in ejection fraction from 40 +/- 13% to 46 +/- 12%.

  17. Aortic valve/root procedures in patients with an anomalous left circumflex coronary artery and a bicuspid aortic valve: anatomical and technical implications.

    PubMed

    Liebrich, Markus; Tzanavaros, Ioannis; Scheid, Michael; Voth, Wladimir; Doll, Kai-Nicolas; Hemmer, Wolfgang B

    2015-07-01

    An anomalous origin of the left circumflex coronary artery that arises as a side branch of the right coronary artery from the right coronary sinus of Valsalva encircling the aortic annulus is usually an incidental finding. However, in patients undergoing aortic valve procedures, its existence can significantly complicate the surgical treatment. We report our operative strategy in patients with an anomalous left circumflex coronary artery, a bicuspid aortic valve morphology and different aortic valve pathologies. PMID:25820760

  18. Myocardial Remodeling With Aortic Stenosis and Following Aortic Valve Replacement- Mechanisms and Future Prognostic Implications

    PubMed Central

    Yarbrough, William M.; Mukherjee, Rupak; Ikonomidis, John S.; Zile, Michael R.; Spinale, Francis G.

    2011-01-01

    Aortic valve stenosis is a common cause of left ventricular pressure overload, a pathologic process that elicits myocyte hypertrophy and alterations in extracellular matrix composition, both of which contribute to increases in left ventricular stiffness. However, clinical and animal studies suggest that increased myocardial extracellular matrix fibrillar collagen content occurs later in the time course of left ventricular pressure overload at a time coincident with severe abnormalities in diastolic function followed by the development of symptomatic heart failure. Aortic valve replacement remains the most effective treatment for elimination of chronic pressure overload secondary to aortic stenosis but has traditionally been recommended only after the onset of clinical symptoms. However, long-term follow-up of symptomatic aortic stenosis patients after aortic valve replacement suggests that valve replacement may not result in complete reversal of the maladaptive changes that occur within the myocardial extracellular matrix secondary to the pressure overload state. Quite the contrary, residual left ventricular extracellular matrix abnormalities such as these are likely responsible for persistent abnormalities in diastolic function and increased morbidity and mortality after aortic valve replacement. Thus, defining the mechanisms and pathways responsible for regulating the myocardial extracellular matrix during the natural history of aortic stenosis may provide a means by which to detect crucial structural milestones and thereby permit more precise identification of the development of maladaptive left ventricular remodeling. PMID:21762938

  19. Coronary flow reserve improves after aortic valve replacement for aortic stenosis: an adenosine transthoracic echocardiography study

    Microsoft Academic Search

    David J. R Hildick-Smith; Leonard M Shapiro

    2000-01-01

    OBJECTIVESThe goal of this study was to assess coronary flow reserve (CFR) before and after aortic valve replacement (AVR).BACKGROUNDCoronary flow reserve is impaired under conditions of left ventricular (LV) hypertrophy. It is not known whether CFR improves with regression of LV hypertrophy in humans.METHODSWe investigated 35 patients with pure aortic stenosis, LV hypertrophy and normal coronary arteriograms. Patients underwent adenosine

  20. The pathology of human aortic valve homografts

    PubMed Central

    Smith, Judith C.

    1967-01-01

    Beta-propiolactone sterilized, freeze-dried aortic valve homografts offer a dead framework which is accepted by the host and is capable of immediate and full function. The survival time of such grafts as fully functional units may be limited by physical and chemical alterations produced in the tissues by sterilization and freeze-drying. The organizing reaction of the host in covering the grafts or using them as a scaffolding may also be affected by these processes. It is possible that better long-term results may be achieved by using fresh grafts. There is no difference in host cellular response to fresh and sterilized and/or freeze-dried grafts. There is a possibility that heterogeneous reactions to polypeptides in the graft may occur in some individuals. Organization and covering of the graft by host tissue occurs from host tissues contiguous to the graft. Cells circulating in the bloodstream play no part in this by seeding on the surface. Thrombosis, in the absence of infection, is a rare complication. (Anticoagulants were not used in these patients.) Calcification occurs as only a late complication in persisting `dead' tissue. Unsuspected, and often extensive, myocardial ischaemia occurs frequently under bypass conditions with coronary artery perfusion and substantially contributes to immediate post-operative mortality and morbidity. Images PMID:6033379

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

    PubMed Central

    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

    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

  2. Resolution of heart block after surgical correction of failed transcatheter aortic valve implantation.

    PubMed

    Weymann, Alexander; Patil, Nikhil Prakash; Karck, Matthias

    2015-04-01

    Surgical aortic valve replacement is the gold standard therapy for severe aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly employed in "high-risk" patients. Atrioventricular block and aortic regurgitation are frequent complications of nitinol-based stented valves. We report a case of successful, but complex reoperative surgery 13 days after failed TAVI with iatrogenic aortic and mitral regurgitation and new-onset heart block. Removal of a CoreValve prosthesis (Medtronic Inc, Minneapolis, MN) with standard aortic valve replacement resulted in restoration of sinus rhythm and valvular competencies. PMID:25841831

  3. Clinical outcome, valve dysfunction, and progressive aortic dilation in a pediatric population with isolated bicuspid aortic valve.

    PubMed

    Spaziani, Gaia; Ballo, Piercarlo; Favilli, Silvia; Fibbi, Veronica; Buonincontri, Lorenzo; Pollini, Iva; Zuppiroli, Alfredo; Chiappa, Enrico

    2014-06-01

    The aim of this study was to explore the medium-term clinical outcome and the risk of progression of aortic valve disease and aortic dilation in pediatric patients with isolated bicuspid aortic valve (BAV). 179 pediatric patients with isolated BAV were prospectively followed from January 1995 to December 2010. Patients with severe valve dysfunction at baseline were excluded. Clinical outcome included cardiac death, infective endocarditis, aortic complications, cardiac surgery and percutaneous valvuloplasty. Echocardiographic endpoints were: progression of aortic stenosis (AS) or regurgitation (AR) and progressive aortic enlargement at different levels of the aortic root, evaluated as z-score. The median age at diagnosis was 7.8 [2.7-12.0] years. After a median followup of 5.4 [2.3-9.2] years, all patients were alive. The clinical endpoint occurred in 4 (2.2 %) patients (0.41 events per 100 patient-years). A progression of AS and AR was observed in 9 (5.0 %) and 29 (16.2 %) patients, respectively. The z-scores at the end of follow-up were not significantly different from baseline at the annulus, Valsalva sinuses and sinotubular junction, whereas a slight increase was observed at the level of the ascending aorta (1.9 vs 1.5, p = 0.046). Significant progressive aortic dilation occurred in a minority of patients (10.6, 5.6, 9.5, and 19.0 % respectively). The clinical outcome in pediatric patients with isolated BAV is favourable and the progression of aortic valve dysfunction and aortic dilation is relatively slow. These findings may be taken into account to better guide risk assessment and clinical follow-up in these patients. PMID:24362596

  4. A planning system for transapical aortic valve implantation

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

    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.

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

    PubMed

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

    2014-08-01

    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

  6. Prosthetic aortic valve selection: current patient experience, preferences and knowledge

    PubMed Central

    Korteland, Nelleke M; Bras, Frans J; van Hout, Fabienne M A; Kluin, Jolanda; Klautz, Robert J M; Bogers, Ad J J C; Takkenberg, Johanna J M

    2015-01-01

    Objective Current clinical practice guidelines advocate shared decision-making (SDM) in prosthetic valve selection. This study assesses among adult patients accepted for aortic valve replacement (AVR): (1) experience with current clinical decision-making regarding prosthetic valve selection, (2) preferences for SDM and risk presentation and (3) prosthetic valve knowledge and numeracy. Methods In a prospective multicentre cohort study, AVR patients were surveyed preoperatively and 3?months postoperatively. Results 132 patients (89 males/43 females; mean age 67?years (range 23–86)) responded preoperatively. Decisional conflict was observed in 56% of patients, and in 25% to such an extent that it made them feel unsure about the decision. 68% wanted to be involved in decision-making, whereas 53% agreed that they actually were. 69% were able to answer three basic knowledge questions concerning prosthetic valves correctly. 56% were able to answer three basic numeracy questions correctly. Three months postsurgery, 90% (n=110) were satisfied with their aortic valve prosthesis, with no difference between mechanical and bioprosthetic valve recipients. Conclusions In current clinical practice, many AVR patients experience decisional conflict and suboptimal involvement in prosthetic valve selection, and exhibit impaired knowledge concerning prosthetic valves and numeracy. Given the broad support for SDM among AVR patients and the obvious need for understandable information, to-be-developed tools to support SDM in the setting of prosthetic valve selection will help to improve quality of decision-making, better inform and actively involve patients, and reduce decisional conflict. Trial registration number NTR3618. PMID:25893105

  7. Emerging trends in heart valve engineering: Part II. Novel and standard technologies for aortic valve replacement.

    PubMed

    Kheradvar, Arash; Groves, Elliott M; Goergen, Craig J; Alavi, S Hamed; Tranquillo, Robert; Simmons, Craig A; Dasi, Lakshmi P; Grande-Allen, K Jane; Mofrad, Mohammad R K; Falahatpisheh, Ahmad; Griffith, Boyce; Baaijens, Frank; Little, Stephen H; Canic, Suncica

    2015-04-01

    The engineering of technologies for heart valve replacement (i.e., heart valve engineering) is an exciting and evolving field. Since the first valve replacement, technology has progressed by leaps and bounds. Innovations emerge frequently and supply patients and physicians with new, increasingly efficacious and less invasive treatment options. As much as any other field in medicine the treatment of heart valve disease has experienced a renaissance in the last 10 years. Here we review the currently available technologies and future options in the surgical and transcatheter treatment of aortic valve disease. Different valves from major manufacturers are described in details with their applications. PMID:25449148

  8. Etiology of bicuspid aortic valve disease: Focus on hemodynamics

    PubMed Central

    Atkins, Samantha K; Sucosky, Philippe

    2014-01-01

    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

  9. Title: Predictors of 6-months clinical poor outcomes after transcatheter aortic valve implantation.

    E-print Network

    Boyer, Edmond

    1 Title: Predictors of 6-months clinical poor outcomes after transcatheter aortic valve.acvd.2013.10.005 #12;2 Abstract Background: Patients' selection for transcatheter aortic valve implantation institution with a transcatheter-implanted aortic valve were prospectively followed. Our population

  10. EXTRACTING GEOMETRIC FEATURES OF AORTIC VALVE ANNULUS MOTION FROM DYNAMIC MRI FOR GUIDING INTERVENTIONS

    E-print Network

    Deng, Zhigang

    EXTRACTING GEOMETRIC FEATURES OF AORTIC VALVE ANNULUS MOTION FROM DYNAMIC MRI FOR GUIDING, Houston, TX 77030, USA ABSTRACT Transcatheter aortic valve implant (TAVI) has emerged as a prominent of the geometric features such as the diameter, center and orien- tation of the aortic valve annulus (AVA

  11. A Computational Model of Aging and Calcification in the Aortic Heart Valve

    E-print Network

    Mofrad, Mohammad R. K.

    A Computational Model of Aging and Calcification in the Aortic Heart Valve Eli J. Weinberg1 of America Abstract The aortic heart valve undergoes geometric and mechanical changes over time. The cusps of a normal, healthy valve thicken and become less extensible over time. In the disease calcific aortic

  12. Inferior myocardial infarction secondary to aortic dissection associated with bicuspid aortic valve

    PubMed Central

    Cai, Jingjing; Cao, Yu; Yuan, Hong; Yang, Kan; Zhu, Yuan-Shan

    2012-01-01

    Aortic dissection (AD) is a life-threatening condition and may present with symptoms which mimic myocardial infarction, leading to misdiagnosis and inappropriate use of anticoagulant and thrombolytic therapy. A 40-year-old woman with no prior history presented in our emergency department with sudden chest pain. Electrocardiography (ECG) showed a ST-segment elevation in leads II, III and avF, suggesting an acute inferior myocardial infarction. The patient was given anticoagulation and antiplatelet treatment. Coronary angiography, transthoracic echocardiography and computed tomography were performed. The patient was diagnosed with DeBakey I aortic dissection extending from ascending aorta to iliac artery, and associated with bicuspid aortic valve.Surgical treatments with a replacement of the ascending aorta, aortic valve replacement and coronary artery bypass grafting were successfully performed. Early imaging examination, if possible, might assist the diagnosis and guide the management of this disease. The condition of myocardial infarction secondary to aortic dissection is discussed. PMID:22629034

  13. The current status of transcutaneous aortic valve implantation.

    PubMed

    Volodarsky, Igor; Shimoni, Sara; George, Jacob

    2014-10-01

    Transcatheter aortic valve implantation (TAVI) is a relatively novel procedure first performed in 2002 and has undergone rapid development since then. Its main indication is treatment of severe symptomatic aortic valve stenosis. Initially, the procedure was indicated for very sick patients who were not eligible for surgical aortic valve replacement. However, rapid development of the technology and operator skill required for TAVI allowed widening of the indications for its use. Currently, there is evidence that TAVI could be better than the surgical intervention in a broad population and not only in the most sick. This paper reviews the medical literature regarding TAVI, including the relevant medical equipment, different modes of its deployment, main complications of the procedure, main indications and contraindications, and the outcome of the patients who undergo it. PMID:25223332

  14. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    PubMed Central

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

    2012-01-01

    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

  15. The functional aortic annulus in the 3D era: focus on transcatheter aortic valve replacement for the perioperative echocardiographer.

    PubMed

    Patel, Prakash A; Gutsche, Jacob T; Vernick, William J; Giri, Jay S; Ghadimi, Kamrouz; Weiss, Stuart J; Jagasia, Dinesh H; Bavaria, Joseph E; Augoustides, John G T

    2015-02-01

    The functional aortic annulus represents a sound clinical framework for understanding the components of the aortic root complex. Recent three-dimensional imaging analysis has demonstrated that the aortic annulus frequently is elliptical rather than circular. Comprehensive three-dimensional quantification of this aortic annular geometry by transesophageal echocardiography and/or multidetector computed tomography is essential to guide precise prosthesis sizing in transcatheter aortic valve replacement to minimize paravalvular leak for optimal clinical outcome. Furthermore, three-dimensional transesophageal echocardiography accurately can quantify additional parameters of the functional aortic annulus such as coronary height for complete sizing profiles for all valve types in transcatheter aortic valve replacement. Although it is maturing rapidly as a clinical imaging modality, its role in transcatheter aortic valve replacement is seen best as complementary to multidetector computed tomography in a multidisciplinary heart team model. PMID:25620147

  16. Transapical Versus Transaortic Transcatheter Aortic Valve Implantation: A Systematic Review.

    PubMed

    Dunne, Ben; Tan, Darren; Chu, Daniel; Yau, Victor; Xiao, Jinguo; Ho, Kwok Ming; Yong, Gerald; Larbalestier, Robert

    2015-07-01

    Two alternative approaches for transcatheter aortic valve implantation (TAVI) exist for patients unsuitable for the transfemoral approach; the transapical and the transaortic approaches. It is unclear as to which approach has superior short-term outcomes. A systematic review and meta-analysis was performed to answer this question. Mortality was equivalent in the 2 groups. There was a trend toward a lower rate of stroke in the transaortic group (0.9% vs 2.1%) but this was not statistically significant. Conversion to surgical aortic valve replacement, paravalvular leak, pacemaker requirement, and major bleeding occurred at equivalent rates. PMID:26002442

  17. Transcatheter aortic valve implantation in end-stage renal disease

    PubMed Central

    Hamilton, Patrick; Coverdale, Arthur; Edwards, Colin; Ormiston, John; Stewart, Jim; Webster, Mark

    2012-01-01

    Valvular heart disease is common in patients with end-stage renal disease and, if symptomatic, may lead to valve replacement surgery. However, some patients with renal failure are deemed unsuitable for cardiac surgery, and in those patients who do undergo surgery, there is a significantly greater morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is recognized as an option for high-risk patients with symptomatic aortic stenosis (AS). Here we describe two patients on haemodialysis who underwent TAVI with satisfactory outcomes. The role of TAVI is evolving and has the potential to play an important role for dialysis patients with AS.

  18. Engineering transcatheter aortic valve devices: a surgeon's perspective.

    PubMed

    Roselli, E E

    2011-03-01

    In recent years transcatheter approaches to treat heart valve disease have played an increasingly important role. This has been especially true for aortic stenosis, with two valves commercially available in Europe and several others under investigation in man. These least invasive therapies have expanded treatment options for the highest surgical risk patients, but there are fundamental differences from conventional surgical repair that warrant further investigation. This manuscript reviews the rapidly evolving field of transcatheter aortic valve intervention from the clinician's perspective. Anatomic, pathologic, and physiologic issues posed by the disease process are first reviewed. Device and design challenges to this new therapy are then addressed. Finally, newer devices and transcatheter approaches to other valve disease are briefly reviewed. The understanding that can come from an engineering approach to address these multiple issues should further improve outcomes and advance development of next-generation devices. PMID:21485323

  19. Pathology Of Explanted Cryopreserved Allograft Heart Valves: Comparison With Aortic Valves From Orthotopic Heart Transplants

    Microsoft Academic Search

    Richard N. Mitchell; Richard A. Jonas; Frederick J. Schoen

    1998-01-01

    Objective: We sought to determine the morphology, mechanisms of deterioration, cellular viability, extracellular matrix integrity, and the role of immune responses in the dysfunction of cryopreserved aortic and pulmonic valve allografts. Methods: We studied 33 explanted left-sided ( n = 20) or right-sided (n = 13) cryopreserved human allograft heart valves explanted several hours to 9 years after operation, 14 nonimplanted allografts,

  20. A stepwise aortic clamp procedure to treat porcelain aorta associated with aortic valve stenosis and hemodialysis.

    PubMed

    Isoda, Susumu; Osako, Motohiko; Kimura, Tamizo; Nishimura, Kenji; Yamanaka, Nozomu; Nakamura, Shingo; Maehara, Tadaaki

    2014-01-01

    A 62-year-old man was referred for an aortic-valve surgery because of severe aortic stenosis. Thirty years ago, he had undergone a mitral valve commissurotomy and after 9 years, the valve had been replaced by a mechanical valve. He had been undergoing hemodialysis for the past 8 years. A computed tomographic (CT) scan of the chest and abdomen showed a dense circumferential calcification in the wall of the entire thoracic and abdominal aorta, pulmonary artery, and left and right atrium. A conventional aortic-valve replacement was performed. To avoid an embolic event, a "stepwise aortic clamp" procedure was attempted and involved the following: (1) brief circulatory arrest and aortotomy during moderate hypothermia; (2) balloon occlusion at the ascending aorta during low-flow cardiopulmonary bypass (CPB); (3) endoarterectomy by using an ultrasonic surgical aspirator to enable aortic cross-clamping; and (4) a cross-clamp reinforced with felt and full-flow CPB. The patient recovered without any thromboembolic events. Using this procedure to treat a porcelain aorta seemed to reduce the time limit and reduced the risk of brain injury during cardiac surgery. PMID:23801177

  1. Transcatheter aortic valve implantation: Current status and future perspectives

    PubMed Central

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

    2011-01-01

    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

  2. Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement

    Microsoft Academic Search

    Claudia Blais; Jean G. Dumesnil; Richard Baillot; Serge Simard; Daniel Doyle; Philippe Pibarot

    2003-01-01

    Background—The prosthesis used for aortic valve replacement (AVR) can be too small in relation to body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. This study examined if there is a relation between PPM and short-term mortality after operation. Methods and Results—The indexed valve effective orifice area (EOA) was estimated for each type and size

  3. Successful trans-apical aortic valve implantation for a high risk patient with aortic stenosis using a new second-generation TAVI device - J-Valve system.

    PubMed

    Cheng, Jiahan; Chen, Miao; Zhu, Da; Zhang, Ji; Hu, Jia; Guo, Yingqiang

    2015-01-01

    Transcatheter aortic valve implantation (TAVI) has evolved as a routine procedure to treat selected high-risk patients with severe aortic stenosis. The new J-Valve prosthesis is designed for antegrade transapical implantation, it is characterized by a porcine aortic prosthesis attaching to a self-expandable Nitinol stent. The key feature of the device are three U-shape anatomically oriented devices - "graspers" which could facilitate intuitive 'self-positioning' valve implantation. Hereby, we report a successful case of trans-apical TAVI in an elderly high-risk patient with severe aortic stenosis using J-Valve system. PMID:25595419

  4. The natural history of a non-stenotic bicuspid aortic valve

    Microsoft Academic Search

    P Mills; G Leech; M Davies; A Leathan

    1978-01-01

    Forty-one patients in whom the diagnosis of a non-stenotic bicuspid aortic valve had been established by noninvasive techniques were followed up for a mean of 10.9 years. During this period, 2 patients required aortic valve replacement because of the development of calcific aortic valve stenosis at the ages of 52 and 64 and 5 others developed evidence of mild aortic

  5. Prevalence of mitral valve prolapse and congenital bicuspid aortic valves in black and white patients undergoing cardiac valve operations.

    PubMed

    Novaro, Gian M; Houghtaling, Penny L; Gillinov, A Marc; Blackstone, Eugene H; Asher, Craig R

    2013-03-15

    The risk factors for aortic and mitral valve diseases that require surgical repair such as congenital bicuspid aortic valve (BAV) and mitral valve prolapse include acquired clinical factors and genetic influences. Whether race affects the prevalence of certain valvular diseases has not been sufficiently investigated. Through the Cleveland Clinic's Cardiovascular Information Registry, we evaluated the data from 40,419 patients who had undergone aortic valve surgery, mitral valve surgery, and/or coronary artery bypass grafting from 1993 to 2007. Of these patients, 38,366 were white and 2,053 were black. The prospective evaluation of valvular disease was coded, identifying the etiology and morphology by echocardiographic, surgical, and pathologic inspection. At baseline, compared to white patients, the black patients were younger, more often women, had a greater body mass index, and a greater prevalence of hypertension, diabetes, tobacco use, and renal disease. The prevalence of congenital BAV and mitral valve prolapse was considerably lower in blacks than in whites (9% vs 25%, p <0.001, and 27% vs 52%, p <0.001, respectively), as was the presence of calcific aortic stenosis (14% vs 28%; p <0.001), pathologically determined aortic valve calcium (50% vs 67%; p <0.001), and mitral valve chordal rupture (13% vs 31%; p <0.001). In conclusion, in the present large surgical series, the valve etiologies and morphology differed among blacks and whites. Despite an adverse cardiovascular risk profile, blacks had a significantly lower prevalence of valvular calcium and degeneration than did the whites and a lower prevalence of congenital BAV and mitral valve prolapse. Our findings offer insight into the influence of race on the development of mitral valve disease and congenital BAV. PMID:23276473

  6. [Transcatheter Aortic Valve Implantation: An Introduction and Patient Care].

    PubMed

    Lu, Shu-Ju; Wang, Shiao-Pei

    2015-06-01

    Aortic stenosis has a high prevalence among individuals over 75 years of age. Transcatheter aortic valve implantation (TAVI) is a novel valve-replacement technique for patients with multiple chronic diseases who are at high risk of requiring aortic valve replacement surgery. Most of the time, the indicators of TAVI are detected during an echocardiographic exam. The femoral artery is the primary insertion site. The complications of TAVI include stroke, vascular dissection, bleeding, aortic valve regurgitation, and arrhythmia. In terms of clinical effectiveness, the mortality rate of TAVI is lower than percutaneous ballon valvuloplasty but similar to AVR. The unplanned cardiac-related re-admission rate within 30 days of discharge is lower for TAVI than for AVR. In terms of activity tolerance, TAVI is significantly better than both percutaneous ballon valvuloplasty and AVR. Comprehensive nursing care may reduce the incidence of complications associated with TAVI. Nursing care of TAVI includes explaining and providing instructions regarding TAVI prior to the procedure. After the TAVI procedure and while the patient is in the ICU, remove the endotracheal tube as soon as possible, monitor his / her neuro-cognitive status, monitor for early detection of a stroke event, record urine output to assess renal function, observe bleeding in the puncture site, and evaluate cardiac arrhythmia and pain. While in the general ward, resume early physical activities and educate the patient regarding the risks and the prevention of bleeding. This article provides references for clinical staff responsible to care for post-TAVI surgery patients. PMID:26073960

  7. Transcatheter aortic valve replacement (TAVR): access planning and strategies.

    PubMed

    Ramlawi, Basel; Anaya-Ayala, Javier E; Reardon, Michael J

    2012-01-01

    Transcatheter aortic valve replacement (TAVR) has proven to be a viable tool for the high-surgical-risk population with severe aortic valve stenosis. Vascular access complications are not uncommon with TAVR and may increase early and late mortality. Avoiding these serious complications is the goal. With experience and careful screening, we are now able to risk-stratify patients who may be at increased risk of vascular complications. While the traditional iliofemoral access site remains the most common for TAVR, alternate access sites that have proven to be viable and safe alternatives include the transapical, direct-aortic, and subclavian techniques. TAVR teams should be familiar and comfortable with these approaches as each of them has its own advantages and weaknesses. The best option is usually one in which the procedure is tailored to the patient. The present review examines our current access planning and strategies for TAVR. PMID:22891124

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

    Microsoft Academic Search

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

    2012-01-01

    The aortic valve exhibits complex three-dimensional (3D) anatomy and heterogeneity essential for the 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 12–22

  9. BIOMECHANICAL CHARACTERIZATION OF ASCENDING AORTIC ANEURYSM WITH CONCOMITANT BICUSPID AORTIC VALVE AND BOVINE AORTIC ARCH

    PubMed Central

    Pham, Thuy; Martin, Caitlin; Elefteriades, John; Sun, Wei

    2013-01-01

    Objectives Studies have shown that patients harboring bicuspid aortic valve (BAV) or bovine aortic arch (BAA) are more likely to develop ascending aortic aneurysm (AsAA) than the general population. A thorough quantification of the AsAA tissue properties for these patient groups may offer insight into the underlying mechanisms of AsAA development in these patients. Thus, the objective of this study was to investigate and compare the mechanical and microstructural properties of aortic tissues from AsAA patients with and without concomitant BAV or BAA. Materials and methods AsAA (n = 20), BAV (n = 20) and BAA (n = 15) human tissues were obtained from patients who underwent elective AsAA surgery. Planar biaxial and uniaxial failure tests were used to characterize the mechanical and failure properties of the tissues, respectively. Histological analysis was performed to detect the medial degenerative characteristics of aortic aneurysm. Individual layer thickness and composition were quantified for each patient group. Results The circumferential (CIRC) response of the BAV samples was stiffer than both AsAA (p = 0.473) and BAA (p = 0.152) tissues at low load. The BAV tissues were nearly isotropic while AsAA and BAA tissues were anisotropic. The areal strain of BAV samples were significantly less than AsAA (p = 0.041) and BAA (p = 0.004) tissues at a low load. The BAA samples were similar to the AsAA samples in both mechanical and failure properties. On the microstructural level, all samples displayed moderate medial degeneration characterized by elastin fragmentation, cell loss, mucoid accumulation and fibrosis. The ultimate tensile strength of BAV and BAA tissues were also found to decrease with age. Conclusions The BAV tissues were stiffer than both AsAA and BAA tissues, and the BAA tissues were similar to the AsAA tissues. The BAV samples were thinnest with less elastin than AsAA and BAA samples, which may attribute to the loss of extensibility at low load of these tissues. No apparent difference in failure mechanics among the tissue groups suggests that each of the patient groups may have a similar risk of rupture. PMID:23643809

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

    PubMed

    Yim, Eugene Sun

    2013-08-01

    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

  11. Idiopathic mitral valve prolapse with tricuspid, aortic and pulmonary valve involvement: an autopsy case report.

    PubMed

    Desai, Heena M; Amonkar, Gayathri P

    2015-01-01

    Mitral valve prolapse (MVP) is usually asymptomatic, but can be associated with complications such as infective endocarditis, mitral regurgitation, thromboembolism and sudden cardiac death. It has been very rarely reported to occur in association with other valvular involvement. A 55-year-old male patient was brought dead and at autopsy the mitral valve orifice was stenotic and the leaflets were enlarged, myxoid and bulging suggestive of MVP and chordae tendinae were thickened, stretched and elongated. Similar changes were seen in the tricuspid valve. The pulmonary and aortic valves also showed myxomatous degeneration of their cusps. Myxomatous degeneration is the most common cause of MVP and it can be associated with involvement of the other valves. Concomitant involvement of the aortic valve has been reported, however it is very rare and simultaneous involvement of the pulmonary valve has not been reported in the literature so far. We report a case of MVP associated with myxomatous degeneration of the tricuspid, pulmonary and aortic valves. PMID:25885138

  12. Hemodynamics and Mechanobiology of Aortic Valve Inflammation and Calcification

    PubMed Central

    Balachandran, Kartik; Sucosky, Philippe; Yoganathan, Ajit P.

    2011-01-01

    Cardiac valves function in a mechanically complex environment, opening and closing close to a billion times during the average human lifetime, experiencing transvalvular pressures and pulsatile and oscillatory shear stresses, as well as bending and axial stress. Although valves were originally thought to be passive pieces of tissue, recent evidence points to an intimate interplay between the hemodynamic environment and biological response of the valve. Several decades of study have been devoted to understanding these varied mechanical stimuli and how they might induce valve pathology. Here, we review efforts taken in understanding the valvular response to its mechanical milieu and key insights gained from in vitro and ex vivo whole-tissue studies in the mechanobiology of aortic valve remodeling, inflammation, and calcification. PMID:21760982

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

    PubMed Central

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

    2014-01-01

    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

  14. Kangaroo vs. porcine aortic valves: calcification potential after glutaraldehyde fixation.

    PubMed

    Narine, K; Chéry, Cyrille C; Goetghebeur, Els; Forsyth, R; Claeys, E; Cornelissen, Maria; Moens, L; Van Nooten, G

    2005-01-01

    The aim of this study was to evaluate and compare the calcification potential of kangaroo and porcine aortic valves after glutaraldehyde fixation at both low (0.6%) and high (2.0%) concentrations of glutaraldehyde in the rat subcutaneous model. To our knowledge this is the first report comparing the time-related, progressive calcification of these two species in the rat subcutaneous model. Twenty-two Sprague-Dawley rats were each implanted with two aortic valve leaflets (porcine and kangaroo) after fixation in 0.6% glutaraldehyde and two aortic valve leaflets (porcine and kangaroo) after fixation in 2% glutaraldehyde respectively. Animals were sacrificed after 24 h and thereafter weekly for up to 10 weeks after implantation. Calcium content was determined using inductively coupled plasma-mass spectrometry and confirmed histologically. Mean calcium content per milligram of tissue (dry weight) treated with 0.6 and 2% glutaraldehyde was 116.2 and 110.4 microg/mg tissue for kangaroo and 95.0 and 106.8 microg/mg tissue for porcine valves. Calcium content increased significantly over time (8.8 microg/mg tissue per week) and was not significantly different between groups. Regression analysis of calcification over time showed no significant difference in calcification of valves treated with 0.6 or 2% glutaraldehyde within and between the two species. Using the subcutaneous model, we did not detect a difference in calcification potential between kangaroo and porcine aortic valves treated with either high or low concentrations of glutaraldehyde. PMID:16088178

  15. [Aortic valve stenosis: computed tomography prior to transcatheter aortic valve implantation (TAVI) : How can the outcome be improved?].

    PubMed

    Hell, M; Achenbach, S; Arnold, M

    2015-06-01

    Computed tomography (CT) plays an important role in the preinterventional work-up of patients referred for transcatheter aortic valve implantation (TAVI). Contrast-enhanced CT allows a comprehensive examination with evaluation of both the vascular access route as well as aortic valve and aortic root geometry. Analysis of the minimum luminal vessel diameter, tortuosity and vascular calcification are important to determine the ability to perform the procedure via a transfemoral access. The size of the aortic annulus can be accurately measured by CT to aid selection of the appropriate prosthesis and the use of CT for prosthesis sizing has been associated with a decreased incidence of paravalvular leakage as compared to 2-dimensional echocardiography. In addition CT permits accurate assessment of aortic root anatomy, distance between coronary ostia and the annulus plane as well as the dimensions of the ascending aorta. Furthermore, suitable fluoroscopic projections that permit an exact orthogonal visualization of the aortic annulus plane by fluoroscopy during the procedure can be extracted from the CT data set. In summary, CT permits comprehensive imaging in TAVI candidates and optimizes procedural outcome. PMID:25963033

  16. Simultaneous transcatheter aortic valve replacement and endovascular repair for critical aortic stenosis and large abdominal aortic aneurysm.

    PubMed

    Aluko, Yele; Diehl, Lance; Jacoby, Richard; Chan, Barry; Andrews, Scott; McMillan, Edward; Sharkey, Kevin; Shook, Paul; Ntim, William; Bolorunduro, Oluwaseyi; Sossoman, Leslie B; Rabb, Cathy

    2015-06-01

    A 75-year-old man with severe aortic stenosis, severe chronic obstructive pulmonary disease, NYHA class III heart failure and a large abdominal aortic aneurysm underwent concurrent transfemoral transcatheter aortic valve replacement (TF-TAVR) and endovascular aneurysm repair (EVAR). An Edwards Sapien device was implanted with resolution of hemodynamics. EVAR was performed using an Endurant bifurcated stent graft system. We describe the procedure technique, periprocedural management and one year outcome. To the authors' best knowledge, this is the first case of simultaneous TF-TAVR and EVAR published in North America. PMID:25573137

  17. Percutaneous Transcatheter Implantation of an Aortic Valve Prosthesis for Calcific Aortic Stenosis First Human Case Description

    Microsoft Academic Search

    Alain Cribier; Helene Eltchaninoff; Assaf Bash; Nicolas Borenstein; Christophe Tron; Fabrice Bauer; Genevieve Derumeaux; Frederic Anselme; François Laborde; Martin B. Leon

    Background—The design of a percutaneous implantable prosthetic heart valve has become an important area for investigation. A percutaneously implanted heart valve (PHV) composed of 3 bovine pericardial leaflets mounted within a balloon-expandable stent was developed. After ex vivo testing and animal implantation studies, the first human implantation was performed in a 57-year-old man with calcific aortic stenosis, cardiogenic shock, subacute

  18. Six-month outcome of transapical transcatheter aortic valve implantation in the initial seven patients

    Microsoft Academic Search

    Jian Ye; Anson Cheung; Samuel V. Lichtenstein; Sanjeevan Pasupati; Ronald G. Carere; Christopher R. Thompson; Ajay Sinhal; John G. Webb

    2007-01-01

    Background: The current treatment of choice for symptomatic aortic stenosis is aortic valve replacement (AVR) with cardiopulmonary bypass (CPB), but AVR is associated with significant operative morbidity and mortality in elderly patients with multiple co-morbid conditions. We recently reported the first successful aortic valve implantation procedure (AVI) via a mini-thoracotomy and left ventricular apical puncture without cardiopulmonary bypass. We now

  19. First beating-heart valve-sparing aortic root repair: a "corset" technique.

    PubMed

    Plonek, Tomasz; Dumanski, Andrzej; Obremska, Marta; Kustrzycki, Wojciech

    2015-04-01

    We present our preliminary experience with beating-heart aortic root remodeling using an external "corset," which we performed in 2 patients with aortic insufficiency and aortic root dilatation. Standard extracorporeal circulation (ECC) was used. After a meticulous dissection of the aortic root and ascending aorta, the bespoke vascular prosthesis was placed around the vessel to decrease its diameter and restore aortic valve function. Postoperative angiographic computed tomography (CT) showed a significant decrease in the diameter of the wrapped aorta. Echocardiography performed 12 months after the operation showed normal aortic valve function with trivial regurgitation and stable aortic diameter in both patients. PMID:25841843

  20. Differential Tensile Strength and Collagen Composition in Ascending Aortic Aneurysms by Aortic Valve Phenotype

    PubMed Central

    Pichamuthu, Joseph E.; Phillippi, Julie A.; Cleary, Deborah A.; Chew, Douglas W.; Hempel, John; Vorp, David A.; Gleason, Thomas G.

    2014-01-01

    Background Ascending thoracic aortic aneurysm (ATAA) predisposes patients to aortic dissection and has been associated with diminished tensile strength and disruption of collagen. ATAA arising in patients with bicuspid aortic valve (BAV) develop earlier than those with tricuspid aortic valves (TAV) and have a different risk of dissection. The purpose of this study was to compare aortic wall tensile strength between BAV and TAV ATAAs and determine if the collagen content of the ATAA wall is associated with tensile strength and valve phenotype. Methods Longitudinally and circumferentially oriented strips of ATAA tissue obtained during elective surgery were stretched to failure and collagen content was estimated by hydroxyproline assay. Experimental stress-strain data were analyzed for failure strength and elastic mechanical parameters: ?, ? and maximum tangential stiffness. Results The circumferential and longitudinal tensile strengths were higher for BAV ATAA when compared with TAV ATAA. The ? and ? were lower for BAV ATAA when compared with TAV ATAA. The maximum tangential stiffness was higher for circumferential when compared with longitudinal orientation in both BAV and TAV ATAA. Amount of hydroxyproline was equivalent in BAV and TAV ATAA specimens. While there was a moderate correlation between the collagen content and tensile strength for TAV, this correlation is not present in BAV. Conclusion The increased tensile strength and decreased values of ? and ? in BAV ATAAs despite uniform collagen content between groups indicate that micro-structural changes in collagen contribute to BAV-associated aortopathy. PMID:24021768

  1. Achromobacter xylosoxidans subsp. xylosoxidans prosthetic aortic valve infective endocarditis and aortic root abscesses.

    PubMed

    van Hal, S; Stark, D; Marriott, D; Harkness, J

    2008-04-01

    We report a case of prosthetic valve infective endocarditis and aortic root abscesses caused by Achromobacter xylosoxidans subsp. xylosoxidans. The patient was an intravenous drug user and had injected amphetamines using 'duck pond water' as a diluent. After surgical intervention and 6 weeks of intravenous meropenem therapy, the patient made an uneventful recovery. PMID:18349376

  2. Colombian Experience with Transcatheter Aortic Valve Implantation of Medtronic CoreValve

    PubMed Central

    Dager, Antonio E.; Nuis, Rutger-Jan; Caicedo, Bernardo; Fonseca, Jaime A.; Arana, Camilo; Cruz, Lidsa; Benitez, Luis M.; Nader, Carlos A.; Duenas, Eduardo; de Marchena, Eduardo J.; O'Neill, William W.; de Jaegere, Peter P.

    2012-01-01

    At our institutions, increasing numbers of aortic stenosis patients were not candidates for surgical aortic valve replacement. Accordingly, we initiated the Cali Colombian Transcatheter Aortic Valve Implantation (TAVI) program. From March 2008 through January 2011, 53 consecutive patients (mean age, 79 ± 6 yr; men, 58%) underwent TAVI with the Medtronic CoreValve System, and data were prospectively collected. Our study's endpoints conformed with Valve Academic Research Consortium recommendations. We report our clinical results. Predicted mortality rates were 25% (interquartile range, 17%–34%) according to logistic EuroSCORE and 6% (interquartile range, 3%–8%) according to the Society of Thoracic Surgeons score. The 30-day mortality rate was 9% (3 intraprocedural deaths, 5 total). The combined 30-day safety endpoint was 30% (major vascular sequelae, 23%; life-threatening bleeding, 12%; myocardial infarction, 4%; major stroke, 4%; and acute kidney injury [stage 3], 2%). Eight patients (15%) required post-implantation balloon dilation and 2 (4%) required valve-in-valve implantation, for a technical device success rate of 77%. Mean peak transvalvular gradient decreased from 74 ± 29 to 17 ± 8 mmHg and mean transvalvular gradient from 40 ± 17 to 8 ± 4 mmHg (both P=0.001). Moderate or severe aortic regurgitation decreased from 32% to 18% (P=0.12) and mitral regurgitation from 32% to 13% (P=0.002). The 1-year survival rate was 81%. We found that TAVI with the CoreValve prosthesis was safe and feasible, with sustained long-term results, for treating aortic stenosis in patients at excessive surgical risk; nonetheless, serious adverse events occurred in 30% of the patients. PMID:22719143

  3. LOWER TRANSIENT STRESSES IN AN AORTIC VALVE LEAFLET WITH OBLIQUE REINFORCEMENT FIBERS: A FINITE ELEMENT STUDY

    E-print Network

    mass density of 42.4 g/cc (40x that of the tissue) to result in a valve closure time equalLOWER TRANSIENT STRESSES IN AN AORTIC VALVE LEAFLET WITH OBLIQUE REINFORCEMENT FIBERS: A FINITE Cambridge, MA, USA INTRODUCTION Native aortic valve leaflets contain a network of strong collagen fibers

  4. Intraoperative transesophageal echocardiography for the evaluation of mitral, aortic and tricuspid valve repair

    Microsoft Academic Search

    R. De Simone; R. Lange; W. Saggau; E. Gams; A. Tanzeem; S. Hag; Universitgt Heidelberg

    The present study reviews the clinical applicability and usefulness of intraoperative transesophageal echocardio- graphy (TEE) during valve repair. Intraoperative TEE was performed in 48 consecutive patients, who were divided into three groups: 1. mitral valve repair (MVR), 2. aortic valve repair (AVR), 3. tricuspid valve repair (TVR). Residual valve regurgitation was assessed by color Doppler echocardiography on a scale from

  5. Congenital bicuspid aortic valve enodocarditis with multiple subvalvular complications and an acquired membranous ventricular septal defect.

    PubMed

    Zelenka, Jason; Akel, Rami; Sawada, Stephen G; Mahenthiran, Jo

    2003-11-01

    We report a case with echocardiographic demonstration of native congenital bicuspid aortic valve endocarditis with multiple subaortic complications. Transesophageal echocardiography in this case revealed large vegetations with multiloculated aortic paravalvular abscess around the cusps; a high-acquired restrictive membranous ventricular septal defect with vegetations extending to the tricuspid leaflets and paravalvular aortic regurgitation caused by aortic leaflet perforation. PMID:14608296

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

    E-print Network

    Weinberg, Eli J.

    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 ...

  7. Minimally invasive primary aortic valve surgery: the OLV Aalst experience

    PubMed Central

    van der Merwe, Johan; Stockman, Bernard; Van Praet, Frank; Beelen, Roel; Maene, Lieven; Vermeulen, Yvette; Degrieck, Ivan

    2015-01-01

    Background The purpose of this study was to evaluate our in-hospital outcomes with primary J-sternotomy aortic valve surgery since the initiation of our program in 1997. Methods Between October 1st 1997 and August 31st 2014, 768 patients (mean age: 69.1±11.2 years, 46.6% females, 15.6% aged greater than 80 years) underwent primary JS-AVS. Additional risk factors included diabetes mellitus (n=98, 12.2%), peripheral vascular disease (n=42, 5.5%) and body mass index greater than 30 (n=144, 18.8%). The mean logistical EuroSCORE I was 5.46%±4.5%. Results Aortic valve replacement and repair were performed in 758 (98.7%) and 10 (1.3%) patients respectively, for isolated valve stenosis (n=472, 61.8%), incompetence (n=56, 7.3%) and mixed valve disease (n=236, 30.9%). Valve pathology included sclerosis (n=516, 67.2%), rheumatic disease (n=110, 14.3%) and endocarditis (n=10, 1.3%). Reasons for conversion to full sternotomy (n=23, 3.0%) included porcelain ascending aorta (n=3, 0.4%), inadequate visualization (n=2, 0.3%) and intra-operative complications (n=18, 2.3%). Mean length of hospital stay was 11.0±7.4 days. Morbidity included stroke (n=15, 2.0%), revision or re-exploration (n=52, 6.8%), atrial fibrillation (n=201, 26.2%) and sternitis (n=5, 0.7%). In-hospital mortality was 1.6% (n=12). Overall survival at 30 days was 98.0%. Conclusions JS-AVS is safe and is our routine approach for isolated aortic valve disease. Procedure related mortality is lower than predicted, conversion rates limited and significant morbidity minimal. PMID:25870811

  8. Oblique aortic valve replacement and coronary artery bypass grafting for severely calcified narrow aortic root with unstable angina

    Microsoft Academic Search

    Toru Ishida; Kiyoharu Nakano; Akihiko Gomi; Hayao Nakatani; Tokuya Sato; Naoki Saegusa

    2001-01-01

    We report an 84-year-old woman diagnosed with aortic stenosis and regurgitation with a severely calcified narrow aortic root\\u000a and left main coronary artery trunk stenosis with triple-vessel coronary artery disease. Emergency aortic valve replacement\\u000a and triple coronary artery bypass grafting were successful. The aortic annulus was small and heavily calcified, and the ascending\\u000a aorta, the sinus of valsalva and the

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

    PubMed Central

    2011-01-01

    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. 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, from patient notes and from questionnaires. A cohort of patients had 2D-echocardiogram with an average of 4.3 ± 0.45 years post-operatively to evaluate valve function, calcification, and the diameter of the conduit. Results Implantation in 67 patients represented a follow-up of 371.3 patient-year. Males were 60% of the operated population, with a mean age of 67.9 ± 1.3 years (range 34.1-83.8 years), 21 of them below the age of 65. After a mean follow-up of 7.1 ± 0.3 years (range of 2.2-10.5 years), more than 50% of the survivors were in NYHA I/II and more than 60% of the survivors were angina-free (CCS 0). The overall 10-year survival following replacement of the aortic valve and root was 51%. During this period, 88% of patients were free from valved-conduit related complications leading to mortality. Post-operative echocardiography studies showed no evidence of stenosis, dilatation, calcification or thrombosis. Importantly, during the 10-year follow-up period no failures of the valved conduit were reported, suggesting that the tissue of the conduit does not structurally change (histology of one explant showed normal cusp and conduit). Conclusions The No-React® BioConduit composite stentless aortic valved conduit provides excellent long-term clinical results for aortic root replacement with few prosthesis-related complications in the first post-operative decade. PMID:21699696

  10. Cognitive Outcomes following Transcatheter Aortic Valve Implantation: A Systematic Review

    PubMed Central

    Lai, Ka Sing Paris; Herrmann, Nathan; Saleem, Mahwesh; Lanctôt, Krista L.

    2015-01-01

    Severe aortic stenosis is the most common valvular heart disease in the elderly in the Western world and contributes to a large proportion of all deaths over the age of 70. Severe aortic stenosis is conventionally treated with surgical aortic valve replacement; however, the less invasive transcatheter aortic valve implantation (TAVI) is suggested for those at high surgical risk. While TAVI has been associated with improved survival and favourable outcomes, there is a higher incidence of cerebral microembolisms in TAVI patients. This finding is of concern given mechanistic links with cognitive decline, a symptom highly prevalent in those with cardiovascular disease. This paper reviews the literature assessing the possible link between TAVI and cognitive changes. Studies to date have shown that global cognition improves or remains unchanged over 3 months following TAVI while individual cognitive domains remain preserved over time. However, the association between TAVI and cognition remains unclear due to methodological limitations. Furthermore, while these studies have largely focused on memory, cognitive impairment in this population may be predominantly of vascular origin. Therefore, cognitive assessment focusing on domains important in vascular cognitive impairment, such as executive dysfunction, may be more helpful in elucidating the association between TAVI and cognition in the long term. PMID:25785192

  11. Stroke following transcatheter aortic valve implantation. Is neuroprotection justified?

    PubMed Central

    Witkowski, Adam

    2013-01-01

    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

  12. Homograft aortic valve replacement: seven years' experience with antibiotic-treated valves.

    PubMed Central

    Khanna, S K; Ross, J K; Monro, J L

    1981-01-01

    One hundred and sixty-five patients had their aortic valve replaced with antibiotic-sterilised homograft. In all cases, a two-layered freehand technique of valve implantation was used. Tailoring (narrowing) of the annulus was required in 29 cases, and an aortic root gusset was used to enlarge the non-coronary sinus in 68 cases. There was an early mortality of 1.8% and late mortality of 2.4%. The actuarial survival rate was 95% at a maximum follow-up of seven years. The incidence of valvar regurgitation (early diastolic murmur) was 11.5% up to six months after operation and an additional 7.2% subsequent to this. Overall, it was trivial in 10.3%, mild in 7.8%, and moderate in 0.6%. Most valve regurgitation was non-progressive and actuarial analysis showed 74% regurgitation-free valves at the end of seven years. The age of the donor and the valve storage time showed some relationship to valve deterioration. Special attention has been paid to the control of hypertension to prevent accelerated graft degeneration. The results suggest that this has been successful. Anticoagulant therapy was not used and thromboembolism has not been seen in patients undergoing isolated aortic valve replacement. There was one case of miliary tuberculosis after homograft valve replacement but no pyogenic or fungal endocarditis occurred. No haemolysis, calcification, or valvar stenosis were observed. This series, followed for a maximum of seven years, shows excellent sustained valve performance and a very low incidence of important postoperative regurgitation, with 91.8% of the survivors symptom-free. Images PMID:7314000

  13. Circulating matrix metalloproteinase patterns in association with aortic dilatation in bicuspid aortic valve patients with isolated severe aortic stenosis.

    PubMed

    Wang, Yongshi; Wu, Boting; Dong, Lili; Wang, Chunsheng; Wang, Xiaolin; Shu, Xianhong

    2014-10-18

    Bicuspid aortic valve (BAV) exhibits a clinical incline toward aortopathy, in which aberrant tensile and shear stress generated by BAV can induce differential expression of matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs). Whether stenotic BAV, which exhibits additional eccentric high-velocity flow jet upon ascending aorta and further worsens circumferential systolic wall shear stress than BAV with echocardiographically normal aortic valve, can lead to unique plasma MMP/TIMP patterns is still unknown. According to their valvulopathy and aortic dilatation status, 93 BAV patients were included in the present study. Group A (n = 37) and B (n = 28) comprised severely stenotic patients with or without ascending aorta dilatation; Group C (n = 12) and D (n = 16) comprised echocardiographically normal BAV patients with or without ascending aorta dilatation. Plasma MMP/TIMP levels (MMP-1, -2, -3, -8, -9, -10, -13 and TIMP-1, -2, -4) were determined via a multiplex ELISA detection system in a single procedure. Among patients with isolated severe aortic stenosis, plasma levels of MMP-2 and -9 were significantly elevated when ascending aortic dilatation was present (p = 0.001 and p = 0.002, respectively). MMP-2, however, remained as the single elevated plasma component among echocardiographically normal BAV patients with dilated ascending aorta (p = 0.027). Multivariate analysis revealed that MMP-2 and MMP-9 could both serve as independent risk factor for aortic dilatation in the case of isolated severe stenosis (p = 0.003 and p = 0.001, respectively), and MMP-2 in echocardiographically normal patients (p = 0.002). In conclusion, BAV patients with isolated severe aortic stenosis demonstrated a distinct plasma MMP/TIMP pattern, which might be utilized as circulating biomarkers for early detection of aortic dilatation. PMID:25325992

  14. Total endoscopic sutureless aortic valve replacement: rationale, development, perspectives

    PubMed Central

    Fuzellier, Jean-Francois; Campisi, Salvatore; Grinberg, Daniel; Albertini, Jean-Noël; Morel, Jerôme; Gerbay, Antoine

    2015-01-01

    Transcatheter valve implantation is progressively becoming the first line option for high risk patients in the management of severe aortic valve stenosis. Surgery is likely to remain the gold standard treatment option for intermediate risk patients since it ensures ablation of the underlying pathology and the calcified aortic valvular tissue, which potentially can act as a nidus of chronic embolization and provoke neurocognitive dysfunction in this subset of active patients. The surgical approach is continually evolving, with sutureless technology having the potential to facilitate ministernotomy and minithoracotomy approaches. Furthermore, Nitinol stented models can be introduced through thoracoscopic trocars, enabling the evolution of totally endoscopic aortic valve replacement (TEAVR). We present herein the development of TEAVR, starting from the cadaver experience in our lab. We transitioned through a clinical minithoracotomy video-assisted experience until we finally could initiate a program of human sutureless TEAVR. The limitations of this approach, which is still in refinement, and possible innovative solutions in order to build up a quick and reproducible procedure are discussed. PMID:25870813

  15. Total endoscopic sutureless aortic valve replacement: rationale, development, perspectives.

    PubMed

    Vola, Marco; Fuzellier, Jean-Francois; Campisi, Salvatore; Grinberg, Daniel; Albertini, Jean-Noël; Morel, Jerôme; Gerbay, Antoine

    2015-03-01

    Transcatheter valve implantation is progressively becoming the first line option for high risk patients in the management of severe aortic valve stenosis. Surgery is likely to remain the gold standard treatment option for intermediate risk patients since it ensures ablation of the underlying pathology and the calcified aortic valvular tissue, which potentially can act as a nidus of chronic embolization and provoke neurocognitive dysfunction in this subset of active patients. The surgical approach is continually evolving, with sutureless technology having the potential to facilitate ministernotomy and minithoracotomy approaches. Furthermore, Nitinol stented models can be introduced through thoracoscopic trocars, enabling the evolution of totally endoscopic aortic valve replacement (TEAVR). We present herein the development of TEAVR, starting from the cadaver experience in our lab. We transitioned through a clinical minithoracotomy video-assisted experience until we finally could initiate a program of human sutureless TEAVR. The limitations of this approach, which is still in refinement, and possible innovative solutions in order to build up a quick and reproducible procedure are discussed. PMID:25870813

  16. Aortic stenosis

    MedlinePLUS

    Aortic valve stenosis; Rheumatic aortic stenosis; Calcific aortic stenosis ... As the aortic valve narrows, the left ventricle has to work harder to pump blood out through the valve. To do this extra ...

  17. Bicuspid Aortic Valve: Unresolved Issues and Role of Imaging Specialists

    PubMed Central

    2015-01-01

    Bicuspid aortic valve (BAV) is the most common congenital heart disease with marked heterogeneity in many aspects. Fusion patterns of the aortic cusp are quite variable with different type and severity of valvular dysfunction. Moreover, non-valvular cardiovascular abnormalities are associated with BAV. Among them, aortic aneurysm/dissection is the most serious clinical condition with variable patterns of segmental aortic dilatation. Potential association between BAV phenotype and valvulopathy or aortopathy has been suggested, but needs to be tested further. A lack of long-term outcome data at this moment is responsible for unresolved debate regarding appropriate management of patients with BAV, specifically to prevent development of aortic dissection. Long-term follow-up data of a well-characterized cohort or registry based on standardized classification of BAV phenotype and aortopathy are necessary for evidence-based medical practice. Advanced imaging techniques such as computed tomography or magnetic resonance imaging offer better opportunities for accurate phenotype classification and imaging specialists should play a central role to establish a collaborative multicenter cohort or registry. PMID:25883749

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

    Microsoft Academic Search

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

    1998-01-01

    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

  19. Current indications for surgical repair in patients with bicuspid aortic valve and ascending aortic ectasia.

    PubMed

    Etz, Christian D; Misfeld, Martin; Borger, Michael A; Luehr, Maximilian; Strotdrees, Elfriede; Mohr, Friedrich-Wilhelm

    2012-01-01

    Preventive surgical repair of the moderately dilated ascending aorta/aortic root in patients with bicuspid aortic valve (BAV) is controversial. Most international reference centers are currently proposing a proactive approach for BAV patients with a maximum ascending aortic/root diameter of 45?mm since the risk of dissection/rupture raises significantly with an aneurysm diameter >50?mm. Current guidelines of the European Society of Cardiology (ESC) and the joint guidelines of the American College of Cardiology (ACC)/American Heart Association (AHA) recommend elective repair in symptomatic patients with dysfunctional BAV (aortic diameter ?45?mm). In asymptomatic patients with a well-functioning BAV, elective repair is recommended for diameters ?50?mm, or if the aneurysm is rapidly progressing (rate of 5?mm/year), or in case of a strong family history of dissection/rupture/sudden death, or with planned pregnancy. As diameter is likely not the most reliable predictor of rupture and dissection and the majority of BAV patients may never experience an aortic catastrophe at small diameters, an overly aggressive approach almost certainly will put some patients with BAV unnecessarily at risk of operative and early mortality. This paper discusses the indications for preventive, elective repair of the aortic root, and ascending aorta in patients with a BAV and a moderately dilated-or ectatic-ascending aorta. PMID:23050195

  20. Current Indications for Surgical Repair in Patients with Bicuspid Aortic Valve and Ascending Aortic Ectasia

    PubMed Central

    Etz, Christian D.; Misfeld, Martin; Borger, Michael A.; Luehr, Maximilian; Strotdrees, Elfriede; Mohr, Friedrich-Wilhelm

    2012-01-01

    Preventive surgical repair of the moderately dilated ascending aorta/aortic root in patients with bicuspid aortic valve (BAV) is controversial. Most international reference centers are currently proposing a proactive approach for BAV patients with a maximum ascending aortic/root diameter of 45?mm since the risk of dissection/rupture raises significantly with an aneurysm diameter >50?mm. Current guidelines of the European Society of Cardiology (ESC) and the joint guidelines of the American College of Cardiology (ACC)/American Heart Association (AHA) recommend elective repair in symptomatic patients with dysfunctional BAV (aortic diameter ?45?mm). In asymptomatic patients with a well-functioning BAV, elective repair is recommended for diameters ?50?mm, or if the aneurysm is rapidly progressing (rate of 5?mm/year), or in case of a strong family history of dissection/rupture/sudden death, or with planned pregnancy. As diameter is likely not the most reliable predictor of rupture and dissection and the majority of BAV patients may never experience an aortic catastrophe at small diameters, an overly aggressive approach almost certainly will put some patients with BAV unnecessarily at risk of operative and early mortality. This paper discusses the indications for preventive, elective repair of the aortic root, and ascending aorta in patients with a BAV and a moderately dilated—or ectatic—ascending aorta. PMID:23050195

  1. Next generation TAVI with the Lotus Valve System: a repositionable and fully retrievable transcatheter aortic valve prosthesis.

    PubMed

    Murdoch, D; Shaw, E; Raffel, O C; Walters, D L

    2015-08-01

    Transcatheter aortic valve implantation (TAVI) is the new standard of care for selected patients with severe symptomatic aortic stenosis who are at high risk for surgical aortic valve replacement (AVR), or are inoperable. Multicentre randomised controlled trials have demonstrated equivalent or superior clinical outcomes for TAVI compared to AVR in carefully selected patient cohorts. A number of important limitations were observed with early generation TAVI valves and their delivery systems, and rapid evolution of the technology continues. The Lotus Valve System aims to address a number of these limitations - it is repositionable and retrievable, and has an adaptive seal to prevent paravalvular aortic regurgitation. Early clinical outcomes for the Lotus Valve System have recently been published with promising results in terms of paravalvular regurgitation and repositionability. PMID:25952129

  2. Feature identification for image-guided transcatheter aortic valve implantation

    NASA Astrophysics Data System (ADS)

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

    2012-02-01

    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.

  3. INCLUDING AORTIC VALVE MORPHOLOGY IN COMPUTATIONAL FLUID DYNAMICS SIMULATIONS: INITIAL FINDINGS AND APPLICATION TO AORTIC COARCTATION

    PubMed Central

    Wendell, David C.; Samyn, Margaret M.; Cava, Joseph R.; Ellwein, Laura M.; Krolikowski, Mary M.; Gandy, Kimberly L.; Pelech, Andrew N.; Shadden, Shawn C.; LaDisa, John F.

    2012-01-01

    Computational fluid dynamics (CFD) simulations quantifying thoracic aortic flow patterns have not included disturbances from the aortic valve (AoV). 80% of patients with aortic coarctation (CoA) have a bicuspid aortic valve (BAV) which may cause adverse flow patterns contributing to morbidity. Our objectives were to develop a method to account for the AoV in CFD simulations, and quantify its impact on local hemodynamics. The method developed facilitates segmentation of the AoV, spatiotemporal interpolation of segments, and anatomic positioning of segments at the CFD model inlet. The AoV was included in CFD model examples of a normal (tricuspid AoV) and a post-surgical CoA patient (BAV). Velocity, turbulent kinetic energy (TKE), time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) results were compared to equivalent simulations using a plug inlet profile. The plug inlet greatly underestimated TKE for both examples. TAWSS differences extended throughout the thoracic aorta for the CoA BAV, but were limited to the arch for the normal example. OSI differences existed mainly in the ascending aorta for both cases. The impact of AoV can now be included with CFD simulations to identify regions of deleterious hemodynamics thereby advancing simulations of the thoracic aorta one step closer to reality. PMID:22917990

  4. Association of Low-Density Lipoprotein Cholesterol–Related Genetic Variants With Aortic Valve Calcium and Incident Aortic Stenosis

    PubMed Central

    Smith, J. Gustav; Luk, Kevin; Schulz, Christina-Alexandra; Engert, James C.; Do, Ron; Hindy, George; Rukh, Gull; Dufresne, Line; Almgren, Peter; Owens, David S.; Harris, Tamara B.; Peloso, Gina M.; Kerr, Kathleen F.; Wong, Quenna; Smith, Albert V.; Budoff, Matthew J.; Rotter, Jerome I.; Cupples, L. Adrienne; Rich, Stephen; Kathiresan, Sekar; Orho-Melander, Marju; Gudnason, Vilmundur; O’Donnell, Christopher J.; Post, Wendy S.; Thanassoulis, George

    2014-01-01

    IMPORTANCE Plasma low-density lipoprotein cholesterol (LDL-C) has been associated with aortic stenosis in observational studies; however, randomized trials with cholesterol-lowering therapies in individuals with established valve disease have failed to demonstrate reduced disease progression. OBJECTIVE To evaluate whether genetic data are consistent with an association between LDL-C, high-density lipoprotein cholesterol (HDL-C), or triglycerides (TG) and aortic valve disease. DESIGN, SETTING, AND PARTICIPANTS Using a Mendelian randomization study design, we evaluated whether weighted genetic risk scores (GRSs), a measure of the genetic predisposition to elevations in plasma lipids, constructed using single-nucleotide polymorphisms identified in genome-wide association studies for plasma lipids, were associated with aortic valve disease. We included community-based cohorts participating in the CHARGE consortium (n = 6942), including the Framingham Heart Study (cohort inception to last follow-up: 1971-2013; n = 1295), Multi-Ethnic Study of Atherosclerosis (2000-2012; n = 2527), Age Gene/Environment Study-Reykjavik (2000-2012; n = 3120), and the Malmö Diet and Cancer Study (MDCS, 1991-2010; n = 28 461). MAIN OUTCOMES AND MEASURES Aortic valve calcium quantified by computed tomography in CHARGE and incident aortic stenosis in the MDCS. RESULTS The prevalence of aortic valve calcium across the 3 CHARGE cohorts was 32% (n = 2245). In the MDCS, over a median follow-up time of 16.1 years, aortic stenosis developed in 17 per 1000 participants (n = 473) and aortic valve replacement for aortic stenosis occurred in 7 per 1000 (n = 205). Plasma LDL-C, but not HDL-C or TG, was significantly associated with incident aortic stenosis (hazard ratio [HR] per mmol/L, 1.28; 95% CI, 1.04-1.57; P = .02; aortic stenosis incidence: 1.3% and 2.4% in lowest and highest LDL-C quartiles, respectively). The LDL-C GRS, but not HDL-C or TG GRS, was significantly associated with presence of aortic valve calcium in CHARGE (odds ratio [OR] per GRS increment, 1.38; 95% CI, 1.09-1.74; P = .007) and with incident aortic stenosis in MDCS (HR per GRS increment, 2.78; 95% CI, 1.22-6.37; P = .02; aortic stenosis incidence: 1.9% and 2.6% in lowest and highest GRS quartiles, respectively). In sensitivity analyses excluding variants weakly associated with HDL-C or TG, the LDL-C GRS remained associated with aortic valve calcium (P = .03) and aortic stenosis (P = .009). In instrumental variable analysis, LDL-C was associated with an increase in the risk of incident aortic stenosis (HR per mmol/L, 1.51; 95% CI, 1.07-2.14; P = .02). CONCLUSIONS AND RELEVANCE Genetic predisposition to elevated LDL-C was associated with presence of aortic valve calcium and incidence of aortic stenosis, providing evidence supportive of a causal association between LDL-C and aortic valve disease. Whether earlier intervention to reduce LDL-C could prevent aortic valve disease merits further investigation. PMID:25344734

  5. Genotype–phenotype correlation in patients with bicuspid aortic valve and aneurysm

    PubMed Central

    Kent, Kathleen C.; Crenshaw, Melissa L.; Goh, Denise L. M.; Dietz, Harry C.

    2013-01-01

    Objectives Bicuspid aortic valve is the most common congenital cardiac abnormality, occurring in 1% to 2% of the population, and often associates with ascending aortic aneurysm. Based on familial studies, bicuspid aortic valve with aneurysm segregates in an autosomal dominant manner with incomplete penetrance. NOTCH1 mutations have been reported in 6 families with prominent valve calcification and dysfunction and low penetrance of aneurysm. We sought to determine the contribution of NOTCH1 mutations to the more common phenotype of highly penetrant aneurysms with low penetrance of bicuspid aortic valve and with rare valve calcification or dysfunction. Methods All exons and splice junctions of NOTCH1 were sequenced in probands from 13 affected families presenting with bicuspid aortic valve with ascending aortic aneurysm in the absence of valve calcification. In addition, mutation analysis was performed on a single individual with aneurysm and calcified tricuspid aortic valve. Sequences were aligned and compared with the reference genomic sequence. Results Corroborating previous studies, analysis of the single sporadic patient with calcified aortic valve in the presence of ascending aortic aneurysm revealed a novel heterozygous missense mutation in NOTCH1 resulting in a nonsynonymous amino acid substitution (p.T1090S, c.C3269G) of an evolutionarily conserved residue. This change was not observed in controls. In contrast, we did not identify any pathologic NOTCH1 mutations in the 13 families segregating noncalcified bicuspid aortic valve with highly penetrant aortic aneurysm. Conclusions These data suggest that there are phenotypic differences that distinguish families with and without NOTCH1 mutations, indicating a genotype–phenotype correlation with potential implications for patient diagnosis, counseling, and management. PMID:23102684

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

    E-print Network

    Paris-Sud XI, Université de

    1 Intraoperative Tracking of Aortic Valve Plane* DLH Nguyen, M Garreau, V Auffret, H Le Breton, JP Verhoye, P Haigron Abstract--The main objective of this work is to track the aortic valve plane in intra-operative fluoroscopic images in order to optimize and secure Transcatheter Aortic Valve Implantation (TAVI) procedure

  7. Multi-detector CT angiography of the aortic valve—Part 2: disease specific findings

    PubMed Central

    Ganeshan, Arul

    2014-01-01

    The aortic valve and adjacent structures should be routinely evaluated on all thoracic cross-sectional imaging studies. Echocardiography and magnetic resonance imaging (MRI) are the main imaging techniques used for assessment of the aortic valve and related pathology but multi-detector computed tomography (MDCT) can offer valuable complimentary information in some clinical scenarios. MDCT is the definite means of assessing aortic valvular calcification, acute aortic syndrome and for non-invasive assessment of the coronary arteries. MDCT also has an emerging role in the planning and follow-up of trans-catheter aortic valve replacement. This article reviews the spectrum of aortic valve disease highlighting the key MDCT imaging features. PMID:25202663

  8. Short-term effects of transcatheter aortic valve implantation on neurohormonal activation, quality of life and 6-minute walk test in severe and symptomatic aortic stenosis

    Microsoft Academic Search

    Michael Gotzmann; Tobias Hehen; Alfried Germing; Michael Lindstaedt; Aydan Yazar; Axel Laczkovics; Achim Mumme; Andreas Mügge; Waldemar Bojara

    2010-01-01

    ObjectiveThis prospective study aimed to determine to what extent clinical symptoms and neurohumoral activation are improved in patients with severe aortic valve stenosis after transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis.MethodsFrom June 2008 to June 2009 consecutive patients with symptomatic severe aortic valve stenosis (area60 years plus additional specified risk factors were evaluated for TAVI. Examinations of study

  9. Echocardiographic and electron beam tomographic assessment of stenosis in patients with aortic valve disease: gradient versus valve area

    PubMed Central

    Piers, L.H.; Dikkers, R.; Tio, R.A.; van den Berg, M.P.; Willems, T.P.; Oudkerk, M.; Zijlstra, F.

    2006-01-01

    Background Transthoracic echocardiography (TTE) is routinely used to evaluate aortic valve stenosis. However, it does not give reliable results in every patient. There is growing interest in electron-beam tomography (EBT) as a noninvasive cardiac imaging technique. The usefulness of EBT to evaluate aortic stenosis has yet to be evaluated. Aim To compare EBT with TTE in assessing severity of aortic stenosis. Methods In total 47 patients (18 females, 29 males) underwent a contrast-enhanced EBT scan and TTE within 6±20 days. The calcium score of the aortic valve was determined and the aortic valve area (AVA) was measured by planimetry. A complete TTE study, during which the peak pressure gradient across the aortic valve was measured, was performed in all patients by an experienced sonographer. Results There was a significant correlation between AVA assessed by EBT and peak pressure gradient (r=-0.38, p=0.009). The calcium score of the aortic valve assessed by EBT correlated with peak pressure gradient (r=0.48, p=0.001). Conclusion EBT is a useful noninvasive method to evaluate the severity of aortic stenosis. It holds the possibility of assessing the AVA as well as quantification of the degree of calcification. ImagesFigure 1 PMID:25696558

  10. Simulation of the aortic valve deformation by considering blood flow reflection.

    PubMed

    Mukai, Nobuhiko; Nakagawa, Masashi; Abe, Yusuke; Chang, Youngha; Niki, Kiyomi; Takanashi, Shuichiro

    2013-01-01

    We have tried to simulate the aortic valve deformation by considering the reflection of blood flow. The aortic valve opens and closes according to blood flow caused by pressure difference between the heart and the aorta. The aortic valve is elastic body while blood is fluid so that two different types of methods are usually used for the simulation; however, it is difficult to calculate collision detection and force between two different types of models. Then, in this paper, both materials are modeled with particles so that collision detection and force between two different types of models can be easily calculated. In addition, by considering the reflection of blood flow at the end of blood vessel, we have succeeded to simulate the deformation of the aortic valve and found that blood flows differently depending on the length of the aortic valve. PMID:23400172

  11. Paravalvular leak after transcatheter aortic valve implantation: trading one disease for another?

    PubMed

    Tam, Derrick Y; Chu, Michael Wa

    2014-04-01

    Paravalvular leak is a common complication occurring after transcatheter aortic valve implantation and is associated with at least a 2-fold increase in 30-day and 1-year mortality risk. In high-risk, inoperable patients with severe aortic stenosis, paravalvular leak may even negate the survival benefit of transcatheter aortic valve implantation. This editorial reviews the anatomy, pathophysiology and predictors of paravalvular leak and discusses preventative and therapeutic strategies to optimally treat this previously underappreciated complication. PMID:24506325

  12. Endocarditis of the native aortic valve caused by Lactobacillus jensenii.

    PubMed

    Patnaik, Soumya; Davila, Carlos Daniel; Chennupati, Anupama; Rubin, Alexander

    2015-01-01

    Lactobacilli are Gram-positive anaerobic rods or coccobacilli, commonly found as commensals in human mucosa. Rarely, they can cause serious infections such as infective endocarditis (IE), and the most frequently implicated species causing serious infections are L. casei and L. rhamnosus. IE caused by Lactobacillus jensenii is very rare, with only six reported cases so far, to the best of our knowledge. We present a case of native aortic valve endocarditis caused by L. jensenii, complicated by root abscess and complete heart block, and requiring emergent surgical intervention. PMID:25750218

  13. Aortic valve replacement in a patient with severe nickel allergy.

    PubMed

    Lusini, Mario; Barbato, Raffaele; Spadaccio, Cristiano; Chello, Massimo

    2011-11-01

    Nickel allergy can raise clinical problems in patients undergoing cardiac surgery who require sternal closure with stainless steel wire. We describe the case of a 51-year-old woman with severe nickel allergy who underwent aortic valve replacement with a nickel-free ON-X prosthesis and sternal closure by Fiberwire # 2 suture without complications. Considering its biocompatibility and its mechanical characteristics including optimal strength and knot resistance, this suture might be a viable alternative in patients in which the use of stainless steel wire is contraindicated. PMID:21929741

  14. Evaluation of calcium loss after transcatheter aortic valve implantation

    PubMed Central

    Nguyen-Kim, Thi Dan Linh; Sahin, Ayhan; Sündermann, Simon H.; Winklehner, Anna; Grünenfelder, Jürg; Emmert, Maximilian Y.; Maier, Willibald; Altwegg, Lukas; Frauenfelder, Thomas; Falk, Volkmar; Plass, André

    2014-01-01

    OBJECTIVES Aortic valve calcification and changes after transcatheter aortic valve implantation (TAVI) were specifically assessed by computed tomography (CT). The main difference between TAVI and the conventional technique is the compression of the cusps of the calcified native valve against the aortic wall before implantation. The objective of this study was to quantify the segmented calcification in the area of the basal annular plane before and after TAVI. METHODS The CT scans of 20 patients (13 male and 7 female; mean age: 82.9 ± 8.1 years) were assessed. The aortic valve calcification was segmented; derived from this segmentation volume, mass and Hounsfield units (HU)/density of the calcifications on the annulus and cusps before and after TAVI were evaluated. Pre- and postoperative data were compared regarding potential calcification loss and calcification distances to the left and right coronary ostia. RESULTS Significantly lower postprocedural mean volumes and masses for all cusps (P < 0.001) were found. The mean differences in the volume for the non-coronary, right-coronary and left-coronary cusp were ?156.8 ± 53.73, ?155.5 ± 62.54 and ?115 ± 57.53 mm3, respectively, and differences in mass were ?88.78 ± 29.48, ?95.2 ± 39.27 and ?71.56 ± 35.62 mg, respectively. Over all cusps, mean HU increased after intervention [784.41 ± 92.5 HU (pre) and 818.63 ± 78.71 HU (post); P < 0.004]. In 80.03% of all cusps, calcification loss was found; all patients were affected. Significantly lower (P < 0.047) postprocedural mean distances were found from the left and right coronary ostia to the next calcification point. CONCLUSIONS Our results show a significant loss of calcification in all patients after TAVI, with a reduction in the calcification distances to the coronary ostia and the compression of calcification in the area of the device landing zone. The clinical implications of this finding need to be investigated further. PMID:24105864

  15. Incidental left atrial blood cyst in a patient undergoing transcatheter aortic valve replacement.

    PubMed

    Suero, Gregory; Shah, Moneal; Hughes-Doichev, Rachel

    2015-02-01

    Blood cysts of the heart are benign cardiovascular tumors found incidentally in approximately 50% of infants who undergo autopsy at less than 2 months of age. These congenital cysts, frequently present on the atrioventricular valves of infants, are exceedingly rare in adults. Nonetheless, in adults, cardiac blood cysts have been found on the mitral valve, papillary muscles, right atrium, right ventricle, left ventricle, and aortic, pulmonic, and tricuspid valves. Reported complications include left ventricular outflow obstruction, occlusion of the coronary arteries, valvular stenosis or regurgitation, and embolic stroke. In high-risk patients with severe aortic stenosis, transcatheter aortic valve replacement has emerged as an alternative to surgical replacement. Transesophageal echocardiography plays a fundamental role in evaluating the feasibility of intraprocedural transcatheter aortic valve replacement, in measuring aortic annular size, in guiding placement of the prosthetic device, and in looking for possible complications. The embolic risk of rapid pacing and transcatheter aortic valve replacement in a patient with an intracardiac blood cyst is unknown, and such a case has not, to our knowledge, been reported heretofore. We present the case of a 78-year-old woman with severe aortic stenosis, in whom a blood cyst was incidentally found in the left atrium upon transesophageal echocardiography. She underwent successful transcatheter aortic valve replacement without embolic complication. PMID:25873801

  16. Thrombogenic potential of transcatheter aortic valve implantation with trivial paravalvular leakage

    PubMed Central

    Siegel, Rolland

    2014-01-01

    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

  17. Dynamic heart phantom with functional mitral and aortic valves

    NASA Astrophysics Data System (ADS)

    Vannelli, Claire; Moore, John; McLeod, Jonathan; Ceh, Dennis; Peters, Terry

    2015-03-01

    Cardiac valvular stenosis, prolapse and regurgitation are increasingly common conditions, particularly in an elderly population with limited potential for on-pump cardiac surgery. NeoChord©, MitraClipand numerous stent-based transcatheter aortic valve implantation (TAVI) devices provide an alternative to intrusive cardiac operations; performed while the heart is beating, these procedures require surgeons and cardiologists to learn new image-guidance based techniques. Developing these visual aids and protocols is a challenging task that benefits from sophisticated simulators. Existing models lack features needed to simulate off-pump valvular procedures: functional, dynamic valves, apical and vascular access, and user flexibility for different activation patterns such as variable heart rates and rapid pacing. We present a left ventricle phantom with these characteristics. The phantom can be used to simulate valvular repair and replacement procedures with magnetic tracking, augmented reality, fluoroscopy and ultrasound guidance. This tool serves as a platform to develop image-guidance and image processing techniques required for a range of minimally invasive cardiac interventions. The phantom mimics in vivo mitral and aortic valve motion, permitting realistic ultrasound images of these components to be acquired. It also has a physiological realistic left ventricular ejection fraction of 50%. Given its realistic imaging properties and non-biodegradable composition—silicone for tissue, water for blood—the system promises to reduce the number of animal trials required to develop image guidance applications for valvular repair and replacement. The phantom has been used in validation studies for both TAVI image-guidance techniques1, and image-based mitral valve tracking algorithms2.

  18. Comparison of Outcomes and Presentation in Men-Versus-Women With Bicuspid Aortic Valves Undergoing Aortic Valve Replacement.

    PubMed

    Andrei, Adin-Cristian; Yadlapati, Ajay; Malaisrie, S Chris; Puthumana, Jyothy J; Li, Zhi; Rigolin, Vera H; Mendelson, Marla; Clennon, Colleen; Kruse, Jane; Fedak, Paul W M; Thomas, James D; Higgins, Jennifer A; Rinewalt, Daniel; Bonow, Robert O; McCarthy, Patrick M

    2015-07-15

    Gender disparities in short- and long-term outcomes have been documented in cardiac and valvular heart surgery. However, there is a paucity of data regarding these differences in the bicuspid aortic valve (BAV) population. The aim of this study was to examine gender-specific differences in short- and long-term outcomes after surgical aortic valve (AV) replacement in patients with BAV. A retrospective analysis was performed in 628 consecutive patients with BAV who underwent AV surgery from April 2004 to December 2013. To reduce bias when comparing outcomes by gender, propensity score matching obtained on the basis of potential confounders was used. Women with BAV who underwent AV surgery presented with more advanced age (mean 60.7 ± 13.8 vs 56.3 ± 13.6 years, p <0.001) and less aortic regurgitation (29% vs 44%, p <0.001) and had a higher risk for in-hospital mortality (mean Ambler score 3.4 ± 4.4 vs 2.5 ± 4.0, p = 0.015). After propensity score matching, women received more blood products postoperatively (48% vs 34%, p = 0.028) and had more prolonged postoperative lengths of stay (median 5 days [interquartile range 5 to 7] vs 5 days [interquartile range 4 to 6], p = 0.027). Operative, discharge, and 30-day mortality and overall survival were not significantly different. In conclusion, women with BAV who underwent AV surgery were older, presented with less aortic regurgitation, and had increased co-morbidities, lending higher operative risk. Although women received more blood products and had significantly longer lengths of stay, short- and long-term outcomes were similar. PMID:25983125

  19. Technique of Transcatheter Aortic Valve Implantation with the Edwards-Sapien ® Heart Valve Using the Transfemoral Approach

    Microsoft Academic Search

    Alain Cribier; Pierre-Yves Litzler; Helene Eltchaninoff; Matthieu Godin; Christophe Tron; Fabrice Bauer; Jean-Paul Bessou

    2009-01-01

    \\u000a Abstract\\u000a   Transcatheter aortic valve implantation (TAVI) using a balloon-expandable valve has been developed by the authors’ group 7\\u000a years ago to offer a therapeutic solution to nonoperable or surgical high-risk patients with degenerative aortic stenosis.\\u000a The technique and the devices used have rapidly evolved thereafter and TAVI has become a clinical reality with more than 3,500\\u000a patients implanted worldwide with

  20. Calculation of aortic valve area by Doppler echocardiography: a direct application of the continuity equation.

    PubMed

    Richards, K L; Cannon, S R; Miller, J F; Crawford, M H

    1986-05-01

    The continuity equation suggests that a ratio of velocities at two different cardiac valves is inversely proportional to the ratio of cross-sectional areas of the valves. To determine whether a ratio of mitral/aortic valve orifice velocities is useful in determining aortic valve area in patients with aortic stenosis, 10 control subjects and 22 patients with predominant aortic stenosis were examined by Doppler echocardiography. The ratio of (mean diastolic mitral velocity)/(mean systolic aortic velocity), (Vm)/(Va), and the ratio of (mitral diastolic velocity-time integral)/(aortic systolic velocity-time integral), (VTm)/(VTa), were determined from Doppler spectral recordings. Aortic valve area determined at catheterization by the Gorlin equation was the standard of reference. High-quality Doppler recordings were obtained in 30 of 32 subjects (94%). Catheterization documented valve areas of 0.5 to 2.6 (mean 1.1) cm2. There was good correlation between Doppler-determined (Vm)/(Va) and Gorlin valve area (r = .90, SEE = 0.23 cm2); a better correlation was noted between (VTm)/(VTa) and Gorlin valve area (r = .93, SEE = 0.18 cm2). The data demonstrate the usefulness of Doppler alone in the determination of aortic valve area in adults with absent or mild aortic or mitral regurgitation and no mitral stenosis. Although the use of mean velocity and velocity-time integral ratios requires accurate measurement of mitral and aortic velocities, it does not require squaring of these velocities or measurement of the cross-sectional area of flow. PMID:3698240

  1. The influence of a nonlinear resistance element upon in vitro aortic pressure tracings and aortic valve motions.

    PubMed

    Scharfschwerdt, Michael; Misfeld, Martin; Sievers, Hans-H

    2004-01-01

    In vitro testing of biological heart valves requires pressure and flow waveforms closely simulating natural conditions, which are mainly influenced by the characteristics of the vascular system. Simulation of the arterial function in artificial circulations was mostly performed by the useful Windkessel model but sometimes failed by generating inadequate systolic pressures. The integration of a novel nonlinear resistance element may improve the Windkessel function. Native porcine aortic valves were studied in a mock circulation with a novel nonlinear resistance element combined with the Windkessel compared with an aperture plate resistance. Pressure and flow measurements were performed at varying heart rates and stroke volumes and analyzed in the time and frequency domain. Aortic valve motions were evaluated using high speed video recording. With the classical afterload configuration including an aperture plate resistance, the pressure tracings showed a nonphysiologic decrease of pressure during systole after early peak pressure. By integration of the novel nonlinear resistance, peak systolic pressure occured later, peak pressure was higher, and the pressure waveform was more physiologically shaped. Leaflet motions of the aortic valves were less oscillatory and compared well with in vivo characteristics. In conclusion, a novel nonlinear resistance element in a mock circulation has the potential to provide more physiologic aortic pressure waveforms as influencing aortic valve dynamics and thus may be a helpful tool for investigation of biological heart valves. PMID:15497392

  2. Particle Based Simulation of the Aortic Valve by Considering Heart's Pulsation.

    PubMed

    Mukai, Nobuhiko; Abe, Yusuke; Chang, Youngha; Niki, Kiyomi; Takanashi, Shuichiro

    2014-01-01

    We have performed a dynamic simulation of the aortic valve by considering heart's pulsation. In the simulation, there are two different types of materials: elastic body for the aortic wall and the aortic valve, and fluid for blood. In order to calculate the collision detection between two different types of materials, we have used a particle method. In addition, the pressure difference between the left ventricle and the aorta causes the blood flow in the inside of the aorta. Then, the pressure change is given as the parameter of the simulation by referring to the typical pattern of the heart's pulsation. Finally, we have succeeded in performing the simulation on opening and closing of the aortic valve, and have also visualized the pressure in the inside of the aorta and the stress distribution on the aortic valve. PMID:24732523

  3. [Usefulness of multidetector computed tomography in transcatheter aortic valve implantation. Advantage of a tridimentional imaging modality].

    PubMed

    Escobedo-Uribe, Carlos; Schoenhagen, Paul

    2015-01-01

    Aortic stenosis is the most common valvular disorder in the United States and Europe. Nowadays, surgical aortic valve replacement remains the standard treatment for patients with severe aortic stenosis; however, transcatheter aortic valve implantation represents a less invasive treatment option for aortic stenosis patients considered as high-risk or not suitable for surgical management. Because of the lack of direct visualization of the operative field in transcatheter aortic valve implantation, there is an increased need for precise pre-operative assessment of vascular anatomy. Therefore, in order to improve outcome and avoid complications, multidetector tomography is part of the routine evaluation of patients considered for this treatment. The data obtained covering the aorta and iliac arteries, allows the physician a precise planning prior to the intervention. In this review, we described basic aspects of the procedure, and the clinical relevance of the multidetector tomography. PMID:25622982

  4. Collagen synthesis by mesenchymal stem cells and aortic valve interstitial cells in response to mechanical stretch

    Microsoft Academic Search

    Ching-Hsin Ku; Philip H. Johnson; Puspa Batten; Padmini Sarathchandra; Rachel C. Chambers; Patricia M. Taylor; Magdi H. Yacoub; Adrian H. Chester

    2006-01-01

    Objective: The synthesis of appropriate extracellular matrix by cells in tissue engineered heart valve constructs will be important for the maintenance of valve cusp integrity and function. We have examined and compared the capacity of mesenchymal stem cells to synthesise collagen in response to stretch in comparison with native aortic valve interstitial cells. Methods: Cells were stretched on a Flexercell

  5. Valve replacement with a stentless bioprosthesis: Versatility of the porcine aortic root

    Microsoft Academic Search

    Stephen Westaby; Xu Y. Jin; Takahiro Katsumata; Ahmed Arifi; Peter Braidley

    1998-01-01

    Objective: Stentless valves convey important hemodynamic benefits but are used selectively depending on aortic root structure. The Freestyle valve (Medtronic, Inc, Minneapolis, Minn) is a versatile device that can be implanted by different methods depending on operating conditions. We aimed to demonstrate that a stentless valve could be used in every patient without increased risk of morbidity or mortality. We

  6. Effects of storage temperature and fetal calf serum on the endothelium of porcine aortic valves

    Microsoft Academic Search

    Xiao J. Feng; Cor E. J. Van Hove; Paul J. Walter; Arnold G. Herman

    1996-01-01

    Endothelial integrity and function may be an important determinant for long-term success of allograft heart valves. To determine the optimal storage temperatures for preservation of long-term endothelial function in porcine aortic valves, different storage temperatures and times were investigated. Fresh valves were either (1) stored at 4° C, with or without 10% fetal calf serum supplement, for 1, 2, 4,

  7. Vascular Biology, Atherosclerosis and Endothelium Biology Identification and Characterization of Aortic Valve

    E-print Network

    Simmons, Craig A.

    of Aortic Valve Mesenchymal Progenitor Cells with Robust Osteogenic Calcification Potential Jan-Hung Chen by an unidentified multipotent progenitor subpopulation within the valve interstitium. The identity, frequency were to determine whether valve intersti- tial cells (VICs) contain a subpopulation of multipo- tent

  8. Aortic Valve Turning Over a New Leaf(let) in Endothelial Phenotypic Heterogeneity

    E-print Network

    Simmons, Craig A.

    Aortic Valve Turning Over a New Leaf(let) in Endothelial Phenotypic Heterogeneity Peter F. Davies, Anthony G. Passerini, Craig A. Simmons A ortic valve diseases are debilitating cardiovascular disorders the longevity of replacement valves and to improve tissue engineered substitutes,1 the underlying mech- anisms

  9. Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry).

    PubMed

    Kochman, Janusz; Huczek, Zenon; Scis?o, Piotr; Dabrowski, Maciej; Chmielak, Zbigniew; Szyma?ski, Piotr; Witkowski, Adam; Parma, Rados?aw; Ochala, Andrzej; Chodór, Piotr; Wilczek, Krzysztof; Reczuch, Krzysztof W; Kubler, Piotr; Rymuza, Bartosz; Ko?towski, Lukasz; Scibisz, Anna; Wilimski, Rados?aw; Grube, Eberhard; Opolski, Grzegorz

    2014-09-01

    The aim of the study was to evaluate the transcatheter aortic valve replacement (TAVR) in high-risk patients with severe bicuspid aortic valve (BAV) stenosis and to compare the outcomes with a matched group of patients with tricuspid aortic valve. TAVR became an alternative treatment method in high-risk patients with symptomatic aortic stenosis; however, BAV stenosis is regarded as a relative contraindication to TAVR. The study population comprised 28 patients with BAV who underwent TAVR. BAV was diagnosed based on a transesophageal echocardiography. CoreValve and Edwards SAPIEN prostheses were implanted. The control group consisted of 84 patients (3:1 matching) with significant tricuspid aortic valve stenosis treated with TAVR. There were no significant differences between patients with and without BAV in device success (93% vs 93%, p = 1.0), risk of annulus rupture (0% in both groups), or conversion to cardiosurgery (4% vs 0%, respectively, p = 0.25). The postprocedural mean pressure gradient (11.5 ± 6.4 vs 10.4 ± 4.5 mm Hg, p = 0.33), aortic regurgitation grade ?2 of 4 (32% vs 23%, p = 0.45), 30-day mortality (4% vs 7%, p = 0.68), and 1-year all-cause mortality (19% vs 18%, p = 1.00) did not differ between the groups. Echocardiography showed well-functioning valve prosthesis with a mean prosthetic valve area of 1.6 ± 0.4 cm(2) versus 1.7 ± 0.3 cm(2) (p = 0.73), a mean pressure gradient of 10.3 ± 5.4 versus 9.8 ± 2.8 mm Hg (p = 0.64), and aortic regurgitation grade ?2 of 4 (22% vs 22%, p = 1.00) for the 2 groups. In conclusion, selected high-risk patients with BAV can be successfully treated with TAVR, and their outcomes are similar to those reported in patients without BAV. PMID:25037674

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

    PubMed

    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

    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

  11. Aortic insufficiency

    MedlinePLUS

    Aortic valve prolapse; Aortic regurgitation ... Any condition that prevents the aortic valve from closing completely can cause this problem. When the valve doesn't close all the way, a small amount of blood comes ...

  12. The vitamin D receptor genotype predisposes to the development of calcific aortic valve stenosis

    PubMed Central

    Ortlepp, J; Hoffmann, R; Ohme, F; Lauscher, J; Bleckmann, F; Hanrath, P

    2001-01-01

    OBJECTIVE—To test the hypothesis that vitamin D receptor polymorphism is associated with calcific aortic valve stenosis.?DESIGN—The distribution of one polymorphism of the vitamin D receptor (BsmI B/b) was examined in 100 consecutive patients with calcific valvar aortic stenosis and compared with a control group of 100 patients (paired match for age, sex, and the presence of coronary artery disease from a total of 630 patients without calcified aortic valves). Polymerase chain reaction and restriction fragment length polymorphism were used to determine genotypes.?RESULTS—There was a significant difference in vitamin D receptor allele and genotype frequencies between the two groups. The allele B had a higher prevalence in patients with calcific aortic stenosis (B = 0.56, b = 0.44) than in the control cohort (B = 0.40, b = 0.60) (p = 0.001).?CONCLUSIONS—There is a significant association of vitamin D receptor polymorphism with calcific aortic valve stenosis. The B allele of the vitamin D receptor is more common in patients with calcific aortic valve stenosis. It now needs to be evaluated whether other genes that control calcium homeostasis are involved in the pathogenesis of this disorder.???Keywords: vitamin D receptor; calcific aortic stenosis; aortic valve; genetic polymorphism PMID:11359741

  13. Do we need sutureless or self-anchoring aortic valve prostheses?

    PubMed

    Shrestha, Malakh

    2015-03-01

    Surgical aortic valve replacement (AVR) is the 'gold standard' for the treatment of aortic valve stenosis. Due to the increasing age of the patient population (reflecting the demographic changes), the use of biological valves has increased over the past years. At the same time, a large proportion of these patients require concomitant surgical procedures in addition to AVR. Although trans-apical or trans-femoral aortic valve implantations (TAVI) have been introduced for high risk patients, they are limited to patients with isolated aortic valve pathology. Therefore, strategies for avoiding long ischemia times, as well as long periods of extra-corporeal circulation (ECC) resulting in reduced peri-operative risks should be welcomed among the surgical community. Modern 'sutureless valves' with reduced cross-clamp and cardio-pulmonary bypass times as a result of the absence of sutures, combined with excellent hemodynamics in the short and mid-term, may be an ideal solution for geriatric patients. Additionally, 'self-anchoring' valves will increase the armament of surgeons in treating 'technically difficult' group of patients needing AVR who have small calcified aortic roots and those coming back after aortic root replacement with homografts. These valves should also expand the application of minimally access AVR. Therefore, the question of whether we need 'self-anchoring valves' is not only redundant, but the time may have come for these type of valves to be considered as the 'valve of choice' for higher risk geriatric patients who may be 'high risk' for conventional valves but not ineligible for TAVIs. PMID:25870814

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

    PubMed Central

    Wang, Qian; Sirois, Eric; Sun, Wei

    2012-01-01

    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

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

    PubMed Central

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

    1987-01-01

    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

  16. Aorta Measurements are Heritable and Influenced by Bicuspid Aortic Valve

    PubMed Central

    Martin, Lisa J.; Hinton, Robert B.; Zhang, Xue; Cripe, Linda H.; Benson, D. Woodrow

    2011-01-01

    Objectives: To determine whether the contributions of genetics and bicuspid aortic valve (BAV) independently influence aortic (Ao) dimensions. Background: Ao dilation is a risk factor for aneurysm, dissection, and sudden cardiac death. Frequent association of BAV with Ao dilation implicates a common underlying defect possibly due to genetic factors. Methods: Families enriched for BAV underwent standardized transthoracic echocardiography. In addition to BAV status, echocardiographic measures of Ao (annulus to descending Ao), pulmonary artery, and mitral valve annulus (MVA) diameters were obtained. Using variance components analysis, heritability was estimated with and without BAV status. Additionally, bivariate genetic analyses between Ao dimensions and BAV were performed. Results: Our cohort was obtained from 209 families enriched for BAV. After adjusting for age, body surface area, and sex, individuals with BAV had a statistically significant increase in all echocardiographic measurements (p?

  17. Reproducibility of Electron-Beam CT Measures of Aortic Valve Calcification

    Microsoft Academic Search

    Matthew J. Budoff; Songshou Mao; Junichiro Takasu; David M. Shavelle; Xue-Qiao Zhao; Kevin D. O'Brien

    2002-01-01

    Rationale and ObjectivesThe authors performed this study to establish the interscan, interobserver, and intraobserver reproducibility of aortic valve calcification (AVC) measurements obtained with electron-beam computed tomography (CT).

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

    Microsoft Academic Search

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

    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-

  19. Transcatheter aortic valve implantation under conscious sedation – the first Indian experience

    PubMed Central

    Maqbool, Syed; Kumar, Vijay; Rastogi, Vishal; Seth, Ashok

    2014-01-01

    Transcatheter aortic valve implantation (TAVI) is maturing strongly as an alternative to surgical aortic valve replacement (SAVR) in patients who are inoperable/high risk for open heart surgery. General anesthesia (GA) is the usual mode of anesthesia in these patients, but local anesthesia with conscious sedation (LACS) has recently been described as a safe alternative with some added advantages. We report 2 cases who were unfit for GA and were done successfully under LACS. PMID:24814117

  20. Histological changes in the aortic valve after balloon dilatation: evidence for a delayed healing process

    Microsoft Academic Search

    M van den Brand; C E Essed; C Di Mario; S Plante; B Mochtar; P J de Feyter; H Suryapranata; P W Serruys

    1992-01-01

    OBJECTIVE--To investigate whether balloon dilatation of the aortic valve induces long-term macroscopic or histological changes or both to explain the restenosis process. DESIGN--Prospective study of 39 consecutive patients. Sixteen later (mean (SD) 12 (10) months) required operation. This non-randomised subgroup was compared with 10 patients who had aortic valve replacement without prior dilatation. SETTING--University cardiology and cardiac surgery centre and

  1. Evaluation of the safety and efficacy of transcatheter aortic valve implantation in patients with a severe stenotic bicuspid aortic valve in a Chinese population*

    PubMed Central

    Liu, Xian-bao; Jiang, Ju-bo; Zhou, Qi-jing; Pu, Zhao-xia; He, Wei; Dong, Ai-qiang; Feng, Yan; Jiang, Jun; Sun, Yong; Xiang, Mei-xiang; He, Yu-xin; Fan, You-qi; Dong, Liang; Wang, Jian-an

    2015-01-01

    Objective: The purpose of this study is to evaluate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with a severe stenotic bicuspid aortic valve (BAV) in a Chinese population. While several groups have reported the feasibility, efficacy, and safety of TAVI for patients with a BAV, worldwide experience of the technique is still limited, especially in China. Methods: From March 2013 to November 2014, high surgical risk or inoperable patients with symptomatic severe aortic stenosis (AS) who had undergone TAVI at our institution were selected for inclusion in our study. Results were compared between a BAV group and a tricuspid aortic valve (TAV) group. Results: Forty patients were included in this study, 15 (37.5%) of whom were identified as having a BAV. In the BAV group, the aortic valve area was smaller ((0.47±0.13) vs. (0.59±0.14) cm2), the ascending aortic diameter was larger ((40.4±4.4) vs. (36.4±4.3) mm), and the concomitant aortic regurgitation was lower. No significant differences were found between the groups in the other baseline characteristics. No differences were observed either in the choice of access or valve size. The procedural success achieved in this study was 100%. There were no differences between groups in device success (86.7% vs. 88.0%), 30-d mortality (6.7% vs. 8.0%), or 30-d combined end point (13.3% vs. 12.0%). The incidences of new pacemaker implantation, paravalvular regurgitation and other complications, recovery of left ventricle ejection fraction and heart function were similar in both groups. Conclusions: Patients with a severely stenotic BAV can be treated with TAVI, and their condition after treatment should be similar to that of people with a TAV. PMID:25743122

  2. Chronic Otitis Media Resulting in Aortic Valve Replacement: A Case Report

    PubMed Central

    Guler, Adem; Sahin, Mehmet Ali; Gurkan Yesil, Fahri; Yildizoglu, Uzeyir; Demirkol, Sait; Arslan, Mehmet

    2015-01-01

    The bicuspid aortic valve is known to be the most common congenital cardiac malformation, with an approximate incidence rate of 1-2% in the general population. Most patients are unaware of the disease until the onset of infective endocarditis, which is a life-threatening complication that may affect a heart valve or other cardiac structures at the site of endothelial damage. A 22-year-old man presented to our internal medicine clinic with a complaint of acute onset dyspnea and fatigue. His body temperature was 38 °C. A diastolic murmur was detected at the right sternal border. Two-dimensional transthoracic echocardiography revealed severe aortic insufficiency, and two-dimensional transesophageal echocardiography showed that the aortic valve was bicuspid. There was also a flail lesion extending the left ventricular outflow tract, resulting in pathological coaptation and severe aortic insufficiency. The patient was referred to our cardiovascular department for surgery. We herein present this case of a bicuspid aortic valve complicated by infective endocarditis due to the underlying disease of chronic otitis media related to a rare pathogen: Alloiococcus otitidis. The patient underwent a successful aortic valve replacement surgery due to aortic insufficiency following infective endocarditis. He was discharged on the 16th postoperative day in good condition.

  3. Optimal timing of valve replacement in asymptomatic severe aortic stenosis.

    PubMed

    Bilen, Emine; Ipek, Gökürk; Ayhan, Huseyin; Nacar, Alper Bugra; Kasapkara, Haci Ahmet; Sani, Cenk; Basbug, Serdar; Kurt, Mustafa; Bozkurt, Engin

    2014-09-01

    Patients with asymptomatic severe aortic stenosis (AS) constitute a heterogeneous group which includes not only certain cases who are at high risk of sudden death and valve-related heart failure, but also those at low risk for these events. Degenerative AS, which includes a majority of patients with AS, is characterized by stricture of the valve, increased arterial stiffness, and diverse left ventricular response to the valvular plus arterial vascular load. In addition to using traditional primary parameters, the severity of AS and the total left ventricular load should be assessed using new measures such as energy loss index and valvulo-arterial impedance. Natriuretic peptide levels and global longitudinal strain imaging may also be used as secondary parameters to obtain information about left ventricular systolic function, although these parameters do not correlate with the severity of AS. Exercise stress testing and exercise echocardiography are also beneficial when assessing the patient if they are symptomatic, and for determining valvular and left ventricular contractile reserves. The aim of this review was to emphasize the importance of risk stratifications in asymptomatic severe AS cases, and to assess the severity of AS using not only conventional methods but also new methods on which much emphasis has been placed during recent years. PMID:25799699

  4. Perioperative conduction disturbances after transcatheter aortic valve replacement.

    PubMed

    Ghadimi, Kamrouz; Patel, Prakash A; Gutsche, Jacob T; Sophocles, Aris; Anwaruddin, Saif; Szeto, Wilson Y; Augoustides, John G T

    2013-12-01

    Cardiac conduction disturbances after transcatheter aortic valve replacement (TAVR) are common and important. The risk factors and outcome effects of atrial fibrillation after TAVR recently have been appreciated. The paucity of clinical trials has resulted in the absence of clinical guidelines for the management of this important arrhythmia in this high-risk patient population. Given this evidence gap and clinical necessity, it is likely that clinical trials in the near future will be designed and implemented to address these issues. Prompt recognition and proper management of atrioventricular block remain essential in the management of patients undergoing TAVR, because heart block of all types is common and may require permanent pacemaker implantation. The current evidence base has described the incidence, risk factors, and current outcomes of this conduction disturbance in detail. As the practice of TAVR evolves and novel valve prostheses are developed, a focus on minimizing damage to the cardiac conductive system remains paramount. It remains to be seen how the next generation of TAVR prostheses will affect the incidence, risk factors, and clinical outcomes of associated conduction disturbances. PMID:24103715

  5. Ross procedure in a child with Aspergillus endocarditis and bicuspid aortic valve.

    PubMed

    Mitropoulos, Fotios A; Kanakis, Meletios A; Contrafouris, Constantinos; Laskari, Cleo; Rammos, Spyridon; Apostolidis, Christos; Azariadis, Prodromos; Chatzis, Andrew C

    2014-01-01

    The case is presented of a previously healthy infant with a known asymptomatic bicuspid aortic valve who developed fungal endocarditis. The patient underwent aortic root replacement with a pulmonary autograft (Ross procedure). Cultured operative material revealed Aspergillus infection. The patient had an excellent recovery and remained well one year later. PMID:25192408

  6. Five-year follow up of Konno aortoventriculoplasty for repeat aortic valve replacement in an adult patient.

    PubMed

    Uyar, I; Demir, T; Uyar, G U; Tulukoglu, E; Parlar, A I; Isik, O

    2015-01-01

    Konno aortoventriculoplasty (AVP) is performed for various types of left ventricular outflow tract obstruction. We report on a 32-year-old woman who had undergone double valve replacement five years earlier. She presented with increased interventricular septum thickness, small aortic root and gradient across the aortic mechanical valve. We performed Konno AVP with repeat aortic valve replacement (AVR). The control echocardiography showed no significant residual gradient. Konno AVP with repeat AVR may be safely performed with satisfactory results. PMID:25784495

  7. Calcification and cellularity in human aortic heart valve tissue determine the differentiation of bone-marrow-derived cells

    Microsoft Academic Search

    Hannu-Ville Leskelä; Jari Satta; Jani Oiva; Heidi Eriksen; Risteli Juha; Paula Korkiamäki; Kaisa K. Ivaska; Ylermi Soini; Petri Lehenkari

    2006-01-01

    Human bone-marrow-derived mesenchymal stem cells (MSC) are responsible the remodeling of human tissue. However, damaged aortic valves are lack the ability to regenerate which is an active cell-mediated process. Diseased aortic valve remodeling has similarities even to bone formation. In this study, the prerequisites for cultured MSCs to undergo osteoblastic differentiation on aortic valves were explored. An ex vivo model

  8. Does diabetes accelerate the progression of aortic stenosis through enhanced inflammatory response within aortic valves?

    PubMed

    Natorska, Joanna; Wypasek, Ewa; Grudzie?, Grzegorz; Sobczyk, Dorota; Marek, Grzegorz; Filip, Grzegorz; Sadowski, Jerzy; Undas, Anetta

    2012-06-01

    Diabetes predisposes to aortic stenosis (AS). We aimed to investigate if diabetes affects the expression of selected coagulation proteins and inflammatory markers in AS valves. Twenty patients with severe AS and concomitant type 2 diabetes mellitus (DM) and 40 well-matched patients without DM scheduled for valve replacement were recruited. Valvular tissue factor (TF), TF pathway inhibitor (TFPI), prothrombin, C-reactive protein (CRP) expression were evaluated by immunostaining and TF, prothrombin, and CRP transcripts were analyzed by real-time PCR. DM patients had elevated plasma CRP (9.2 [0.74-51.9] mg/l vs. 4.7 [0.59-23.14] mg/l, p?=?0.009) and TF (293.06 [192.32-386.12] pg/ml vs. 140 [104.17-177.76] pg/ml, p?=?0.003) compared to non-DM patients. In DM group, TF-, TFPI-, and prothrombin expression within valves was not related to demographics, body mass index, and concomitant diseases, whereas increased expression related to DM was found for CRP on both protein (2.87 [0.5-9]% vs. 0.94 [0-4]%, p?=?0.01) and transcript levels (1.3?±?0.61 vs. 0.22?±?0.43, p?=?0.009). CRP-positive areas were positively correlated with mRNA TF (r?=?0.84, p?=?0.036). Diabetes mellitus is associated with enhanced inflammation within AS valves, measured by CRP expression, which may contribute to faster AS progression. PMID:21935671

  9. EFFECT OF OXYGEN INHALATION ON MICROEMBOLIC SIGNALS IN PATIENTS WITH MECHANICAL AORTIC VALVE

    Microsoft Academic Search

    K. Ghandehari; Z. Izadimoud

    Microembolic signals (MES) are frequently observed in transcranial Doppler (TCD) recordings of patients with mechanical heart valve (MHV). If gaseous bubbles are the underlying cause, number of MES produced by MHV could be reduced with oxygen inhalation. From September 2003 to September 2004, a consecutive series of 14 patients with St Jude aortic valve visited in the cardiology clinic were

  10. Transthoracic access for transcatheter aortic valve replacement: technique using the Edwards Sapien Retroflex delivery system.

    PubMed

    George, Isaac; Kriegel, Jacob; Nazif, Tamim; Kalesan, Bindu; Paradis, Jean-Michel; Khalique, Omar; Hahn, Rebecca T; Leon, Martin B; Kodali, Susheel; Williams, Mathew R

    2014-07-01

    We describe our experience using the Edwards Sapien transfemoral Retroflex 3 catheter delivery system for transcatheter aortic valve replacement through the transapical and transaortic approaches. Transthoracic transcatheter valve replacement by the transapical and transaortic approaches can be safely and effectively performed with the Retroflex 3 delivery catheter, which affords several advantages over other available delivery devices. PMID:24996727

  11. Multi-detector CT angiography of the aortic valve—Part 1: anatomy, technique and systematic approach to interpretation

    PubMed Central

    Ganeshan, Arul

    2014-01-01

    The aortic valve and adjacent structures should be routinely evaluated on all thoracic cross-sectional imaging studies. Echocardiography and magnetic resonance imaging (MRI) are the main imaging techniques used for assessment of the aortic valve and related pathology but multi-detector computed tomography (MDCT) can offer valuable complimentary information in some clinical scenarios. Radiologists should be familiar with the indications, advantages and limitations of MDCT for assessment of the aortic valve. This article reviews aortic valve anatomy and relevant terminology, technical aspects of MDCT image optimisation and describes a suggested approach to interpretation. PMID:25202662

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

    PubMed Central

    2015-01-01

    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. PMID:25694974

  13. Textile heart valve: first in-vivo experiment in the aortic position.

    PubMed

    Heim, Frederic; Gasser, Bernard; Khoffi, Foued; Blondel, Philippe

    2014-05-01

    Non-invasive aortic valve implantation has become an alternative technique to surgical valve replacement in patients at high risk for open-chest surgery. With over 100,000 procedures already performed clinically, the technology is expected to involve less-critical patients in future. Whereas, biological valve tissue is a fragile material when folded for low-diameter catheter insertion purposes, textile polyester is a less-fragile material and may offer an alternative material to replace valve leaflets. One issue related to textile is the porosity of the material, which may induce exaggerated tissue ingrowth. Today, data relating to interactions between living tissues and fabrics used as valve materials are available only in the mitral position. Hence, the study aim was to observe the interaction pattern when the valve is implanted in the aortic position, and to assess the influence of sinus whirls on this pattern. PMID:25296455

  14. 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

    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

    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

  15. Erysipelothrix rhusiopathiae-induced aortic valve endocarditis: case report and literature review

    PubMed Central

    Hua, Ping; Liu, Jialiang; Tao, Jun; Liu, Jianyang; Yang, Yanqi; Yang, Songran

    2015-01-01

    Erysipelothrix rhusiopathiae is a pathogen of zoonosis often associated with occupational exposure. Although Erysipelothrix rhusiopathiae infection has high mortality, the heart valves in humans are rarely involved. The clinical data of a case of a 65-year-old male with Erysipelothrix rhusiopathiae-induced aortic valve endocarditis was summarized retrospectively and analyzed with a literature review. Based on a literature review and our experience, cases of E. rhusiopathiae-induced aortic valve endocarditis are extremely rare and surgical treatment for this condition is useful and recommended. PMID:25785050

  16. Assessment of Perfusion toward the Aortic Valve Using the New Dispersion Aortic Cannula during Coronary Artery Bypass Surgery

    PubMed Central

    Grooters, Ronald K.; Thieman, Kent C.; Schneider, Robert F.; Nelson, Mark G.

    2000-01-01

    When there is an echocardiographic diagnosis of severe mobile atherosclerotic plaque in the aortic arch or descending aorta, perfusion toward the aortic arch during cardiopulmonary bypass may create a high risk of embolic neurologic injury. Other perfusion methods, such as cannulation of the femoral or axillary arteries, are not always possible, due to atherosclerosis. The ascending aorta may be an alternative site for perfusion, since it is less frequently diseased. We assessed a new technique of perfusion toward the aortic valve using a new cannula designed for this purpose (Dispersion aortic cannula). Our study included 100 consecutive patients, 72 men and 28 women, with an average age of 68 ± 1.0 years (range, 39–89 years). There were no complications related to insertion of the cannula or perfusion. The ascending aorta could be cross-clamped and side-clamped without perfusion problems. Three deaths occurred; none was related to the cannulation technique. No intra-operative stroke occurred. Two patients suffered neurologic events, one on day 1 and the other on day 6; both had been fully alert after surgery. Perfusion toward the aortic valve appears to be safe and hemodynamically effective. This cannulation technique appears to be an acceptable alternative to present methods. Comparative studies will be needed to determine whether this alternative technique is effective in patients with severe aortic arch disease. PMID:11198309

  17. Design of a Cyclic Pressure Bioreactor for the Ex Vivo Study of Aortic Heart Valves

    PubMed Central

    Schipke, Kimberly J.; Filip To, S. D.; Warnock, James N.

    2011-01-01

    The aortic valve, located between the left ventricle and the aorta, allows for unidirectional blood flow, preventing backflow into the ventricle. Aortic valve leaflets are composed of interstitial cells suspended within an extracellular matrix (ECM) and are lined with an endothelial cell monolayer. The valve withstands a harsh, dynamic environment and is constantly exposed to shear, flexion, tension, and compression. Research has shown calcific lesions in diseased valves occur in areas of high mechanical stress as a result of endothelial disruption or interstitial matrix damage1-3. Hence, it is not surprising that epidemiological studies have shown high blood pressure to be a leading risk factor in the onset of aortic valve disease4. The only treatment option currently available for valve disease is surgical replacement of the diseased valve with a bioprosthetic or mechanical valve5. Improved understanding of valve biology in response to physical stresses would help elucidate the mechanisms of valve pathogenesis. In turn, this could help in the development of non-invasive therapies such as pharmaceutical intervention or prevention. Several bioreactors have been previously developed to study the mechanobiology of native or engineered heart valves6-9. Pulsatile bioreactors have also been developed to study a range of tissues including cartilage10, bone11 and bladder12. The aim of this work was to develop a cyclic pressure system that could be used to elucidate the biological response of aortic valve leaflets to increased pressure loads. The system consisted of an acrylic chamber in which to place samples and produce cyclic pressure, viton diaphragm solenoid valves to control the timing of the pressure cycle, and a computer to control electrical devices. The pressure was monitored using a pressure transducer, and the signal was conditioned using a load cell conditioner. A LabVIEW program regulated the pressure using an analog device to pump compressed air into the system at the appropriate rate. The system mimicked the dynamic transvalvular pressure levels associated with the aortic valve; a saw tooth wave produced a gradual increase in pressure, typical of the transvalvular pressure gradient that is present across the valve during diastole, followed by a sharp pressure drop depicting valve opening in systole. The LabVIEW program allowed users to control the magnitude and frequency of cyclic pressure. The system was able to subject tissue samples to physiological and pathological pressure conditions. This device can be used to increase our understanding of how heart valves respond to changes in the local mechanical environment. PMID:21876532

  18. Design of a cyclic pressure bioreactor for the ex vivo study of aortic heart valves.

    PubMed

    Schipke, Kimberly J; To, S D Filip; Warnock, James N

    2011-01-01

    The aortic valve, located between the left ventricle and the aorta, allows for unidirectional blood flow, preventing backflow into the ventricle. Aortic valve leaflets are composed of interstitial cells suspended within an extracellular matrix (ECM) and are lined with an endothelial cell monolayer. The valve withstands a harsh, dynamic environment and is constantly exposed to shear, flexion, tension, and compression. Research has shown calcific lesions in diseased valves occur in areas of high mechanical stress as a result of endothelial disruption or interstitial matrix damage(1-3). Hence, it is not surprising that epidemiological studies have shown high blood pressure to be a leading risk factor in the onset of aortic valve disease(4). The only treatment option currently available for valve disease is surgical replacement of the diseased valve with a bioprosthetic or mechanical valve(5). Improved understanding of valve biology in response to physical stresses would help elucidate the mechanisms of valve pathogenesis. In turn, this could help in the development of non-invasive therapies such as pharmaceutical intervention or prevention. Several bioreactors have been previously developed to study the mechanobiology of native or engineered heart valves(6-9). Pulsatile bioreactors have also been developed to study a range of tissues including cartilage(10), bone(11) and bladder(12). The aim of this work was to develop a cyclic pressure system that could be used to elucidate the biological response of aortic valve leaflets to increased pressure loads. The system consisted of an acrylic chamber in which to place samples and produce cyclic pressure, viton diaphragm solenoid valves to control the timing of the pressure cycle, and a computer to control electrical devices. The pressure was monitored using a pressure transducer, and the signal was conditioned using a load cell conditioner. A LabVIEW program regulated the pressure using an analog device to pump compressed air into the system at the appropriate rate. The system mimicked the dynamic transvalvular pressure levels associated with the aortic valve; a saw tooth wave produced a gradual increase in pressure, typical of the transvalvular pressure gradient that is present across the valve during diastole, followed by a sharp pressure drop depicting valve opening in systole. The LabVIEW program allowed users to control the magnitude and frequency of cyclic pressure. The system was able to subject tissue samples to physiological and pathological pressure conditions. This device can be used to increase our understanding of how heart valves respond to changes in the local mechanical environment. PMID:21876532

  19. First Human Case of Retrograde Transcatheter Implantation of an Aortic Valve Prosthesis

    PubMed Central

    Paniagua, David; Condado, José A.; Besso, José; Vélez, Manuel; Burger, Bruno; Bibbo, Salvatore; Cedeno, Douglas; Acquatella, Harry; Mejia, Carlos; Induni, Eduardo; Fish, R. David

    2005-01-01

    The transcatheter route is an emerging approach to treating valvular disease in high-risk patients. The 1st clinical antegrade transcatheter placement of an aortic valve prosthesis was reported in 2002. We describe the first retrograde transcatheter implantation of a new aortic valve prosthesis, in a 62-year-old man with inoperable calcific aortic stenosis and multiple severe comorbidities. Via the right femoral artery, a Cook introducer was advanced into the abdominal aorta. The aortic valve was crossed with a straight wire, and a pigtail catheter was advanced into the left ventricle to obtain pressure-gradient and anatomic measurements. An 18-mm valvuloplasty balloon was then used to predilate the aortic valve. Initial attempts to position the prosthetic valve caused a transient cardiac arrest. Implantation was achieved by superimposing the right coronary angiogram onto fluoroscopic landmarks in the same radiographic plane. A balloon-expandable frame was used to deliver the valve. After device implantation, the transvalvular gradient was <5 mmHg. The cardiac output increased from 1 to 5 L/min, and urine production increased to 200 mL/h. The patient was extubated on the 2nd postimplant day. Twelve hours later, he had to be reintubated because of respiratory distress and high pulmonary pressures. His condition deteriorated, and he died of biventricular failure and refractory hypotension on day 5. Despite the severe hypotension, valve function was satisfactory on echo-Doppler evaluation. In our patient, retrograde transcatheter implantation of a prosthetic aortic valve yielded excellent hemodynamic results and paved the way for further use of this technique in selected high-risk patients. PMID:16392228

  20. Factor XIII expression within aortic valves and its plasma activity in patients with aortic stenosis: association with severity of disease.

    PubMed

    Kapusta, Przemyslaw; Wypasek, Ewa; Natorska, Joanna; Grudzien, Grzegorz; Sobczyk, Dorota; Sadowski, Jerzy; Undas, Anetta

    2012-12-01

    Aortic valve stenosis (AS) shares several similarities with atherosclerosis. Factor XIII (FXIII) has been detected within atherosclerotic plaques and may contribute to the development of atherosclerosis via multiple mechanisms. In the current study, we sought to investigate FXIII expression within human stenotic aortic valves and its association with severity of the disease. We prospectively enrolled 91 consecutive patients with AS scheduled for isolated valve replacement. Valvular FXIII subunit A (FXIII-A), fibrin and macrophages expression was evaluated by immunostaining. FXIII-A subunit transcripts and FXIII-A Val34Leu polymorphism was determined by real-time PCR. Plasma FXIII (pFXIII) activity was measured. We demonstrated that the valvular FXIII-A was predominantly expressed on the aortic side of leaflets, colocalized with alternatively activated macrophages (AAM). Areas stained for FXIII-A showed positive correlations with valvular fibrin presence, degree of calcification, pFXIII activity and the severity of AS, reflected by mean and maximum transvalvular gradients (all, p<0.001). The FXIII-A mRNA in the stenotic leaflets was significantly elevated compared to control leaflets. Interestingly, pFXIII activity was also positively correlated with mean (p<0.001) and maximum (p=0.001) transvalvular gradient. The FXIII-A Val34Leu polymorphism did not affect FXIII-A and fibrin expression in AS valves. In conclusion, the study is the first to show abundant expression of FXIII-A at the mRNA and protein levels within human stenotic aortic valves, which is associated with the severity of AS. Our findings might suggest that FXIII in the stenotic valves is presented in AAM and may be involved in the AS progression. PMID:23052999

  1. Bridge to long-term mechanical circulatory support with a left ventricular assist device: novel use of transcatheter aortic valve replacement.

    PubMed

    Ganapathi, Asvin M; Hirji, Sameer A; Wang, Andrew; Patel, Chetan B; Gaca, Jeffrey G; Schroder, Jacob N

    2015-04-01

    We describe the use of transcatheter aortic valve replacement to allow for bridging to a left ventricular assist device in a patient with end-stage heart failure, secondary to nonischemic cardiomyopathy and severe bioprosthetic aortic valve regurgitation. PMID:25841859

  2. Relapsing tricuspid valve endocarditis by multidrug-resistant Pseudomonas aeruginosa in 11 years: tricuspid valve replacement with an aortic valve homograft.

    PubMed

    Kim, Min-Seok; Chang, Hyoung Woo; Lee, Seung-Pyo; Kang, Dong Ki; Kim, Eui-Chong; Kim, Ki-Bong

    2015-01-01

    Eleven years ago, a 27-year-old non-drug abuser woman was admitted to the hospital due to a burn injury. During the treatment, she was diagnosed with tricuspid valve infective endocarditis caused by multi-drug resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa). She underwent tricuspid valve replacement (TVR) using a bioprosthetic valve, followed by 6 weeks of meropenem antibiotic therapy. Ten years later, she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P. aeruginosa. She underwent redo-TVR with a bioprosthetic valve and was treated with colistin and ciprofloxacin. Ten months later, she was again diagnosed with prosthetic valve infective endocarditis with MDR P. aeruginosa as a pathogen. She underwent a second redo-TVR with a tissue valve and was treated with colistin. Two months later, her fever recurred and she was again diagnosed with prosthetic valve infective endocarditis caused by MDR P. aeruginosa. She eventually underwent a third redo-TVR using an aortic valve homograft and was discharged from the hospital after additional 6 weeks' of antibiotic therapy. All the strains of P. aeruginosa isolated from each event of infective endocarditis were analyzed by repetitive deoxyribonucleic acid sequence-based polymerase chain reaction (rep-PCR) deoxyribonucleic acid (DNA) strain typing to determine the correlation of isolates. All of the pathogens in 11 years were similar enough to be classified as the same strain, and this is the first case report of TVR using an aortic valve homograft to treat relapsing endocarditis. PMID:26051245

  3. SU-C-18C-02: Specifcation of X-Ray Projection Angles Which Are Aligned with the Aortic Valve Plane From a Planar Image of a Valvuloplasty Balloon Inflated Across the Aortic Valve

    SciTech Connect

    Fetterly, K; Mathew, V [Mayo Clinic, Rochester, MN (United States)

    2014-06-01

    Purpose: Transcatheter aortic valve replacement (TAVR) procedures provide a method to implant a prosthetic aortic valve via a minimallyinvasive, catheter-based procedure. TAVR procedures require use of interventional fluoroscopy c-arm projection angles which are aligned with the aortic valve plane to minimize prosthetic valve positioning error due to x-ray imaging parallax. The purpose of this work is to calculate the continuous range of interventional fluoroscopy c-arm projection angles which are aligned with the aortic valve plane from a single planar image of a valvuloplasty balloon inflated across the aortic valve. Methods: Computational methods to measure the 3D angular orientation of the aortic valve were developed. Required inputs include a planar x-ray image of a known valvuloplasty balloon inflated across the aortic valve and specifications of x-ray imaging geometry from the DICOM header of the image. A-priori knowledge of the species-specific typical range of aortic orientation is required to specify the sign of the angle of the long axis of the balloon with respect to the x-ray beam. The methods were validated ex-vivo and in a live pig. Results: Ex-vivo experiments demonstrated that the angular orientation of a stationary inflated valvuloplasty balloon can be measured with precision less than 1 degree. In-vivo pig experiments demonstrated that cardiac motion contributed to measurement variability, with precision less than 3 degrees. Error in specification of x-ray geometry directly influences measurement accuracy. Conclusion: This work demonstrates that the 3D angular orientation of the aortic valve can be calculated precisely from a planar image of a valvuloplasty balloon inflated across the aortic valve and known x-ray geometry. This method could be used to determine appropriate c-arm angular projections during TAVR procedures to minimize x-ray imaging parallax and thereby minimize prosthetic valve positioning errors.

  4. Aortic coarctation associated with aortic valve stenosis and mitral regurgitation in an adult patient: a two-stage approach using a large-diameter stent graft.

    PubMed

    Novosel, Luka; Perkov, Dražen; Dobrota, Savko; ?ori?, Vedran; Štern Padovan, Ranka

    2014-02-01

    We report a case of a staged surgical and endovascular management in a 62-year-old woman with aortic coarctation associated with aortic valve stenosis and mitral regurgitation. The patient was admitted for severe aortic valve stenosis and mitral valve incompetence. During hospitalization and preoperative imaging, a previously undiagnosed aortic coarctation was discovered. The patient underwent a 2-stage approach that combined a Bentall procedure and mitral valve replacement in the first stage, followed by correction of the aortic coarctation by percutaneous placement of an Advanta V12 large-diameter stent graft (Atrium, Mijdrecht, The Netherlands) which to our knowledge has not been used in an adult patient with this combination of additional cardiac comorbidities. A staged approach combining surgical treatment first and endovascular placement of an Advanta V12 stent graft in the second stage can be effective and safe in adult patients with coarctation of the aorta and additional cardiac comorbidities. PMID:24332897

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

    PubMed

    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

    2012-09-01

    The aortic valve exhibits complex three-dimensional (3D) anatomy and heterogeneity essential for the 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 12-22 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 tenfold 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 min, 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

  6. Differential activation of valvulogenic, chondrogenic, and osteogenic pathways in mouse models of myxomatous and calcific aortic valve disease.

    PubMed

    Cheek, Jonathan D; Wirrig, Elaine E; Alfieri, Christina M; James, Jeanne F; Yutzey, Katherine E

    2012-03-01

    Studies of human diseased aortic valves have demonstrated increased expression of genetic markers of valve progenitors and osteogenic differentiation associated with pathogenesis. Three potential mouse models of valve disease were examined for cellular pathology, morphology, and induction of valvulogenic, chondrogenic, and osteogenic markers. Osteogenesis imperfecta murine (Oim) mice, with a mutation in Col1a2, have distal leaflet thickening and increased proteoglycan composition characteristic of myxomatous valve disease. Periostin null mice also exhibit dysregulation of the ECM with thickening in the aortic midvalve region, but do not have an overall increase in valve leaflet surface area. Klotho null mice are a model for premature aging and exhibit calcific nodules in the aortic valve hinge-region, but do not exhibit leaflet thickening, ECM disorganization, or inflammation. Oim/oim mice have increased expression of valve progenitor markers Twist1, Col2a1, Mmp13, Sox9 and Hapln1, in addition to increased Col10a1 and Asporin expression, consistent with increased proteoglycan composition. Periostin null aortic valves exhibit relatively normal gene expression with slightly increased expression of Mmp13 and Hapln1. In contrast, Klotho null aortic valves have increased expression of Runx2, consistent with the calcified phenotype, in addition to increased expression of Sox9, Col10a1, and osteopontin. Together these studies demonstrate that oim/oim mice exhibit histological and molecular characteristics of myxomatous valve disease and Klotho null mice are a new model for calcific aortic valve disease. PMID:22248532

  7. Association between Aortic Valve Sclerosis and Risk Factors of Coronary Artery Disease in Patients with Suspected Coronary Artery Disease

    Microsoft Academic Search

    Young-Woo Park; Dong-Soo Kim; Yong-Suk Jeong; Seok-Ju Park; Han-Young Jin; Seong-Gill Park; Yang-Chun Han; Jeong-Sook Seo; Su-Kyong Cho; Tae-Hyun Yang; Seong-Man Kim; Dae-Kyeong Kim; Doo-Il Kim

    Background and Objectives:Aortic valve sclerosis (AVS) is often considered to be benign and it is also consi- dered to be a manifestation of generalized atherosclerosis that involves the aortic valve. However, it is associated with high cardiovascular morbidity and mortality in a population-based study. This study was performed to evaluate the significance of AVS in patients with suspected coronary artery

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

    Microsoft Academic Search

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

    2002-01-01

    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

  9. AbstractThe main objective of this work is to track the aortic valve plane in intra-operative fluoroscopic images in

    E-print Network

    Boyer, Edmond

    Abstract²The main objective of this work is to track the aortic valve plane in intra-operative fluoroscopic images in order to optimize and secure Transcatheter Aortic Valve Implantation (TAVI) procedure. This paper is focused on the issue of aortic valve calcifications tracking in fluoroscopic images. We propose

  10. Gender-Associated Differences in Left Ventricular Geometry in Patients With Aortic Valve Disease and Effect of Distinct Overload Subsets

    Microsoft Academic Search

    1997-01-01

    Gender-associated differences may play an important role in the way the left ventricle adapts to overload. The purpose of this study is to evaluate left ventricular (LV) geometry in patients referred for aortic valve replacement with distinct overload subsets. The echocardiograms of 128 patients with isolated aortic stenosis (n = 44), mixed aortic valvular disease (n = 51), and pure

  11. The Effect of Aortic Valve Replacement on Coronary Flow Reserve in Patients with a Normal Coronary Angiogram

    Microsoft Academic Search

    Attila Nemes; Tamás Forster; Zsolt Kovács; Attila Thury; Imre Ungi; Miklós Csanády

    2002-01-01

    Background: In patients with aortic stenosis and a normal coronary angiogram, a coronary flow reserve (CFR) is impaired. The aim of the present study was to examine the effect of aortic valve replacement (AVR) on the CFR after a long-term follow-up. Patients and Methods: 30 patients with aortic stenosis and a normal coronary angiogram were enrolled in the study. CFR

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

    PubMed

    Pan, Youlian; Qiao, Aike; Dong, Nianguo

    2015-06-01

    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

  13. Sutureless aortic valve replacement using a novel autologous tissue heart valve with stent (stent biovalve): proof of concept.

    PubMed

    Kishimoto, Satoru; Takewa, Yoshiaki; Nakayama, Yasuhide; Date, Kazuma; Sumikura, Hirohito; Moriwaki, Takeshi; Nishimura, Motonobu; Tatsumi, Eisuke

    2015-06-01

    We developed an autologous, trileaflet tissue valve ("biovalve") using in-body tissue architecture technology to overcome the disadvantages of current bioprosthetic valves. We designed a novel biovalve with a balloon-expandable stent: the stent biovalve (SBV). This study evaluated the technical feasibility of sutureless aortic valve replacement using the SBV in an orthotopic position, as well as the functionality of the SBV under systemic circulation, in an acute experimental goat model. Three adult goats (54.5-56.1 kg) underwent sutureless AVR under cardiopulmonary bypass (CPB). The technical feasibility and functionality of the SBVs were assessed using angiography, pressure catheterization, and two-dimensional echocardiography. The sutureless AVR was successful in all goats, and all animals could be weaned off CPB. The mean aortic cross-clamp time was 45 min. Angiogram, after weaning the animals off CPB, showed less than mild paravalvular leakage and central leakage was not detected in any of the goats. The mean peak-to-peak pressure gradient was 6.3 ± 5.0 mmHg. Epicardial two-dimensional echocardiograms showed smooth leaflet movement, including adequate closed positions with good coaptation; the open position demonstrated a large orifice area (average aortic valve area 2.4 ± 0.1 cm(2)). Sutureless AVR, using SBVs, was feasible in a goat model. The early valvular functionalities of the SBV were sufficient; future long-term experiments are needed to evaluate its durability and histological regeneration potential. PMID:25604149

  14. A roadmap to investigate the genetic basis of bicuspid aortic valve and its complications: insights from the International BAVCon (Bicuspid Aortic Valve Consortium).

    PubMed

    Prakash, Siddharth K; Bossé, Yohan; Muehlschlegel, Jochen D; Michelena, Hector I; Limongelli, Giuseppe; Della Corte, Alessandro; Pluchinotta, Francesca R; Russo, Maria Giovanna; Evangelista, Artur; Benson, D Woodrow; Body, Simon C; Milewicz, Dianna M

    2014-08-26

    Bicuspid aortic valve (BAV) is the most common adult congenital heart defect and is found in 0.5% to 2.0% of the general population. The term "BAV" refers to a heterogeneous group of disorders characterized by diverse aortic valve malformations with associated aortopathy, congenital heart defects, and genetic syndromes. Even after decades of investigation, the genetic determinants of BAV and its complications remain largely undefined. Just as BAV phenotypes are highly variable, the genetic etiologies of BAV are equally diverse and vary from complex inheritance in families to sporadic cases without any evidence of inheritance. In this paper, the authors discuss current concepts in BAV genetics and propose a roadmap for unraveling unanswered questions about BAV through the integrated analysis of genetic and clinical data. PMID:25145529

  15. Orthotopic Replacement of Aortic Heart Valves with Tissue-Engineered Grafts

    PubMed Central

    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

    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

  16. Aortic valve dynamics using a fluid structure interaction model - The physiology of opening and closing.

    PubMed

    Kalyana Sundaram, Govinda Balan; Balakrishnan, Komarakshi R; Kumar, Ramarathnam Krishna

    2015-07-16

    Comparative study among aortic valves requires the use of an unbiased and relevant boundary condition. Pressure and flow boundary conditions used in literature are not sufficient for an unbiased analysis. We need a different boundary condition to analyze the valves in an unbiased, relevant environment. The proposed boundary condition is a combination of the pressure and flow boundary condition methods, which is chosen considering the demerits of the pressure and flow boundary conditions. In order to study the valve in its natural environment and to give a comparative analysis between different boundary conditions, a fluid-structure interaction analysis is made using the pressure and the proposed boundary conditions for a normal aortic valve. Commercial software LS-DYNA is used in all our analysis. The proposed boundary condition ensures a full opening of the valve with reduced valve regurgitation. It is found that for a very marginal raise in the ventricular pressure caused by pumping a fixed stroke volume, the cardiac output is considerably raised. The mechanics of the valve is similar between these two boundary conditions, however we observe that the importance of the root to raise the cardiac output may be overstated, considering the importance of the fully open nodule of arantius. Our proposed boundary condition delivers all the insights offered by the pressure and flow boundary conditions, along with providing an unbiased framework for the analysis of different valves and hence, more suitable for comparative analysis. PMID:26058838

  17. Incidence and risk factors of hemolysis after transcatheter aortic valve implantation with a balloon-expandable valve.

    PubMed

    Laflamme, Jérôme; Puri, Rishi; Urena, Marina; Laflamme, Louis; DeLarochellière, Hugo; Abdul-Jawad Altisent, Omar; Del Trigo, Maria; Campelo-Parada, Francisco; DeLarochellière, Robert; Paradis, Jean-Michel; Dumont, Eric; Doyle, Daniel; Mohammadi, Siamak; Côté, Mélanie; Pibarot, Philippe; Laroche, Vinçent; Rodés-Cabau, Josep

    2015-06-01

    There are currently no data evaluating the hematologic and biocompatibility profile of transcatheter aortic valves in vivo. We evaluated the incidence, predictive factors, and clinical consequences associated with hemolysis post-transcatheter aortic valve implantation (TAVI). A total of 122 patients who underwent TAVI with a balloon-expandable valve were included. Baseline blood sampling and echocardiography, followed by early post-TAVI echocardiography and repeat blood sampling, at 6 to 12 months post-TAVI were performed. Hemolysis post-TAVI was defined according to the established criteria. The incidence of hemolysis post-TAVI was 14.8% yet no patient experienced severe hemolytic anemia requiring transfusion. Compared with the nonhemolysis group, those with hemolysis demonstrated significant reductions in hemoglobin (p = 0.012), were more frequently women (67% vs 34%, p = 0.016), and had a higher incidence of post-TAVI severe prosthesis-patient mismatch (PPM) (44% vs 17%, p = 0.026). The rate of mild or more prosthetic valve regurgitation did not significantly differ between those patients with and without hemolysis (56% vs 37%, p = 0.44). Wall shear rate (WSR) and energy loss index (ELI), both indirect measures of shear stress, were higher (p = 0.039) and lower (p = 0.004), respectively, in those patients with hemolysis. Increasing PPM severity was also associated with significant stepwise WSR increments and ELI decrements (p <0.01 for both). In conclusion, subclinical hemolysis occurred in 15% of patients following TAVI. Although prosthetic valve regurgitation had no impact on hemolysis, a novel association between PPM and hemolysis was found, likely driven by higher shear stress as determined by WSR and ELI. These hematologic and biomechanical findings may have long-term clinical implications and could affect future transcatheter aortic valve design. PMID:25862156

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

    PubMed Central

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

    2013-01-01

    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

  19. Aortic valve replacement and repair of left ventricular pseudoaneurysm in a Jehovah’s Witness

    PubMed Central

    Perrotti, Andrea; Vaislic, Claude; Chocron, Sidney

    2013-01-01

    The preoperative and surgical management of a giant left ventricular pseudoaneurysm(LVP) associated with aortic valve replacement in a 76 year old male Jehovah’s Witness patient is reported. The satisfactory recovery observed in this patient demonstrates the feasibility of this complex surgical procedure even in this particular patient population. PMID:25478494

  20. Electrospinning versus knitting: two scaffolds for tissue engineering of the aortic valve

    Microsoft Academic Search

    M. I. VAN LIESHOUT; C. M. VAZ; M. C. M. RUTTEN; G. W. M. PETERS; F. P. T. Baaijens

    2002-01-01

    Two types of scaffolds were developed for tissue engineering of the aortic valve; an electrospun valvular scaffold and a knitted valvular scaffold. These scaffolds were compared in a physiologic flow system and in a tissue-engineering process. In fibrin gel enclosed human myofibroblasts were seeded onto both types of scaffolds and cultured for 23 days under continuous medium perfusion. Tissue formation

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

    PubMed Central

    2013-01-01

    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

  2. Accidental pulmonary emboli noted by TEE during aortic valve replacement: a case report

    Microsoft Academic Search

    Chia-Ling Lee; Jimmy Ong; Bee-Song Chang; Tsung-Ying Chen; Hsien-Yong Lai

    2011-01-01

    Pulmonary embolism (PE) is difficult to diagnose clinically. In a patient who was scheduled for elective aortic valve replacement, several fresh emboli were recognized in the right atrium on transesophageal echocardiography (TEE). The PEs then disappeared on the echocardiographic image, with significant immediate hemodynamic changes noted by real-time monitors, such as tachycardia and increased pulmonary artery (PA) pressure. Pulmonary embolism

  3. Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome

    Microsoft Academic Search

    C E Handler; A Child; N D Light; D E Dorrance

    1985-01-01

    Mitral valve prolapse was sought clinically and with phonocardiography and M mode and sector echocardiography in 15 women aged 22-57 years with joint hypermobility syndrome. The type III:III + I collagen ratio was measured in skin biopsy specimens and was found to be raised in seven of 10 patients sampled. Thirteen patients had increased aortic wall compliance measured by the

  4. Regression of left ventricular hypertrophy after stentless versus conventional aortic valve replacement.

    PubMed

    Walther, T; Falk, V; Langebartels, G; Krüger, M; Schilling, L; Diegeler, A; Gummert, J; Autschbach, R; Mohr, F W

    1999-10-01

    The goal of this study was to analyze regression of left ventricular hypertrophy after randomization to conventional biological versus stentless aortic valve replacement. Stentless (Freestyle, Toronto, n = 106) or conventional biological aortic valves (Carpentier-Edwards, n = 74) were evaluated prospectively. Preoperatively there were no differences with regard to aortic valve pathology, left ventricular function, and pressure gradients between the two patient groups. The patient annulus index (13.55 vs. 13.46 mm; NS) measured intraoperatively was used as baseline for further comparison. Postoperatively, left ventricular mass index was 213+/-77 g/m2 (stentless) compared with 202+/-72 (conventional group) g/m2 (NS), whereas after 6 months it was 141+/-41 g/m2 in the stentless and 170+/-43 g/m2 in the conventional group (P<.05). Regression of left ventricular hypertrophy occurs in all patients after aortic valve replacement. Nevertheless, the use of stentless bioprostheses leads to a significant enhancement, which may result in a reduction of the cardiac risk profile for the patient. PMID:10660161

  5. Aortic valve replacement and repair of left ventricular pseudoaneurysm in a Jehovah's Witness.

    PubMed

    Perrotti, Andrea; Vaislic, Claude; Chocron, Sidney

    2013-02-01

    The preoperative and surgical management of a giant left ventricular pseudoaneurysm(LVP) associated with aortic valve replacement in a 76 year old male Jehovah's Witness patient is reported. The satisfactory recovery observed in this patient demonstrates the feasibility of this complex surgical procedure even in this particular patient population. PMID:25478494

  6. Acute improvement in arterial-ventricular coupling after transcatheter aortic valve implantation (CoreValve) in patients with symptomatic aortic stenosis.

    PubMed

    Di Bello, Vitantonio; Giannini, Cristina; De Carlo, Marco; Delle Donne, Maria Grazia; Nardi, Carmela; Palagi, Caterina; Cucco, Cuono; Dini, Frank Lloyd; Guarracino, Fabio; Marzilli, Mario; Petronio, Anna Sonia

    2012-01-01

    The recent development of transcatheter aortic valve implantation (TAVI) to treat severe aortic stenosis (AS) offers a viable option for high-risk patients categories. Our aim is to evaluate the early effects of implantation of CoreValve aortic valve prosthesis on arterial-ventricular coupling by two dimensional echocardiography. Sixty five patients with severe AS performed 2D conventional echocardiography before, immediately after TAVI, at discharge (mean age: 82.6 ± 5.9 years; female: 60%). The current third generation (18-F) CoreValve Revalving system (Medtronic, Minneapolis, MN) was used in all cases. Vascular access was obtained by percutaneous approach through the common femoral artery; the procedure was performed with the patient under local anesthesia. We calculated, apart the conventional parameters regarding left ventricular geometry and the Doppler parameters of aortic flow (valvular load), the vascular load and the global left ventricular hemodynamic load. After TAVI we showed, by echocardiography, an improvement of valvular load. In particular we observed an immediate reduction of transaortic peak pressure gradient (P < 0.0001), of mean pressure gradient (P < 0.0001) and a concomitant increase in aortic valve area (AVA) (0.97 ± 0.3 cm(2)). Left ventricular ejection fraction improved early after TAVI (before: 47 ± 11, after: 54 ± 11; P < .0001). Vascular load, expressed by systemic arterial compliance, showed a low but significant improvement after procedure (P < 0.01), while systemic vascular resistances showed a significant reduction after procedure (P < 0.001). As a global effect of the integrated changes of these hemodynamic parameters, we observed a significant improvement of global left ventricular hemodynamic load, in particular through a significant reduction of end-systolic meridional stress (before: 80 ± 34 and after: 55 ± 29, P < 0.0001). The arterial-valvular impedance showed a significant reduction (before: 7.6 ± 2 vs after: 5.8 ± 2; P < 0.0001. Furthermore we observed a significant reduction with a normalization of arterial-ventricular coupling (P < 0.005). With regard to left ventricular (LV) efficiency, we observed, after the procedure, a significant reduction of stroke work (P < 0.001) and potential energy (P < 0.001), with a significant increase of work efficiency early after the procedure (P < 0.001). Our results showed that the TAVI procedure was able to determine an early improvement of the global left ventricular hemodynamic load, allowing a better global LV performance. Further follow-up investigations are needed to evaluate these results in a more prolonged time observation. PMID:21222040

  7. 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

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

    2013-01-01

    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

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

    PubMed Central

    2011-01-01

    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

  9. Acute left main occlusion during transcatheter aortic valve implantation.

    PubMed

    Kleczy?ski, Pawe?; Witkowski, Adam; Tr?bacz, Jaros?aw; Sorysz, Danuta; Rzeszutko, Lukasz; Sobczy?ski, Robert; Dziewierz, Artur; Zmudka, Krzysztof; Sadowski, Jerzy; Dudek, Dariusz

    2013-01-01

    We present a case of a 92 year-old female with severe aortic stenosis who underwent TAVI. The procedure resulted with acute left main coronary artery occlusion requiring an immediate percutaneous coronary intervention. PMID:23797447

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

    PubMed

    Glauber, Mattia; Ferrarini, Matteo; Miceli, Antonio

    2015-01-01

    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. PMID:25694973

  11. Comparison of tricuspid and bicuspid aortic valve hemodynamics under steady flow conditions

    NASA Astrophysics Data System (ADS)

    Seaman, Clara; Ward, James; Sucosky, Philippe

    2011-11-01

    The bicuspid aortic valve (BAV), a congenital valvular defect consisting of two leaflets instead of three, is associated with a high prevalence of calcific aortic valve disease (CAVD). CAVD also develops in the normal tricuspid aortic valve (TAV) but its progression in the BAV is more severe and rapid. Although hemodynamic abnormalities are increasingly considered potential pathogenic contributor, the native BAV hemodynamics remain largely unknown. Therefore, this study aims at comparing experimentally the hemodynamic environments in TAV and BAV anatomies. Particle-image velocimetry was used to characterize the flow downstream of a native TAV and a model BAV mounted in a left-heart simulator and subjected to three steady flow rates characterizing different phases of the cardiac cycle. While the TAV developed a jet aligned along the valve axis, the BAV was shown to develop a skewed systolic jet with skewness decreasing with increasing flow rate. Measurement of the transvalvular pressure revealed a valvular resistance up to 50% larger in the BAV than in the TAV. The increase in velocity between the TAV and BAV leads to an increase in shear stress downstream of the valve. This study reveals strong hemodynamic abnormalities in the BAV, which may contribute to CAVD pathogenesis.

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

    PubMed

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

    2014-05-01

    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

  13. Single-Stage Repair of Thoracic Aortic Aneurysm through a Median Sternotomy in a Patient with Pseudocoarctation of the Aorta and Severe Aortic Valve Stenosis

    PubMed Central

    Morimoto, Hironobu; Mukai, Shogo

    2015-01-01

    Pseudocoarctation of the aorta is a rare anomaly and considered a benign condition. Pseudocoarctation of the aorta has been associated with aneurysm formation in the thoracic aorta, which may cause sudden rupture or dissection. Thus, the presence of an aneurysm in combination with pseudocoarctation of the aorta is thought to be an indication for surgery. We present a case of pseudocoarctation of the aorta associated with thoracic aortic aneurysm and severe aortic valve stenosis with a bicuspid aortic valve. In our case, single-stage repair was performed through a median sternotomy using our “pleural-window approach.” PMID:26131037

  14. Endocarditis with Left Ventricular Cutaneous Fistula after Aortic Root Replacement with a Valved Conduit

    PubMed Central

    Hollinger, Laura; Perryman, Lynda; Reardon, Michael J.

    2010-01-01

    Infection after aortic root replacement is uncommon, and it can be fatal. Herein, we present the case of a patient who underwent aortic root replacement with a valved conduit and coronary reimplantation. Prosthetic valve endocarditis and left ventricular cutaneous fistula ensued. Either condition alone could have been fatal. The fistula coursed from the valved conduit through the left ventricular outflow tract, behind the left main coronary artery, and to the skin at the upper sternum. Safe surgical entry into the chest was crucial, due to the free communication between the left ventricle, mediastinum, and skin. We discuss our surgical approach to this unusual combination of conditions, and the postoperative treatment of the patient. PMID:20401302

  15. Comparison of balloon-expandable versus self-expandable valves for transcatheter aortic valve implantation in patients with low-gradient severe aortic stenosis and preserved left ventricular ejection fraction.

    PubMed

    Covolo, Elisa; Saia, Francesco; Napodano, Massimo; Frigo, Anna Chiara; Agostoni, Pierfrancesco; Mojoli, Marco; Fraccaro, Chiara; Ciuca, Cristina; Presbitero, Patrizia; Moretti, Claudio; D'Ascenzo, Fabrizio; Tarantini, Giuseppe

    2015-03-15

    A relevant proportion of patients, classified as severe aortic stenosis on the basis of valve area ?1 cm(2), have a mean transvalvular gradient ?40 mm Hg, despite a preserved left ventricular ejection fraction (LGSAS). We assessed the clinical and hemodynamic impact of transcatheter aortic valve implantation in patients with symptomatic LGSAS at high risk for surgery or inoperable, according to the type of percutaneous valve implanted. Ninety-five patients received an Edwards SAPIEN valve (Edwards Lifesciences, Irvine, California) and 51 received a Medtronic CoreValve (Medtronic, Inc., Minneapolis, Minnesota). The hemodynamic performance of the 2 valves was similar in term of final transvalvular gradients (10 mm Hg, p = 0.069). Early mortality rate was 7% and was not different between the 2 valves (p = 0.73). During follow-up, cardiovascular mortality rate was similar between groups, and valve type was not a predictor of outcome (p = 0.72). Estimated survival by Kaplan-Meier at 2 years was 70%. At multivariate analysis, life-threatening or major bleeding, postprocedural aortic insufficiency, and acute kidney injury were the major predictors of an adverse outcome. In patients with LGSAS treated by transcatheter aortic valve implantation, the use of balloon-expandable versus self-expandable valves resulted in similar hemodynamic, early, and long-term clinical outcomes. PMID:25620039

  16. Survival after aortic valve replacement for severe aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction

    NASA Technical Reports Server (NTRS)

    Pereira, Jeremy J.; Lauer, Michael S.; Bashir, Mohammad; Afridi, Imran; Blackstone, Eugene H.; Stewart, William J.; McCarthy, Patrick M.; Thomas, James D.; Asher, Craig R.

    2002-01-01

    OBJECTIVE: We sought to assess whether aortic valve replacement (AVR) among patients with severe aortic stenosis (AS), severe left ventricular (LV) dysfunction and a low transvalvular gradient (TVG) is associated with improved survival. BACKGROUND: The optimal management of patients with severe AS with severe LV dysfunction and a low TVG remains controversial. METHODS: Between 1990 and 1998, we evaluated 68 patients who underwent AVR at our institution (AVR group) and 89 patients who did not undergo AVR (control group), with an aortic valve area < or = 0.75 cm(2), LV ejection fraction < or = 35% and mean gradient < or = 30 mm Hg. Using propensity analysis, survival was compared between a cohort of 39 patients in the AVR group and 56 patients in the control group. RESULTS: Despite well-matched baseline characteristics among propensity-matched patients, the one- and four-year survival rates were markedly improved in patients in the AVR group (82% and 78%), as compared with patients in the control group (41% and 15%; p < 0.0001). By multivariable analysis, the main predictor of improved survival was AVR (adjusted risk ratio 0.19, 95% confidence interval 0.09 to 0.39; p < 0.0001). The only other predictors of mortality were age and the serum creatinine level. CONCLUSIONS: Among select patients with severe AS, severe LV dysfunction and a low TVG, AVR was associated with significantly improved survival.

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

    PubMed Central

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

    2014-01-01

    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. PMID:25544931

  18. Minimally invasive valve sparing aortic root replacement (David procedure) is safe

    PubMed Central

    Krueger, Heike; Umminger, Julia; Koigeldiyev, Nurbol; Beckmann, Erik; Haverich, Axel; Martens, Andreas

    2015-01-01

    Objective Even though minimally invasive cardiac surgery may reduce morbidity, this approach is not routinely performed for aortic root replacements. The purpose of this pilot study was to assess the safety and feasibility of valve sparing aortic root replacement via an upper mini-sternotomy up to the 3rd intercostal space. Methods Between April 2011 and March 2014, 26 patients (22 males, age 47.6±13 years) underwent elective minimally invasive aortic valve sparing root replacement (David procedure, group A). Twelve patients underwent additional leaflet repair. Concomitant procedures were: four proximal aortic arch replacements and one coronary artery bypass grafting (CABG) to the proximal right coronary artery (RCA). During the same time period, 14 patients (ten males, age 64.2±9.5 years) underwent elective David procedure via median full sternotomy (group B). Concomitant procedures included six proximal aortic arch replacements. Although the patient cohorts were small, the results of these two groups were compared. Results In group A, there were no intra-operative conversions to full sternotomy. The aortic cross-clamp and cardiopulmonary bypass (CPB) times were 115.6±30.3 and 175.8±41.9 min, respectively. One patient was re-opened (via same access) due to post-operative bleeding. The post-operative ventilation time and hospital stay were 0.5±0.3 and 10.4±6.8 days, respectively. There was no 30-day mortality. The patient questionnaire showed that the convalescence time was approximately two weeks. In group B: the cross-clamp and CPB times were 114.1±19.9 and 163.0±24.5 min, respectively. One patient was re-opened (7.1%) due to post-operative bleeding. The post-operative ventilation time and hospital stay were 0.6±0.7 and 14.2±16.7 days, respectively. There was no 30-day mortality. Conclusions Minimally invasive valve sparing aortic root replacement can be safely performed in selected patients. The results are comparable to those operated via a full sternotomy. The key to success is a ‘step by step’ technique of moving from minimally invasive aortic valve replacements (AVR) to more demanding aortic root replacements. Meticulous hemostasis & attention to surgical details is of utmost importance to prevent perioperative complications. PMID:25870810

  19. Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: Clinical relevance to the ross procedure

    Microsoft Academic Search

    Mauro de Sa; Yaron Moshkovitz; Jagdish Butany; Tirone E. David

    1999-01-01

    Objective: Bicuspid aortic valve disease is often associated with dilation of the aortic root and ascending aorta. This study examines the histologic features of the ascending aorta and main pulmonary artery of patients with and without aortic valve disease. Methods: Samples from ascending aorta and main pulmonary artery were obtained at the time of the operation from 20 patients with

  20. Percutaneous Transcatheter One-Step Mechanical Aortic Disc Valve Prosthesis Implantation: A Preliminary Feasibility Study in Swine

    SciTech Connect

    Sochman, Jan [Institute for Clinical and Experimental Medicine, Intensive Care Unit, Clinic of Cardiology (Czech Republic)], E-mail: jan.sochman@medicon.cz; Peregrin, Jan H.; Rocek, Miloslav [Institute for Clinical and Experimental Medicine, Department of Diagnostic and Interventional Radiology (Czech Republic); Timmermans, Hans A.; Pavcnik, Dusan; Roesch, Josef [Oregon Health and Sciences University, Dotter Interventional Institute (United States)

    2006-02-15

    Purpose. To evaluate the feasibility of one-step implantation of a new type of stent-based mechanical aortic disc valve prosthesis (MADVP) above and across the native aortic valve and its short-term function in swine with both functional and dysfunctional native valves. Methods. The MADVP consisted of a folding disc valve made of silicone elastomer attached to either a nitinol Z-stent (Z model) or a nitinol cross-braided stent (SX model). Implantation of 10 MADVPs (6 Z and 4 SX models) was attempted in 10 swine: 4 (2 Z and 2 SX models) with a functional native valve and 6 (4 Z and 2 SX models) with aortic regurgitation induced either by intentional valve injury or by MADVP placement across the native valve. MADVP function was observed for up to 3 hr after implantation. Results. MADVP implantation was successful in 9 swine. One animal died of induced massive regurgitation prior to implantation. Four MADVPs implanted above functioning native valves exhibited good function. In 5 swine with regurgitation, MADVP implantation corrected the induced native valve dysfunction and the device's continuous good function was observed in 4 animals. One MADVP (SX model) placed across native valve gradually migrated into the left ventricle. Conclusion. The tested MADVP can be implanted above and across the native valve in a one-step procedure and can replace the function of the regurgitating native valve. Further technical development and testing are warranted, preferably with a manufactured MADVP.

  1. Comparing Aortic Valve Replacement through Right Anterolateral Thoracotomy with Median Sternotomy

    PubMed Central

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

    2013-01-01

    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

  2. Application of Gene Network Analysis Techniques Identifies AXIN1/PDIA2 and Endoglin Haplotypes Associated with Bicuspid Aortic Valve

    E-print Network

    Housman, David E.

    Bicuspid Aortic Valve (BAV) is a highly heritable congenital heart defect. The low frequency of BAV (1% of general population) limits our ability to perform genome-wide association studies. We present the application of ...

  3. A New Cone-Shaped Aortic Valve Prosthesis for Orthotopic Position: An Experimental Study in Swine

    SciTech Connect

    Sochman, Jan, E-mail: jan.sochman@medicon.c [Institute for Clinical and Experimental Medicine, Clinic of Cardiology (Czech Republic); Peregrin, Jan H.; Pulda, Zdenek [Institute for Clinical and Experimental Medicine, Department of Diagnostic and Interventional Radiology (Czech Republic); Pavcnik, Dusan; Uchida, Barry T.; Timmermans, Hans A.; Roesch, Josef [Oregon Health and Science University, Dotter Interventional Institute (United States)

    2010-04-15

    The aim of this experimental study was to evaluate a newly designed cone-shaped aortic valve prosthesis (CAVP) for one-step transcatheter placement in an orthotopic position. The study was conducted in 15 swine using either the transcarotid (11 animals) or the transfemoral (4 animals) artery approach. A 12- or 13-Fr sheath was inserted via arterial cutdown. The CAVP was deployed under fluoroscopic control and its struts, by design, induced significant native valve insufficiency. CAVP function was evaluated by aortography and aortic pressure curve tracing. In 11 of 15 swine the CAVP was properly deployed and functioned well throughout the scheduled period of 2-3 h. In three swine the CAVPs were placed lower than intended, however, they were functional even in the left ventricular outflow tract position. One swine expired due to inadvertent low CAVP placement that caused both aortic regurgitation and immobilization of the anterior mitral valve leaflet by the valve struts. We conclude that this design of CAVP is relatively easy to deploy, works well throughout a short time period (2-3 h), and, moreover, seems to be reliable even in a lower-than-orthotopic position (e.g., infra-annulary space). Longer-term studies are needed for its further evaluation.

  4. Ochronotic Involvement of the Aortic and Mitral Valves in a 72-Year-Old Man

    PubMed Central

    Gocen, Ugur; Basturk, Yuksel; Kozanoglu, Erkan; Yaliniz, Hafize

    2015-01-01

    Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis. PMID:25873809

  5. Ochronotic involvement of the aortic and mitral valves in a 72-year-old man.

    PubMed

    Atalay, Atakan; Gocen, Ugur; Basturk, Yuksel; Kozanoglu, Erkan; Yaliniz, Hafize

    2015-02-01

    Ochronosis, an autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in adverse pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular abnormalities are less frequently reported than are other manifestations. In rare cases, ochronosis can cause valvular heart disease. We report the case of a 72-year-old man with aortic stenosis and mitral insufficiency who was diagnosed with ochronosis while undergoing surgical aortic and mitral valve replacement. We discuss the history and surgical management of alkaptonuric ochronosis. PMID:25873809

  6. Aortic Valve Cyclic Stretch Causes Increased Remodeling Activity and Enhanced Serotonin Receptor Responsiveness

    PubMed Central

    Balachandran, Kartik; Bakay, Marina A.; Connolly, Jeanne M.; Zhang, Xuemei; Yoganathan, Ajit P.; Levy, Robert J.

    2011-01-01

    Background Increased serotonin(5HT) receptor(5HTR) signaling has been associated with cardiac valvulopathy. Prior cell culture studies of 5HTR signaling in heart valve interstitial cells have provided mechanistic insights concerning only static conditions. We investigated the hypothesis that aortic valve biomechanics participate in the regulation of both 5HTR expression and inter-related extracellular matrix remodeling events. Methods The effects of cyclic-stretch on aortic valve 5HTR, expression, signaling and extracellular matrix remodeling were investigated using a tensile stretch bioreactor in studies which also compared the effects of adding 5HT and/or the 5HT-transporter inhibitor, Fluoxetine. Results Cyclic-stretch alone increased both proliferation and collagen in porcine aortic valve cusp samples. However, with cyclic-stretch, unlike static conditions, 5HT plus Fluoxetine caused the greatest increase in proliferation (p<0.0001), and also caused significant increases in collagen(p<0.0001) and glycosaminoglycans (p<0.0001). DNA microarray data demonstrated upregulation of 5HTR2A and 5HTR2B (>4.5 fold) for cyclic-stretch versus static (p<0.001), while expression of the 5HT transporter was not changed significantly. Extracellular matrix genes (eg. Collagen Types I,II,III, and proteoglycans) were also upregulated by cyclic-stretch. Conclusions Porcine aortic valve cusp samples subjected to cyclic stretch upregulate 5HTR2A and 2B, and also initiate remodeling activity characterized by increased proliferation and collagen production. Importantly, enhanced 5HTR responsiveness, due to increased 5HTR2A and 2B expression, results in a significantly greater response in remodeling endpoints (proliferation, collagen and GAG production) to 5HT in the presence of 5HT transporter blockade. PMID:21718840

  7. The impact of age and severity of comorbid illness on outcomes after isolated aortic valve replacement for aortic stenosis

    PubMed Central

    Russo, Mark J; Iribarne, Alexander; Chen, Emily; Karanam, Ashwin; Pettit, Chris; Barili, Fabio; Shah, Atman P; Saunders, Craig R

    2015-01-01

    Objectives This study examines outcomes in a national sample of patients undergoing isolated aortic valve replacement (AVR) for aortic stenosis, with particular focus on advanced-age patients and those with extreme severity of comorbid illness (SOI). Methods Data were obtained from the Nationwide Inpatient Sample and included all patients undergoing AVRs performed from January 1, 2006 to December 31, 2008. Patients with major concomitant cardiac procedures, as well as those aged, 20 years, and those with infective endocarditis or aortic insufficiency without aortic stenosis, were excluded from analysis. The analysis included 13,497 patients. Patients were stratified by age and further stratified by All Patient Refined Diagnosis Related Group SOI into mild/moderate, major, and extreme subgroups. Results Overall in-hospital mortality was 2.96% (n=399); in-hospital mortality for the ?80-year-old group (n=139, 4.78%) was significantly higher than the 20- to 49-year-old (n=9, 0.84%, P<0.001) or 50- to 79-year-old (n=251, 2.64%, P<0.001) groups. In-hospital mortality was significantly higher in the extreme SOI group (n=296, 15.33%) than in the minor/moderate (n=22, 0.35%, P<0.001) and major SOI groups (n=81, 1.51%, P<0.001). Median in-hospital costs in the mild/moderate, major, and extreme SOI strata were $29,202.08, $36,035.13, and $57,572.92, respectively. Conclusion In the minor, moderate, and major SOI groups, in-hospital mortality and costs are low regardless of age; these groups represent >85% of patients undergoing isolated AVR for aortic stenosis. Conversely, in patients classified as having extreme SOI, surgical therapy is associated with exceedingly high inpatient mortality, low home discharge rates, and high resource utilization, particularly in the advanced age group. PMID:26056500

  8. Mitral valve prolapse, aortic compliance, and skin collagen in joint hypermobility syndrome.

    PubMed Central

    Handler, C E; Child, A; Light, N D; Dorrance, D E

    1985-01-01

    Mitral valve prolapse was sought clinically and with phonocardiography and M mode and sector echocardiography in 15 women aged 22-57 years with joint hypermobility syndrome. The type III:III + I collagen ratio was measured in skin biopsy specimens and was found to be raised in seven of 10 patients sampled. Thirteen patients had increased aortic wall compliance measured by the continuous wave Doppler ultrasound technique. Ten (67%) patients had mitral valve prolapse shown by auscultatory signs or echocardiography or both--a prevalence at least three times greater than that in the general adult population. It is concluded that if the abnormality of collagen biosynthesis found in skin biopsy samples in these patients is also present in their mitral valve tissue this may predispose them to prolapse of the valve. Images PMID:3902069

  9. Balloon aortic valvuloplasty (BAV) as a bridge to aortic valve replacement in cancer patients who require urgent non-cardiac surgery

    PubMed Central

    Kogoj, Polonca; Devjak, Rok; Bunc, Matjaz

    2014-01-01

    Background Balloon aortic valvuloplasty (BAV) is a percutaneous treatment option for severe, symptomatic aortic stenosis. Due to early restenosis and failure to improve long term survival, BAV is considered a palliative measure in patients who are not suitable for open heart surgery due to increased perioperative risk. BAV can be used also as a bridge to surgical or transcatheter aortic valve implantation (TAVI) in haemodinamically unstable patients or in patients who require urgent major non-cardiac surgery. Patients and methods. We reported on 6 oncologic patients with severe aortic stenosis that required a major abdominal and gynaecological surgery. In 5 cases we performed BAV procedure alone; in one patient with concomitant coronary artery disease we combined BAV and percutaneous coronary intervention (PCI). Results With angioplasty and BAV we achieved a good coronary artery flow and an increase in aortic valve area without any periprocedural complications. After the successful procedure, we observed a hemodynamic and symptomatic improvement. As a consequence the operative risk for non-cardiac surgery decreased and the surgical treatment of cancer was done without complications in all the 6 cases. Conclusions BAV can be utilized as a part of a complex therapy in severe aortic stenosis aimed to improve the quality of life, decrease the surgical risk for major non-cardiac surgery or as a bridge to surgical or transcatheter aortic valve implantation. PMID:24587781

  10. Cellular Changes during Renal Failure-Induced Inflammatory Aortic Valve Disease

    PubMed Central

    Mustafa, Mahmoud; Duvdevan, Nitsan; Meir, Karen; Beeri, Ronen; Lotan, Chaim

    2015-01-01

    Background Aortic valve calcification (AVC) secondary to renal failure (RF) is an inflammation-regulated process, but its pathogenesis remains unknown. We sought to assess the cellular processes that are involved in the early phases of aortic valve disease using a unique animal model of RF-associated AVC. Methods Aortic valves were obtained from rats that were fed a uremia-inducing diet exclusively for 2, 3, 4, 5, and 6 weeks as well as from controls. Pathological examination of the valves included histological characterization, von Kossa staining, and antigen expression analyses. Results After 2 weeks, we noted a significant increase in urea and creatinine levels, reflecting RF. RF parameters exacerbated until the Week 5 and plateaued. Whereas no histological changes or calcification was observed in the valves of any study group, macrophage accumulation became apparent as early as 2 weeks after the diet was started and rose after 3 weeks. By western blot, osteoblast markers were expressed after 2 weeks on the diet and decreased after 6 weeks. Collagen 3 was up-regulated after 3 weeks, plateauing at 4 weeks, whereas collagen 1 levels peaked at 2 and 4 weeks. Fibronectin levels increased gradually until Week 5 and decreased at 6 weeks. We observed early activation of the ERK pathway, whereas other pathways remained unchanged. Conclusions We concluded that RF induces dramatic changes at the cellular level, including macrophage accumulation, activation of cell signaling pathway and extracellular matrix modification. These changes precede valve calcification and may increase propensity for calcification, and have to be investigated further. PMID:26070132

  11. Increased dietary intake of vitamin A promotes aortic valve calcification in vivo

    PubMed Central

    Huk, Danielle J.; Hammond, Harriet L.; Kegechika, Hiroyuki; Lincoln, Joy

    2013-01-01

    Objective Calcific aortic valve disease (CAVD) is a major public health problem with no effective treatment available other than surgery. We previously showed that mature heart valves calcify in response to retinoic acid (RA) treatment through downregulation of the SRY-transcription factor Sox9. In this study, we investigated the effects of excess vitamin A and its metabolite RA on heart valve structure and function in vivo, and examined the molecular mechanisms of RA signaling during the calcification process in vitro. Methods and Results Using a combination of approaches, we defined CAVD pathogenesis in mice fed 200 IU/g and 20 IU/g of retinyl palmitate for 12 months at molecular, cellular and functional levels. We show that mice fed excess vitamin A develop aortic valve stenosis and leaflet calcification associated with increased expression of osteogenic genes and decreased expression of cartilaginous markers. Using a pharmacological approach, we show that RA-mediated Sox9 repression and calcification is regulated by classical RA signaling and requires both RAR and RXR receptors. Conclusions Our studies demonstrate that excess vitamin A dietary intake promotes heart valve calcification in vivo. Therefore suggesting that hypervitaminosis A could serve as a new risk factor of CAVD in the human population. PMID:23202364

  12. A Roadmap to Investigate the Genetic Basis of Bicuspid Aortic Valve and its Complications

    PubMed Central

    Prakash, Siddharth K.; Bossé, Yohan; Muehlschlegel, Jochen D.; Michelena, Hector I.; Limongelli, Giuseppe; Della Corte, Alessandro; Pluchinotta, Francesca R.; Russo, Maria Giovanna; Evangelista, Artur; Benson, D. Woodrow; Body, Simon C.; Milewicz, Dianna M.

    2015-01-01

    Bicuspid aortic valve (BAV) is the most common adult congenital heart defect and is found in 0.5% to 2.0% of the general population. The term “BAV” refers to a heterogeneous group of disorders characterized by diverse aortic valve malformations with associated aortopathy, congenital heart defects, and genetic syndromes. Even after decades of investigation, the genetic determinants of BAV and its complications remain largely undefined. Just as BAV phenotypes are highly variable, the genetic etiologies of BAV are equally diverse and vary from complex inheritance in families to sporadic cases without any evidence of inheritance. In this paper, the authors discuss current concepts in BAV genetics and propose a roadmap for unraveling unanswered questions about BAV through the integrated analysis of genetic and clinical data. PMID:25145529

  13. Cardiac Hemodynamics in the Pathogenesis of Congenital Heart Disease and Aortic Valve Calcification

    NASA Astrophysics Data System (ADS)

    Nigam, Vishal

    2011-11-01

    An improved understanding of the roles of hemodynamic forces play in cardiac development and the pathogenesis of cardiac disease will have significant scientific and clinical impact. I will focus on the role of fluid dynamics in congenital heart disease and aortic valve calcification. Congenital heart defects are the most common form of birth defect. Aortic valve calcification/stenosis is the third leading cause of adult heart disease and the most common form of acquired valvular disease in developed countries. Given the high incidence of these diseases and their associated morbidity and mortality, the potential translational impact of an improved understanding of cardiac hemodynamic forces is very large. Division of Pediatric Cardiology, Rady Children's Hospital, San Diego

  14. Localization and tracking of aortic valve prosthesis in 2D fluoroscopic image sequences

    NASA Astrophysics Data System (ADS)

    Karar, M.; Chalopin, C.; Merk, D. R.; Jacobs, S.; Walther, T.; Burgert, O.; Falk, V.

    2009-02-01

    This paper presents a new method for localization and tracking of the aortic valve prosthesis (AVP) in 2D fluoroscopic image sequences to assist the surgeon to reach the safe zone of implantation during transapical aortic valve implantation. The proposed method includes four main steps: First, the fluoroscopic images are preprocessed using a morphological reconstruction and an adaptive Wiener filter to enhance the AVP edges. Second, a target window, defined by a user on the first image of the sequences which includes the AVP, is tracked in all images using a template matching algorithm. In a third step the corners of the AVP are extracted based on the AVP dimensions and orientation in the target window. Finally, the AVP model is generated in the fluoroscopic image sequences. Although the proposed method is not yet validated intraoperatively, it has been applied to different fluoroscopic image sequences with promising results.

  15. Thermal analysis characterization of aortic tissues for cardiac valve bioprostheses.

    PubMed

    Samouillan, V; Dandurand-Lods, J; Lamure, A; Maurel, E; Lacabanne, C; Gerosa, G; Venturini, A; Casarotto, D; Gherardini, L; Spina, M

    1999-09-15

    Two multistep extractions were achieved on porcine aortic tissues to obtain acellular matrices used for cardiac bioprostheses. The evaluation of structural modifications and the possible damage of extracellular matrix fibrous proteins were investigated by means of thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). Protein-water interactions and degradation temperatures were determined by TGA. DSC was used to characterize protein thermal transitions (glass transition and denaturation), which provided information on the dynamic structure of the aortic tissue components. Sodium dodecyl sulfate (SDS) extraction had a destructuring effect, while Triton and cholate treatments did not affect the structural integrity of either elastin and collagen. A DSC comparison showed that SDS destabilizes the collagen triple helical domain and swells the elastin network. PMID:10398014

  16. Left Ventricular Diastolic Function in Children and Young Adults with Congenital Aortic Valve Disease

    PubMed Central

    Friedman, Kevin G.; McElhinney, Doff B.; Rhodes, Jonathan; Powell, Andrew J.; Colan, Steven D.; Lock, James E.; Brown, David W.

    2012-01-01

    Young patients with congenital aortic valve disease are at risk for left ventricular (LV) diastolic dysfunction (DD). We evaluated LV remodeling and prevalence of and risk factors for DD in patients with aortic stenosis (AS), pure aortic regurgitation (AR), and AS+AR. Patients age 8–39 years with congenital AS (n=103), AR (n=36), or AS+AR (n=107) were identified. Cross-sectional assessment of LV remodeling pattern and diastolic function was performed. A diastolic function score (DFS) (0–4) was assigned to each patient with 1 point for an abnormal value in each of 4 categories: mitral inflow (E:A and E-wave deceleration time), tissue Doppler E?, E/E?, and left atrial volume. Patients with DFS ?2 were compared to those with a score <2. Concentric hypertrophy was the most common remodeling pattern in AS (51%), while mixed/physiologic hypertrophy in AS+AR (48%) and eccentric hypertrophy in AR (49%) predominated. In the entire cohort, 91 patients (37%) had DFS ? 2. Patients with AS or AS+AR had higher DFS than pure AR patients (p<0.001). In multivariable analysis, higher LV mass z-score and prior aortic valve balloon dilation were associated with DFS ?2. In patients with catheterization data (n=65), E/E? correlated with LV end-diastolic pressure. Those with DFS ?2 had higher LV end-diastolic pressure and mean pulmonary artery pressure than those with DFS <2. In conclusion, DD is common in young patients with AS and AS+AR, but not in pure AR patients. Higher LV mass and prior aortic valve dilation were associated with DD. PMID:23102884

  17. MECHANISMS OF THE IN VIVO INHIBITION OF CALCIFICATION OF BIOPROSTHETIC PORCINE AORTIC VALVE CUSPS AND AORTIC WALL WITH TRIGLYCIDYLAMINE/MERCAPTO BISPHOSPHONATE

    PubMed Central

    Rapoport, H. Scott; Connolly, Jeanne M.; Fulmer, James; Dai, Ning; Murti, Brandon H.; Gorman, Robert C.; Gorman, Joseph H.; Alferiev, Ivan; Levy, Robert J.

    2007-01-01

    Heart valve replacements fabricated from glutaraldehyde (Glut)-crosslinked heterograft materials, porcine aortic valves or bovine pericardium, have been widely used in cardiac surgery to treat heart valve disease. However, these bioprosthetic heart valves often fail in long-term clinical implants due to pathologic calcification of the bioprosthetic leaflets, and for stentless porcine aortic valve bioprostheses, bioprosthetic aortic wall calcification also typically occurs. Previous use of the epoxide-based crosslinker, Triglycidyl amine (TGA), on cardiac bioprosthetic valve materials demonstrated superior biocompatibility, mechanics, and calcification resistance for porcine aortic valve cusps (but not porcine aortic wall) and bovine pericardium, versus Glut-prepared controls. However, TGA preparation did not completely prevent long-term calcification of cusps or pericardium. Herein we report further mechanistic investigations of an added therapeutic component to this system, 2-Mercaptoethylidene-1,1-bisphosphonic acid (MABP), a custom synthesized thiol bisphosphonate, which has previously been shown in a preliminary report to prevent bioprosthetic heterograft biomaterial calcification when used in combination with initial TGA crosslinking for 7 days. In the present studies we have further investigated the effectiveness of MABP in experiments that examined: 1) The use of MABP after optimal TGA crosslinking, in order to avoid any competitive interference of MABP-reactions with TGA during crosslinking; 2) Furthermore, recognizing the importance of alkaline phosphatase in the formation of dystrophic calcific nodules, we have investigated the hypothesis that the mechanism by which MABP primarily functions is through the reduction of alkaline phosphatase activity. Results from cell-free model systems, cell culture studies, and rat subcutaneous implants, show that materials functionalized with MABP after TGA crosslinking have reduced alkaline phosphatase activity, and in vivo have no significant calcification in long term implant studies. It is concluded that bioprosthetic heart valves prepared in this fashion are compelling alternatives for Glut-prepared bioprostheses. PMID:17027944

  18. Progressive aortic valve calcification: three-dimensional visualization and biomechanical analysis.

    PubMed

    Halevi, Rotem; Hamdan, Ashraf; Marom, Gil; Mega, Mor; Raanani, Ehud; Haj-Ali, Rami

    2015-02-01

    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

  19. Left ventricular support adjustment to aortic valve opening with analysis of exercise capacity

    PubMed Central

    2014-01-01

    Background LVAD speed adjustment according to a functioning aortic valve has hypothetic advantages but could lead to submaximal support. The consequences of an open aortic valve policy on exercise capacity and hemodynamics have not yet been investigated systematically. Methods Ambulatory patients under LVAD support (INCOR®, Berlin Heart, mean support time 465?±?257 days, average flow 4.0?±?0.3 L/min) adjusted to maintain a near normal aortic valve function underwent maximal cardiopulmonary exercise testing (CPET) and right heart catheterization (RHC) at rest and during constant work rate exercise (20 Watt). Results Although patients (n?=?8, mean age 45?±?13 years) were in NYHA class 2, maximum work-load and peak oxygen uptake on CPET were markedly reduced with 69?±?13 Watts (35% predicted) and 12?±?2 mL/min/kg (38% predicted), respectively. All patients showed a typical cardiac limitation pattern and severe ventilatory inefficiency with a slope of ventilation to carbon dioxide output of 42?±?12. On RHC, patients showed an exercise-induced increase of mean pulmonary artery pressure (from 16?±?2.4 to 27?±?2.8 mmHg, p?aortic valve strategy leads to impaired exercise capacity and hemodynamics, which is not reflected by NYHA-class. Unknown compensatory mechanisms can be suspected. Further studies comparing higher vs. lower support are needed for optimization of LVAD adjustment strategies. PMID:24884921

  20. Antithrombotic therapy before, during and after transcatheter aortic valve replacement (TAVR).

    PubMed

    Sharma, Abhishek; Goel, Sunny; Lavie, Carl J; Arbab-Zadeh, Armin; Mukherjee, Debabrata; Lazar, Jason

    2015-05-01

    Transcatheter aortic valve replacement (TAVR) has been emerged as a promising alternative for the management of patients with severe AS who otherwise are deemed inappropriate candidates for surgery. Post procedural thromboembolic events and risk of bleeding continue to be a significant challenge in managing patients who underwent TAVR. This article systematically reviews the evidence, current guidelines and upcoming studies investigating antithrombotic therapy before, during and after TAVR. PMID:25103613

  1. Posterior thoracic echocardiography for assessment of native and prosthetic aortic valves in the presence of pleural effusion.

    PubMed

    Lee, Ming-Sum; Naqvi, Tasneem Z

    2014-04-01

    Many patients with aortic stenosis have difficult imaging windows due to advanced age, kyphosis, prior chest surgeries, radiation-induced skin changes, or hyperinflated lungs from pulmonary disease. Here we describe 4 cases to illustrate that in a subset of patients with pleural effusion, a posterior imaging approach can be used to obtain diagnostic images for native and prosthetic aortic valves. In these cases, nondiagnostic transthoracic echocardiographic images were obtained from conventional imaging windows, leading to inaccurate or incomplete assessment of the aortic valve. In all cases, images obtained from a posterior thoracic approach provided important additional diagnostic information. PMID:24658954

  2. Monitored anesthesia care with dexmedetomidine in transfemoral percutaneous trans-catheter aortic valve implantation: two cases report.

    PubMed

    Park, Hee-Sun; Kim, Kyung-Mi; Joung, Kyoung-Woon; Choi, In-Cheol; Sim, Ji-Yeon

    2014-04-01

    Percutaneous trans-catheter aortic valve implantation (TAVI) is recommended for inoperable patients with severe aortic stenosis at high risk for conventional aortic valve replacement. Originally, TAVI was mostly performed under general anesthesia. Here we describe two cases of transfemoral TAVI performed under monitored anesthesia care (MAC) with dexmedetomidine. Dexmedetomidine provides sedation, analgesia with minimal respiratory depression. Although MAC during transfemoral TAVI has limitations, such as unexpected patient movement and difficulty in intra-procedural use of transesophageal echocardiography, MAC with dexmedetomidine is feasible with close monitoring, fluoroscopic guidance and the participation of experienced anesthesiologists. PMID:24851170

  3. Left ventricular reverse remodeling after transcatheter aortic valve implantation: a cardiovascular magnetic resonance study

    PubMed Central

    2013-01-01

    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

  4. [Surgical treatment for aortic valve endocarditis combined with bacterial meningitis and vertebral osteomyelitis;report of a case].

    PubMed

    Masuda, Noriyasu; Kobayashi, Takuma; Yamasaki, Takuma; Kou, Eisei

    2015-02-01

    A 59-year-old man was referred to our hospital with disturbance of consciousness. Bacterial meningitis was diagnosed by a spinal tap, and penicillin sensitive Streptococcus pneumonia was detected by blood culture. Magnetic resonance imaging revealed a vertebral osteomyelitis. Treatment with antibiotics was started immediately. Four days after admission, congestive heart failure suddenly occurred. Echocardiography showed mobile vegetation on the aortic valve, and severe regurgitation. As acute heart failure could not be controlled, the aortic valve was replaced by ATS 22AP valve on the 7th day after admission. Antibiotic therapy was continued for 8 weeks. The postoperative course was uneventful. PMID:25743355

  5. Haemodynamic outcome at four-dimensional flow magnetic resonance imaging following valve-sparing aortic root replacement with tricuspid and bicuspid valve morphology

    PubMed Central

    Semaan, Edouard; Markl, Michael; Chris Malaisrie, S.; Barker, Alex; Allen, Bradley; McCarthy, Patrick; Carr, James C.; Collins, Jeremy D.

    2014-01-01

    OBJECTIVE To provide a more complete characterization of aortic blood flow in patients following valve-sparing aortic root replacement (VSARR) compared with presurgical cohorts matched by tricuspid and bicuspid valve morphology, age and presurgical aorta size. METHODS Four-dimensional (4D) flow magnetic resonance imaging (MRI) was performed to analyse three-dimensional (3D) blood flow in the thoracic aorta of n = 13 patients after VSARR with reimplantation of native tricuspid aortic valve (TAV, n = 6) and bicuspid aortic valve (BAV, n = 7). Results were compared with presurgical age and aortic size-matched control cohorts with TAV (n = 10) and BAV (n = 10). Pre- and post-surgical aortic flow was evaluated using time-resolved 3D pathlines using a blinded grading system (0–2, 0 = small, 1 = moderate and 2 = prominent) analysing ascending aortic (AAo) helical flow. Systolic flow profile uniformity in the aortic root, proximal and mid-AAo was evaluated using a four-quadrant model. Further analysis in nine analysis planes distributed along the thoracic aorta quantified peak systolic velocity, retrograde fraction and peak systolic flow acceleration. RESULTS Pronounced AAo helical flow in presurgical control subjects (both BAV and TAV: helix grading = 1.8 ± 0.4) was significantly reduced (0.2 ± 0.4, P < 0.001) in cohorts after VSARR independent of aortic valve morphology. Presurgical AAo flow was highly eccentric for BAV patients but more uniform for TAV. VSARR resulted in less eccentric flow profiles. Systolic peak velocities were significantly (P < 0.05) increased in post-root repair BAV patients throughout the aorta (six of nine analysis planes) and to a lesser extent in TAV patients (three of nine analysis planes). BAV reimplantation resulted in significantly increased peak velocities in the proximal AAo compared with root repair with TAV (2.3 ± 0.6 vs 1.6 ± 0.4 m/s, P = 0.017). Post-surgical patients showed a non-significant trend towards higher systolic flow acceleration as a surrogate measure of reduced aortic compliance. CONCLUSIONS VSARR restored a cohesive flow pattern independent of native valve morphology but resulted in increased peak velocities throughout the aorta. 4D flow MRI methods can assess the clinical implications of altered aortic flow dynamics in patients undergoing VSARR. PMID:24317086

  6. Echocardiographic integrated backscatter for detecting progression and regression of aortic valve calcifications in rats

    PubMed Central

    2013-01-01

    Background Calcification is an independent predictor of mortality in calcific aortic valve disease (CAVD). The aim of this study was to evaluate the use of non-invasive, non-ionizing echocardiographic calibrated integrated backscatter (cIB) for monitoring progression and subsequent regression of aortic valvular calcifications in a rat model of reversible renal failure with CAVD, compared to histology. Methods 28 male Wistar rats were prospectively followed during 21 weeks. Group 1 (N=14) was fed with a 0.5% adenine diet for 9 weeks to induce renal failure and CAVD. Group 2 (N=14) received a standard diet. At week 9, six animals of each group were killed. The remaining animals of group 1 (N=8) and group 2 (N=8) were kept on a standard diet for an additional 12 weeks. cIB of the aortic valve was calculated at baseline, 9 and 21 weeks, followed by measurement of the calcified area (Ca Area) on histology. Results At week 9, cIB values and Ca Area of the aortic valve were significantly increased in the adenine-fed rats compared to baseline and controls. After 12 weeks of adenine diet cessation, cIB values and Ca Area of group 1 decreased compared to week 9, while there was no longer a significant difference compared to age-matched controls of group 2. Conclusions cIB is a non-invasive tool allowing quantitative monitoring of CAVD progression and regression in a rat model of reversible renal failure, as validated by comparison with histology. This technique might become useful for assessing CAVD during targeted therapy. PMID:23351880

  7. Comparative transcriptome profiling in human bicuspid aortic valve disease using RNA sequencing.

    PubMed

    Padang, Ratnasari; Bagnall, Richard D; Tsoutsman, Tatiana; Bannon, Paul G; Semsarian, Christopher

    2015-03-01

    Intrinsic valvular degeneration and dysfunction is the most common complication of bicuspid aortic valve (BAV) disease. Phenotypically, it ranges from calcific aortic stenosis to redundant or prolapsing regurgitant leaflets. The underlying molecular mechanism underpinning phenotype heterogeneity of valvular degeneration in BAV is poorly understood. We used RNA sequencing (RNA-seq) to identify genes and pathways responsible for the development of valvular degeneration in BAV, compared with tricuspid aortic valve (TAV). Comparative transcriptome analysis was performed on total RNA of aortic valve tissues of patients with diseased BAV (n = 5) and calcified TAV (n = 3). RNA-seq findings were validated by RT-qPCR. A total of 59 and 177 genes were significantly up- and downregulated, respectively, in BAV compared with TAV. Hierarchical clustering indicated heterogeneity within the BAV group, separating those with heavy calcification (BAVc) from those with redundant leaflets and/or minimal calcification (BAVr). Interestingly, the gene expression profile of the BAVc group closely resembled the TAV, with shared up- and downregulation of inflammatory and NOTCH1 signaling pathways, respectively. Downregulation of matrix protease ADAMTS9 and protein aggrecan were observed in BAVr compared with TAV. Dysregulation of fetal gene programs were also present, with notable downregulation of SEMA6B and SEMA3F in BAVr and BAVc compared with TAV, respectively. Upregulation of TBX20 was observed exclusively in BAVr compared with BAVc. In conclusion, diverging molecular mechanisms underpin phenotype heterogeneity of valvular degeneration in BAV and data from the present study suggest that there may be shared mechanisms leading to calcification in BAV and TAV. Recognition of these pathways is fundamental to improve our understanding of the molecular basis of human BAV disease. PMID:25547111

  8. Clinical and echocardiographic assessment of the Medtronic Advantage aortic valve prosthesis: the Scandinavian multicentre, prospective study

    PubMed Central

    Haaverstad, Rune; Vitale, Nicola; Karevold, Asbjørn; Cappabianca, Giangiuseppe; Tromsdal, Arve; Olsen, Peter Skov; Köber, Lars; Ihlen, Halfdan; Rein, Kjell Arne; Svennevig, Jan L

    2007-01-01

    Objective The aim of this report is the prospective, multicentre evaluation of clinical results and haemodynamic performance of the Medtronic Advantage aortic valve prosthesis. Methods From April 2001 to June 2003, 166 patients (male:female 125:41; mean (SD) age 61.8 (11.8)?years) received an aortic advantage valve prosthesis. Complete cumulative follow?up was 242.7 patient?years (maximum 3.2; mean 1.6?years). Postoperatively, patients underwent early (within 30?days) and 1?year transthoracic echocardiography. Results 30?day mortality was 2.4% (n?=?4). Kaplan–Meier estimates of freedom from complications and linearised rates were as follows: 96.9 (1.6)% survival; 94.7 (1.3)% (2.06?patients/year) thrombo?embolism; 99.4 (0.6)% (0.4?patients/year) bleeding; 98.8 (0.9)% (0.8?patients/year) non?structural valve dysfunction; 98.8 (0.9)% (0.8?patients/year) reoperation. Valvular mean pressure gradients ranged from 16 (3)?mm Hg for size 19 to 7 (2)?mm Hg for size 27 and the corresponding effective orifice areas ranged from 1.2 (0.25) to 3.2 (0.66)?cm2. In all, left ventricular mass significantly decreased (p<0.001) and fractional shortening increased (p<0.001) from postoperative to 1?year echocardiography. Conclusions Haemodynamic performance and early clinical results of Medtronic advantage in the aortic position were satisfactory and comparable with those of other bileaflet valves in current clinical use. PMID:17065186

  9. Outcomes of Transfemoral Transcatheter Aortic Valve Implantation in Patients With Previous Coronary Bypass.

    PubMed

    Leshem-Rubinow, Eran; Abramowitz, Yigal; Steinvil, Arie; Ben-Assa, Eyal; Chorin, Ehud; Shacham, Yacov; Yankelson, Lior; Konigstein, Maayan; Keren, Gad; Banai, Shmuel; Finkelstein, Ariel

    2015-08-01

    Patients with previous coronary artery bypass grafting (CABG) are considered to be at increased perioperative risk for a redo cardiac operation. In the era of transcatheter aortic valve implantation (TAVI), these patients constitute a considerable portion of those with severe aortic stenosis referred for TAVI. We evaluated the impact of previous CABG on transfemoral TAVI outcomes. Patients with severe symptomatic aortic stenosis (n = 515) who underwent transfemoral TAVI were divided according to the presence of history of CABG. Patients with previous valvular surgery were excluded (n = 12). TAVI clinical end points and adverse events were considered according to the Valve Academic Research Consortium 2 definitions. Survival was estimated using Cox regression models at the enter mode with the dependent variable defined as all-cause mortality. Of the total 503 patients who underwent TAVI, 91 (18.1%) had previous CABG. At baseline, patients with previous CABG were younger (80.8 vs 83.1 years, p <0.001), mostly men (85% vs 35%, p <0.001), had more cardiac and vascular co-morbidities, higher mean logistic EuroSCORE (32.8 vs 22; p <0.001), lower ejection fraction (53% vs 56%, p <0.001), and lower AV gradients and larger valve area. At a mean follow-up of 636 days, the overall Valve Academic Research Consortium 2-adjudicated end points did not differ. No differences in mortality were observed at 30 days, 6 months, and 1 year after TAVI (hazard ratio 1.34, p = 0.55, Cox regression). We conclude that patients with previous CABG who underwent TAVI do not have increased risk of periprocedural complications or mortality, although having distinct clinical features compared with the total TAVI population. PMID:26054290

  10. Transcatheter Aortic Valve Implantation: First Applications and Short Term Outcomes in Our Clinic

    PubMed Central

    Aksoy, Mehmet; Ince, Ilker; Ahiskalioglu, Ali; Dogan, Nazim; Colak, Abdurrahim; Sevimli, Serdar

    2015-01-01

    Objective: The objective of this study is to evaluate the first applications and short term outcomes of transcatheter aortic valve implantation (TAVI) in our clinic, which is a new technology for the patients with high risk for surgical aortic valve replacement (SAVR). Materials and Methods: Between January 2010 and December 2012, twenty five patients (16 males, 9 females; mean age 74.04±8.86 years) diagnosed with severe aortic stenosis, who were at high risk for surgery (EuroSCORE II: 5.58±4.20) and underwent TAVI in our clinic, were evaluated. The demographic and clinical characteristics of patients, anaesthetic management, complications during pre- and post-operative periods and the mortality rate in the first 30 days and six months were recorded. Results: Edwards SAPIEN Valve prostheses were implanted by transfemoral approach (percutaneously in 10 patients and surgically in 15 patients) in all patients. The TAVI procedure was performed under general anaesthesia. The success rate of the TAVI procedure was 100%. Three patients had limited dissection of the femoral artery; however, intervention was not needed due to good distal perfusion rate. Permanent pacemaker was implanted to four patients because of long-term atrioventricular blockage. After the procedure, all patients were transferred to the Intensive Care Unit (ICU) and all patients were extubated in the ICU. The mean mechanical ventilation duration (minutes) was 166.20±39.32, the mean critical care unit stay (day) was 5.64±2.99 and the mean hospital stay (day) was 11.92±5.54. Acute renal failure was observed in one patient and stroke was observed in two patients on the first postoperative day. The mortality rate in the first 30 days and 6 months was found to be 4% and 16%, respectively. Conclusion: Transcatheter aortic valve implantation is a great option for patients with severe aortic stenosis who are at high risk for SAVR. In our institute, procedural success and short term outcomes for patients underwent TAVI were found to be similar to the other studies in the national and international literature.

  11. Gene Profiling of Aortic Valve Interstitial Cells under Elevated Pressure Conditions: Modulation of Inflammatory Gene Networks

    PubMed Central

    Warnock, James N.; Nanduri, Bindu; Pregonero Gamez, Carol A.; Tang, Juliet; Koback, Daniel; Muir, William M.; Burgess, Shane C.

    2011-01-01

    The study aimed to identify mechanosensitive pathways and gene networks that are stimulated by elevated cyclic pressure in aortic valve interstitial cells (VICs) and lead to detrimental tissue remodeling and/or pathogenesis. Porcine aortic valve leaflets were exposed to cyclic pressures of 80 or 120?mmHg, corresponding to diastolic transvalvular pressure in normal and hypertensive conditions, respectively. Linear, two-cycle amplification of total RNA, followed by microarray was performed for transcriptome analysis (with qRT-PCR validation). A combination of systems biology modeling and pathway analysis identified novel genes and molecular mechanisms underlying the biological response of VICs to elevated pressure. 56 gene transcripts related to inflammatory response mechanisms were differentially expressed. TNF-?, IL-1?, and IL-1? were key cytokines identified from the gene network model. Also of interest was the discovery that pentraxin 3 (PTX3) was significantly upregulated under elevated pressure conditions (41-fold change). In conclusion, a gene network model showing differentially expressed inflammatory genes and their interactions in VICs exposed to elevated pressure has been developed. This system overview has detected key molecules that could be targeted for pharmacotherapy of aortic stenosis in hypertensive patients. PMID:21876831

  12. Left ventricular mass regression after sutureless implantation of the Perceval S aortic valve bioprosthesis: preliminary results

    PubMed Central

    Santarpino, Giuseppe; Pfeiffer, Steffen; Pollari, Francesco; Concistrè, Giovanni; Vogt, Ferdinand; Fischlein, Theodor

    2014-01-01

    OBJECTIVES Left ventricular (LV) hypertrophy in aortic stenosis (AS) is considered a compensatory response helping maintain systolic function, but constitutes a risk factor for cardiac morbidity and mortality. The aim of this study was to assess the degree of LV mass regression after sutureless implantation of the Perceval S aortic valve bioprosthesis (Sorin Group, Saluggia, Italy). METHODS Between March 2010 and July 2012, 78 patients with symptomatic AS underwent isolated aortic valve replacement (AVR) with the Perceval bioprosthesis. Mean age was 77.1 ± 5.3 years, 46 patients were female (59%) and mean logistic EuroSCORE was 11 ± 7.5%. Echocardiography was performed preoperatively, at discharge, and at follow-up (mean 13.5 ± 7.3 months). LV mass was calculated using the Devereux formula and indexed to body surface area. RESULTS There was 1 in-hospital non-cardiac death and 3 late deaths. LV mass index decreased from 148.4 ± 46 g/m2 at baseline to 119.7 ± 38.5 g/m2 at follow-up (P = 0.002). No significant changes were observed in LV hypertrophy and/or relative wall thickness >0.42 as well as in LV ejection fraction. Mean aortic gradient decreased from 49.5 ± 15.8 mmHg at baseline to 11.6 ± 5.1 mmHg at discharge and 8.3 ± 4.4 mmHg at follow-up (P < 0.001), resulting in significant clinical improvement. No moderate or severe paravalvular leakage was observed at discharge and at follow-up. CONCLUSIONS In AS patients, isolated AVR with the Perceval sutureless bioprosthesis is associated with significant LV mass regression at 1-year follow-up. However, longer-term follow-up is necessary to confirm these findings. PMID:24105865

  13. Midterm Results of the Ross Procedure in a Pediatric Population: Bicuspid Aortic Valve Is Not a Contraindication

    Microsoft Academic Search

    S. El Behery; J. Rubay; T. Sluysmans; B. Absil; C. Ovaert

    2009-01-01

    Our objective was to analyze retrospectively the short- and midterm results of the Ross operation in children and the impact\\u000a of bicuspid aortic valve (BAV) disease on outcome. From 1991 to 2003, 41 patients (26 male, 15 female) underwent a Ross procedure.\\u000a Aortic disease was congenital in all but one. Sixty-six percent had BAV. Mean age at operation was 10.13 ± 5.6 years

  14. Enhanced expression of hemoglobin scavenger receptor and heme oxygenase-1 is associated with aortic valve stenosis in patients undergoing hemodialysis.

    PubMed

    Inaba, Mayumi; Sugioka, Kenichi; Naruko, Takahiko; Yunoki, Kei; Kato, Yasuyuki; Shibata, Toshihiko; Inoue, Takeshi; Ohsawa, Masahiko; Yoshiyama, Minoru; Ueda, Makiko

    2014-07-01

    A high prevalence and a rapid progression of aortic valve stenosis (AS) in patients undergoing hemodialysis (HD) has been reported. In these circumstances, intraleaflet hemorrhage of aortic valve may be related to the development of AS in HD patients. We immunohistochemically examined the relationship among intraleaflet hemorrhage, neovascularization, hemoglobin scavenger receptor (CD163), and heme oxygenase-1 (HO-1) using surgically resected aortic valve specimens from AS patients undergoing HD. The study population consisted of 26 HD patients and 25 non-HD patients with severe AS who had undergone aortic valve replacement. Frozen aortic valve samples surgically obtained from AS patients were stained immunohistochemically with antibodies against smooth muscle cells, macrophages, glycophorin-A (a protein specific to erythrocyte membranes), CD31, CD163, and HO-1. Morphometric analysis demonstrated that the CD163-positive macrophage score, the number of CD31-positive microvessels, and the percentage of glycophorin-A and HO-1-positive area were significantly higher in HD patients than in non-HD patients (CD163-positive macrophage score, P?aortic valves in AS patients undergoing HD. PMID:24612419

  15. A case of hypoplastic left heart syndrome and bicuspid aortic valve in monochorionic twins.

    PubMed

    Mu, T S; McAdams, R M; Bush, D M

    2005-01-01

    The etiology of hypoplastic left heart syndrome (HLHS) remains unclear. Since a genetic cause for HLHS has not been obvious, it is generally considered to be inherited in a multifactorial manner. Studies of twins are valuable in elucidating the genetic contribution to a birth defect such as HLHS. We report a case of monochorionic twins in whom one has HLHS and the other has a bicuspid aortic valve. Predisposing genetic and environmental influences on individuals with identical genotypes, such as twins, may result in discordance of left-sided flow lesions. PMID:16235019

  16. Myocardial oxygen consumption in aortic valve disease with and without left ventricular dysfunction.

    PubMed Central

    Schwitter, J; Eberli, F R; Ritter, M; Turina, M; Krayenbuehl, H P

    1992-01-01

    OBJECTIVE--To assess whether and to what extent myocardial oxygen consumption is modified by hypertrophy and alterations in contractility in patients with aortic valve disease and to evaluate the influence of regression of left ventricular hypertrophy and improvement of contractility on myocardial oxygen consumption after successful aortic valve replacement. DESIGN--A cohort analytical study to investigate the influence of the "explanatory" variables of myocardial oxygen consumption by multiple regression analysis. A comparison of myocardial oxygen consumption in preoperative patients with that after operation in a group with comparable severity of aortic valve disease before operation (analysis of covariance). PATIENTS--In six controls and in 43 patients with aortic valve disease and normal coronary arteries standard haemodynamic variables were measured, left ventricular biplane cineangiography performed, and coronary sinus blood flow measured by thermodilution. The patients were divided into three groups: 19 preoperative patients with normal ejection fraction (greater than or equal to 57%) (group 1); nine preoperative patients with reduced ejection fraction (less than 57%) (group 2); 16 postoperative patients (one with preoperative and postoperative measurements (group 3). Postoperative evaluation was performed 12-51 months after surgery. MAIN OUTCOME MEASUREMENTS--Myocardial oxygen consumption/100 g left ventricular muscle mass and its suspected "explanatory" variables--that is, peak systolic left ventricular circumferential wall stress, heart rate, contractility (assessed by left ventricular ejection fraction), and left ventricular muscle mass index. RESULTS--Multiple regression analysis showed that the product of peak systolic stress and heart rate (p less than 0.0001) and ejection fraction (p less than 0.03) were positively correlated with myocardial oxygen consumption/100 g and that left ventricular muscle mass index (p less than 0.002) was negatively correlated with myocardial oxygen consumption/100 g (r = 0.72; n = 50 measurements). Myocardial oxygen consumption per 100 g at a given stress-rate product was higher in the controls than in group 1 (hypertrophied ventricles with normal ejection fraction) and was also higher in group 1 than in group 2 (hypertrophied ventricles with reduced ejection fraction). In a subgroup of the postoperative patients with complete regression of hypertrophy and normalisation of contractility, myocardial oxygen consumption per 100 g at a given stress-rate product was indistinguishable from that in controls. CONCLUSIONS--When the actual stress-rate product was used as an index of overall left ventricular performance the results suggested that mechanical efficiency was increased in hypertrophied ventricles especially when contractility was decreased. These changes in mechanical efficiency seemed to be reversible during the postoperative course when muscle mass and contractility returned to normal. PMID:1531759

  17. Metabolic differences between hearts of patients with aortic valve disease and hearts of patients with ischaemic disease.

    PubMed

    Suleiman, M S; Caputo, M; Ascione, R; Bryan, A J; Lucchetti, V; Gomes, W J; Angelini, G D

    1998-11-01

    The hypertrophic hearts of patients with aortic valve disease are likely to have metabolic demands different from hearts with ischaemic disease. In this study we measured the myocardial concentration of ATP, ADP, lactate and 16 different amino acids in left ventricular biopsies collected from patients with aortic valve disease and from patients with ischaemic heart disease. Compared to hearts with ischaemic disease, hypertrophic hearts had significantly higher concentrations of ATP, but lower concentrations of lactate, branched-chain amino acids and alanine. These differences have important implications for energy metabolism and protein turnover in the two pathologies. PMID:9925386

  18. Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation

    PubMed Central

    Dato, Ilaria; Burzotta, Francesco; Trani, Carlo; Crea, Filippo; Ussia, Gian Paolo

    2014-01-01

    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

  19. Emergent use of Impella CP™ during transcatheter aortic valve replacement: Transaortic access.

    PubMed

    Singh, Vikas; Yarkoni, Alon; O'Neill, William W

    2015-07-01

    Sudden onset of hypotension is a rare but emergent event in patients undergoing transcatheter aortic valve replacement (TAVR). This primarily occurs due to coronary artery obstruction, valve misplacement/migration, ventricular perforation, cardiac tamponade, severe paravalvular regurgitation, stunned myocardium, ventricular arrhythmia, and annulus rupture. While the operator makes an attempt to identify and correct the underlying problem, an emergent placement of mechanical hemodynamic assist device may be necessary and crucial for a successful outcome. We describe a unique and challenging case of complete circulatory collapse in a patient undergoing transaortic TAVR with Edwards SAPIEN prosthesis (Edwards Lifesciences, CA) who required rescue Impella CP™ (Abiomed, Danvers, MA) placement directly through the ascending aorta due to unfavorable femoral access. © 2015 Wiley Periodicals, Inc. PMID:25529629

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

    PubMed

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

    2012-01-01

    Aortic valve (AV) calcification is a highly prevalent disease with serious impact on mortality and morbidity. The exact causes and mechanisms of AV calcification are unclear, although previous studies suggest that mechanical forces play a role. It has been clinically demonstrated that calcification preferentially occurs on the aortic surface of the AV. This is hypothesized to be due to differences in the mechanical environments on the two sides of the valve. It is thus necessary to characterize fluid shear forces acting on both sides of the leaflet to test this hypothesis. The current study is one of two studies characterizing dynamic shear stress on both sides of the AV leaflets. In the current study, shear stresses on the ventricular surface of the AV leaflets were measured experimentally on two prosthetic AV models with transparent leaflets in an in vitro pulsatile flow loop using two-component Laser Doppler Velocimetry (LDV). Experimental measurements were utilized to validate a theoretical model of AV ventricular surface shear stress based on the Womersley profile in a straight tube, with corrections for the opening angle of the valve leaflets. This theoretical model was applied to in vivo data based on MRI-derived volumetric flow rates and valve dimension obtained from the literature. Experimental results showed that ventricular surface shear stress was dominated by the streamwise component. The systolic shear stress waveform resembled a half-sinusoid during systole and peaks at 64-71 dyn/cm(2), and reversed in direction at the end of systole for 15-25 ms, and reached a significant negative magnitude of 40-51 dyn/cm(2). Shear stresses from the theoretical model applied to in vivo data showed that shear stresses peaked at 77-92 dyn/cm(2) and reversed in direction for substantial period of time (108-110 ms) during late systole with peak negative shear stress of 35-38 dyn/cm(2). PMID:21465260

  1. Differential Changes in the Molecular Stability of Collagen from the Pulmonary and Aortic Valves During the Fetal-to-Neonatal Transition

    Microsoft Academic Search

    Ian G. Aldous; J. Michael Lee; Sarah M. Wells

    2010-01-01

    During the fetal-to-neonatal transition, transvalvular pressures (TVPs) on the aortic and pulmonary valves change dramatically—but\\u000a differently for each valve. We have examined changes in the molecular stability and crosslinking of collagen during this transition.\\u000a Aortic and pulmonary valves were harvested from fetal and neonatal cattle. Using differential scanning calorimetry (DSC),\\u000a denaturation of valvular collagen was examined and, using HPLC, the

  2. Live en face imaging of aortic valve leaflets under mechanical stress.

    PubMed

    Metzler, Scott A; Digesu, Christopher S; Howard, Joel I; Filip To, S D; Warnock, James N

    2012-03-01

    Soft tissues, such as tendons, skin, arteries, or lung, are constantly subject to mechanical stresses in vivo. None more so than the aortic heart valve that experiences an array of forces including shear stress, cyclic pressure, strain, and flexion. Anisotropic biaxial cyclic stretch maintains valve homeostasis; however, abnormal forces are implicated in disease progression. The response of the valve endothelium to deviations from physiological levels has not been fully characterized. Here, we show the design and validation of a novel stretch apparatus capable of applying biaxial stretch to viable heart valve tissue, while simultaneously allowing for live en face endothelial cell imaging via confocal laser scanning microscopy (CLSM). Real-time imaging of tissue is possible while undergoing highly characterized mechanical conditions and maintaining the native extracellular matrix. Thus, it provides significant advantages over traditional cell culture or in vivo animal models. Planar biaxial tissue stretching with simultaneous live cell imaging could prove useful in studying the mechanobiology of any soft tissue. PMID:21604147

  3. Differential changes in the molecular stability of collagen from the pulmonary and aortic valves during the fetal-to-neonatal transition.

    PubMed

    Aldous, Ian G; Lee, J Michael; Wells, Sarah M

    2010-09-01

    During the fetal-to-neonatal transition, transvalvular pressures (TVPs) on the aortic and pulmonary valves change dramatically-but differently for each valve. We have examined changes in the molecular stability and crosslinking of collagen during this transition. Aortic and pulmonary valves were harvested from fetal and neonatal cattle. Using differential scanning calorimetry (DSC), denaturation of valvular collagen was examined and, using HPLC, the types and quantities of enzymatic crosslinks were examined. No difference in hydrothermal stability was found between the collagens in the fetal aortic and pulmonary valves; this was expected since the TVP is approximately the same across both valves before birth. Only in the neonatal samples was the collagen from aortic valves (higher TVP) less stable than that from pulmonary valves (lower TVP). Surprisingly, the enthalpy of denaturation did not differ either between valve type or with age, suggesting an entropic mechanism of altered molecular stability. A significant difference in immature-to-mature crosslink ratio was found between neonatal aortic and pulmonary valves: a difference absent in fetal valves. This ratio-indicative of remodeling rate-parallels (and may be a function of) the changing in vivo load. This study highlights the relationship between in vivo load and both (i) molecular stability and (ii) collagen remodeling in heart valves. PMID:20473570

  4. Topography of aortic heart valves. [applied to the development of a prosthetic heart valve

    NASA Technical Reports Server (NTRS)

    Karara, H. M.

    1974-01-01

    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.

  5. Influence of Valve Size, Orientation and Downstream Geometry of an Aortic BMHV on Leaflet Motion and Clinically Used Valve Performance Parameters.

    PubMed

    Annerel, S; Claessens, T; Taelman, L; Degroote, J; Van Nooten, G; Verdonck, P; Segers, P; Vierendeels, J

    2015-06-01

    The aim of this study was to reconcile some of our own previous work and the work of others to generate a physiologically realistic numerical simulation environment that allows to virtually assess the performance of BMHVs. The model incorporates: (i) a left ventricular deformable model to generate a physiological inflow to the aortic valve; (ii) a patient-specific aortic geometry (root, arch and descending aorta); (iii) physiological pressure and flow boundary conditions. We particularly studied the influence of downstream geometry, valve size and orientation on leaflet kinematics and functional indices used in clinical routine. Compared to the straight tube geometry, the patient-specific aorta leads to a significant asynchronous movement of the valve, especially during the closing of the valve. The anterior leaflet starts to close first, impacts the casing at the closed position and remains in this position. At the same time, the posterior leaflet impacts the pivoting mechanisms at the fully open position. At the end of systole, this leaflet subsequently accelerates to the closed position, impacting the casing with an angular velocity of approximately -477 rad/s. The valve size greatly influences the transvalvular pressure gradient (TPG), but does not change the overall leaflet kinematics. This is in contrast to changes in valve orientation, where changing valve orientation induces large differences in leaflet kinematics, but the TPG remains approximately the same. PMID:25186435

  6. Quadricuspid aortic valve and a ventricular septal defect in a horse

    PubMed Central

    2014-01-01

    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

  7. Effect of preoperative pulmonary hypertension on outcomes in patients with severe aortic stenosis following surgical aortic valve replacement.

    PubMed

    Zlotnick, David M; Ouellette, Michelle L; Malenka, David J; DeSimone, Joseph P; Leavitt, Bruce J; Helm, Robert E; Olmstead, Elaine M; Costa, Salvatore P; DiScipio, Anthony W; Likosky, Donald S; Schmoker, Joseph D; Quinn, Reed D; Sisto, Donato; Klemperer, John D; Sardella, Gerald L; Baribeau, Yvon R; Frumiento, Carmine; Brown, Jeremiah R; O'Rourke, Daniel J

    2013-11-15

    Pulmonary hypertension (PH) is prevalent in patients with aortic stenosis (AS); however, previous studies have demonstrated inconsistent results regarding the association of PH with adverse outcomes after aortic valve replacement (AVR). The goal of this study was to evaluate the effects of preoperative PH on outcomes after AVR. We performed a regional prospective cohort study using the Northern New England Cardiovascular Disease Study Group database to identify 1,116 consecutive patients from 2005 to 2010 who underwent AVR ± coronary artery bypass grafting for severe AS with a preoperative assessment of pulmonary pressures by right-sided cardiac catheterization. PH was defined as a mean pulmonary artery pressure of ?25 mm Hg, with severity based on the pulmonary artery systolic pressure-mild, 35 to 44 mm Hg; moderate, 45 to 59 mm Hg; and severe, ?60 mm Hg. We found that PH was present in 536 patients (48%). Postoperative acute kidney injury, low-output heart failure, and in-hospital mortality increased with worsening severity of PH. In multivariate logistic regression, severe PH was independently associated with postoperative acute kidney injury (adjusted odds ratio 4.1, 95% confidence interval [CI] 1.7 to 10, p = 0.002) and in-hospital mortality (adjusted odds ratio 6.9, 95% CI 2.5 to 19.1, p <0.001). There was a significant association between PH and decreased 5-year survival (adjusted log-rank p value = 0.006), with severe PH being associated with the poorest survival (adjusted hazard ratio 2.4, 95% CI 1.3 to 4.2, p = 0.003). In conclusion, severe PH in patients with severe AS is associated with increased rates of in-hospital adverse events and decreased 5-year survival after AVR. PMID:23998349

  8. Percutaneous closure of the aortic valve as a bridge to heart transplantation to treat severe aortic insufficiency after ventricular assist device.

    PubMed

    Sauer, Andrew J; Davidson, Charles J; McGee, Edwin C

    2015-08-01

    Aortic insufficiency (AI) following rotary left ventricular assist device (LVAD) implantation is an increasingly common problem with inadequately defined treatment options. Percutaneous transcatheter (PTC) closure of the aortic valve (AV) has been described as a potential nonsurgical approach. Alternatively, we present a case of decompensated heart failure due to de novo severe AI following LVAD in which successful PTC closure of the AV resolved the severe AI and allowed for clinical recovery and stability for more than 10 months as a bridge to heart transplantation. © 2014 Wiley Periodicals, Inc. PMID:24975484

  9. Relation of Frailty to Outcomes After Transcatheter Aortic Valve Replacement (from the PARTNER Trial).

    PubMed

    Green, Philip; Arnold, Suzanne V; Cohen, David J; Kirtane, Ajay J; Kodali, Susheel K; Brown, David L; Rihal, Charanjit S; Xu, Ke; Lei, Yang; Hawkey, Marian C; Kim, Rebeca J; Alu, Maria C; Leon, Martin B; Mack, Michael J

    2015-07-15

    Transcatheter aortic valve replacement (TAVR) is an effective treatment for severe symptomatic aortic stenosis (AS) in patients who are inoperable or at high risk for surgery. However, the intermediate- to long-term mortality is high, emphasizing the importance of patient selection. We, therefore, sought to evaluate the prognostic value of frailty in older recipients of TAVR, hypothesizing that frail patients would experience a higher mortality rate and a higher likelihood of poor outcome 1 year after TAVR. This substudy of the Placement of Aortic Transcatheter Valves trial was conducted at 3 high-enrolling sites where frailty was assessed systematically before TAVR. In total, 244 patients received TAVR at the participating sites. Frailty was assessed using a composite of 4 markers (serum albumin, dominant handgrip strength, gait speed, and Katz activity of daily living survey), which were combined into a frailty score. The cohort was dichotomized at median frailty score. Outcomes measures were the time to death from any cause for >1 year of follow-up and poor outcome at 1 year. Poor outcome was defined as (1) death, (2) Kansas City Cardiomyopathy Questionnaire overall summary (KCCQ-OS) score <60, or (3) decrease of ?10 points in the KCCQ-OS score from baseline to 1 year. At 1 year, the Kaplan-Meier-estimated all-cause mortality rate was 32.7% in the frail group and 15.9% in the nonfrail group (log-rank p = 0.004). At 1 year, poor outcome occurred in 50.0% of the frail group and 31.5% of the nonfrail group (p = 0.02). In conclusion, frailty was associated with increased mortality and a higher rate of poor outcome 1 year after TAVR. PMID:25963221

  10. Four year follow up of aortic valve replacement for isolated aortic stenosis: a link between reduction in pressure overload, regression of left ventricular hypertrophy, and diastolic function

    PubMed Central

    Ikonomidis, I; Tsoukas, A; Parthenakis, F; Gournizakis, A; Kassimatis, A; Rallidis, L; Nihoyannopoulos, P

    2001-01-01

    OBJECTIVE—To evaluate changes in left ventricular function and the impact of ventricular hypertrophy and pressure gradient early and late after aortic valve replacement in patients with isolated aortic stenosis.?DESIGN—41 patients with isolated aortic stenosis and normal systolic function underwent cross sectional and Doppler echocardiography two months before and two weeks and four years after aortic valve replacement.?RESULTS—Early after the operation, left ventricular mass index (mean (SD)) decreased from 187 (44) g/m2 to 179 (46) g/m2, because of a reduction in end diastolic diameter (p < 0.05). Aortic pressure gradients were reduced, as expected. Isovolumic relaxation time was reduced from 93 (20) ms to 78 (12) ms, and deceleration time from 241 (102) ms to 205 (77) ms (p < 0.05). At four years, left ventricular mass index was further reduced to 135 (30) g/m2 (p < 0.01) as a result of wall thickness reduction in the interventricular septum (from 14 (1.6) mm to 12 (1.4) mm, p < 0.01) and the posterior wall (from 14 (1.6) mm to 12 (1.3) mm, p < 0.01). Diastolic function, expressed by a reduction in isovolumic relaxation time from 93 (20) ms to 81 (15) ms (p < 0.01) and deceleration time from 241 (102) ms to 226 (96) ms (p < 0.05), remained improved. Prolonged isovolumic relaxation time was associated with significant septal and posterior wall hypertrophy (wall thickness > 13 mm) (p < 0.05), whereas prolonged deceleration time was related to high residual gradient (peak gradient > 30 mm Hg ) (p < 0.01).?CONCLUSIONS—Left ventricular diastolic function improves early after surgery for aortic stenosis in parallel with the reduction in the aortic gradient. However, prolongation of Doppler indices of myocardial relaxation and ventricular filling is observed in patients with significant left ventricular hypertrophy and a residual pressure gradient early after surgery. At four years postoperatively, diastolic function remains improved.???Keywords: diastolic function; hypertrophy regression; aortic valve replacement; aortic stenosis PMID:11514485

  11. World experience of percutaneous ultrasound-guided balloon valvuloplasty in human fetuses with severe aortic valve obstruction

    Microsoft Academic Search

    Thomas Kohl; Gurleen Sharland; Lindsey D Allan; Ulrich Gembruch; Rabih Chaoui; Lilian M Lopes; Paulo Zielinsky; James Huhta; Norman H Silverman

    2000-01-01

    Prenatal alleviation of severe fetal aortic valve obstructions by percutaneous ultrasound-guided balloon valvuloplasty has been performed to improve the fate of affected fetuses. The purpose of this study was to analyze the current world experience of these procedures in human fetuses. Data from 12 human fetuses were available for analysis. The mean gestational age at intervention was 29.2 weeks (range

  12. Percutaneous transfemoral closure of a pseudoaneurysm at the left ventricular apical access site for transcatheter aortic valve implantation.

    PubMed

    Karimi, Ashkan; Beaver, Thomas M; Fudge, James C

    2015-02-01

    This case report illustrates a left ventricular pseudoaneurysm that developed at the transapical access site for transcatheter aortic valve implantation and was successfully excluded percutaneously through a femoral approach using an Amplatzer muscular VSD occluder (St. Jude Medical). We also discuss various currently available devices and technical pearls for percutaneous closure of left ventricular pseudoaneurysms. PMID:25661768

  13. Papillary Fibroelastoma of the Aortic Valve: Analysis of 21 Cases, Including a Presentation with Cardiac Arrest

    PubMed Central

    Andrei, Adin-Cristian; Li, Zhi; McCarthy, Patrick M.; Malaisrie, S. Chris

    2015-01-01

    Cardiac papillary fibroelastoma is a rare, benign tumor, arising predominantly from cardiac valves. This tumor can cause a variety of symptoms due to thromboembolism. We describe our single-center surgical experience with papillary fibroelastoma of the aortic valve. From April 2004 through June 2013, 6,530 patients underwent cardiac surgery. Of those, 6,098 patients were included in the final analysis. Twenty-one patients (0.34%) underwent surgical resection of 30 papillary fibroelastomas of the aortic valve. Most patients (67%) were incidentally diagnosed to have cardiac papillary fibroelastoma. The usual symptom was cerebral infarction (in 5 of 7 symptomatic patients). A rare presentation of papillary fibroelastoma in one patient was cardiac arrest caused by left main coronary artery ostial obstruction. Tumor size was not related to patient age (Pearson correlation coefficient, 0.34; P=0.13). Neither the number of tumors (1.43 ± 0.72 vs 1.43 ± 0.62) nor tumor size (8.14 ± 2.42 vs 8.07 ± 3.31 mm) was significantly different between symptomatic and asymptomatic patients. All lesions were resected by means of the simple shave technique. There were no operative or 30-day deaths. Follow-up echocardiograms showed no tumor recurrence (mean follow-up duration, 17 ± 14 mo). We identified no significant relationship among tumor size, number of tumors, symptoms, or patient age. Because simple shave excision of the tumor can be safely achieved without evidence of tumor recurrence, we conclude that surgical resection can be reasonable in asymptomatic patients. PMID:25873822

  14. Analysis of early out-of hospital mortality after transcatheter aortic valve implantation among patients with aortic stenosis successfully discharged from the hospital and alive at 30 days (from the placement of aortic transcatheter valves trial).

    PubMed

    Beohar, Nirat; Zajarias, Alan; Thourani, Vinod H; Herrmann, Howard C; Mack, Michael; Kapadia, Samir; Green, Philip; Arnold, Suzanne V; Cohen, David J; Généreux, Philippe; Xu, Ke; Leon, Martin B; Kirtane, Ajay J

    2014-11-15

    In high-risk or inoperable patients with severe symptomatic aortic stenosis, transcatheter aortic valve implantation (TAVI) is a proven alternative to standard (i.e., medical) therapy or surgical aortic valve replacement. Concerns have been raised, however, about patients who survive the procedure but have short subsequent survival. The aim of this study was therefore to identify correlates of early out-of-hospital mortality (EOHM) in patients who underwent successful TAVI, rendering TAVI potentially "futile." Patients who were discharged from the hospital and survived >30 days but <12 months after TAVI were identified (the EOHM group). Independent predictors of EOHM were explored, including patient-level factors and procedural nonfatal major complications (NFMCs). A sensitivity analysis was also performed, excluding patients with NFMCs. Among 485 patients who were discharged from the hospital and survived 30 days after TAVI, 101 (21%) were dead within 1 year. Independent predictors of EOHM included serum creatinine, liver disease, coagulopathy, mental status, body mass index, male gender, and Society of Thoracic Surgeons score. Although NFMCs were strongly associated with EOHM, patient-level risk factors for EOHM were similar between patients who did and those who did not experience NFMCs. Compared with standard therapy, TAVI patients with EOHM had similar 6-month 6-minute walk distances and functional classes, with higher rates of repeat hospitalization. In conclusion, in high-risk or inoperable patients who underwent TAVI and were discharged and alive at 30 days, EOHM was not infrequent and was determined largely by presenting characteristics and the occurrence of periprocedural NFMCs. Careful screening and minimization of NFMCs may maximize the benefit of TAVI. PMID:25277334

  15. Mechanisms of regional ischaemic changes during dipyridamole echocardiography in patients with severe aortic valve stenosis and normal coronary arteries.

    PubMed Central

    Baroni, M.; Maffei, S.; Terrazzi, M.; Palmieri, C.; Paoli, F.; Biagini, A.

    1996-01-01

    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

  16. Tissue engineering of heart valves: PEGylation of decellularized porcine aortic valve as a scaffold for in vitro recellularization

    PubMed Central

    2013-01-01

    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

  17. Changes of the eSheath Outer Dimensions Used for Transfemoral Transcatheter Aortic Valve Replacement

    PubMed Central

    Koehler, Till; Buege, Michael; Schleiting, Heinrich; Seyfarth, Melchior; Tiroch, Klaus; Vorpahl, Marc

    2015-01-01

    Innovative catheter systems with lower-profile sheaths and a dynamic expansion mechanism (DEM) were recently introduced for transcatheter aortic valve replacement (TAVR). However, the labeling of 14?F and 16?F eSheaths denote the inner nominal diameter. Exact changes of the clinically relevant outer diameters during usage are not available. eSheaths were measured every 30?mm using a digital caliper. Unused 14?F and 16?F eSheaths served as controls. Maximum eSheath diameters were measured after insertion of the Edwards Commander Delivery System (ECDS) into 14?F and 16?F eSheaths.Finally, eSheaths were retrieved and measured after TAVR. Outer diameters of control 14?F eSheaths were 5.8?mm and 6.50?mm for the 16?F eSheath. Introduction of the 23?mm and 26?mm ECDS into 14?F eSheaths showed a maximum diameter of 7.65?mm and 7.64?mm (P = NS). Introduction of the 29?mm ECDS into the 16?F eSheath showed the greatest diameter of 8.18?mm (P = 0.03). After TAVR, diameters of the 14?F eSheaths were 7.14?mm (23?mm valve) and 7.26?mm (26?mm valve) (P = NS), while 16?F eSheaths were 8.10?mm (29?mm valve) (P ? 0.03). Nominal 14?F and 16?F eSheaths showed a significant increase of the outer diameter during advancement of the ECDS and after TAVR implantation. PMID:26000297

  18. The Leaflex™ Catheter System - a viable treatment option alongside valve replacement? Preclinical feasibility of a novel device designed for fracturing aortic valve calcification.

    PubMed

    Jonas, Michael; Rozenman, Yoseph; Moshkovitz, Yaron; Hamdan, Ashraf; Kislev, Yael; Tirosh, Nitzan; Sax, Sharon; Trumer, Dror; Golan, Erez; Raanani, Ehud

    2014-11-25

    Aims: To demonstrate the feasibility of the Leaflex™ Catheter System, a novel percutaneous device for fracturing valve calcification using mechanical impact in order to regain leaflet mobility. Methods and results: Radiographic analysis of calcium patterns in 90 ex vivo human aortic valve leaflets demonstrated that 82% of leaflets had a typical "bridge" or "half-bridge" pattern, which formed the basis for the catheter design. The therapeutic effect was quantified in 13 leaflets showing a reduction of 49±16% in leaflet resistance to folding after treatment. A pulsatile flow simulator was then used with 11 ex vivo valves demonstrating an increase in aortic valve area of 35±12%. Using gross pathology and histology on fresh calcified leaflets, we then verified that mechanical impacts do not entail excessive risk of embolisation. In vivo safety and usability were then confirmed in the ovine model. Conclusions: We demonstrated preclinically that it is feasible to improve valve function using the Leaflex™ technology. Once demonstrated clinically, such an approach may have an important role as preparation for or bridging to TAVI, as destination treatment for patients where TAVI is clinically or economically questionable and, in the future, maybe even as a means to slow disease progression in asymptomatic patients. PMID:25420790

  19. Intercostal artery pseudoaneurysm: a rare complication of transaortic transcatheter aortic valve implantation.

    PubMed

    Lenders, Guy; Van Schil, Paul; Rodrigus, Inez; Bosmans, Johan

    2012-09-01

    In this case report, we present an 86-year old patient with an intercostal pseudoaneurysm after transaortic transcatheter aortic valve implantation (TAVI). This new technique of a transaortic approach is considered a possible alternative to the more usual transfemoral, trans-subclavian or transapical access site, mainly in patients with extensive peripheral arterial disease. A mini-thoracotomy or mini-sternotomy is needed to access the ascending aorta. The patient presented with a painless but progressive pulsatile mass right parasternally, 3 months after the procedure. An intercostal pseudoaneurysm was diagnosed with duplex examination and chest CT. Successful treatment with an ultrasound-guided injection of thrombin resulted in a complete obliteration of the pseudoaneurysm. Only nine reported cases of intercostal pseudoaneurysms have been reported worldwide, and this is the first case in a patient who underwent a transaortic TAVI. Since the transaortic access is used more frequently, it is important to report on possible complications of this new technique. PMID:22685024

  20. Triglycidylamine Crosslinking of Porcine Aortic Valve Cusps or Bovine Pericardium Results in Improved Biocompatibility, Biomechanics, and Calcification Resistance

    PubMed Central

    Connolly, Jeanne M.; Alferiev, Ivan; Clark-Gruel, Jocelyn N.; Eidelman, Naomi; Sacks, Michael; Palmatory, Elizabeth; Kronsteiner, Allyson; DeFelice, Suzanne; Xu, Jie; Ohri, Rachit; Narula, Navneet; Vyavahare, Narendra; Levy, Robert J.

    2005-01-01

    We investigated a novel polyepoxide crosslinker that was hypothesized to confer both material stabilization and calcification resistance when used to prepare bioprosthetic heart valves. Triglycidylamine (TGA) was synthesized via reacting epichlorhydrin and NH3. TGA was used to crosslink porcine aortic cusps, bovine pericardium, and type I collagen. Control materials were crosslinked with glutaraldehyde (Glut). TGA-pretreated materials had shrink temperatures comparable to Glut fixation. However, TGA crosslinking conferred significantly greater collagenase resistance than Glut pretreatment, and significantly improved biomechanical compliance. Sheep aortic valve interstitial cells grown on TGA-pretreated collagen did not calcify, whereas sheep aortic valve interstitial cells grown on control substrates calcified extensively. Rat subdermal implants (porcine aortic cusps/bovine pericardium) pretreated with TGA demonstrated significantly less calcification than Glut pretreated implants. Investigations of extracellular matrix proteins associated with calcification, matrix metalloproteinases (MMPs) 2 and 9, tenascin-C, and osteopontin, revealed that MMP-9 and tenascin-C demonstrated reduced expression both in vitro and in vivo with TGA crosslinking compared to controls, whereas osteopontin and MMP-2 expression were not affected. TGA pretreatment of heterograft biomaterials results in improved stability compared to Glut, confers biomechanical properties superior to Glut crosslinking, and demonstrates significant calcification resistance. PMID:15631995

  1. Closed-bore XMR (CBXMR) systems for aortic valve replacement: X-ray tube imaging performance

    SciTech Connect

    Bracken, John A.; Komljenovic, Philip; Lillaney, Prasheel V.; Fahrig, Rebecca; Rowlands, J. A. [Department of Medical Biophysics and Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 (Canada); Department of Radiology, Stanford University, Stanford, California 94305 (United States); Department of Medical Biophysics and Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 (Canada)

    2009-04-15

    A hybrid closed-bore x-ray/MRI system (CBXMR) is proposed to improve the safety and efficacy of percutaneous aortic valve replacement procedures. In this system, an x-ray C-arm will be positioned about 1 m from the entrance of a 1.5 T MRI scanner. The CBXMR system will harness the complementary strengths of both modalities to guide and deploy a bioprosthetic valve into the aortic annulus of the heart without coronary artery obstruction. A major challenge in constructing this system is ensuring proper operation of a rotating-anode x-ray tube in the MRI magnetic fringe field environment. The electron beam in the x-ray tube responsible for producing x rays can be deflected by the fringe field. However, the clinical impact of electron beam deflection in a magnetic field has not yet been studied. Here, the authors investigated changes in focal spot resolving power, field of view shift, and field of view truncation in x-ray images as a result of electron beam deflection. The authors found that in the fringe field acting on the x-ray tube at the clinical location for the x-ray C-arm (4 mT), focal spot size increased by only 2%, so the fringe field did not limit the resolving power of the x-ray system. The magnetic field also caused the field of view to shift by 3 mm. This shift must be corrected to avoid unnecessary primary radiation exposure to the patient and the staff in the cardiac catheterization laboratory. The fringe field was too weak to cause field of view truncation.

  2. CT evaluation prior to transapical aortic valve replacement: semi-automatic versus manual image segmentation.

    PubMed

    Foldyna, Borek; Jungert, Camelia; Luecke, Christian; von Aspern, Konstantin; Boehmer-Lasthaus, Sonja; Rueth, Eva Maria; Grothoff, Matthias; Nitzsche, Stefan; Gutberlet, Matthias; Mohr, Friedrich Wilhelm; Lehmkuhl, Lukas

    2015-08-01

    To compare the performance of semi-automatic versus manual segmentation for ECG-triggered cardiovascular computed tomography (CT) examinations prior to transcatheter aortic valve replacement (TAVR), with focus on the speed and precision of experienced versus inexperienced observers. The preoperative ECG-triggered CT data of 30 consecutive patients who were scheduled for TAVR were included. All datasets were separately evaluated by two radiologists with 1 and 5 years of experience (novice and expert, respectively) in cardiovascular CT using an evaluation software program with or without a semi-automatic TAVR workflow. The time expended for data loading and all segmentation steps required for the implantation planning were assessed. Inter-software as well as inter-observer reliability analysis was performed. The CT datasets were successfully evaluated, with mean duration between 520.4 ± 117.6 s and 693.2 ± 159.5 s. The three most time-consuming steps were the 3D volume rendering, the measurement of aorta diameter and the sizing of the aortic annulus. Using semi-automatic segmentation, a novice could evaluate CT data approximately 12.3 % faster than with manual segmentation, and an expert could evaluate CT data approximately 10.3 % faster [mean differences of 85.4 ± 83.8 s (p < 0.001) and 59.8 ± 101 s (p < 0.001), respectively]. The inter-software reliability for a novice was slightly lower than for an expert; however, the reliability for a novice and expert was excellent (ICC 0.92, 95 % CI 0.75-0.97/ICC 0.96, 95 % CI 0.91-0.98). Automatic aortic annulus detection failed in two patients (6.7 %). The study revealed excellent inter-software and inter-observer reliability, with a mean ICC of 0.95. TAVR evaluation can be accomplished significantly faster with semi-automatic rather than with manual segmentation, with comparable exactness, showing a benefit for experienced and inexperienced observers. PMID:25893746

  3. [Predictive indices of the persistence of left ventricular dilatation after valve replacement for chronic aortic insufficiency. Echocardiographic study].

    PubMed

    Khatouri, A; Fall, P D; Mouyopa, C; Kendoussi, M; Elyounassi, B; Raissouni, M; Nazzi, M; Zbir, E; Hamani, A

    1998-12-01

    The objective of this study was to define the echocardiographic indices predictive of persistence of left ventricular dilatation one year after valve replacement for chronic aortic incompetence. Thirty four consecutive patients (32 men and 2 women, age: 35.6 +/- 10 years) operated for post-rheumatic chronic aortic incompetence, were included in this series. All patients were investigated by echocardiography less than 15 days before and one, six and twelve months after surgery. The parameters studied consisted of measurement of ventricular diameter, shortening fraction and ejection fraction as well as aortic incompetence Doppler indices (jet-left ventriculr outflow tract diameter, jet-left ventricular outflow tract diameter/subaortic diameter ratio, half-pressure time, aortic isthmus end-diastolic velocity). Preoperative echocardiographic data and the results one year after valve replacement were compared for each patient. The left ventricle remained more dilated at one year in patients with a preoperative end-diastolic diameter > 80 mm, an end-systolic diameter > 55 mm, a shortening fraction < 25%, an ejection fraction < 50%, a jet diameter > 16 mm, a jet diameter/subaortic diameter ratio > 65% or a half-pressure time < 350 ms. In conclusion; an end-diastolic diameter > 80 mm, an end-systolic diameter > 55 mm, a shortening fraction < 25%, a jet diameter > 16 mm, a jet diaméter/subaortic diameter ratio > 65% and a half-pressure time < 350 ms appear to represent the main predictive factors of the persistence of ventricular dilatation one year after aortic valve replacement for chronic aortic incompetence. PMID:9922848

  4. Challenges after the first decade of transcatheter aortic valve replacement: focus on vascular complications, stroke, and paravalvular leak.

    PubMed

    Reidy, Christopher; Sophocles, Aris; Ramakrishna, Harish; Ghadimi, Kamrouz; Patel, Prakash A; Augoustides, John G T

    2013-02-01

    Transcatheter aortic valve replacement (TAVR) is entering its second decade. Three major clinical challenges have emerged from the first decade of experience: vascular complications, stroke, and paravalvular leak (PVL). Major vascular complications remain common and independently predict major bleeding, transfusion, renal failure, and mortality. Although women are more prone to vascular complications, overall they have better survival than men. Further predictors of major vascular complications include heavily diseased femoral arteries and operator experience. Strategies to minimize vascular complications include a multimodal approach and sleeker delivery systems. Although cerebral embolism is very common during TAVR, it mostly is asymptomatic. Major stroke independently predicts prolonged recovery and increased mortality. Identified stroke predictors include functional disability, previous stroke, a transapical approach, and atrial fibrillation. Embolic protection devices are in development to mitigate the risk of embolic stroke after TAVR. PVL is common and significantly decreases survival. Undersizing of the valve prosthesis can be minimized with 3-dimensional imaging by computed tomography or echocardiography to describe the elliptic aortic annulus accurately. The formal grading of PVL severity in TAVR is based on its percentage of the circumferential extent of the aortic valve annulus. Further emerging management strategies for PVL include a repositionable valve prosthesis and transcatheter plugging. The first decade of TAVR has ushered in a new paradigm for the multidisciplinary management of valvular heart disease. The second decade likely will build on this wave of initial success with further significant innovations. PMID:23141627

  5. Removal of alpha-Gal epitopes from porcine aortic valve and pericardium using recombinant human alpha galactosidase A.

    PubMed

    Park, Seongsik; Kim, Woong-Han; Choi, Sun-Young; Kim, Yong-Jin

    2009-12-01

    It has been reported that the immune response due to alpha-Gal epitopes is an important factor in tissue valve failure. The elimination of the interaction between the natural anti-Gal antibodies and alpha-gal epitopes on the xenografts is a prerequisite to the success of xenografts in humans. Previously, we reported that the green coffee bean alpha-galactosidase could remove all alpha-Gal epitopes from cell surface of porcine aortic valve and pericardial tissue, but it has limitations on cost effectiveness. In this study we wanted to know whether the recently produced recombinant human alpha-galactosidase A has the same effective enzymatic activity as green coffee bean alpha-galactosidase in removing alpha-Gal epitopes from the same tissues. After treating fresh porcine aortic valve and pericardial tissue with recombinant alpha-galactosidase A, each sample was stained with Griffonia simplicifolia type I isolectin B4 indirect immunoperoxidase avidin-biotin technique. We then examined whether the alpha-Gal epitopes were reduced or abolished in each consecutive concentration of recombinant alpha-galactosidase A by comparing the degree of the Griffonia simplicifolia isolectin B4 staining. As a result, the recombinant alpha-galactosidase A could remove cell surface alpha-Gals on porcine aortic valve and pericardial tissue as effectively as green coffee bean alpha-galactosidase. PMID:19949670

  6. Successful pregnancy achieved by assisted reproductive techniques in a woman with severe congenital bicuspid aortic valve stenosis

    Microsoft Academic Search

    Cemal Tamer Erel; Sanli Erkan; Omer Yavuz Simsek; Serdar Kucukoglu

    2007-01-01

    Objectives  To report a twin pregnancy achieved by assisted reproductive techniques in a woman with severe congenital bicuspid aortic\\u000a valve stenosis.\\u000a \\u000a \\u000a \\u000a Methods  Intracytoplasmic sperm injection and embryo transfer was performed in a 38-year-old woman with a complaint of infertility\\u000a for 8 years due to male factor and who previously had the diagnosis of severe congenital bicuspid aortic stenosis. Clinical\\u000a and echocardiography follow-up during

  7. Aneurysmal aorto-left ventricular tunnel causing right ventricular outflow tract obstruction, associated with bicuspid aortic valve.

    PubMed

    Toganel, Rodica; Benedek, Theodora; Suteu, Carmen; Benedek, Imre

    2015-01-01

    We report the case of a newborn with an aneurysmal aorto-left ventricular tunnel causing significant paravalvular aortic regurgitation and obstruction of the right ventricular outflow tract (RVOT), coexisting with a bicuspid aortic valve. The coexistence of the two malformations together with the obstruction of the RVOT is very rare. In this case, the prompt diagnosis and surgery led to significant improvement of the clinical status and to recovery of the left ventricular function (increase of the ejection fraction from 21 to 41 %), underlining the importance of early diagnosis in this rare malformation. PMID:24252970

  8. Quantification of the aortic valve area in three-dimensional echocardiographic data sets: Analysis of orifice overestimation resulting from suboptimal cut-plane selection

    Microsoft Academic Search

    Jaroslaw D. Kasprzak; Youssef F. M. Nosir; Anita Dall'Agata; Abdou Elhendy; Meindert Taams; Folkert J. Ten Cate; Jos R. T. C. Roelandt

    1998-01-01

    Background: Our study was designed to determine the feasibility of three-dimensional echocardiographic (3DE) aortic valve area planimetry and to evaluate potential errors resulting from suboptimal imaging plane position. Methods and Results: Transesophageal echocardiography with acquisition of images for 3DE was performed in 27 patients. Aortic valve orifice was planimetered in two-dimensional echocardiograms (2DE) and in two-dimensional views reconstructed from 3DE

  9. Increased transcript level of poly(ADP-ribose) polymerase (PARP-1) in human tricuspid compared with bicuspid aortic valves correlates with the stenosis severity

    SciTech Connect

    Nagy, Edit, E-mail: edit.nagy@karolinska.se [Department of Medicine, Karolinska Institutet, Stockholm (Sweden) [Department of Medicine, Karolinska Institutet, Stockholm (Sweden); Department of Cardiology, Karolinska University Hospital, Stockholm (Sweden); Caidahl, Kenneth [Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (Sweden) [Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (Sweden); Department of Clinical Physiology, Karolinska University Hospital, Stockholm (Sweden); Franco-Cereceda, Anders [Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (Sweden) [Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (Sweden); Department of Throracic Surgery, Karolinska University Hospital, Stockholm (Sweden); Baeck, Magnus [Department of Medicine, Karolinska Institutet, Stockholm (Sweden) [Department of Medicine, Karolinska Institutet, Stockholm (Sweden); Department of Cardiology, Karolinska University Hospital, Stockholm (Sweden)

    2012-04-13

    Highlights: Black-Right-Pointing-Pointer Oxidative stress has been implicated in the pathomechanism of calcific aortic valve stenosis. Black-Right-Pointing-Pointer We assessed the transcript levels for PARP-1 (poly(ADP-ribose) polymerase), acts as a DNA damage nick sensor in stenotic valves. Black-Right-Pointing-Pointer Early stage of diseased tricuspid valves exhibited higher mRNA levels for PARP-1 compared to bicuspid valves. Black-Right-Pointing-Pointer The mRNA levels for PARP-1 inversely correlated with the clinical stenosis severity in tricuspid valves. Black-Right-Pointing-Pointer Our data demonstrated that DNA damage pathways might be associated with stenosis severity only in tricuspid valves. -- Abstract: Oxidative stress may contribute to the hemodynamic progression of aortic valve stenosis, and is associated with activation of the nuclear enzyme poly(ADP-ribose) polymerase (PARP) 1. The aim of the present study was to assess the transcriptional profile and the topological distribution of PARP-1 in human aortic valves, and its relation to the stenosis severity. Human stenotic aortic valves were obtained from 46 patients undergoing aortic valve replacement surgery and used for mRNA extraction followed by quantitative real-time PCR to correlate the PARP-1 expression levels with the non invasive hemodynamic parameters quantifying the stenosis severity. Primary isolated valvular interstitial cells (VICs) were used to explore the effects of cytokines and leukotriene C{sub 4} (LTC{sub 4}) on valvular PARP-1 expression. The thickened areas of stenotic valves with tricuspid morphology expressed significantly higher levels of PARP-1 mRNA compared with the corresponding part of bicuspid valves (0.501 vs 0.243, P = 0.01). Furthermore, the quantitative gene expression levels of PARP-1 were inversely correlated with the aortic valve area (AVA) (r = -0.46, P = 0.0469) and AVA indexed for body surface area (BSA) (r = -0.498; P = 0.0298) only in tricuspid aortic valves. LTC{sub 4} (1 nM) significantly elevated the mRNA levels of PARP-1 by 2.38-fold in VICs. Taken together, these data suggest that valvular DNA-damage pathways may be associated with inflammation and the stenosis severity in tricuspid aortic valves.

  10. Distant downstream steady-state flow studies of a mechanical heart valve: PIV study of secondary flow in a model aortic arch

    NASA Astrophysics Data System (ADS)

    Fix, Brandon R.; Popma, Christopher J.; Bulusu, Kartik V.; Plesniak, Michael W.

    2013-11-01

    Each year, hundreds of thousands of aortic and mitral heart valves are replaced with prosthetic valves. In efforts to develop a valve that does not require lifelong anticoagulation therapy, previous experimental research has been devoted to analyzing the hemodynamics of various heart valve designs, limited to the flow up to only 2 diameters downstream of the valve. Two-component, two-dimensional (2C-2D) particle image velocimetry (PIV) was used in this study to examine secondary flow velocity fields in a curved tube modeling an aorta at five locations (0-, 45-, 90-, 135-, 180-degrees). A bileaflet valve, opened to 30-, 45-, and 59-degrees, and one (no-valve) baseline condition were examined under three steady flow inflows (Re = 218, 429, 634). In particular, variations in the two-dimensional turbulent shear stresses at each cross sectional plane were analyzed. The results suggest that bileaflet valves in the aortic model produce significant turbulence and vorticity up to 5.5 downstream diameters, i.e. up to the 90-degrees location. Expanding this research towards aortic heart valve hemodynamics highlights a need for additional studies extending beyond the typical few diameters downstream to fully characterize valvular function. Each year, hundreds of thousands of aortic and mitral heart valves are replaced with prosthetic valves. In efforts to develop a valve that does not require lifelong anticoagulation therapy, previous experimental research has been devoted to analyzing the hemodynamics of various heart valve designs, limited to the flow up to only 2 diameters downstream of the valve. Two-component, two-dimensional (2C-2D) particle image velocimetry (PIV) was used in this study to examine secondary flow velocity fields in a curved tube modeling an aorta at five locations (0-, 45-, 90-, 135-, 180-degrees). A bileaflet valve, opened to 30-, 45-, and 59-degrees, and one (no-valve) baseline condition were examined under three steady flow inflows (Re = 218, 429, 634). In particular, variations in the two-dimensional turbulent shear stresses at each cross sectional plane were analyzed. The results suggest that bileaflet valves in the aortic model produce significant turbulence and vorticity up to 5.5 downstream diameters, i.e. up to the 90-degrees location. Expanding this research towards aortic heart valve hemodynamics highlights a need for additional studies extending beyond the typical few diameters downstream to fully characterize valvular function. Supported by the NSF Grant No. CBET- 0828903 and GW Center for Biomimetics and Bioinspired Engineering.

  11. Morphological and chemical study of pathological deposits in human aortic and mitral valve stenosis: a biomineralogical contribution.

    PubMed

    Cottignoli, Valentina; Cavarretta, Elena; Salvador, Loris; Valfré, Carlo; Maras, Adriana

    2015-01-01

    Aim of this study was to investigate heart valve calcification process by different biomineralogical techniques to provide morphological and chemical features of the ectopic deposit extracted from patients with severe mitral and aortic valve stenosis, to better evaluate this pathological process. Polarized light microscopy and scanning electron microscopy analyses brought to light the presence of nodular and massive mineralization forms characterized by different levels of calcification, as well as the presence of submicrometric calcified globular cluster, micrometric cavities containing disorganized tissue structures, and submillimeter pockets formed by organic fibers very similar to amyloid formations. Electron microprobe analyses showed variable concentrations of Ca and P within each deposit and the highest content of Ca and P within calcified tricuspid aortic valves, while powder X-ray diffraction analyses indicated in the nanometer range the dimension of the pathological bioapatite crystals. These findings indicated the presence of highly heterogeneous deposits within heart valve tissues and suggested a progressive maturation process with continuous changes in the composition of the valvular tissue, similar to the multistep formation process of bone tissue. Moreover the micrometric cavities represent structural stages of the valve tissue that immediately precedes the formation of heavily mineralized deposits such as bone-like nodules. PMID:25685595

  12. [Monodimensional echographic study of echogenic masses in the left ventricular outflow tract in aortic valve insufficiencies. Apropos 5 cases].

    PubMed

    Schmitt, R; Grinneiser, D; Bourlon, F; Sabatier, M; Elbeze, J P

    1982-03-01

    The presence of a mass in the left ventricular outflow tract is often a sign of severe pathology. The authors report 4 cases illustrating this echocardiographic diagnosis. In bacterial or mycotic endocarditis these masses suggest either aortic valve vegetations or prolapse of an aortic cusp. Two causes may be observed in patients with aortic bioprostheses: paravalvular leak with rocking of the sewing ring and destruction of the bioprosthetic cusps. In the 4 cases presented hemodynamic and angiographic investigations were contra indicated because of the risk of embolism of bacterial vegetations. Echocardiography gave precise diagnosis of the causal disease process and led to early surgical cure. Correlations between the anatomical and echocardiographic appearances are described and discussed. PMID:6807243

  13. An isolated left common carotid artery from the main pulmonary artery in a neonate with aortic valve atresia.

    PubMed

    Ahmadi, Alireza; Sabri, Mohammadreza; Dehghan, Bahar

    2015-08-01

    A 20-day-old girl was referred to our clinic for systolic murmur, cyanosis, and dyspnoea with feeding. Echocardiography revealed an atretic aortic valve. CT angiography scan revealed that the left common carotid artery originated from the distal main pulmonary artery. The plan was patent ductus artriosus stenting and bilateral pulmonary artery banding and then follow-up for any possible future intervention. PMID:25928632

  14. Design and Validation of a Novel Bioreactor to Subject Aortic Valve Leaflets to Side-Specific Shear Stress

    Microsoft Academic Search

    Ling Sun; Nalini M. Rajamannan; Philippe Sucosky

    2011-01-01

    Hemodynamic stresses are presumed to play an important role in the development of calcific aortic valve disease (CAVD). The\\u000a elucidation of the shear stress mechanisms involved in the pathogenesis of CAVD has been hampered by the complexity of the\\u000a native unsteady and side-specific valvular flow environment. To address this gap, this article describes the design and validation\\u000a of a novel

  15. Closed bore XMR (CBXMR) systems for aortic valve replacement: Investigation of rotating-anode x-ray tube heat loadability

    Microsoft Academic Search

    John A. Bracken; Prasheel V. Lillaney; Rebecca Fahrig; J. A. Rowlands

    2008-01-01

    In order to improve the safety and efficacy of percutaneous aortic valve replacement procedures, a closed bore hybrid x-ray\\/MRI (CBXMR) system is proposed in which an x-ray C-arm will be positioned with its isocenter 1 m from the entrance of a clinical MRI scanner. This system will harness the complementary strengths of both modalities to improve clinical outcome. A key

  16. Effects of shear stress pattern and magnitude on mesenchymal transformation and invasion of aortic valve endothelial cells.

    PubMed

    Mahler, Gretchen J; Frendl, Christopher M; Cao, Qingfeng; Butcher, Jonathan T

    2014-11-01

    Understanding the role of mechanical forces on cell behavior is critical for tissue engineering, regenerative medicine, and disease initiation studies. Current hemodynamic bioreactors are largely limited to 2D substrates or the application of general flow conditions at a tissue level, which eliminates the investigation of some essential physiological and pathological responses. One example is the mesenchymal transformation of endothelial cells in response to shear stress. Endothelial to mesenchymal transformation (EndMT) is a valve morphogenic mechanism associated with aortic valve disease initiation. The aortic valve experiences oscillatory shear on the disease-susceptible fibrosa, and the role of hemodynamics on adult EndMT is unknown. The goal of this work was to develop and characterize a microfluidic bioreactor that applies physiologically relevant laminar or oscillatory shear stresses to endothelial cells and permits the quantitative analysis of 3D cell-extracellular matrix (ECM) interactions. In this study, porcine aortic valve endothelial cells were seeded onto 3D collagen I gels and exposed to different magnitudes of steady or oscillatory shear stress for 48?h. Cells elongated and aligned perpendicular to laminar, but not oscillatory shear. Low steady shear stress (2?dyne/cm(2) ) and oscillatory shear stress upregulated EndMT (ACTA2, Snail, TGFB1) and inflammation (ICAM1, NFKB1) related gene expression, EndMT-related (?SMA) protein expression, and matrix invasion when compared with static controls or cells exposed to high steady shear (10 and 20?dyne/cm(2) ). Our system enables direct testing of the role of shear stress on endothelial cell mesenchymal transformation in a dynamic, 3D environment and shows that hemodynamics regulate EndMT in adult valve endothelial cells. PMID:24898772

  17. [Severe aortic incompetence from dysplasia of the valve. A report on 19 cases of this real but often unrecognized disorder (author's transl)].

    PubMed

    Acar, J; Laudet, J; Belkaid, M; Ricoux, M; Jallut, H

    1979-01-01

    A total of 19 patients were found to have severe aortic incompetence from dysplasia of the valve (thin, spread-out valves having a tendency towards eversion). This type of valve abnormality is often unrecognized but is found in 13,6% of cases of severe aortic incompetence. The relationship between this condition and Marfan's syndrome or its aberrant forms are discussed, as well as its frequency when unrelated to this disease. The dysplasias can be isolated phenomena or associated with pathological conditions of the ascending aorta. The results of this review suggest that some of these dysplasias might be rheumatic in origin. PMID:484988

  18. Echocardiographic evaluation of myocardial strain in patients after transcatheter aortic valve implantation

    PubMed Central

    Kusz, Blazej; Mizia, Magdalena; Lelek, Michal; Turski, Maciej; Wita, Krystian; Ocha?a, Andrzej; Mizia-Stec, Katarzyna

    2015-01-01

    Introduction Echocardiographic evaluation of regional myocardial function helps to assess the efficacy of therapeutic interventions and to predict the prognosis and clinical outcomes. Aim To assess whether myocardial strain can be useful in estimation of left ventricle (LV) function in patients who have undergone transcatheter aortic valve implantation (TAVI). Material and methods Twenty-six patients with severe aortic stenosis, who successfully underwent TAVI, were enrolled in the study. Left ventricular peak systolic longitudinal strain (LV PSLS) was obtained before and 1 year after the procedure. Analysis included the potent influence of factors such as sex, LV ejection fraction (LVEF), type of prosthesis implanted or the type of the approach on LV PSLS values. Results We observed a significant improvement in LV PSLS values after TAVI (–10.9 ±5.7 vs. –13.4 ±4.7, p < 0.05). Men had better improvement in LV PSLS after TAVI, but their starting values were considerably lower (M: –10.7 ±4.5 before vs. –13.3 ±4.9 after, p < 0.05; W: –11.8 ±6.8 before vs. –11.9 ±5.6 after, p = NS). Patients with starting LVEF ? 40% benefited from the procedure (LV PSLS: –10.3 ±6.4 before vs. –13.7 ±2.9 after, p < 0.05), but in the group of patients with the higher starting LVEF no significant changes in LV PSLS were observed. We also did not note any differences in LV PSLS depending on type of the prosthesis implemented (Edwards Sapiens/CoreValve). Patients in whom the prostheses were implemented via the femoral approach only presented significant increase in LV PSLS values (before: –10.4 ±6.7 vs. after: –13.6 ±3.7, p < 0.05). Conclusions The TAVI results in improvement of LV systolic function according to LV PSLS values. Some factors, especially lower baseline LVEF, are related to increased benefit in LV PSLS after TAVI. PMID:26161100

  19. Timing of staged percutaneous coronary intervention before transcatheter aortic valve implantation.

    PubMed

    van Rosendael, Philippe J; van der Kley, Frank; Kamperidis, Vasileios; Katsanos, Spyridon; Al Amri, Ibtihal; Regeer, Madelien; Schalij, Martin J; Ajmone Marsan, Nina; Bax, Jeroen J; Delgado, Victoria

    2015-06-15

    Significant coronary artery disease is highly prevalent in patients who underwent transcatheter aortic valve implantation (TAVI). Timing of staged percutaneous coronary intervention (PCI) in TAVI candidates remains debated. The present study assessed the impact of timing of the staged PCI on TAVI outcomes. Ninety-six patients (age 81 ± 5 years, 57% men) who had undergone staged PCI within 1 year before TAVI were included. The population was dichotomized according to the median time elapsed between PCI and TAVI (<30 and ?30 days). Inhospital events and 30-day outcomes after TAVI were defined according to Valve Academic Research Consortium-2 definitions. Forty-eight patients underwent PCI <30 days and 48 patients underwent PCI ?30 days before TAVI. Patients treated with PCI <30 days had lower hemoglobin levels at baseline (7.2 ± 0.9 mmol/L vs 7.9 ± 0.9 mmol/L, p = 0.002), more frequently atrial fibrillation (27% vs 13%, p = 0.018), and a shorter time interval between computed tomography acquisition and TAVI (7 days [2 to 10] vs 22 days [6 to 39], p <0.001) than their counterparts. Minor bleedings (13% vs 0%, p = 0.011) and overall vascular injury (27% vs 8%, p = 0.016 [minor injury: 17% vs 2%, p = 0.014; major injury: 10% vs 6%, p = 0.460]) were more frequently recorded in patients with staged PCI <30 days before TAVI. There were no differences in the incidence of other events and in 2-year survival. In conclusion, shortly (<30 days) or remote (?30 days) staged PCI before TAVI resulted in comparable outcomes with the exception of minor vascular injury and minor bleeding events which were more frequently observed in patients treated with shortly staged PCI. PMID:25890631

  20. Iatrogenic Aortic Insufficiency Following Mitral Valve Replacement: Case Report and Review of the Literature

    PubMed Central

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-01-01

    We report a 28-year-old white female who suffered significant aortic insufficiency (AI) following mitral valve (MV) replacement for endocarditis. The patient had history of rheumatoid arthritis and presented to our emergency department with a 3-month history of dyspnea, orthopnea, fevers and weight loss, worsening over 2 weeks, for which she took intermittent acetaminophen. On admission, vital signs revealed blood pressure of 99/70 mm Hg, heart rate of 120 beats/minute, and temperature of 98.8 °F; her weight was 100 lbs. Physical exam revealed a thin and pale female. Cardiac auscultation revealed regular tachycardic rhythm with a third heart sound, and a short early systolic murmur at the left lower sternal border without radiation. Lungs revealed right lower lobe rhonchi. Initial pertinent laboratory evaluation revealed hemoglobin 9.6 g/dL and white blood cell count 17,500/?L. Renal function was normal, and hepatic enzymes were mildly elevated. Chest radiogram revealed right lower lobe infiltrate. Blood cultures revealed Enterococcus faecalis. Two-dimensional echocardiogram revealed large multilobed vegetation attached to the anterior MV leaflet with severe mitral regurgitation (MR), otherwise normal left ventricular systolic function. She was started on appropriate antibiotics and underwent MV replacement with 25-mm On-X prosthesis. She was noted post-operatively to have prominent systolic and diastolic murmurs. Repeat echocardiogram revealed normal mitral prosthesis function, with new moderately severe AI. Transesophageal echocardiogram revealed AI originating from a tethered non-coronary cusp, due to a suture preventing proper cusp mobility. The patient declined further surgery. She recovered slowly and was discharged to inpatient rehabilitation 4 weeks later. This case highlights the importance of vigilance to this potential serious complication of valve surgery with regard to diagnosis and treatment to prevent long-term adverse consequences. PMID:25883714

  1. Iatrogenic aortic insufficiency following mitral valve replacement: case report and review of the literature.

    PubMed

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-06-01

    We report a 28-year-old white female who suffered significant aortic insufficiency (AI) following mitral valve (MV) replacement for endocarditis. The patient had history of rheumatoid arthritis and presented to our emergency department with a 3-month history of dyspnea, orthopnea, fevers and weight loss, worsening over 2 weeks, for which she took intermittent acetaminophen. On admission, vital signs revealed blood pressure of 99/70 mm Hg, heart rate of 120 beats/minute, and temperature of 98.8 °F; her weight was 100 lbs. Physical exam revealed a thin and pale female. Cardiac auscultation revealed regular tachycardic rhythm with a third heart sound, and a short early systolic murmur at the left lower sternal border without radiation. Lungs revealed right lower lobe rhonchi. Initial pertinent laboratory evaluation revealed hemoglobin 9.6 g/dL and white blood cell count 17,500/?L. Renal function was normal, and hepatic enzymes were mildly elevated. Chest radiogram revealed right lower lobe infiltrate. Blood cultures revealed Enterococcus faecalis. Two-dimensional echocardiogram revealed large multilobed vegetation attached to the anterior MV leaflet with severe mitral regurgitation (MR), otherwise normal left ventricular systolic function. She was started on appropriate antibiotics and underwent MV replacement with 25-mm On-X prosthesis. She was noted post-operatively to have prominent systolic and diastolic murmurs. Repeat echocardiogram revealed normal mitral prosthesis function, with new moderately severe AI. Transesophageal echocardiogram revealed AI originating from a tethered non-coronary cusp, due to a suture preventing proper cusp mobility. The patient declined further surgery. She recovered slowly and was discharged to inpatient rehabilitation 4 weeks later. This case highlights the importance of vigilance to this potential serious complication of valve surgery with regard to diagnosis and treatment to prevent long-term adverse consequences. PMID:25883714

  2. Meta-analysis of comparison between self-expandable and balloon-expandable valves for patients having transcatheter aortic valve implantation.

    PubMed

    Moretti, Claudio; D'Ascenzo, Fabrizio; Mennuni, Marco; Taha, Salma; Brambilla, Nedy; Nijhoff, Freek; Fraccaro, Chiara; Barbanti, Marco; Tamburino, Corrado; Tarantini, Giuseppe; Rossi, Marco L; Presbitero, Patrizia; Napodanno, Massimo; Stella, Pieter; Bedogni, Francesco; Omedè, Pierluigi; Conrotto, Federico; Montefusco, Antonio; Giordana, Francesca; Biondi Zoccai, Giuseppe; Agostoni, Piefrancesco; D'Amico, Maurizio; Rinaldi, Mauro; Marra, Sebastiano; Gaita, Fiorenzo

    2015-06-15

    Two different devices, 1 self-expanding and 1 balloon-expandable, have been developed for patients who underwent transcatheter aortic valve implantation with contrasting data about efficacy and safety. Pubmed, Medline, and Google Scholar were systematically searched for studies of these different devices, with data derived from randomized controlled trial or registries with multivariate analysis. All-cause death at 30 days and at follow-up were the primary end points, whereas postprocedural moderate or severe aortic regurgitation (AR), stroke, major vascular complications, bleedings, and pacemaker implantation the secondary ones. Six studies with 957 self-expanding and 947 balloon-expandable valves were included: 1 randomized controlled trial and 5 observational studies. At 30 days follow-up, rates of death did not differ between self-expanding and balloon-expandable valves (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.47 to 1.17), whereas balloon expandable reduced rates of moderate or severe AR (OR 0.51, 95% CI 0.27 to 0.99) and of pacemaker implantation (OR 0.28, 95% CI 0.17 to 0.47). After a follow-up of 360 days (300 to 390), rates of all-cause death did not differ between the 2 groups. In conclusion, risks of moderate or severe AR and pacemaker implantation were lower with the balloon-expandable devices without an impact on 30 days and midterm mortality. PMID:25890630

  3. Severe Left Atrioventricular Valve Regurgitation Due to Discontinuity between the Leaflets of the Aortic and Left Atrioventricular Valves in a Patient with Endocardial Cushion Defect: A Rare Case Report.

    PubMed

    Nabati, Maryam; Habibi, Valiolla; Soleimani, Aria; Shokri, Mojtaba

    2015-06-01

    Discontinuities between the leaflets of the aortic and left atrioventricular valves are uncommon congenital malformations. The anomaly may be discovered during surgery without preoperative diagnosis. It represents a spectrum of anomalies that result from interruption of the normal development of the endocardial cushions during the fetal life. We describe a rare case of Down syndrome with transient complete atrioventricular block and discontinuity between the leaflets of the aortic and left atrioventricular valves without intervening fibrous band, leading to separation and detachment between them. It caused severe eccentric jet of regurgitation originated from left ventricular outflow tract and base of anterior leaflet of left atrioventricular valve into the left atrium. He underwent cardiopulmonary bypass, and the defect between left atrioventricular valve and aortic annuli was sewn. Permanent epicardial pacing was inserted during cardiac surgery. To the best of our knowledge, such a case has not been previously reported in the literature. PMID:25483555

  4. Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.

    PubMed

    Ussia, Gian Paolo; Scarabelli, Marilena; Mulè, Massimiliano; Barbanti, Marco; Sarkar, Kunal; Cammalleri, Valeria; Immè, Sebastiano; Aruta, Patrizia; Pistritto, Anna Maria; Gulino, Simona; Deste, Wanda; Capodanno, Davide; Tamburino, Corrado

    2011-12-15

    Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve implantation (TAVI), but this approach is not evidence based. The goal of the present study was to determine whether DAPT in patients undergoing TAVI is associated with improved outcomes compared to aspirin alone. From May 2009 to August 2010, consecutive patients were randomized to receive a 300-mg loading dose of clopidogrel on the day before TAVI followed by a 3-month maintenance daily dose of 75 mg plus aspirin 100 mg lifelong (DAPT group) or aspirin 100 mg alone (ASA group). The primary end point was the composite of major adverse cardiac and cerebrovascular events, defined as death from any cause, myocardial infarction, major stroke, urgent or emergency conversion to surgery, or life-threatening bleeding. The cumulative incidence of major adverse cardiac and cerebrovascular events at 30 days and 6 months was 14% and 16%, respectively. No significant differences between the DAPT and ASA groups were noted at both 30 days (13% vs 15%, p = 0.71) and 6 months (18% vs 15%; p = 0.85). In conclusion, the strategy of adding clopidogrel to aspirin for 3 months after TAVI was not found to be superior to aspirin alone. These results must be confirmed in a larger randomized trial. PMID:21907949

  5. Traveling for care: inter-regional mobility for aortic valve substitution in Italy.

    PubMed

    Fattore, Giovanni; Petrarca, Giuseppina; Torbica, Aleksandra

    2014-07-01

    Patient flows across the regions of the Italian National Health Service can shed light on patient mobility, including cross-border flows within the European Union. We used 2009 data on 11,531 NHS admissions for aortic valve replacement operations to measure the extent of inter-regional patient mobility and to determine whether resident and non-resident patients differ. We also investigated whether public and private hospitals behave differently in terms of attracting patients. For this major cardio-surgical intervention, patient mobility in Italy is substantial (13.6% of total admissions). Such mobility mainly involves patients moving from southern to northern regions, which often requires several hundred kilometers of travel and a transfer of financial resources from poorer to richer regions. Patients admitted in the regions where they reside are older than those admitted outside their regions (69.2 versus 65.6, p<0.0001), and stay in hospital approximately 0.7 days longer (14.7 versus 14.0, p=0.017). Compared to public hospitals, private hospitals are more likely to admit non-resident patients (OR between 2.1 and 4.4). The extent and direction of patients' mobility raise equity concerns, as receiving care in locations that are distant from home requires substantial financial and relational resources. PMID:24726508

  6. Simulation of Exercise-Induced Syncope in a Heart Model with Severe Aortic Valve Stenosis

    PubMed Central

    Sever, Matjaž; Ribari?, Samo; Kordaš, Marjan

    2012-01-01

    Severe aortic valve stenosis (AVS) can cause an exercise-induced reflex syncope (RS). The precise mechanism of this syncope is not known. The changes in hemodynamics are variable, including arrhythmias and myocardial ischemia, and one of the few consistent changes is a sudden fall in systemic and pulmonary arterial pressures (suggesting a reduced vascular resistance) followed by a decline in heart rate. The contribution of the cardioinhibitory and vasodepressor components of the RS to hemodynamics was evaluated by a computer model. This lumped-parameter computer simulation was based on equivalent electronic circuits (EECs) that reflect the hemodynamic conditions of a heart with severe AVS and a concomitantly decreased contractility as a long-term detrimental consequence of compensatory left ventricular hypertrophy. In addition, the EECs model simulated the resetting of the sympathetic nervous tone in the heart and systemic circuit during exercise and exercise-induced syncope, the fluctuating intra-thoracic pressure during respiration, and the passive relaxation of ventricle during diastole. The results of this simulation were consistent with the published case reports of exertional syncope in patients with AVS. The value of the EEC model is its ability to quantify the effect of a selective and gradable change in heart rate, ventricular contractility, or systemic vascular resistance on the hemodynamics during an exertional syncope in patients with severe AVS. PMID:23251225

  7. Early and late improvement of global and regional left ventricular function after transcatheter aortic valve implantation in patients with severe aortic stenosis: an echocardiographic study.

    PubMed

    Giannini, Cristina; Petronio, Anna Sonia; Talini, Enrica; De Carlo, Marco; Guarracino, Fabio; Grazia, Maria; Donne, Delle; Nardi, Carmela; Conte, Lorenzo; Barletta, Valentina; Marzilli, Mario; Di Bello, Vitantonio

    2011-01-01

    The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm(2)/m(2); p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings. PMID:22254204

  8. Early and late improvement of global and regional left ventricular function after transcatheter aortic valve implantation in patients with severe aortic stenosis: an echocardiographic study

    PubMed Central

    Giannini, Cristina; Petronio, Anna Sonia; Talini, Enrica; De Carlo, Marco; Guarracino, Fabio; Grazia, Maria; Donne, Delle; Nardi, Carmela; Conte, Lorenzo; Barletta, Valentina; Marzilli, Mario; Di Bello, Vitantonio

    2011-01-01

    The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm2/m2; p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings. PMID:22254204

  9. Transcatheter aortic valve replacement: establishing a comprehensive program model for hybrid cardiac catheterization laboratories in the Department of Veterans Affairs.

    PubMed

    Speiser, Bernadette; Dutra-Brice, Cynthia

    2014-01-01

    Aortic valve disease, especially aortic stenosis, becomes progressively debilitating and carries a high mortality risk if it is categorized as severe and symptomatic (J Thorac Cardiovas Surg. 2012;144(3):e29-e84). In the past, the only treatment for aortic stenosis was surgical aortic valve replacement. Surgical treatment may require several hours of cardioplegia, and if the patient has comorbidities, such as renal failure or chronic obstructive pulmonary disease, their operative mortality percentage increases.In 2011, the US Food and Drug Administration approved the use of a transcatheter aortic valve replacement (TAVR) procedure for patients who were deemed high risk or inoperative for the routine surgical aortic valve replacement surgery. More than 20,?000 TAVRs have been performed in patients worldwide since 2002 when Dr Alain Cribier performed the first-in-man TAVR (Arch Cardiovasc Dis. 2012;105(3):145-152). The Edwards Lifesciences SAPIEN XT valve and the Medtronic CoreValve are commercially available.The clinical findings and economic statistic have supported the expansion of the TAVR procedure. However, there has been considerable controversy over where the procedure is to occur and who is directly responsible for directing the TAVR care. This debate has identified barriers to the implementation of a TAVR program. The operating rooms and a cardiac catheterization laboratory are underprepared for the hybrid valve replacement therapy. Because of the barriers identified, the Department of Veterans Affairs determined a need for a systematic approach to review the programs that applied for this structural heart disease program. A centralized team was developed to ensure room readiness and staff competency. The use of the Health Failure Mode and Effects Analysis can define high-risk clinical processes and conduct a hazard analysis. Worksheets can show potential failure modes and their probabilities, along with actions and outcome measures, team collaboration, extensive screening, and selection process. The TAVR program begins implementation with data entry with each case into CART-CL (Cardiovascular Assessment, Reporting and Tracking System for Cath Labs, Veteran Administration database for interventional cardiology procedures). If an untoward event occurs, within 24 hours the CART-CL Quality Assessment Team is activated to begin the review process. This provides real-time review and feedback to the local facility in an expeditious manner. Cardiac catheterization laboratories have been inundated with rapidly changing technological advances in the past decade. The era for structural heart repair is rapidly mobilizing from a surgical/operating room setting to a transcatheter/hybrid catheterization laboratory suite. The use of the new hybrid catheterization laboratories will continue to expand as the approval of future transcatheter therapies evolve. Editor's note: Due to the volume of important information presented in each table, only the first table is included in the print version of the article, however, all tables may be viewed in their entirety free of charge on the online version of this article: http://journals.lww.com/dccnjournal/pages/default.aspx. PMID:25144213

  10. Comparison of outcomes after one-versus-two transcatheter aortic valve implantation during a same procedure (from the FRANCE2 Registry).

    PubMed

    Clerfond, Guillaume; Pereira, Bruno; Innorta, Andrea; Motreff, Pascal; Gilard, Martine; Laskar, Marc; Eltchaninoff, Helene; Iung, Bernard; Leprince, Pascal; Teiger, Emmanuel; Chevreul, Karine; Prat, Alain; Lievre, Michel; Leguerrier, Alain; Donzeau-Gouge, Patrick; Fajadet, Jean; Souteyrand, Géraud

    2015-05-01

    Analysis of the causes, outcomes, and mortality of patients with severe symptomatic aortic stenosis requiring the implantation of 2 valves during transcatheter aortic valve implantation was conducted from the French Aortic National CoreValve and Edwards 2 (FRANCE2) registry. Pre- and postprocedural data from 3,919 patients from January 2010 to December 2011 (CoreValve or Edwards) were collated and analyzed. Characteristics of patients requiring immediate second valve procedures were compared with those of the other patients. The 72 patients (1.8%) who underwent implantation of a second valve were studied. Indications were device malpositioning (72%) and embolization (28%). Clinical and echocardiographic characteristics of patients receiving 2 valves were comparable with those of the other patients. The 2-year survival rate was 51.7% for patients with 2 valves as opposed to 62.3% for those with 1 valve (p<0.001). The need for a second valve was an independent predictor of all-cause (hazard ratio 2.32, 95% confidence interval 1.50 to 3.60, p<0.001) and cardiovascular (hazard ratio 2.64, 95% confidence interval 1.35 to 5.15, p<0.001) mortality at 2 years. During follow-up, clinical and echocardiographic data remained similar between the 2 groups. In conclusion, in the FRANCE2 study, the main causes for second valve implantation during the same procedure were malpositioning and embolization. Although the procedure was feasible, it was accompanied by excess mortality. Valve hemodynamic status was preserved during the course of follow-up. PMID:25791239

  11. Beating Heart Mitral Valve Replacement Surgery without Aortic Cross-Clamping via Right Thoracotomy in a Patient with Compromised Left Ventricular Functions

    PubMed Central

    Durukan, Ahmet Baris; Gurbuz, Hasan Alper; Tavlasoglu, Murat; Ucar, Halil Ibrahim; Yorgancioglu, Cem

    2015-01-01

    Abstract Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous.

  12. On the Biomechanical Role of Glycosaminoglycans in the Aortic Heart Valve Leaflet

    PubMed Central

    Eckert, Chad E.; Fan, Rong; Mikulis, Brandon; Barron, Mathew; Carruthers, Christopher A.; Friebe, Vincent M.; Vyavahare, Naren R.; Sacks, Michael S.

    2012-01-01

    While the role of collagen and elastin fibrous components in heart valve valvular biomechanics has been extensively investigated [see Sacks et al. 2009 J. Biomech. 42, 1804-24], the biomechanical role of the glycosaminoglycan (GAG) gelatinous-like material phase remains unclear. In the present study, we investigated the biomechanical role of GAGs in porcine aortic valve (AV) leaflets under tension utilizing enzymatic removal. Tissue specimens were removed from the belly region of porcine AVs and subsequently treated with either an enzyme solution for GAG removal, or a control (buffer with no enzyme) solution. A dual stress level test methodology was used to determine the effects at low and high (physiological) stress levels). In addition, planar biaxial tests were conducted both on-axis (i.e. aligned to the circumferential and radial axes) and at 45° off-axis to induce maximum shear, to explore the effects of augmented fiber rotations on the fiber-fiber interactions. Changes in hysteresis were used as the primary metric of GAG functional assessment. A simulation of the low force experimental setup was also conducted to clarify the internal stress system and provide viscoelastic model parameters fo this loading range. Results indicated that under planar tension the removal of GAGs had no measureable affect extensional mechanical properties (either on- or 45° off-axis) including peak stretch, hysteresis, or creep. Interestingly, in the low force range, hysteresis was markedly reduced from 35.96 ± 2.65% in control group to 25.00 ± 1.64% (p < 0.001) as a result of GAG removal. Collectively, these results suggest that GAGs do not play a direct role in modulating the time-dependent tensile properties of valvular tissues. Rather, they appear to be strongly connected with fiber-fiber and fiber-matrix interactions at low forces levels. Thus, we speculate that GAGs may be important in providing a damping mechanism to reduce leaflet flutter when the leaflet is not under high tensile stress. PMID:23036945

  13. Long-Term Results of Balloon Valvuloplasty as Primary Treatment for Congenital Aortic Valve Stenosis: a 20-Year Review.

    PubMed

    Soulatges, Camille; Momeni, Mona; Zarrouk, Nadia; Moniotte, Stéphane; Carbonez, Karlien; Barrea, Catherine; Rubay, Jean; Poncelet, Alain; Sluysmans, Thierry

    2015-08-01

    In the presence of new surgical techniques, the treatment of congenital valvular aortic stenosis is under debate. We reviewed the results and late outcomes of all 93 patients aged 1 day to 18 years, treated with balloon valvuloplasty (BAV) as first-line therapy for congenital aortic valve stenosis in our center from January 1991 to May 2012. Mean age at procedure time was 2.4 years; 37 patients underwent BAV at age ?30 days (neonates), 29 patients at age ?1 month and <1 year (infants), and 27 patients were older than 1 year (children). The invasive BAV peak-to-peak aortic valve gradient (mean 59 ± 22 mmHg) was immediately reduced (mean 24 ± 12 mmHg). The observed diminution of gradient was similar for each age group. Four patients had significant post-BAV AI. Mean follow-up after BAV was 11.4 ± 7 years. The last echo peak aortic gradient was 37 ± 18 mmHg and mean gradient was 23 ± 10 mmHg, and two patients had significant AI. Actuarial survival for the whole cohort was 88.2 and 72.9 % for the neonates. All infants, except one, and all children survived. Sixty-six percent of patients were free from surgery, and 58 % were free from any reintervention, with no difference according to age. Freedom from surgery after BAV at 5, 10, and 20 years, respectively, was 82, 72, and 66 %. Our study confirms that BAV as primary treatment for congenital AS is an efficient and low-risk procedure in infants and children. In neonates, the prognosis is more severe and clearly related to "borderline LV." PMID:25788411

  14. Prognostic significance of valvuloarterial impedance and left ventricular longitudinal function in asymptomatic severe aortic stenosis involving three-cuspid valves.

    PubMed

    Zito, Concetta; Salvia, Josephal; Cusmà-Piccione, Maurizio; Antonini-Canterin, Francesco; Lentini, Salvatore; Oreto, Giuseppe; Di Bella, Gianluca; Montericcio, Vincenzo; Carerj, Scipione

    2011-11-15

    The purpose of the present study was to evaluate the role of left ventricular global afterload and various echocardiographic parameters of systolic function in a prospective cohort of 52 asymptomatic patients with severe aortic stenosis (indexed aortic valve area 0.4 ± 0.1 cm²/m²) and normal left ventricular ejection fraction (61 ± 5%). Using 2-dimensional speckle tracking echocardiography, myocardial strain, rotation, and twist were evaluated. The valvuloarterial impedance (Zva) was calculated as a measure of left ventricular global afterload. The predefined end points were the occurrence of symptoms (dyspnea, angina, syncope), aortic valve replacement, and death. At study entry, all patients had decreased longitudinal strain (LS) (-15 ± 4%) and increased circumferential strain (-22 ± 5%), twist (24 ± 7°), and Zva (5.8 ± 2 mm Hg/ml/m²). Increased Zva was closely associated with the circumferential strain increase (r = 0.59, p = 0.02) and LS decrease (r = -0.56, p = 0.016). In contrast, no relation was found between myocardial function and transaortic gradients. During follow-up (11 ± 7.5 months), on univariate Cox regression analysis, the predictors of events were the left ventricular ejection fraction (p = 0.02), mass index (p = 0.01), LS (p < 0.0001), radial strain (p = 0.04), and Zva (p = 0.0002). On multivariate Cox regression analysis, only the global LS (p = 0.03) and Zva (p = 0.03) were independently associated with the combined end point. Using receiver operating characteristic curve analysis, a LS of ?-18% (sensitivity 96%, specificity 73%) and a Zva of ? 4.7 mm Hg/ml/m² (sensitivity 100%, specificity 91%) were identified as the best cutoff values to be associated with events. In conclusion, in asymptomatic patients with severe aortic stenosis, the degree of global afterload and its consequences on longitudinal function might play a role in clinical practice. PMID:21872194

  15. Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

    PubMed Central

    Zanettini, Renzo; Gatto, Gemma; Mori, Ileana; Pozzoni, Maria Beatrice; Pelenghi, Stefano; Martinelli, Luigi; Klugmann, Silvio

    2014-01-01

    Background Evaluation of patient outcomes following transcatheter aortic valve implantation (TAVI) has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic activities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be transferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at discharge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days (range: 192–738 days), five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients referred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up. PMID:25593575

  16. Trend in Hospitalizations among Medicare Survivors of Aortic Valve Replacement in United States, 1999–2010

    PubMed Central

    Murugiah, Karthik; Wang, Yun; Dodson, John A; Nuti, Sudhakar V; Dharmarajan, Kumar; Ranasinghe, Isuru; Cooper, Zack; Krumholz, Harlan M.

    2015-01-01

    Background Mortality rates after aortic valve replacement (AVR) have declined, but little is known about the risk of hospitalization among survivors, and how that has changed over time. Methods Among Medicare patients who underwent AVR from 1999–2010 and survived to one year, we assessed trends in 1-year hospitalization rates, mean cumulative length of stay (LOS) (average number of hospitalization days per patient in the entire year), and adjusted annual Medicare payments per patient toward hospitalizations. We characterized hospitalizations by principal diagnosis and mean LOS. Results Among 1-year survivors of AVR, 43% of patients were hospitalized within that year, of whom 44.5% were hospitalized within 30 days (19.2% for overall cohort). Hospitalization rates were higher for older (50.3% for >85 years), female (45.1%) and black (48.9%) patients. One-year hospitalization rate decreased from 44.2% (43.5–44.8) in 1999 to 40.9% (40.3–41.4) in 2010. Mean cumulative LOS decreased from 4.8 days to 4.0 days (p <0.05 for trend); annual Medicare payments per patient were unchanged ($5709 to $5737, p=0.32 for trend). The three most common principal diagnoses in hospitalizations were heart failure (12.7%), arrhythmia (7.9%), and postoperative complications (4.4%). Mean LOS declined from 6.0 days to 5.3 days (p <0.05 for trend). Conclusions Among Medicare beneficiaries who survived one year after AVR, 3 in 5 remained free of hospitalization; however, certain subgroups had higher rates of hospitalization. After the 30-day period, the hospitalization rate was similar to the general Medicare population. Hospitalization rates and cumulative days spent in hospital decreased over time. PMID:25527425

  17. [Diastolic function of the left ventricle in aortic valve stenosis. Doppler echocardiography].

    PubMed

    Habib, G; Vittot, P; Cornen, A; Boulain, L; Bonnet, J L; Djiane, P; Luccioni, R

    1992-06-01

    Doppler echocardiographic parameters of LV diastolic function (isovolumic relaxation time, E wave velocity, ratio of E/A wave velocities, mitral valve pressure half time) were compared to catheter data in 35 patients (average age 67 years) with pure or dominant aortic stenosis (mean gradient: 65 +/- 30 mmHg). The isovolumic relaxation time was prolonged in most patients (m = 103 +/- 23 ms) and seemed uninfluenced by any haemodynamic parameter. There was a positive correlation between pressure half time and ejection fraction (r = 0.41, p = 0.02) and a negative correlation with pulmonary capillary pressure (r = -0.61, p < 0.01). The E and E/A ratio were negatively correlated with the ejection fraction (r = -0.41 and -0.52) and positively correlated with pulmonary capillary pressure (r = 0.46 and 0.62). The Doppler parameters were independant of the patients' age, severity of stenosis and degree of left ventricular hypertrophy. Patients with normal pulmonary capillary pressure (< 15 mmHg, N = 19) had abnormal diastolic filling with low E wave velocities (71 +/- 28 cm/s) and E/A ratios (0.9 +/- 0.6) and prolonged half pressure times (96 +/- 37 ms). Conversely, patients with high pulmonary capillary pressures (> 15 mmHg, N = 16) had normal or high E wave velocities (107 +/- 31 cm/s) and E/A ratios (1.5 +/- 0.6) and normal or shortened isovolumic relaxation times (62 +/- 22 ms).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1417407

  18. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication after minimally invasive mitral valve repair

    PubMed Central

    Spampinato, Ricardo A.; Borger, Michael A.; Strotdrees, Elfriede; Mohr, Friedrich W.

    2013-01-01

    Pseudoaneurysm of the mitral-aortic intervalvular body is a rare condition, which has been reported as a result of endocarditis, chest trauma or cardiac surgery. We describe here the first case after minimally invasive mitral valve repair. Such a complication may be overlooked in the early postoperative echocardiographic study and may lead to fistula formation, compression of adjacent structures, infection, or rupture. Both computed tomography and echocardiography provide a detailed anatomy of the pseudoaneurysm and its communication with the left ventricular outflow tract. PMID:23223670

  19. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication after minimally invasive mitral valve repair.

    PubMed

    Spampinato, Ricardo A; Borger, Michael A; Strotdrees, Elfriede; Mohr, Friedrich W

    2013-03-01

    Pseudoaneurysm of the mitral-aortic intervalvular body is a rare condition, which has been reported as a result of endocarditis, chest trauma or cardiac surgery. We describe here the first case after minimally invasive mitral valve repair. Such a complication may be overlooked in the early postoperative echocardiographic study and may lead to fistula formation, compression of adjacent structures, infection, or rupture. Both computed tomography and echocardiography provide a detailed anatomy of the pseudoaneurysm and its communication with the left ventricular outflow tract. PMID:23223670

  20. IgG4-related disease of the aortic valve: a report of two cases and review of the literature.

    PubMed

    Maleszewski, Joseph J; Tazelaar, Henry D; Horcher, Heidi M; Hinkamp, Thomas J; Conte, John V; Porterfield, James K; Halushka, Marc K

    2015-01-01

    IgG4-related disease (IgG4-RD) is a relatively recently described disorder that can affect multiple organ systems, including the cardiovascular system. While most reported cases of cardiovascular involvement are of the aorta, usually the abdominal aorta, rare isolated reports of involvement of the heart proper have been described. Herein, we describe two cases of IgG4-RD involving the aortic valve. Each case was found to be associated with increased levels of IgG4 in the tissue and one case resulted in the subsequent discovery of IgG4-related pancreatitis. PMID:25283128

  1. Brachial artery diameter has a predictive value in the improvement of flow-mediated dilation after aortic valve replacement for aortic stenosis.

    PubMed

    Takata, Munenori; Amiya, Eisuke; Watanabe, Masafumi; Ozeki, Atsuko; Watanabe, Aya; Kawarasaki, Shuichi; Nakao, Tomoko; Hosoya, Yumiko; Uno, Kansei; Saito, Aya; Murasawa, Takahide; Ono, Minoru; Nagai, Ryozo; Komuro, Issei

    2015-03-01

    Aortic stenosis (AS) is the most common valvular disease and aortic valve replacement (AVR) is one of its most effective interventions. AS affects not only the left ventricle, but also vascular function beyond the stenotic valve, which can lead to various types of vascular dysfunction. However, research evaluating the effect of AS on aortic vascular function is limited. In this study, we investigated clinical meaning to evaluate endothelial function in subjects with AS. From April 2011 to April 2012, 20 consecutive adult patients with degenerative AS (mean age, 74.7 ± 7.4 years; range 50-83 years) who underwent AVR at our institution were included in the study. We measured flow-mediated dilation (FMD) to evaluate the effect of AS on endothelial function. The difference between brachial artery diameter (BAD) before (4.0 ± 0.7 mm) and after AVR (3.9 ± 0.6 mm) was not significant (p = 0.043), but FMD significantly improved after AVR (from 3.1 ± 1.8 to 6.0 ± 2.7 %, p < 0.0001). We also analyzed FMD × BAD index, endogenous vasodilatory capability independent of BAD, resulting that it also significantly increased after AVR (12.3 ± 7.0-22.5 ± 9.3, p < 0.0001). We divided patients into two groups by pre- to post-AVR change in FMD (?FMD); large-?FMD group [?FMD >3.0 % (median value)] and small-?FMD group (?FMD <3.0 %). There were no significant changes in age, blood pressure, heart rate, B-type natriuretic peptide, or echocardiographic parameters in either group. In contrast, BAD was significantly larger in the small ?FMD group (4.3 ± 0.7 mm) than in the large ?FMD group (3.7 ± 0.7 mm) (p = 0.030). In addition, cardio-thoracic ratio was significantly greater in the small ?FMD group (58.4 ± 7.1 %) than in the large ?FMD group (53.7 ± 4.6 %) (p = 0.048). Receiver operating characteristic curve analysis of BAD to differentiate large and small ?FMD demonstrated an area under the curve of 0.750 (p = 0.059) and that optimal cutoff for BAD was 4.28 mm (70 % sensitivity, 80 % specificity). AVR in subjects with AS is associated with a significant improvement in FMD in the brachial artery. Measurement of the BAD may be helpful in distinguishing whether the impairment of FMD in AS derives from a stenotic valve or vascular remodeling. PMID:24497127

  2. [Changes in left-ventricular contractility and diastolic rigidity and the dynamics of various indicators of blood circulation in patients after aortic valve prosthesis].

    PubMed

    Vladimirov, P V; Tskhovrebov, S V; Lishchuk, V A; Zhadin, M M; Mostkova, E V

    1988-04-01

    The relationship between the stroke output and parameters relating to left-ventricular contraction and relaxation was examined within the early hours after the implantation of prosthetic aortic valve. Quantitative analysis demonstrated a close correlation between left-ventricular performance and diastolic regidity. Left-ventricular diastolic regidity is shown to make a more important contribution than contractility to the formation of stroke output. For this reasons, a therapy aiming only to improve myocardial contractility in patients after prosthetic aortic valve implantation failed to effectively improve their clinical condition. PMID:3392873

  3. Transcatheter aortic valve replacement: from the femoral artery to the left ventricular apex--the spectrum to access.

    PubMed

    Feezor, Robert J; Janelle, Gregory M; Klodell, Charles T

    2015-03-01

    The role of transcatheter aortic valve replacement (TAVR) continues to evolve and expand at a rapid pace. The advanced age and frailty of many TAVR candidates often presents complex vascular access challenges when contemplating the exact route of valve delivery. As the indications and approved routes of delivery have evolved, so have the direct open vascular and percutaneous techniques paramount to success. We review the spectrum of access options that may be available for consideration during TAVR procedures and highlight the "pearls and pitfalls" of each technique. We additionally highlight reasons a technique may be preferred for a specific patient subset, as well as the concerns addressed by the anesthesiologist in approaching TAVR. PMID:25425153

  4. Steady flow hemodynamic and energy loss measurements in normal and simulated calcified tricuspid and bicuspid aortic valves.

    PubMed

    Seaman, Clara; Akingba, A George; Sucosky, Philippe

    2014-04-01

    The bicuspid aortic valve (BAV), which forms with two leaflets instead of three as in the normal tricuspid aortic valve (TAV), is associated with a spectrum of secondary valvulopathies and aortopathies potentially triggered by hemodynamic abnormalities. While studies have demonstrated an intrinsic degree of stenosis and the existence of a skewed orifice jet in the BAV, the impact of those abnormalities on BAV hemodynamic performance and energy loss has not been examined. This steady-flow study presents the comparative in vitro assessment of the flow field and energy loss in a TAV and type-I BAV under normal and simulated calcified states. Particle-image velocimetry (PIV) measurements were performed to quantify velocity, vorticity, viscous, and Reynolds shear stress fields in normal and simulated calcified porcine TAV and BAV models at six flow rates spanning the systolic phase. The BAV model was created by suturing the two coronary leaflets of a porcine TAV. Calcification was simulated via deposition of glue beads in the base of the leaflets. Valvular performance was characterized in terms of geometric orifice area (GOA), pressure drop, effective orifice area (EOA), energy loss (EL), and energy loss index (ELI). The BAV generated an elliptical orifice and a jet skewed toward the noncoronary leaflet. In contrast, the TAV featured a circular orifice and a jet aligned along the valve long axis. While the BAV exhibited an intrinsic degree of stenosis (18% increase in maximum jet velocity and 7% decrease in EOA relative to the TAV at the maximum flow rate), it generated only a 3% increase in EL and its average ELI (2.10 cm2/m2) remained above the clinical threshold characterizing severe aortic stenosis. The presence of simulated calcific lesions normalized the alignment of the BAV jet and resulted in the loss of jet axisymmetry in the TAV. It also amplified the degree of stenosis in the TAV and BAV, as indicated by the 342% and 404% increase in EL, 70% and 51% reduction in ELI and 48% and 51% decrease in EOA, respectively, relative to the nontreated valve models at the maximum flow rate. This study indicates the ability of the BAV to function as a TAV despite its intrinsic degree of stenosis and suggests the weak dependence of pressure drop on orifice area in calcified valves. PMID:24474392

  5. Fluid-structure interaction of an aortic heart valve prosthesis driven by an animated anatomic left ventricle

    NASA Astrophysics Data System (ADS)

    Le, Trung Bao; Sotiropoulos, Fotis

    2013-07-01

    We develop a novel large-scale kinematic model for animating the left ventricle (LV) wall and use this model to drive the fluid-structure interaction (FSI) between the ensuing blood flow and a mechanical heart valve prosthesis implanted in the aortic position of an anatomic LV/aorta configuration. The kinematic model is of lumped type and employs a cell-based, FitzHugh-Nagumo framework to simulate the motion of the LV wall in response to an excitation wavefront propagating along the heart wall. The emerging large-scale LV wall motion exhibits complex contractile mechanisms that include contraction (twist) and expansion (untwist). The kinematic model is shown to yield global LV motion parameters that are well within the physiologic range throughout the cardiac cycle. The FSI between the leaflets of the mechanical heart valve and the blood flow driven by the dynamic LV wall motion and mitral inflow is simulated using the curvilinear immersed boundary (CURVIB) method (Ge and Sotiropoulos, 2007; Borazjani et al., 2008) [1,2] implemented in conjunction with a domain decomposition approach. The computed results show that the simulated flow patterns are in good qualitative agreement with in vivo observations. The simulations also reveal complex kinematics of the valve leaflets, thus, underscoring the need for patient-specific simulations of heart valve prosthesis and other cardiac devices.

  6. The utility of trans-catheter aortic valve replacement after commercialization: does the European experience provide a glimpse into the future use of this technology in the United States?

    PubMed

    Linke, Axel; Walther, Thomas; Schuler, Gerhard

    2010-03-01

    Treatment of aortic stenosis remains challenging in older individuals, as their perioperative mortality for open heart surgery is increased due to comorbidities. Transcatheter aortic valve implantation using the CoreValve ReValving System (Medtronic, Minneapolis, USA) and the Edwards SAPIEN transcatheter heart valve (THV; Edwards Lifescience, Irvine, California, USA) represents an alternative to conventional valve replacement in elderly patients that have a high risk for conventional surgery. This article summarizes the evidence-base from recent clinical trials. The early results of these landmark studies suggest that transcatheter aortic valve implantation with either one of the prosthesis is feasible, safe, improves hemodynamics and, therefore, might be an alternative to conventional aortic valve replacement in very high-risk patients. However, all of the available transcatheter heart valves have certain disadvantages, limiting their use in daily clinical practice. The process of decision making, which valve to use and which access route to choose is illustrated in this article through clinical case scenarios. Additionally, the lessons learned thus far from the European perspective and the potential impact on the future use in the US are discussed. Despite of the progress in this field, we are still lacking an optimal transcatheter heart valve. Once it is available, we can take the plunge to compare transcatheter valve implantation with convention surgery in severe aortic stenosis! PMID:20088019

  7. Early and late outcomes after isolated aortic valve replacement in octogenarians: an Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Study

    PubMed Central

    Saxena, Akshat; Poh, Chin-Leng; Dinh, Diem T.; Reid, Christopher M.; Smith, Julian A.; Shardey, Gilbert C.; Newcomb, Andrew E.

    2012-01-01

    OBJECTIVE The advent of percutaneous aortic valve implantation has increased interest in the outcomes of conventional aortic valve replacement in elderly patients. The current study critically evaluates the short-term and long-term outcomes of elderly (?80 years) Australian patients undergoing isolated aortic valve replacement. METHODS Data obtained prospectively between June 2001 and December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analysed. Isolated aortic valve replacement was performed in 2791 patients; of these, 531 (19%) were at least 80 years old (group 1). The patient characteristics, morbidity and short-term mortality of these patients were compared with those of patients who were <80 years old (group 2). The long-term outcomes in elderly patients were compared with the age-adjusted Australian population. RESULTS Group 1 patients were more likely to be female (58.6% vs 38.0%, p < 0.001) and presented more often with co-morbidities including hypertension, cerebrovascular disease and peripheral vascular disease (all p < 0.05). The 30-day mortality rate was not independently higher in group 1 patients (4.0% vs 2.0%, p = 0.144). Group 1 patients had an independently increased risk of complications including new renal failure (11.7% vs 4.2%, p < 0.001), prolonged (?24 h) ventilation (12.4% vs 7.2%, p = 0.003), gastrointestinal complications (3.0% vs 1.3%, p = 0.012) and had a longer mean length of intensive care unit stay (64 h vs 47 h, p < 0.001). The 5-year survival post-aortic valve replacement was 72%, which is comparable to that of the age-matched Australian population. CONCLUSION Conventional aortic valve replacement in elderly patients achieves excellent outcomes with long-term survival comparable to that of an age-adjusted Australian population. In an era of percutaneous aortic valve implantation, it should still be regarded as the gold standard in the management of aortic stenosis. PMID:21601470

  8. First report on intraoperative vector flow imaging of the heart among patients with healthy and diseased aortic valves.

    PubMed

    Hansen, Kristoffer Lindskov; Møller-Sørensen, Hasse; Pedersen, Mads Møller; Hansen, Peter Møller; Kjaergaard, Jesper; Lund, Jens Teglgaard; Nilsson, Jens Christian; Jensen, Jørgen Arendt; Nielsen, Michael Bachmann

    2015-02-01

    The vector velocity method Transverse Oscillation (TO) implemented on a conventional ultrasound (US) scanner (ProFocus, BK Medical, Herlev, Denmark) can provide real-time, angle-independent estimates of the cardiac blood flow. During cardiac surgery, epicardial US examination using TO was performed on (A) 3 patients with healthy aortic valve and (B) 3 patients with aortic valve stenosis. In group B, the systolic flow of the ascending aorta had higher velocities, was more aliased and chaotic. The jet narrowed to 44% of the lumen compared to 75% in group A and with a vector concentration, a measure of flow complexity, of 0.41 compared to 0.87 in group A. The two groups had similar secondary flow of the ascending aorta with an average rotation frequency of 4.8 Hz. Simultaneous measurements were obtained with spectral Doppler (SD) and a thermodilution technique (TD). The mean difference in peak systolic velocity compared to SD in group A was 22% and 45% in B, while the mean difference in volume flow compared to TD in group A was 30% and 32% in B. TO can potentially reveal new information of cardiac blood flow, and may become a valuable diagnostic tool in the evaluation of patients with cardiovascular diseases. PMID:25128079

  9. Quantification of Hemodynamic Wall Shear Stress in Patients with Bicuspid Aortic Valve Using Phase-Contrast MRI

    PubMed Central

    Barker, Alex J.; Lanning, Craig; Shandas, Robin

    2010-01-01

    Bicuspid aortic valve (BAV) is often concomitant with aortic dilatation, aneurysm, and dissection. This valve lesion and its complications may affect positional and temporal wall shear stress (WSS), a parameter reported to regulate transcriptional events in vascular remodeling. Thus, this pilot study seeks to determine if the WSS in the ascending aorta (AAo) of BAV patients differs from control patients. Phase-contrast magnetic resonance imaging (PC-MRI) was used to perform flow analysis at the level of the AAo in 15 BAV and 15 control patients. Measurement of the aorta dimensions, flow rates, regurgitant fraction (RF), flow reversal ratio (FRR), temporal and spatial WSS, and shear range indices (SRI) were performed. The BAV and control group showed a significant difference between the circumferentially averaged WSS (p = 0.03) and positional WSS at systole (minimum p<0.001). Regressions found that SRI (r = 0.77, p<0.001), RF (r = 0.68, p<0.001), and WSS at systole (r = 0.66, p<0.001) were correlated to AAo size. The spatial distribution and magnitude of systolic WSS in BAV patients (?6.7 ± 4.3 dynes/cm2) differed significantly from control patients (?11.5 ± 6.6 dynes/cm2, p = 0.03). The SRI metric, a measure of shear symmetry along the lumen circumference, was also significantly different (p = 0.006) and indicated a heterogenic pattern of dilatation in the BAV patients. PMID:19953319

  10. Patient-specific simulation of a trileaflet aortic heart valve in a realistic left ventricle and aorta

    NASA Astrophysics Data System (ADS)

    Gilmanov, Anvar; Le, Trung; Stolarski, Henryk; Sotiropoulos, Fotis

    2013-11-01

    We develop a patient-specific model of the left ventricle consisting of: (1) magnetic-resonance images (MRI) data for wall geometry and kinematics reconstruction of the left ventricle during one cardiac cycle and (2) an elastic trileaflet aortic heart valve implanted in (3) a realistic aorta interacting with blood flow driven by the pulsating left ventricle. Blood flow is simulated via a new fluid-structure interaction (FSI) method, which couples the sharp-interface CURVIB [L. Ge, F. Sotiropoulos, JCP, (2007)] for handling complex moving boundaries with a new, rotation-free finite-element (FE) formulation for simulating large tissue deformations [H. Stolarski, A. Gilmanov, F. Sotiropoulos, IJNME, (2013)] The new FE shell formulation has been extensively tested and validated for a range of relevant problems showing good agreements. Validation of the coupled FSI-FE-CURVIB model is carried out for a thin plate undergoing flow-induced vibrations in the wake of a square cylinder and the computed results are in good agreement with published data. The new approach has been applied to simulate dynamic interaction of a trileaflet aortic heart valve with pulsating blood flow at physiological conditions and realistic artery and left ventricle geometry.

  11. Frequency, determinants and prognostic implications of infectious complications after transcatheter aortic valve implantation.

    PubMed

    van der Boon, Robert M A; Nuis, Rutger-Jan; Benitez, Luis M; Van Mieghem, Nicolas M; Perez, Sergio; Cruz, Lidsa; van Geuns, Robert-Jan; Serruys, Patrick W; van Domburg, Ron T; Dager, Antonio E; de Jaegere, Peter P T

    2013-07-01

    In-hospital infection (IHI) after transcatheter aortic valve implantation (TAVI) has received little attention, although it may have a significant effect on outcomes and costs because of prolonged hospital stay. Therefore, the aim of this study was to determine the incidence, type, predictors, and prognostic effects of IHI after TAVI. This study included 298 consecutive patients from 2 centers who underwent TAVI from November 2005 to November 2011. IHI during the hospital stay was defined on the basis of symptoms and signs assessed by the attending physician in the cardiac care unit or medium care unit in combination with all technical examinations performed to confirm infection. IHI after TAVI was observed in 58 patients (19.5%): urinary tract infections in 25 patients (43.1%), pneumonia in 12 patients (20.7%), and access-site infections in 7 patients (12.1%). In 12 patients (20.7%), the site of infection could not be determined, and 2 patients (3.4%) had multiple infection sites. Multivariate analysis revealed that surgical access through the femoral artery was the most important determinant of infection (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.02 to 17.19), followed by perioperative major stroke (OR 3.21, 95% CI 1.01 to 9.52) and overweight (body mass index ?25 kg/m²; OR 2.27, 95% CI 1.12 to 4.59). The length of hospital stay in patients with IHIs was 15.0 days (interquartile range 8.0 to 22.0) compared with 7.0 days (interquartile range 4.0 to 10.0) in patients without infections (p <0.0001). Kaplan-Meier estimates of survival at 1 year were 76.6% and 74.4% (log-rank, p = 0.61), respectively. Unadjusted and adjusted OR analysis revealed that IHI did not predict mortality at 30 days (OR 1.27, 95% CI 0.49 to 3.30) or at 1 year (hazard ratio 1.24, 95% CI 0.68 to 2.25). In conclusion, IHI occurred in 19.5% of the patients. Patient-related and, more important, procedure-related variables play a role in the occurrence of infection, indicating that improvements in the execution of TAVI may lead to a reduction of this complication. PMID:23566540

  12. Unicuspid and bicuspid tooth crown formation in squamates.

    PubMed

    Handrigan, Gregory R; Richman, Joy M

    2011-12-15

    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

  13. Immunohistochemical and functional analysis of ectonucleoside triphosphate diphosphohydrolase 1 (CD39) and ecto-5'-nucleotidase (CD73) in pig aortic valves.

    PubMed

    Kaniewska, Ewa; Sielicka, Alicja; Sarathchandra, Padmini; Pelikant-Ma?ecka, Iwona; Olkowicz, Mariola; S?omi?ska, Ewa M; Chester, Adrian H; Yacoub, Magdi H; Smole?ski, Ryszad T

    2014-01-01

    Extracellular nucleotides control mechanisms such as thrombosis or inflammation that are important in several pathologies, including heart valve disease and calcification. Ectonucleoside triphosphate diphosphohydrolase 1 (eNTPD1, CD39) and ecto-5'-nucleotidase (e5NT, CD73) are ectoenzymes that convert adenosine triphosphate to adenosine diphosphate, adenosine monophosphate and finally to adenosine. Changes in activities of these enzymes influence extracellular nucleotide concentrations and therefore could be involved in valve pathology. This study aimed to analyze type of cells, specific area, level of expression and biochemical function of CD39 and CD73 in pig aortic valves. Samples were collected from aortic valves of domestic pigs. Histological sections were cut from paraffin embedded tissue blocks. Following incubation with primary antibody against CD39 or CD73, washing and secondary goat anti-rabbit secondary antibodies, slides were viewed with NanoZoomer scanner. Substantial expression CD39 and CD73 was observed in two main types of valve cells: endothelial and valve interstitial cells. Subsequently, biochemical function of CD39 and CD73 was evaluated in cells cultured from pig aortic valve. Breakdown of extracellular nucleotides added to cell medium was analyzed with high performance liquid chromatography. In the interstitial cells, the CD73 products formation was much faster than in endothelium, while for the CD39 activity this relation was opposite. Expression and high concentration of CD39 and CD73 products in endothelium are expected, but presence of CD73 in valve interstitial cells is a surprise. We conclude that CD39 and CD73 and their enzymatic activities that convert extracellular nucleotides are highly expressed and could have special function in the valve. PMID:24940684

  14. Quadricuspid aortic valve and anomalous origin of the left circumflex coronary artery in a young man with Down syndrome

    PubMed Central

    Bassareo, Pier Paolo; Hasan, Tammam; Bonvicini, Marco; Mercuro, Giuseppe

    2015-01-01

    Key Clinical Message The Authors present the case of an asymptomatic 36-year-old man, affected by Down syndrome, with an unexpected quadricuspid aortic valve coupled with the anomalous origin of the left circumflex coronary artery from the proximal right coronary artery. This is the first report of the concomitant presence of these three conditions. PMID:25914823

  15. Does Patient Gender Affect Outcomes after Concomitant Coronary Artery Bypass Graft and Aortic Valve Replacement? An Australian Society of Cardiac and Thoracic Surgeons Database Study

    Microsoft Academic Search

    Akshat Saxena; Chin-Leng Poh; Diem T. Dinh; Christopher M. Reid; Julian A. Smith; Gilbert C. Shardey; Andrew E. Newcomb

    2011-01-01

    Objectives: Women undergoing isolated coronary artery bypass graft (CABG) surgery have been previously shown to be at an independently increased risk for post-operative morbidity and mortality. However, there are considerably less data on whether this trend remains true in patients undergoing concomitant aortic valve replacement (AVR) and CABG surgery. The aim of our study was to investigate this pertinent issue.

  16. Method to measure the 3D angular orientation of the aortic valve plane from a single image of a valvuloplasty balloon: findings of a large animal proof of concept experiment.

    PubMed

    Fetterly, Kenneth A; Mathew, Verghese

    2015-02-01

    During transcatheter aortic valve replacement procedures, alignment of the interventional x-ray beam with the aortic valve plane is required to guide valve placement. The purpose of this work was to develop methods to measure x-ray beam angles which are aligned with the aortic valve plane from a single x-ray image of a valvuloplasty balloon inflated across the left ventricular outflow tract (LVOT). A custom valvuloplasty balloon and image analytics were developed. In-vivo pig experiments demonstrated that the angular orientation of the LVOT can be measured with precision less than 3°, including the influence of cardiac motion during rapid pacing. Using these methods, the angular orientation of the LVOT of a large mammal can be measured precisely and the continuous range of x-ray projection angles which are aligned with the aortic valve plane can be calculated. PMID:25431321

  17. Effect of coarctation of the aorta and bicuspid aortic valve on flow dynamics and turbulence in the aorta using particle image velocimetry

    NASA Astrophysics Data System (ADS)

    Keshavarz-Motamed, Zahra; Garcia, Julio; Gaillard, Emmanuel; Maftoon, Nima; Di Labbio, Giuseppe; Cloutier, Guy; Kadem, Lyes

    2014-03-01

    Blood flow in the aorta has been of particular interest from both fluid dynamics and physiology perspectives. Coarctation of the aorta (COA) is a congenital heart disease corresponding to a severe narrowing in the aortic arch. Up to 85 % of patients with COA have a pathological aortic valve, leading to a narrowing at the valve level. The aim of the present work was to advance the state of understanding of flow through a COA to investigate how narrowing in the aorta (COA) affects the characteristics of the velocity field and, in particular, turbulence development. For this purpose, particle image velocimetry measurements were conducted at physiological flow and pressure conditions, with three different aorta configurations: (1) normal case: normal aorta + normal aortic valve; (2) isolated COA: COA (with 75 % reduction in aortic cross-sectional area) + normal aortic valve and (3) complex COA: COA (with 75 % reduction in aortic cross-sectional area) + pathological aortic valve. Viscous shear stress (VSS), representing the physical shear stress, Reynolds shear stress (RSS), representing the turbulent shear stress, and turbulent kinetic energy (TKE), representing the intensity of fluctuations in the fluid flow environment, were calculated for all cases. Results show that, compared with a healthy aorta, the instantaneous velocity streamlines and vortices were deeply changed in the presence of the COA. The normal aorta did not display any regions of elevated VSS, RSS and TKE at any moment of the cardiac cycle. The magnitudes of these parameters were elevated for both isolated COA and complex COA, with their maximum values mainly being located inside the eccentric jet downstream of the COA. However, the presence of a pathologic aortic valve, in complex COA, amplifies VSS (e.g., average absolute peak value in the entire aorta for a total flow of 5 L/min: complex COA: = 36 N/m2; isolated COA = 19 N/m2), RSS (e.g., average peak value in the entire aorta for a total flow of 5 L/min: complex COA: = 84.6 N/m2; isolated COA = 44 N/m2) and TKE (e.g., average peak value in the entire aorta for a total flow of 5 L/min: complex COA: = 215 N/m2; isolated COA = 100 N/m2). This demonstrates that the pathological aortic valve strongly interacts with the COA. Findings of this study indicate that the presence of both a COA and a pathological aortic valve significantly alters hemodynamics in the aorta and thus might contribute to the progression of the disease in this region. This study can partially explain the complications associated in patients with COA, in the presence of a pathological aortic valve and the consequent adverse outcome post-surgery.

  18. Aortic valve replacement in a dialysis-dependent Jehovah's Witness: successful use of a minicircuit, microplegia, and multimodality blood conservation technique

    PubMed Central

    Sutton, Steve W.; Marcel, Randy

    2007-01-01

    We present the first reported case of an aortic valve replacement operation without blood transfusion in a 62-year-old Jehovah's Witness with dialysis-dependent chronic renal failure, severe anemia, severe aortic stenosis, and symptomatic angina with minimal exertion after an accident in which she suffered fractures of both her right arm and leg. She underwent successful valve replacement surgery after preoperative stabilization of her fractures and high-dose erythropoietin and iron supplement therapy preoperatively and postoperatively. The intraoperative blood conservation technique included a novel approach with a miniature cardiopulmonary bypass circuit and microplegia with limited hemodilution. High-risk valve surgery in patients who are Jehovah's Witnesses can be successful with a carefully planned multimodality blood conservation strategy. PMID:17256040

  19. The impact of transcatheter aortic valve implantation on left ventricular performance and wall thickness – single-centre experience

    PubMed Central

    Szyma?ski, Piotr; D?browski, Maciej; Zakrzewski, Dariusz; Micha?ek, Piotr; Or?owska-Baranowska, Ewa; El-Hassan, Kamal; Chmielak, Zbigniew; Witkowski, Adam; Hryniewiecki, Tomasz

    2015-01-01

    Introduction Transcatheter aortic valve implantation (TAVI) is a treatment alternative for the elderly population with severe symptomatic aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR). Aim To assess the impact of TAVI on echocardiographic parameters of left ventricular (LV) performance and wall thickness in patients subjected to the procedure in a single-centre between 2009 and 2013. Material and methods The initial group consisted of 170 consecutive patients with severe AS unsuitable for SAVR. Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 21.73 ±12.42% and mean age was 79.9 ±7.5 years. Results The TAVI was performed in 167 (98.2%) patients. Mean aortic gradient decreased significantly more rapidly after the procedure (from 58.6 ±16.7 mm Hg to 11.9 ±4.9 mm Hg, p < 0.001). The LV ejection fraction (LVEF) significantly increased in both short-term and long-term follow-up (57 ±14% vs. 59 ±13%, p < 0.001 and 56 ±14% vs. 60 ±12%, p < 0.001, respectively). Significant regression of interventricular septum diameter at end-diastole (IVSDD) and end-diastolic posterior wall thickness (EDPWth) was noted in early (15.0 ±2.4 mm vs. 14.5 ±2.3 mm, p < 0.001 and 12.7 ±2.1 mm vs. 12.4 ±1.9 mm, p < 0.028, respectively) and late post-TAVI period (15.1 ±2.5 mm to 14.3 ±2.5 mm, p < 0.001 and 12.8 ±2.0 mm to 12.4 ±1.9 mm, p < 0.007, respectively). Significant paravalvular leak (PL) was noted in 21 (13.1%) patients immediately after TAVI and in 13 (9.6%) patients in follow-up (p < 0.001). Moderate or severe mitral regurgitation (msMR) was seen in 24 (14.9%) patients from the initial group and in 19 (11.8%) patients after TAVI (p < 0.001). Conclusions The TAVI had an immediate beneficial effect on LVEF, LV walls thickness, and the incidence of msMR. The results of the procedure are comparable with those described in other centres. PMID:25848369

  20. Pulse wave velocity and neutrophil gelatinase-associated lipocalin as predictors of acute kidney injury following aortic valve replacement

    PubMed Central

    2014-01-01

    Background Accurate prediction, early detection and treatment of acute kidney injury (AKI) are essential for improving post-operative outcomes. This study aimed to examine the role of aortic stiffness and neutrophil gelatinase-associated lipocalin (NGAL) as predictors of AKI or need for early medical renal intervention following aortic valve replacement (AVR). Methods Aortic pulse wave velocity and plasma NGAL were measured pre-operatively in recruited patients undergoing AVR for aortic stenosis (AS). Plasma NGAL was also measured at 3 and 18–24 hours after cardiopulmonary bypass (CPB). AKI was defined using RIFLE criteria. Early medical renal intervention included diuretics or dopamine infusion exclusively for renal causes. Results Fifty-three patients aged 71?±?9 years were included. Sixteen (30%) developed AKI (AKI-Yes) and 24 patients (45%) received early medical intervention (Intervention-Yes). There was no significant difference in the demographic, clinical or operative characteristics between the two groups for either outcome. PWV did not significantly correlate with AKI (r?=?0.12, P?=?0.13) or early intervention (r?=?0.18, P?=?0.18). At 3 h post-CPB, plasma NGAL was a much stronger predictor of both AKI and the need for early medical intervention than conventional markers such as creatinine (AKI: AUC 83%, 95%?CI 0.70–0.95 vs. AUC 65%, 95%?CI 0.47- 0.82; Medical intervention: AUC 84%, 95%?CI 0.72–0.96 vs. AUC 56%, 95%?CI 0.38–0.73). Post-CPB (3 hr) plasma NGAL was also significantly associated with AKI (r?=?0.68, P?Aortic PWV does not correlate significantly with post-operative AKI or plasma NGAL levels in surgical AS patients. Post-operative NGAL is however an early and powerful predictive biomarker of both post-operative AKI and the need for early medical renal intervention and should consequently be considered in prediction models for AKI after cardiac surgery. PMID:24886694

  1. Rest and exercise hemodynamics of 20 to 23 mm allograft, Medtronic Intact (porcine), and St. Jude Medical valves in the aortic position.

    PubMed

    Jaffe, W M; Coverdale, H A; Roche, A H; Whitlock, R M; Neutze, J M; Barratt-Boyes, B G

    1990-08-01

    Doppler echocardiography was used to measure gradients and valve areas at rest and after supine bicycle exercise in 35 patients with valve replacements 20 to 23 mm in size. Thirteen patients with a St. Jude Medical valve (St. Jude Medical, Inc., St. Paul, Minn.) were matched to 13 patients with an allograft valve, and seven patients with a Medtronic Intact (porcine) valve (Medtronic, Inc., Minneapolis, Minn.) to seven patients with an allograft valve. Patients were matched for age, sex, valve size, body surface area, and left ventricular systolic function. There was no statistically significant difference between the matched groups for body surface areas, resting cardiac output, exercise heart rate, or workload achieved. Mean pressure gradient was higher for St. Jude Medical than for allograft groups, both at rest (11.8 +/- 6.67 mm Hg for St. Jude Medical versus 6.67 +/- 2.98 mm Hg for allografts) and after exercise (16.4 +/- 8.47 mm Hg versus 9.7 +/- 3.94 mm Hg), but the differences were of borderline significance (p = 0.016 and 0.027, respectively). Valve area at rest was similar for both devices (1.4 +/- 0.45 cm2 for St. Jude Medical versus 1.8 +/- 0.56 cm2 for allograft; p greater than 0.1). There were highly significant differences between patients with Intact and those with allograft valves for resting mean pressure gradient (19.3 +/- 4.23 mm Hg for Intact versus 5.9 +/- 3.68 mm Hg for allograft; p less than 0.001) and for exercise mean pressure gradient (27.8 +/- 8.63 mm Hg versus 8.1 +/- 8.43 mm Hg; p less than 0.001). The differences between the valve areas at rest also were significant (1.1 +/- 0.12 cm2 versus 2.2 +/- 0.62 cm2; p less than 0.01). It is concluded that when a tissue valve is indicated in patients with a small aortic root, the freehand allograft aortic valve is an ideal device from the hemodynamic perspective and is superior to the Intact valve. It is also probably superior in this respect to the St. Jude Medical valve, although the analysis may be biased slightly in favor of the allograft valve. PMID:2385114

  2. Early Regression of Severe Left Ventricular Hypertrophy after Transcatheter Aortic Valve Replacement is Associated with Decreased Hospitalizations

    PubMed Central

    Lindman, Brian R.; Stewart, William J.; Pibarot, Philippe; Hahn, Rebecca T.; Otto, Catherine M.; Xu, Ke; Devereux, Richard B.; Weissman, Neil J.; Enriquez-Sarano, Maurice; Szeto, Wilson Y.; Makkar, Raj; Miller, D. Craig; Lerakis, Stamatios; Kapadia, Samir; Bowers, Bruce; Greason, Kevin L.; McAndrew, Thomas C.; Lei, Yang; Leon, Martin B.; Douglas, Pamela S.

    2014-01-01

    Objective Examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). Background LVM regression after valve replacement for aortic stenosis (AS) is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. Methods Of 2115 patients with symptomatic AS at high surgical risk receiving TAVR in the PARTNER randomized trial or continued access registry, 690 had both severe LVH (LVM index [LVMi] ³149 g/m2 men, ³122 g/m2 women) at baseline and an LVMi measurement 30 days post-TAVR. Clinical outcomes were compared for patients with greater than vs. lesser than median percent change in LVMi between baseline and 30 days using Cox proportional hazard models to evaluate event rates from 30 to 365 days. Results Compared to patients with lesser regression, patients with greater LVMi regression had a similar rate of all-cause mortality (14.1% vs. 14.3%, p=0.99), but a lower rate of rehospitalization (9.5% vs. 18.5%, HR 0.50; 95% CI, 0.32–0.78; p=0.002) and a lower rate of rehospitalizations specifically for heart failure (7.3% vs. 13.6%, p=0.01). The association with a lower rate of hospitalizations was consistent across sub-groups and remained significant after multivariable adjustment (HR 0.53; 95% CI, 0.34–0.84; p=0.007). Patients with greater LVMi regression had lower BNP (p=0.002) and a trend toward better quality of life (p=0.06) at 1 year compared to those with lesser regression. Conclusions In high-risk patients with severe AS and severe LVH undergoing TAVR, those with greater early LV mass regression had half the rate of rehospitalization over the subsequent year. PMID:24947722

  3. Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER trial).

    PubMed

    Green, Philip; Cohen, David J; Généreux, Philippe; McAndrew, Tom; Arnold, Suzanne V; Alu, Maria; Beohar, Nirat; Rihal, Charanjit S; Mack, Michael J; Kapadia, Samir; Dvir, Danny; Maurer, Mathew S; Williams, Mathew R; Kodali, Susheel; Leon, Martin B; Kirtane, Ajay J

    2013-09-01

    Functional capacity as assessed by 6-minute walk test distance (6MWTD) has been shown to predict outcomes in selected cohorts with cardiovascular disease. To evaluate the association between 6MWTD and outcomes after transcatheter aortic valve implantation (TAVI) among participants in the Placement of AoRTic TraNscathetER valve (PARTNER) trial, TAVI recipients (n = 484) were stratified into 3 groups according to baseline 6MWTD: unable to walk (n = 218), slow walkers (n = 133), in whom 6MWTD was below the median (128.5 meters), and fast walkers (n = 133) with 6MWTD >128.5 meters. After TAVI, among fast walkers, follow-up 6MWTD decreased by 44 ± 148 meters at 12 months (p <0.02 compared with baseline). In contrast, among slow walkers, 6MWTD improved after TAVI by 58 ± 126 meters (p <0.001 compared with baseline). Similarly, among those unable to walk, 6MWTD distance increased by 66 ± 109 meters (p <0.001 compared with baseline). There were no differences in 30-day outcomes among 6MWTD groups. At 2 years, the rate of death from any cause was 42.5% in those unable to walk, 31.2% in slow walkers, and 28.8% in fast walkers (p = 0.02), driven primarily by differences in noncardiac death. In conclusion, among high-risk older adults undergoing TAVI, baseline 6MWTD does not predict procedural outcomes but does predict long-term mortality. Nonetheless, patients with poor baseline functional status exhibit the greatest improvement in 6MWTD. Additional work is required to identify those with poor functional status who stand to benefit the most from TAVI. PMID:23725996

  4. Closed bore XMR (CBXMR) systems for aortic valve replacement: Investigation of rotating-anode x-ray tube heat loadability

    SciTech Connect

    Bracken, John A.; Lillaney, Prasheel V.; Fahrig, Rebecca; Rowlands, J. A. [Sunnybrook Health Sciences Center, Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 (Canada); Department of Radiology, Lucas MRS Center, Stanford University, 1201 Welch Road, Stanford, California 94305-5488 (United States); Sunnybrook Health Sciences Center, Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 (Canada)

    2008-09-15

    In order to improve the safety and efficacy of percutaneous aortic valve replacement procedures, a closed bore hybrid x-ray/MRI (CBXMR) system is proposed in which an x-ray C-arm will be positioned with its isocenter {approx_equal}1 m from the entrance of a clinical MRI scanner. This system will harness the complementary strengths of both modalities to improve clinical outcome. A key component of the CBXMR system will be a rotating anode x-ray tube to produce high-quality x-ray images. There are challenges in positioning an x-ray tube in the magnetic fringe field of the MRI magnet. Here, the effects of an external magnetic field on x-ray tube induction motors of radiography x-ray tubes and the corresponding reduction of x-ray tube heat loadability are investigated. Anode rotation frequency f{sub anode} was unaffected when the external magnetic field B{sub b} was parallel to the axis of rotation of the anode but decreased when B{sub b} was perpendicular to the axis of rotation. The experimental f{sub anode} values agreed with predicted values to within {+-}3% over a B{sub b} range of 0-30 mT. The MRI fringe field at the proposed location of the x-ray tube mounted on the C-arm ({approx_equal}4 mT) reduced f{sub anode} by only 1%, so x-ray tube heat loadability will not be compromised when using CBXMR systems for percutaneous aortic valve replacement procedures. Eddy current heating power in the rotor due to an MRI fringe field was found to be two orders of magnitude weaker than the heating power produced on the anode due to a fluoroscopic exposure, so eddy current heating had no effect on x-ray tube heat loadability.

  5. Closed bore XMR (CBXMR) systems for aortic valve replacement: Active magnetic shielding of x-ray tubes

    SciTech Connect

    Bracken, John A.; DeCrescenzo, Giovanni; Komljenovic, Philip; Lillaney, Prasheel V.; Fahrig, Rebecca; Rowlands, J. A. [Department of Medical Biophysics and Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 (Canada); Department of Radiology, Stanford University, Stanford, California 94305 (United States); Department of Medical Biophysics and Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 (Canada)

    2009-05-15

    Hybrid closed bore x-ray/MRI systems are being developed to improve the safety and efficacy of percutaneous aortic valve replacement procedures by harnessing the complementary strengths of the x-ray and MRI modalities in a single interventional suite without requiring patient transfer between two rooms. These systems are composed of an x-ray C-arm in close proximity ({approx_equal}1 m) to an MRI scanner. The MRI magnetic fringe field can cause the electron beam in the x-ray tube to deflect. The deflection causes the x-ray field of view to shift position on the detector receptacle. This could result in unnecessary radiation exposure to the patient and the staff in the cardiac catheterization laboratory. Therefore, the electron beam deflection must be corrected. The authors developed an active magnetic shielding system that can correct for electron beam deflection to within an accuracy of 5% without truncating the field of view or increasing exposure to the patient. This system was able to automatically adjust to different field strengths as the external magnetic field acting on the x-ray tube was changed. Although a small torque was observed on the shielding coils of the active shielding system when they were placed in a magnetic field, this torque will not impact their performance if they are securely mounted on the x-ray tube and the C-arm. The heating of the coils of the shielding system for use in the clinic caused by electric current was found to be slow enough not to require a dedicated cooling system for one percutaneous aortic valve replacement procedure. However, a cooling system will be required if multiple procedures are performed in one session.

  6. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis.

    PubMed

    Durand, Eric; Eltchaninoff, Hélène; Canville, Alexandre; Bouhzam, Najime; Godin, Matthieu; Tron, Christophe; Rodriguez, Carlos; Litzler, Pierre-Yves; Bauer, Fabrice; Cribier, Alain

    2015-04-15

    There is currently no consensus on the duration of hospitalization required after transfemoral transcatheter aortic valve implantation (TAVI). We report the feasibility and safety of early discharge after TAVI with the Edwards SAPIEN-XT prosthesis. From 2009 to 2013, 337 patients underwent transfemoral TAVI with the Edwards SAPIEN-XT prosthesis using local anesthesia and were discharged home either early (?3 days, Early Discharge group, n = 121) or after 3 days (Late Discharge group, n = 216). The primary end point of the study combined death and rehospitalization from discharge to 30-day follow-up. Patients in the Early Discharge group were less symptomatic (New York Heart Association class ?III: 64.5% vs 75.5%, p = 0.01) and had less renal failure (creatinine: 102.1 ± 41.0 vs 113.3 ± 58.9 ?mol/L, p = 0.04), atrial fibrillation (33.1% vs 46.3%, p = 0.02), and previous balloon aortic valvuloplasty (11.6% vs 23.1%, p = 0.01) and were more likely to have a pacemaker before TAVI (16.5% vs 8.3%, p = 0.02). Pre-existing pacemaker (p = 0.05) and the absence of acute kidney injury (p = 0.02) were independent predictors of an early discharge, whereas previous balloon aortic valvuloplasty (p = 0.03) and post-TAVI blood transfusions (p = 0.002) were independent predictors of late discharge. The primary end point occurred in 4 patients (3.3%) in the Early Discharge group and in 11 patients (5.1%) in the Late Discharge group (p = 0.58). In conclusion, the results of our study suggest that early discharge after transfemoral TAVI using the Edwards SAPIEN-XT prosthesis is feasible and safe in selected patients. PMID:25726383

  7. A simple risk tool (the OBSERVANT score) for prediction of 30-day mortality after transcatheter aortic valve replacement.

    PubMed

    Capodanno, Davide; Barbanti, Marco; Tamburino, Corrado; D'Errigo, Paola; Ranucci, Marco; Santoro, Gennaro; Santini, Francesco; Onorati, Francesco; Grossi, Claudio; Covello, Remo Daniel; Capranzano, Piera; Rosato, Stefano; Seccareccia, Fulvia

    2014-06-01

    Risk stratification tools used in patients with severe aortic stenosis have been mostly derived from surgical series. Although specific predictors of early mortality with transcatheter aortic valve replacement (TAVR) have been identified, the prognostic impact of their combination is unexplored. We sought to develop a simple score, using preprocedural variables, for prediction of 30-day mortality after TAVR. A total of 1,878 patients from a national multicenter registry who underwent TAVR were randomly assigned in a 2:1 manner to development and validation data sets. Baseline characteristics of the 1,256 patients in the development data set were considered as candidate univariate predictors of 30-day mortality. A bootstrap multivariate logistic regression process was used to select correlates of 30-day mortality that were subsequently weighted and integrated into a scoring system. Seven variables were weighted proportionally to their respective odds ratios for 30-day mortality (glomerular filtration rate <45 ml/min [6 points], critical preoperative state [5 points], New York Heart Association class IV [4 points], pulmonary hypertension [4 points], diabetes mellitus [4 points], previous balloon aortic valvuloplasty [3 points], and left ventricular ejection fraction <40% [3 points]). The model showed good discrimination in both the development and validation data sets (C statistics 0.73 and 0.71, respectively). Compared with the logistic European System for Cardiac Operative Risk Evaluation in the validation data set, the model showed better discrimination (C statistic 0.71 vs 0.66), goodness of fit (Hosmer-Lemeshow p value 0.81 vs 0.00), and global accuracy (Brier score 0.054 vs 0.073). In conclusion, the risk of 30-day mortality after TAVR may be estimated by combining 7 baseline clinical variables into a simple risk scoring system. PMID:24837264

  8. Proof of concept of FOLDAVALVE, a novel 14 Fr totally repositionable and retrievable transcatheter aortic valve.

    E-print Network

    Kheradvar, A; Groves, EM; Tseng, E

    2015-01-01

    full release and sepa- ration from the delivery system, thesystem attached to FOLDAVALVE. B) The valve release andsystem provides exceptional flexibility and control in Figure 5. Positioning and release

  9. Invariant formulation for dispersed transverse isotropy in aortic heart valves: An efficient means for modeling fiber splay

    SciTech Connect

    Freed, Alan D.; Einstein, Daniel R.; Vesely, Ivan

    2005-11-01

    Most soft tissues possess an oriented architecture of collagen fiber bundles, conferring both anisotropy and nonlinearity to their elastic behavior. Transverse isotropy has often been assumed for a subset of these tissues that have a single macroscopically-identifiable preferred fiber direction. Micro-structural studies, however, suggest that, in some tissues, collagen fibers are approximately normally distributed about a mean preferred fiber direction. Structural constitutive equations that account for this dispersion of fibers have been shown to capture the mechanical complexity of these tissues quite well. Such descriptions, however, are computationally cumbersome for two-dimensional (2D) fiber distributions, let alone for fully three-dimensional (3D) fiber populations. In this paper, we develop a new constitutive law for such tissues, based on a novel invariant theory for dispersed transverse isotropy. The invariant theory is based on a novel closed-form ''splay invariant'' that can easily handle 3D fiber populations, and that only requires a single parameter in the 2D case. The model is polyconvex and fits biaxial data for aortic valve tissue as accurately as the standard structural model. Modification of the fiber stress-strain law requires no re-formulation of the constitutive tangent matrix, making the model flexible for different types of soft tissues. Most importantly, the model is computationally expedient in a finite-element analysis, demonstrated by modeling a bioprosthetic heart valve.

  10. Transcatheter valve implantation for patients with aortic stenosis: A position statement from the European Association of CardioThoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

    Microsoft Academic Search

    A. Vahanian; O. Alfieri; N. Al-Attar; M. Antunes; J. J. Bax; B. Cormier; A. Cribier; P. De Jaegere; G. Fournial; A. P. Kappetein; J. Kovac; S. Ludgate; F. Maisano; N. Moat; F. W. Mohr; P. Nataf; L. Piérard; J. L. Pomar; J. Schofer; P. Tornos; M. Tuzcu; Hout van B. A; Segesser von L. K; T. Walther

    2008-01-01

    Aims: To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. Methods and results: A committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic

  11. Analysis of Long-Term Survival Following Transcatheter Aortic Valve Implantation from a Single High-Volume Center.

    PubMed

    Escárcega, Ricardo O; Lipinski, Michael J; Baker, Nevin C; Magalhaes, Marco A; Minha, Sa'ar; Torguson, Rebecca; Chen, Fang; Ben-Dor, Itsik; Satler, Lowell F; Pichard, Augusto D; Corso, Paul; Waksman, Ron

    2015-07-15

    Mortality after transcatheter aortic valve implantation (TAVI) has been reported to range up to 3 years. However, long-term mortality remains underexplored. The aims of this study were to determine long-term mortality in patients who undergo TAVI and to identify correlates of long-term death. From a single institution's prospectively collected TAVI database, all patients who underwent TAVI with a maximum follow-up duration of 5 years were analyzed. The population was analyzed on the basis of access route (transapical TAVI or transfemoral TAVI). Cox regression and Kaplan-Meier survival analysis were conducted. A total of 511 patients who underwent TAVI were included in the analysis (transapical TAVI n = 115, transfemoral TAVI n = 396). The mean Society of Thoracic Surgeons score was 9.6 ± 4. Mortality at 30 days (18% vs 6%, p <0.001) and 1 year (32% vs 21%, p <0.01) was significantly increased in the transapical TAVI group. Long-term survival probability was <50% for the 2 approaches (log-rank p = 0.33). Vascular complications (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.38 to 3.33, p = 0.001), more than mild aortic insufficiency (HR 1.81, 95% CI 1.15 to 2.83, p = 0.01), atrial fibrillation (HR 1.87, 95% CI 1.36 to 2.57, p <0.001), and in-hospital stroke (HR 2.35, 95% CI 1.39 to 4.00, p = 0.002) were independently associated with long-term death. The survival probability of patients at high surgical risk versus those who were inoperable was similar in the long term (log-rank p = 0.53). In conclusion, the overall long-term survival of patients with aortic stenosis who were approved to undergo TAVI was <50% irrespective of access method. Strategies geared toward reducing in-hospital stroke, vascular complications, and aortic regurgitation are still needed, as these variables are correlates of long-term mortality. PMID:25978977

  12. Evaluation of the Valve Academic Research Consortium-2 Criteria for Myocardial Infarction in Transcatheter Aortic Valve Implantation: A Prospective Observational Study

    PubMed Central

    Nilsson, Lennart; Appel, Carl-Fredrik; Hultkvist, Henrik; Vánky, Farkas

    2015-01-01

    Objective To evaluate the relevance of the individual components of the Valve Academic Research Consortium (VARC)-2 criteria for periprocedural myocardial infarction (MI) in transcatheter aortic valve implantation (TAVI). The association between biomarkers and adverse procedural outcome has been established. However, the additive prognostic importance of signs and symptoms are more uncertain. Methods A total of 125 consecutive TAVI patients were prospectively included in this study. Biomarkers for MI were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records. Results The criteria of elevated biomarkers and of signs or symptoms were found in 27 (22%) and 32 (26%) of the patients, respectively. According to VARC-2 definition, 12 (10%) had MI. VARC-2 definition of MI, Troponin T (TnT) > 600 ng/L, and presence of signs or symptoms correlated with 6 months mortality, prolonged ICU stay, elevation of N-terminal prohormone brain natriuretic peptide, and renal impairment. No signs or symptoms were found in 7 (44%) of the patients who fulfilled the criterion of elevated TnT > 600 ng/L. In the group with positive TnT criterion, there were no significant differences between those with and without signs or symptoms in respect to levels of TnT (1014 [585–1720] ng/L versus 704 [515–905] ng/L, p = 0.17) or creatine kinase-MB (36 [25–52] ?g/L versus 29 [25–39] ?g/L, p = 0.32). In the multivariate Cox regression analysis, TnT > 600 ng/L was the only significant independent variable associated with 6-months postprocedural mortality. Conclusions Myocardial injury in TAVI, measured with biomarkers, correlates well with adverse procedural outcome. In this study it is also the strongest predictor for early postprocedural mortality. The additional requirement of signs or symptoms for the diagnosis of MI results in omission of a considerable number of clinically significant MI. PMID:26069958

  13. Performance of the EuroSCORE II and the Society of Thoracic Surgeons Score in patients undergoing aortic valve replacement for aortic stenosis.

    PubMed

    Kuwaki, K; Inaba, H; Yamamoto, T; Dohi, S; Matsumura, T; Morita, T; Amano, A

    2015-06-01

    Aim. The aim of this study was to evaluate the performance of the new European System for Cardiac Operative Risk Evaluation (EuroSCORE) II and the Society of Thoracic Surgeons (STS) score in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS). This study also evaluated the performance of the EuroSCORE II in high-risk patients. Methods. Three hundred and six consecutive adult patients underwent AVR with or without coronary artery bypass grafting at our institution from August 2002 to June 2012. The cut-off value of 6% for the EuroSCORE II and 10% for the STS score was used to identify high-risk in this study. Results. Operative mortality was 3.5% (N.=11). The mean expected mortality for all patients was 3.1% (O/E ratio=1.12) for the EuroSCORE II and 5.1% (O/E ratio=0.68) for the STS score. Observed versus expected mortality for the high-risk patients was 17.2% versus 11.9% (O/E ratio=1.44) for the EuroSCORE II (N.=29) and 19.3% versus 18.5% (O/E ratio=1.04) for the STS score (N.=31), and that for the low-risk was 2.1% versus 2.2% (O/E ratio=0.95) for the EuroSCORE II and 1.8% versus 3.5% (O/E ratio=0.51) for the STS score. Discrimination power of the STS score was good (area under the receiver operating characteristics curve [AUC] 0.74), but that of the EuroSCORE II was suboptimal (AUC 0.66). Conclusion. Good calibration ability of the EuroSCORE II for low-risk patients and that of the STS score for high-risk are observed. However, the EuroSCORE II underestimates the operative mortality in high-risk patients and the STS score overestimates the risk in low-risk patients. PMID:25729918

  14. Model based Estimation of Aortic and Mitral valves Opening and Closing Timings in Developing Human Fetuses.

    PubMed

    Marzbanrad, Faezeh; Kimura, Yoshitaka; Endo, Miyuki; Oshio, Sayaka; Funamoto, Kiyoe; Sato, Naoaki; Palaniswami, Marimuthu; Khandoker, Ahsan

    2014-10-16

    Electromechanical coupling of the fetal heart can be evaluated non-invasively using Doppler Ultrasound (DUS) signal and fetal electrocardiography (fECG). In this study, an efficient model is proposed using K-means clustering and hybrid SVM-HMM modeling techniques. Opening and closing of the cardiac valves were detected from peaks in the high frequency component of the DUS signal decomposed by wavelet analysis. It was previously proposed to automatically identify the valve motion by hybrid Support Vector Machine- Hidden Markov Model (SVM-HMM) [1] based on the amplitude and timing of the peaks. However, in the present study, six patterns were identified for the DUS components which were actually variable on a beat to beat basis and found to be different for the early gestation (16- 32 weeks), compared to the late gestation fetuses (36-41 weeks). The amplitude of the peaks linked to the valve motion was different across the six patterns and this affected the precision of valve motion identification by the previous hybrid SVM-HMM method. Therefore in the present study, clustering of the DUS components based on K-means was proposed and the hybrid SVM-HMM was trained for each cluster separately. The valve motion events were consequently identified more efficiently by beat-to-beat attribution of the DUS component peaks. Applying this method, more than 98.6% of valve motion events were beatto- beat identified with average precision and recall of 83.4% and 84.2% respectively. It was an improvement compared to the hybrid method without clustering with average precision and recall of 79.0% and 79.8%. Therefore, this model would be useful for reliable screening of fetal wellbeing. PMID:25343774

  15. Trends of Hospitalizations in the United States from 2000 to 2012 of Patients >60 Years With Aortic Valve Disease.

    PubMed

    Badheka, Apurva O; Singh, Vikas; Patel, Nileshkumar J; Arora, Shilpkumar; Patel, Nilay; Thakkar, Badal; Jhamnani, Sunny; Pant, Sadip; Chothani, Ankit; Macon, Conrad; Panaich, Sidakpal S; Patel, Jay; Manvar, Sohilkumar; Savani, Chirag; Bhatt, Parth; Panchal, Vinaykumar; Patel, Neil; Patel, Achint; Patel, Darshan; Lahewala, Sopan; Deshmukh, Abhishek; Mohamad, Tamam; Mangi, Abeel A; Cleman, Michael; Forrest, John K

    2015-07-01

    In recent years, there has been an increased emphasis on the diagnosis and treatment of valvular heart disease and, in particular, aortic stenosis. This has been driven in part by the development of innovative therapeutic options and by an aging patient population. We hypothesized an increase in the number of hospitalizations and the economic burden associated with aortic valve disease (AVD). Using Nationwide Inpatient Sample from 2000 to 2012, AVD-related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification, code 424.1, as the principal discharge diagnosis. Overall AVD hospitalizations increased by 59% from 2000 to 2012. This increase was most significant in patients >80 years and those with higher burden of co-morbidities. The most frequent coexisting conditions were hypertension, heart failure, renal failure, anemia, and diabetes. Overall inhospital mortality of patients hospitalized for AVD was 3.8%, which significantly decreased from 4.5% in 2000 to 3.5% in 2012 (p <0.001). The largest decrease in mortality was seen in the subgroup of patients who had heart failure (62% reduction), higher burden of co-morbidities (58% reduction), and who were >80 years (53% reduction). There was a substantial increase in the cost of hospitalization in the last decade from $31,909 to $38,172 (p <0.001). The total annual cost for AVD hospitalization in the United States increased from $1.3 billion in 2001 to $2.1 billion in 2011 and is expected to increase to nearly 3 billion by 2020. The last decade has witnessed a significant increase in hospitalizations for AVD in the United States. The associated decrease in inhospital mortality and increase in the cost of hospitalization have considerably increased the economic burden on the public health system. PMID:25983278

  16. Effect of Correction of Anemia on Echocardiographic and Clinical Parameters in Patients With Aortic Stenosis Involving a Three-Cuspid Aortic Valve and Normal Left Ventricular Ejection Fraction.

    PubMed

    Gómez, Miquel; Ble, Mireia; Cladellas, Mercedes; Molina, Luis; Comín-Colet, Josep; Enjuanes, Cristina; Roqueta, Cristina; Soler, Cristina; Bruguera, Jordi

    2015-07-15

    The objective of the study is to investigate the impact of anemia (defined as hemoglobin concentration of <12 g/dl in women and 13 g/dl in men) on prognosis and to study the effect of recovery from anemia on echocardiographic and clinical parameters in patients with aortic stenosis (AS). This was a prospective study in 315 patients with moderate or severe AS. Patients with anemia received oral iron (ferrous sulfate with mucoproteose, 160 mg iron/day) and erythropoietin, if needed, or intravenous iron, if necessary. The following tests were performed before and after normalization of hemoglobin values: echocardiogram, 6-minute walk test, N-terminal B-type natriuretic peptide, and measures of depression, cognitive impairment, and dependence. Patient mean age was 74 years (SD 9). Mean follow-up was 25 months (SD 8). Anemia prevalence in the overall group was 22% (n = 70). Patients who are anemic had a higher rate of complications at follow-up (mortality, hospital admission, or need for valve procedure; 80% vs 62%, p = 0.009). In total, 89% of patients recovered from anemia, with a mean time to recovery of 4.6 weeks (SD 1.4). Improvements were observed on echocardiographic parameters of peak velocity (4.1 to 3.7 m/s, p = 0.02) and mean gradient (44 to 35 mm Hg, p = 0.02). Performance on the 6-minute walk test improved from 235 to 303 m (p <0.001). Median N-terminal B-type natriuretic peptide value decreased from 612 to 189 pg/dl (p <0.001). In conclusion, patients with AS and anemia have a worse prognosis than those without anemia. Resolution of anemia is associated with improvements in echocardiographic parameters and functional status, suggesting that treatment of iron deficiency is a relevant option in the management of patients with AS, particularly in nonoperable cases. PMID:25983280

  17. Efficacy of amiodarone on refractory ventricular fibrillation resistant to lidocaine and cardioversion during weaning from cardiopulmonary bypass in aortic valve replacement for severe aortic stenosis with left ventricular hypertrophy.

    PubMed

    Morita, Yoshihisa; Mizuno, Ju; Yoshimura, Tatsuya; Morita, Shigeho

    2010-10-01

    Intravenous injection of amiodarone, a class III anti-arrhythmic is widely used for persistent refractory arrhythmias. We present a case report suggesting the efficacy of amiodarone in refractory ventricular fibrillation (Vf) during weaning from cardiopulmonary bypass (CPB). A 66-year-old woman with hypertension had a medical examination as a result of an episode of palpitations and syncope. Echocardiography and an invasive hemodynamic study revealed severe aortic stenosis (AS) with left ventricular (LV) hypertrophy because of calcified degeneration in a congenital bicuspid aortic valve (AV). Aortic valve replacement (AVR) was scheduled under general anesthesia and CPB. Intraoperative diagnosis was AS with calcified AV, LV hypertrophy, and aneurysm of ascending aorta (Ao). AVR with a biological valve, artificial vessel replacement of ascending Ao, and excision of the outflow myocardial septum were performed under CPB with intermittent antegrade blood cardioplegia at a body temperature (BT) of 24°C. The patient suffered from Vf at a BT of 35.3°C. Vf was not responsive to lidocaine 100 mg and 10 direct current (DC) shocks. After continuous intravenous infusion of amiodarone 225 mg/h for 10 min and a single intravenous injection of amiodarone 150 mg followed by a single DC shock, she returned to normal sinus rhythm. Sinus rhythm was maintained by continuous intravenous infusion of amiodarone 60 mg/h. Total CPB time was 5 h 43 min. Aortic cross-clamping time was 3 h 50 min. Administration of amiodarone is effective for refractory Vf resistant to lidocaine and cardioversion during weaning from CPB in cardiac surgery for heart diseases with LV hypertrophy. PMID:20665054

  18. Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation.

    PubMed

    De Backer, Ole; Arnous, Samer; Sandholt, Benjamin; Brooks, Matthew; Biasco, Luigi; Franzen, Olaf; Lönn, Lars; Bech, Bo; Søndergaard, Lars

    2015-04-15

    Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI-induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients. PMID:25728645

  19. Effect of depletion of monocytes\\/macrophages on early aortic valve lesion in experimental hyperlipidemia

    Microsoft Academic Search

    Manuela Voinea Calin; Ileana Manduteanu; Elena Dragomir; Emanuel Dragan; Manuela Nicolae; Ana Maria Gan; Maya Simionescu

    2009-01-01

    Monocytes\\/macrophages are key players throughout atheroma development. The aim of this study was to determine the role of\\u000a macrophages in lesion formation in heart valves in hyperlipidemia. We examined whether systemic depletion of monocytes\\/macrophages\\u000a had a beneficial or adverse effect on the development of lesions in hyperlipemic hamsters injected twice weekly (for 2 months)\\u000a with clodronate-encapsulated liposomes (H+Lclod), a treatment that

  20. Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices

    PubMed Central

    2010-01-01

    Background Cardiovascular magnetic resonance (CMR) is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI) featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve®) including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve® prosthesis as an initial step towards real-time CMR-guided TAVI. Methods The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T1-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding. Results CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences. Conclusions The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement in vivo after suggested design modifications of the delivery system. PMID:20942968

  1. Comparison of Outcome of Transcatheter Aortic Valve Implantation With Versus Without Previous Coronary Artery Bypass Grafting (from the FRANCE 2 Registry).

    PubMed

    Castellant, Philippe; Didier, Romain; Bezon, Eric; Couturaud, Francis; Eltchaninoff, Hélène; Iung, Bernard; Donzeau-Gouge, Patrick; Chevreul, Karine; Fajadet, Jean; Leprince, Pascal; Leguerrier, Alain; Lievre, Michel; Prat, Alain; Teiger, Emmanuel; Laskar, Marc; Boschat, Jacques; Gilard, Martine

    2015-08-01

    Previous coronary artery bypass grafting (CABG) increases operative risk in conventional valve replacement. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high-risk patient subgroups. The present study compared outcome and overall survival in patients who underwent TAVI with and without history of CABG. From January 2010 to December 2011, 683 of the 3,761 patients selected for TAVI in 34 French centers (18%) had a history of CABG. Outcomes (mortality and complications) were collected prospectively according to the Valve Academic Research Consortium (VARC) criteria. Patients with previous CABG were younger, with higher rates of diabetes and vascular disease and higher logistic European System for Cardiac Operative Risk Evaluation (29.8 ± 16.4 vs 20.1 ± 13.0, p <0.001) but lower rates of pulmonary disease. Two types of valve (Edwards SAPIEN and Medtronic CoreValve) were implanted in equal proportions in the 2 groups. The 30-day and 1-year mortality rates from all causes on Kaplan-Meier analysis (9.2% vs 9.7%, p = 0.71; and 19.0% vs 20.2%, p = 0.49, respectively) did not differ according to the history of CABG. There were no significant differences in the Valve Academic Research Consortium complications (myocardial infarction, stroke or vascular, and bleeding complications). On multivariate analysis, CABG was not associated with greater 1-year post-TAVI mortality. In conclusion, previous CABG did not adversely affect outcome in patients who underwent TAVI, which may be an alternative to surgery in high-risk patients with severe aortic stenosis and history of CABG. PMID:26071993

  2. Elastic fibers in the aortic valve spongiosa: a fresh perspective on its structure and role in overall tissue function

    PubMed Central

    Tseng, Hubert; Grande-Allen, K. Jane

    2015-01-01

    This study characterized the elastic fiber structure within the aortic valve spongiosa, the middle layer of the tri-laminate leaflet. The layer is rich in glycosaminoglycans and proteoglycans, through which it resists compression and lubricates shear between the outer layers. Elastin in this layer forms a fine, interweaving structure, yet it is unclear how this particular structure, which uses elasticity to preload the leaflet, assists spongiosa function. In this study, immunohistochemistry and scanning electron microscopy were used to characterize spongiosa elastin, as well as investigate regional differences in structure. Immunohistochemistry for elastin highlighted an intermediate structure that varied in thickness and density between regions. In particular, the spongiosa elastin was thicker in the hinge and coaptation region than in the belly. Scanning electron microscopy of NaOH-digested leaflets showed a rectilinear pattern of elastic fibers in the hinge and coaptation region, as opposed to a radially oriented stripe pattern in the belly. In conclusion, elastic fibers in the spongiosa connect the two outer layers and vary regionally in structure, while possible playing a role in responding to regionally specific loading patterns. PMID:21255691

  3. Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

    PubMed Central

    Lee, Seitetsu L.; Hashimoto, Hideki; Kohro, Takahide; Horiguchi, Hiromasa; Koide, Daisuke; Komuro, Issei; Fushimi, Kiyohide; Yamazaki, Tsutomu; Yasunaga, Hideo

    2014-01-01

    Background Universal health-care coverage has attracted the interest of policy makers as a way of achieving health equity. However, previous reports have shown that despite universal coverage, socioeconomic disparity persists in access to high-tech invasive care, such as cardiac treatment. In this study, we aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan's health-care system, which is mainly publicly funded. Methods We chose aortic stenosis in older people as a target because such patients are likely to be affected by socioeconomic disparity. Using a large Japanese claim-based inpatient database, we identified 12,893 isolated aortic stenosis patients aged over 65 years who were hospitalized between July 2010 and March 2012. Municipality socioeconomic status was represented by the mean household income of the patients' residential municipality, categorized into quartiles. The likelihood of undergoing aortic valve surgery and in-hospital mortality was regressed against socioeconomic status level with adjustments for hospital volume, regional number of cardiac surgeons per 1 million population, and patients' clinical status. Results We found no significant differences between the highest and lowest quartile groups in surgical indication (odds ratio, 0.84; 95% confidence interval, 0.69–1.03) or in-hospital mortality (1.00; 0.68–1.48). Hospital volume was significantly associated with lower postoperative mortality (odds ratio of the highest volume tertile to the lowest, 0.49; 0.34–0.71). Conclusions Under Japan's current universal health-care coverage, municipality socioeconomic status did not appear to have a systematic relationship with either treatment decision for surgical intervention or postoperative survival following aortic valve surgery among older patients. Our results imply that universal health-care coverage with high publicly funded coverage offers equal access to high-tech cardiovascular care. PMID:25360759

  4. A case of aortic and mitral valve involvement in granulomatosis with polyangiitis.

    PubMed

    Espitia, Olivier; Droy, Laure; Pattier, Sabine; Naudin, Frédérique; Mugniot, Antoine; Cavailles, Arnaud; Hamidou, Mohamed; Bruneval, Patrick; Agard, Christian; Toquet, Claire

    2014-01-01

    Granulomatosis with polyangiitis (GPA) (Wegener's) is a necrotizing systemic vasculitis of the small-sized blood vessels, affecting kidneys, lungs, upper respiratory tract and skin. Cardiac valvular involvement is an uncommon manifestation of GPA. We report the case of a 60-year-old woman with arthritis and lung nodules due to GPA without antineutrophil cytoplasmic antibodies (ANCA) at time of diagnosis. Remission was obtained with cyclophosphamide and corticosteroid. Azathioprine was then prescribed for 2years. Four years later, she developed severe inflammatory aortic and mitral valvular involvement characterized by GPA typical histopathological valvular lesions. Search for ANCA was positive at this time (anti-myeloperoxidase). Cardiac valvular involvement is a rare and potentially fatal complication of GPA and may misleadingly suggest infectious endocarditis. A review of literature revealed few cases of histologically well-documented cardiac valvular involvement in GPA. Pathologists should be aware of valvular heart diseases in GPA, which usually comprise valvular necrotic lesions without any microbial agents. PMID:25194969

  5. How to assess aortic annular size before transcatheter aortic valve implantation (TAVI): the role of echocardiography compared with other imaging modalities.

    PubMed

    Kenny, Cliona; Monaghan, Mark

    2015-05-01

    After reading this article, the reader should be able to: Recognise the complex 3 dimensional anatomy of the aortic annulus. Select appropriate cardiac imaging modalities for measurement of aortic annulus size and distinguish the different measurements which may be made. Describe the advantages & limitations of different imaging modalities with reference to clinical outcomes and complications. PMID:25227703

  6. Advanced 3-D analysis, client-server systems, and cloud computing-Integration of cardiovascular imaging data into clinical workflows of transcatheter aortic valve replacement.

    PubMed

    Schoenhagen, Paul; Zimmermann, Mathis; Falkner, Juergen

    2013-06-01

    Degenerative aortic stenosis is highly prevalent in the aging populations of industrialized countries and is associated with poor prognosis. Surgical valve replacement has been the only established treatment with documented improvement of long-term outcome. However, many of the older patients with aortic stenosis (AS) are high-risk or ineligible for surgery. For these patients, transcatheter aortic valve replacement (TAVR) has emerged as a treatment alternative. The TAVR procedure is characterized by a lack of visualization of the operative field. Therefore, pre- and intra-procedural imaging is critical for patient selection, pre-procedural planning, and intra-operative decision-making. Incremental to conventional angiography and 2-D echocardiography, multidetector computed tomography (CT) has assumed an important role before TAVR. The analysis of 3-D CT data requires extensive post-processing during direct interaction with the dataset, using advance analysis software. Organization and storage of the data according to complex clinical workflows and sharing of image information have become a critical part of these novel treatment approaches. Optimally, the data are integrated into a comprehensive image data file accessible to multiple groups of practitioners across the hospital. This creates new challenges for data management requiring a complex IT infrastructure, spanning across multiple locations, but is increasingly achieved with client-server solutions and private cloud technology. This article describes the challenges and opportunities created by the increased amount of patient-specific imaging data in the context of TAVR. PMID:24282750

  7. Ex Vivo Evidence for the Contribution of Hemodynamic Shear Stress Abnormalities to the Early Pathogenesis of Calcific Bicuspid Aortic Valve Disease

    PubMed Central

    Sun, Ling; Chandra, Santanu; Sucosky, Philippe

    2012-01-01

    The bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly and is frequently associated with calcific aortic valve disease (CAVD). The most prevalent type-I morphology, which results from left-/right-coronary cusp fusion, generates different hemodynamics than a tricuspid aortic valve (TAV). While valvular calcification has been linked to genetic and atherogenic predispositions, hemodynamic abnormalities are increasingly pointed as potential pathogenic contributors. In particular, the wall shear stress (WSS) produced by blood flow on the leaflets regulates homeostasis in the TAV. In contrast, WSS alterations cause valve dysfunction and disease. While such observations support the existence of synergies between valvular hemodynamics and biology, the role played by BAV WSS in valvular calcification remains unknown. The objective of this study was to isolate the acute effects of native BAV WSS abnormalities on CAVD pathogenesis. Porcine aortic valve leaflets were subjected ex vivo to the native WSS experienced by TAV and type-I BAV leaflets for 48 hours. Immunostaining, immunoblotting and zymography were performed to characterize endothelial activation, pro-inflammatory paracrine signaling, extracellular matrix remodeling and markers involved in valvular interstitial cell activation and osteogenesis. While TAV and non-coronary BAV leaflet WSS essentially maintained valvular homeostasis, fused BAV leaflet WSS promoted fibrosa endothelial activation, paracrine signaling (2.4-fold and 3.7-fold increase in BMP-4 and TGF-?1, respectively, relative to fresh controls), catabolic enzyme secretion (6.3-fold, 16.8-fold, 11.7-fold, 16.7-fold and 5.5-fold increase in MMP-2, MMP-9, cathepsin L, cathepsin S and TIMP-2, respectively) and activity (1.7-fold and 2.4-fold increase in MMP-2 and MMP-9 activity, respectively), and bone matrix synthesis (5-fold increase in osteocalcin). In contrast, BAV WSS did not significantly affect ?-SMA and Runx2 expressions and TIMP/MMP ratio. This study demonstrates the key role played by BAV hemodynamic abnormalities in CAVD pathogenesis and suggests the dependence of BAV vulnerability to calcification on the local degree of WSS abnormality. PMID:23119099

  8. Successful use of fondaparinux early after mechanical aortic valve replacement in a patient with a history of heparin-induced thrombocytopenia.

    PubMed

    Willenborg, Katie L

    2014-06-01

    Thromboembolic complications such as systemic embolization and valve thrombosis are a major concern early after mechanical valve replacement; however, the benefit of anticoagulation must be weighed against the risk of early postoperative bleeding complications. Thromboembolic risk is also higher in the early postoperative period (less than 6 mo) compared with the risk in the late postoperative period. Current evidence supports the use of unfractionated heparin or low-molecular-weight heparin early after valve replacement to prevent valve thrombosis or systemic embolization but provides no recommendations for the management of patients with a history of heparin-induced thrombocytopenia (HIT), in which heparin products are contraindicated. We describe the use of fondaparinux early after aortic mechanical valve replacement in a 63-year-old, 95-kg woman with a history of HIT. Fondaparinux was initiated on postoperative day 2 at a prophylactic dose of 2.5 mg subcutaneously daily; the dose was increased to a therapeutic weight-based dose of 7.5 mg subcutaneously daily on postoperative day 3. Warfarin was initiated on postoperative day 1, and fondaparinux was continued until a therapeutic international normalized ratio was achieved. The patient was discharged from the hospital receiving warfarin alone on postoperative day 6. No signs or symptoms of thrombosis or bleeding were noted during or after fondaparinux therapy or at hospital follow-up visits. To our knowledge, this is the first case report to describe the use of fondaparinux within the first 48 hours after mechanical valve replacement in a patient with a history of HIT. This case suggests that fondaparinux may be a safe and effective option to prevent thromboembolic complications early after mechanical valve replacement when heparin products are contraindicated. PMID:24644124

  9. Two-year survival of patients screened for transcatheter aortic valve replacement with potentially malignant incidental findings in initial body computed tomography

    PubMed Central

    Stachon, Peter; Kaier, Klaus; Milde, Simone; Pache, Gregor; Sorg, Stefan; Siepe, Matthias; von zur Mühlen, Constantin; Zirlik, Andreas; Beyersdorf, Friedhelm; Langer, Mathias; Zehender, Manfred; Bode, Christoph; Reinöhl, Jochen

    2015-01-01

    Aims Recently, transcatheter aortic valve replacement (TAVR) has evolved as the standard treatment in patients with inoperable aortic valve stenosis. According to TAVR guidelines, body computed tomography (CT) is recommended for pre-procedural planning. Due to the advanced age of these patients, multiple radiological potentially malignant incidental findings (pmIFs) appear in this cohort. It is unknown how pmIFs influence the decision by the heart team to intervene and the mortality. Methods and results We evaluated in a retrospective single-centre observational study 414 participants screened for TAVR with dual-source CT between October 2010 and December 2012. pmIFs are common and appeared in 18.7% of all patients screened for TAVR. The decision to intervene by TAVR or surgical aortic valve replacement (SAVR) was made by an interdisciplinary heart team and the role of pmIF in decision-making and time to treatment with TAVR or SAVR was analysed, retrospectively. The appearance of a pmIF vs. no pmIF did not significantly influence therapeutic decisions [odds ratio (OR) 1.14; P = 0.835] or time to treatment (91 ± 152 vs. 61 ± 109 days, respectively). Several findings, which are highly suspicious for malignancy, were less likely associated with invasive treatment (OR 0.207; P = 0.046). Patient survival was evaluated for at least 2 years until January 2014. Two-year survival of patients after TAVR or SAVR, treated according to the heart team decision, was ?75% and independent from the presence of a non-severe (P = 0.923) or severe (P = 0.823) pmIF. Conclusion The study indicates that frequently occurring radiologic pmIF did not influence 2-year survival after a decision to intervene was made by an interdisciplinary heart team. PMID:25759083

  10. Clinical Factors Associated With Calcific Aortic Valve Disease fn1 fn1 This study was supported in part by Contracts NO1HC85079 through HC850086 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland

    Microsoft Academic Search

    B. Fendley Stewart; David Siscovick; Bonnie K. Lind; Julius M. Gardin; John S. Gottdiener; Vivienne E. Smith; Dalane W. Kitzman; Catherine M. Otto

    1997-01-01

    Objectives. The aim of this study was to determine the prevalence of aortic sclerosis and stenosis in the elderly and to identify clinical factors associated with degenerative aortic valve disease.Background. Several lines of evidence suggest that degenerative aortic valve disease is not an inevitable consequence of aging and may be associated with specific clinical factors.Methods. In 5,201 subjects ?65 years

  11. Valve

    DOEpatents

    Cho, Nakwon (Knoxville, TN)

    1980-01-01

    A positive acting valve suitable for operation in a corrosive environment is provided. The valve includes a hollow valve body defining an open-ended bore for receiving two, axially aligned, spaced-apart, cylindrical inserts. One insert, designated the seat insert, terminates inside the valve body in an annular face which lies within plane normal to the axis of the two inserts. An elastomeric O-ring seal is disposed in a groove extending about the annular face. The other insert, designated the wedge insert, terminates inside the valve body in at least two surfaces oppositely inclined with respect to each other and with respect to a plane normal to the axis of the two inserts. An elongated reciprocable gate, movable between the two inserts along a path normal to the axis of the two inserts, has a first flat face portion disposed adjacent and parallel to the annular face of the seat insert. The gate has a second face portion opposite to the first face portion provided with at least two oppositely inclined surfaces for mating with respective inclined surfaces of the wedge insert. An opening is provided through the gate which registers with a flow passage through the two inserts when the valve is open. Interaction of the respective inclined surfaces of the gate and wedge insert act to force the first flat face portion of the gate against the O-ring seal in the seat insert at the limits of gate displacement where it reaches its respective fully open and fully closed positions.

  12. Transcatheter aortic valve implantation: recommendations for practice based on a multidisciplinary review including cost-effectiveness and ethical and organizational issues.

    PubMed

    Boothroyd, Lucy J; Spaziano, Marco; Guertin, Jason R; Lambert, Laurie J; Rodés-Cabau, Josep; Noiseux, Nicolas; Nguyen, Michel; Dumont, Éric; Carrier, Michel; de Varennes, Benoit; Ibrahim, Reda; Martucci, Giuseppe; Xiao, Yongling; Morin, Jean E; Bogaty, Peter

    2013-06-01

    Transcatheter aortic valve implantation (TAVI) is a relatively new technology for the treatment of severe and symptomatic aortic valve stenosis. TAVI offers an alternative therapy for patients unable to be treated surgically because of contraindications or severe comorbidities. It is being rapidly dispersed in Canada, as it is worldwide. The objective of this article is to present our recommendations for the use of TAVI, based on a multidisciplinary evaluation of recently published evidence. We systematically searched and summarized published data (2008-2011) on benefits, risks, and cost-effectiveness of TAVI. We also examined ethical issues and organizational aspects of delivering the intervention. We discussed the soundness and applicability of our recommendations with clinical experts active in the field. The published TAVI results for high-risk and/or inoperable patients are promising in terms of survival, function, quality of life, and cost-effectiveness, although we noted large variability in the survival rates at 1 year and in the frequency of important adverse outcomes such as stroke. Until more data from randomized controlled trials and registries become available, prudence and discernment are necessary in the choice of patients most likely to benefit. Patients need to be well-informed about gaps in the evidence base. Our recommendations support the use of TAVI in the context of strict conditions with respect to patient eligibility, the patient selection process, organizational requirements, and the tracking of patient outcomes with a mandatory registry. PMID:23218465

  13. The Importance of Contrast Volume/Glomerular Filtration Rate Ratio in Contrast-Induced Nephropathy Patients after Transcatheter Aortic Valve Implantation

    PubMed Central

    Gul, Ilker; Zungur, Mustafa; Tastan, Ahmet; Okur, Faik Fevzi; Damar, Ertan; Uyar, Samet; Sahin, Veysel; Tavli, Talat

    2015-01-01

    Background/Aim Transcatheter aortic valve implantation (TAVI) is a method which is increasingly applied in severe aortic stenosis treatment. The development of contrast-induced nephropathy (CIN) after TAVI increases morbidity and mortality rates. Within the scope of this study, the importance of the contrast medium volume to glomerular filtration rate (CV/GFR) ratio in determining the development of CIN and the amount of CV that could be applied was evaluated. Methods Seventy-two patients (aged 78.6 ± 11.6 years; 38 females) who underwent aortic valve replacement with the TAVI method between June 2013 and August 2014 were included in the study. CIN was defined as an absolute increase in serum creatinine of >0.5 mg/dl or a relative increase of >25% within 48-72 h after TAVI. CIN+ and CIN-patients were classified into two groups. The ?2 test, t test, Mann-Whitney U test, ROC analysis, and univariate and multivariate regression analyses were applied for statistical analyses. Results CIN was detected in 16 patients (22%) in our study. Baseline creatinine, baseline GFR, the Mehran risk score, CV, and the CV/GFR ratio were determined as the predictive factors of CIN development. A CV/GFR ratio of 3.9 was specified to predict CIN development with 71% sensitivity and 80% specificity. Conclusion After TAVI, CIN may develop due to various reasons. In patients to whom TAVI was applied, the CV/GFR ratio may be a guideline helping to prevent the development of renal pathologies. The amount of contrast medium that can be given to a patient can be calculated in terms of baseline GFR. PMID:25759698

  14. Use of a targeted, combinatorial next-generation sequencing approach for the study of bicuspid aortic valve

    PubMed Central

    2014-01-01

    Background Bicuspid aortic valve (BAV) is the most common type of congenital heart disease with a population prevalence of 1-2%. While BAV is known to be highly heritable, mutations in single genes (such as GATA5 and NOTCH1) have been reported in few human BAV cases. Traditional gene sequencing methods are time and labor intensive, while next-generation high throughput sequencing remains costly for large patient cohorts and requires extensive bioinformatics processing. Here we describe an approach to targeted multi-gene sequencing with combinatorial pooling of samples from BAV patients. Methods We studied a previously described cohort of 78 unrelated subjects with echocardiogram-identified BAV. Subjects were identified as having isolated BAV or BAV associated with coarctation of aorta (BAV-CoA). BAV cusp fusion morphology was defined as right-left cusp fusion, right non-coronary cusp fusion, or left non-coronary cusp fusion. Samples were combined into 19 pools using a uniquely overlapping combinatorial design; a given mutation could be attributed to a single individual on the basis of which pools contained the mutation. A custom gene capture of 97 candidate genes was sequenced on the Illumina HiSeq 2000. Multistep bioinformatics processing was performed for base calling, variant identification, and in-silico analysis of putative disease-causing variants. Results Targeted capture identified 42 rare, non-synonymous, exonic variants involving 35 of the 97 candidate genes. Among these variants, in-silico analysis classified 33 of these variants as putative disease-causing changes. Sanger sequencing confirmed thirty-one of these variants, found among 16 individuals. There were no significant differences in variant burden among BAV fusion phenotypes or isolated BAV versus BAV-CoA. Pathway analysis suggests a role for the WNT signaling pathway in human BAV. Conclusion We successfully developed a pooling and targeted capture strategy that enabled rapid and cost effective next generation sequencing of target genes in a large patient cohort. This approach identified a large number of putative disease-causing variants in a cohort of patients with BAV, including variants in 26 genes not previously associated with human BAV. The data suggest that BAV heritability is complex and polygenic. Our pooling approach saved over $39,350 compared to an unpooled, targeted capture sequencing strategy. PMID:25260786

  15. Hypotension during carotid artery stenting with severe aortic stenosis: the intra-aortic balloon pump option.

    PubMed

    Anzuini, Angelo; Frigerio, Sillia; Bianchi, Michele; Palloshi, Altin

    2011-08-01

    This case highlights the importance of intra-aortic balloon pump (IABP) during carotid artery stenting (CAS) in patients with severe aortic stenosis. We report the case of a patient with severe carotid artery disease and aortic stenosis who first underwent CAS using IABP and subsequently underwent aortic valve replacement. We conclude that IABP could be helpful in the staged treatment of patients with concomitant severe carotid artery disease and aortic valve disease. PMID:21828408

  16. A pre-operative CT and non-contrast-enhanced C-arm CT registration framework for trans-catheter aortic valve implantation.

    PubMed

    Lu, Yongning; Sun, Ying; Liao, Rui; Ong, Sim Heng

    2014-12-01

    Contrast-enhanced C-arm CT is routinely used for intra-operative guidance during the trans-catheter aortic valve implantation (TAVI); however, the requirement for contrast agent injection is not preferable, especially for patients with renal insufficiencies. To address this problem, we present a novel framework for fully automatic registration of pre-operative CT and non-contrast-enhanced C-arm CT. The proposed framework provides an improved workflow and minimizes the usage of contrast agent in the TAVI procedure. Our framework consists of three steps: coarse rigid-body alignment, anatomical knowledge-based prior deformation field generation, and fine deformable registration. We validated the proposed framework on 20 real patient data sets. Based on the 20 data sets, the mesh-to-mesh errors at the aortic root from different methods are measured. Our proposed method significantly outperforms the other state-of-the-art methods. Specifically, we achieve the registration accuracy at 1.76±0.43 mm which is clinically plausible. Quantitative evaluation on real non-contrast enhanced C-arm CT data sets confirms the applicability in the clinical usage. The proposed heart registration method is generic and hence can be easily applied to other cardiac applications. PMID:25158997

  17. Extracellular Matrix Biomarker, Fibulin-1, Is Closely Related to NT-proBNP and Soluble Urokinase Plasminogen Activator Receptor in Patients with Aortic Valve Stenosis (The SEAS Study)

    PubMed Central

    Kruger, Ruan; Rasmussen, Lars M.; Argraves, William S.; Eugen-Olsen, Jesper; Nielsen, Olav W.; Blyme, Adam; Willenheimer, Ronnie; Wachtell, Kristian; Olsen, Michael H.

    2014-01-01

    Background Fibulin-1, a circulating extracellular matrix glycoprotein, has been associated with arterial disease and elevated N-terminal prohormone B-type natriuretic peptide (NT-proBNP) in diabetes. Soluble urokinase plasminogen activator receptor (suPAR), a marker of inflammation, has been associated with subclinical atherosclerosis. Therefore, we aimed to explore the interplay between these biomarkers and mild to moderate aortic valve stenosis (AS). Methods In 374 patients with mild to moderate AS, we investigated the relationship of fibulin-1 with NT-proBNP, levels of suPAR and the degree of AS at baseline and after one and four years of treatment with Simvastatin 40 mg and Ezetimibe 10 mg or placebo. Results During treatment, fibulin-1 became more closely associated with NT-proBNP (?year0?=?0.10, p?=?0.08, ?year1?=?0.16, p?=?0.005, ?year4?=?0.22, p<0.001) and suPAR (?year0?=?0.05, p?=?0.34, ?year1?=?0.16, p?=?0.006, ?year4?=?0.13, p?=?0.03) at the expense of the association to aortic valve area index (AVAI) (?year0?=??0.14, p?=?0.005, ?year1?=??0.08, p?=?0.11, ?year4?=??0.06, p?=?0.22) independently of age, gender, creatinine, and serum aspartate aminotransferase (Adj.Ryear02?=?0.19, Adj.Ryear12?=?0.22, Adj.Ryear42?=?0.27). Fibulin-1 was unrelated to aortic regurgitation, left ventricular mass, and ejection fraction. In patients with baseline AVAI<0.58 cm2/m2 (median value), fibulin-1 was more closely associated to NT-proBNP (?year0?=?0.25, ?year1?=?0.21, ?year4?=?0.22, all p<0.01), and suPAR (?year0?=?0.09, p?=?0.26, ?year1?=?0.23, ?year4?=?0.21, both p<0.01) independently of age, gender, AST and treatment allocation. Conclusions Increased levels of fibulin-1 were independently associated with higher levels of suPAR and NT-proBNP especially in patients with lower AVAI, suggesting that fibulin-1 may be an early marker of AS as well as cardiac fibrosis secondarily to elevated left ventricular hemodynamic load. PMID:25014213

  18. The phenotypic spectrum of contiguous deletion of CYP21A2 and tenascin XB: quadricuspid aortic valve and other midline defects.

    PubMed

    Chen, Wuyan; Kim, Mimi S; Shanbhag, Sujata; Arai, Andrew; VanRyzin, Carol; McDonnell, Nazli B; Merke, Deborah P

    2009-12-01

    Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency is an autosomal recessive disorder and is the most common cause of ambiguous genitalia in the newborn. The genes encoding 21-hydroxylase, CYP21A2, and tenascin-X (TNX), TNXB, are located within the HLA complex, in a region of high gene density termed the RCCX module. The module has multiple pseudogenes as well as tandem repeat sequences that promote misalignment during meiosis leading to complex gene rearrangements, deletions and gene conversion events. CYP21A2 mutations cause CAH, and TNX deficiency has been identified as a cause of hypermobility type Ehlers-Danlos syndrome (EDS). Here we report on a three-generation family with a heterozygous deletion encompassing CYP21A2 and TNXB that initially came to medical attention due to the diagnosis of CAH in the proposita. Southern blotting and PCR-based analysis of the RCCX module revealed a CYP21A2 deletion extending into TNXB in one allele and a CYP21A2 point mutation in the other allele. Family history is notable for joint hypermobility. Additional radiological and clinical investigations showed a quadricuspid aortic valve, single kidney, bicornuate uterus and a bifid uvula in the proposita, and mitral valve prolapse in her mother. These findings further delineate the phenotype of the CAH-TNX contiguous gene deletion syndrome and point to an intersection of connective tissue dysplasias with a common gene-mediated endocrine disorder. PMID:19921645

  19. Ligation of ICAM-1 on human aortic valve interstitial cells induces the osteogenic response: A critical role of the Notch1-NF-?B pathway in BMP-2 expression.

    PubMed

    Wang, Dong; Zeng, Qingchun; Song, Rui; Ao, Lihua; Fullerton, David A; Meng, Xianzhong

    2014-11-01

    Calcific aortic valve disease (CAVD) is a chronic inflammatory condition and affects a large number of elderly people. Aortic valve interstitial cells (AVICs) occupy an important role in valvular calcification and CAVD progression. While pro-inflammatory mechanisms are capable of inducing the osteogenic responses in AVICs, the molecular interaction between pro-inflammatory and pro-osteogenic mechanisms remains poorly understood. This study tested the hypothesis that intercellular adhesion molecule-1 (ICAM-1) plays a role in mediating pro-osteogenic factor expression in human AVICs. AVICs were isolated from normal human aortic valves and cultured in M199 medium. Treatment with leukocyte function-associated factor-1 (LFA-1, an ICAM-1 ligand) up-regulated the expression of bone morphogenetic protein-2 (BMP-2) and resulted in increased alkaline phosphatase activity and formation of calcification nodules. Pre-treatment with lipopolysaccharide (LPS, 0.05?g/ml) increased ICAM-1 levels on cell surfaces and exaggerated the pro-osteogenic response to LFA-1, and neutralization of ICAM-1 suppressed this response. Further, ligation of ICAM-1 by antibody cross-linking also up-regulated BMP-2 expression. Interestingly, LFA-1 elicited Notch1 cleavage and NF-?B activation. Inhibition of NF-?B markedly reduced LFA-1-induced BMP-2 expression, and inhibition of Notch1 cleavage with a ?-secretase inhibitor suppressed LFA-1-induced NF-?B activation and BMP-2 expression. Ligation of ICAM-1 on human AVICs activates the Notch1 pathway. Notch1 up-regulates BMP-2 expression in human AVICs through activation of NF-?B. The results demonstrate a novel role of ICAM-1 in translating a pro-inflammatory signal into a pro-osteogenic response in human AVICs and suggest that ICAM-1 on the surfaces of AVICs contributes to the mechanism of aortic valve calcification. PMID:25101972

  20. Comparative analysis of oncofetal fibronectin and tenascin-C expression in right atrial auricular and left ventricular human cardiac tissue from patients with coronary artery disease and aortic valve stenosis

    Microsoft Academic Search

    Anja Baldinger; Bernhard R. Brehm; Petra Richter; Torsten Bossert; Katja Gruen; Khosro Hekmat; Hartwig Kosmehl; Dario Neri; Hans-Reiner Figulla; Alexander Berndt; Marcus Franz

    2011-01-01

    Aortic valve stenosis (AVS) and coronary artery disease (CAD) are accompanied by changes in the cardiac extra cellular matrix\\u000a (cECM) including the re-expression of oncofetal fibronectin (Fn) and tenascin-C (Tn-C) variants. Human antibodies against\\u000a these variants are usable for targeted therapy. Aim of the study was the comparative analysis of cECM remodelling in tissue\\u000a samples from right atrial auricle (RAA)

  1. Aortic angiography

    MedlinePLUS

    ... problem with the aorta or its branches, including: Aortic aneurysm Aortic dissection Congenital (present from birth) problems AV ... Abnormal results may be due to: Abdominal aortic aneurysm Aortic ... aortic arch Coarction of the aorta Vascular ring Injury to the ...

  2. Preoperative atrial fibrillation is an independent risk factor for mid-term mortality after concomitant aortic valve replacement and coronary artery bypass graft surgery

    PubMed Central

    Saxena, Akshat; Dinh, Diem; Dimitriou, Jim; Reid, Christopher; Smith, Julian; Shardey, Gilbert; Newcomb, Andrew

    2013-01-01

    OBJECTIVES Preoperative atrial fibrillation (PAF) has been associated with poorer early and mid-term outcomes after isolated valvular or coronary artery bypass graft surgery. Few studies, however, have evaluated the impact of PAF on early and mid-term outcomes after concomitant aortic valve replacement and coronary aortic bypass graft (AVR-CABG) surgery. METHODS Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program was retrospectively analysed. Patients who underwent concomitant atrial arrhythmia surgery/ablation were excluded. Demographic and operative data were compared between patients undergoing concomitant AVR-CABG who presented with PAF and those who did not using chi-square and t-tests. The independent impact of PAF on 12 short-term complications and mid-term mortality was determined using binary logistic and Cox regression, respectively. RESULTS Concomitant AVR-CABG surgery was performed in 2563 patients; 322 (12.6%) presented with PAF. PAF patients were generally older (mean age 76 vs 74 years; P < 0.001) and presented more often with comorbidities including congestive heart failure, chronic pulmonary disease and cerebrovascular disease (all P < 0.05). PAF was associated with 30-day mortality on univariate analysis (P = 0.019) but not multivariate analysis (P = 0.53). The incidence of early complications was not significantly higher in the PAF group. PAF was independently associated with reduced mid-term survival (HR, 1.58; 95% CI, 1.14–2.19; P = 0.006). CONCLUSIONS PAF is associated with reduced mid-term survival after concomitant AVR-CABG surgery. Patients with PAF undergoing AVR-CABG should be considered for a concomitant surgical ablation procedure. PMID:23287590

  3. B-type natriuretic peptide as a biochemical marker of left ventricular diastolic function: assessment in asymptomatic patients 1 year after valve replacement for aortic stenosis

    PubMed Central

    Mannacio, Vito; Antignano, Anita; De Amicis, Vincenzo; Di Tommaso, Luigi; Giordano, Raffaele; Iannelli, Gabriele; Vosa, Carlo

    2013-01-01

    OBJECTIVES Left ventricular (LV) diastolic dysfunction after aortic valve replacement (AVR) carries a substantial risk of development of heart failure and reduced survival. In addition to echocardiography, B-type natriuretic peptide (BNP) provides a powerful incremental assessment of diastolic function. This study evaluates BNP as a marker of LV diastolic dysfunction in a cohort of patients with preserved LV ejection fraction who underwent AVR for pure aortic stenosis and the relationship between BNP values and the grade of LV diastolic dysfunction. METHODS A total of 113 patients were included in the study. Echocardiographic evaluation was performed preoperatively, 5 days postoperatively and at 12-month follow-up, to assess LV dimensional and functional parameters. Diastolic function was labelled as normal, mild, moderate or severe dysfunction. Concomitantly, BNP levels were evaluated. RESULTS Mild to severe diastolic dysfunction occurred preoperatively in all patients. At 12-month follow-up, 65 (62.5%) patients had mild and 25 (24.1%) moderate to severe diastolic dysfunction. BNP values, categorized for quartile distribution, correlated with diastolic dysfunction grade (P < 0.001 for each comparison). At receiver operating characteristic analysis, the BNP level of 120 pg/ml was 91% sensitive and 85% specific for diastolic disease, while 300 pg/ml was 80% sensitive and 91% specific for moderate or severe diastolic dysfunction. Twelve months after AVR, BNP values were strongly correlated with the significant echocardiographic parameters suggestive of diastolic dysfunction (P ? 0.006 in all cases). CONCLUSIONS The BNP level following AVR is related to diastolic disease severity and may complement echocardiographic evaluation when symptoms are unclear and LV function is difficult to interpret. PMID:23656924

  4. Chronic sustained inflammation links to left ventricular hypertrophy and aortic valve sclerosis: a new link between S100/RAGE and FGF23

    PubMed Central

    Yan, Ling; Bowman, Marion A Hofmann

    2015-01-01

    Background Cardiovascular disease including left ventricular hypertrophy, diastolic dysfunction and ectopic valvular calcification are common in patients with chronic kidney disease (CKD). Both S100A12 and fibroblast growth factor 23 (FGF23) have been identified as biomarkers of cardiovascular morbidity and mortality in patients with CKD. We tested the hypothesis that human S100/calgranulin would accelerate cardiovascular disease in mice subjected to CKD. Methods This review paper focuses on S100 proteins and their receptor for advanced glycation end products (RAGE) and summarizes recent findings obtained in novel developed transgenic hBAC-S100 mice that express S100A12 and S100A8/9 proteins. A bacterial artificial chromosome of the human S100/calgranulin gene cluster containing the genes and regulatory elements for S100A8, S100A9 and S100A12 was expressed in C57BL/6J mice (hBAC-S100). CKD was induced by ureteral ligation, and hBAC-S100 mice and WT mice were studied after 10 weeks of chronic uremia. Results hBAC-S100 mice with CKD showed increased FGF23 in the heart, left ventricular hypertrophy (LVH), diastolic dysfunction, focal cartilaginous metaplasia and calcification of the mitral and aortic valve annulus together with aortic valve sclerosis. This phenotype was not observed in WT mice with CKD or in hBAC-S100 mice lacking RAGE with CKD, suggesting that the inflammatory milieu mediated by S100/RAGE promotes pathological cardiac hypertrophy in CKD. In vitro, inflammatory stimuli including IL-6, TNF?, LPS, or serum from hBAC-S100 mice up regulated FGF23 mRNA and protein in primary murine neonatal and adult cardiac fibroblasts. Conclusions Taken together, our study shows that myeloid-derived human S100/calgranulin is associated with the development of cardiac hypertrophy and ectopic cardiac calcification in a RAGE dependent manner in a mouse model of CKD. We speculate that FGF23 produced by cardiac fibroblasts in response to cytokines may act in a paracrine manner to accelerate LVH and diastolic dysfunction in hBAC-S100 mice with CKD. We suggest that S100/RAGE-mediated chronic sustained systemic inflammation is linked to pathological cardiac remodeling via direct up regulation of FGF23 in cardiac fibroblasts, thereby providing a new mechanistic understanding for the common association between CKD, diabetes, metabolic syndrome, or hypertension with left ventricular hypertrophy with diastolic dysfunction.

  5. Impact on Left Ventricular Function and Remodeling and on 1-Year Outcome in Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation.

    PubMed

    Carrabba, Nazario; Valenti, Renato; Migliorini, Angela; Marrani, Marco; Cantini, Giulia; Parodi, Guido; Dovellini, Emilio Vincenzo; Antoniucci, David

    2015-07-01

    Conflicting results have been reported about the prognostic impact of left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the impact of LBBB after TAVI on left ventricular (LV) function and remodeling and on 1-year outcomes. Of 101 TAVI patients, 9 were excluded. All complications were evaluated according to the Valve Academic Research Consortium 2 definition. Of 92 patients, 34 developed LBBB without more advanced myocardial damage or inflammation biomarkers in comparison with patients without LBBB. The only predictor of new LBBB was larger baseline LV end-diastolic volume. LBBB plus advanced atrioventricular block was strongly correlated with permanent pacemaker implantation (p <0.0001). Patients with LBBB had a higher rate of permanent pacemaker implantation at 30 days (59% vs 19%, p <0.0001) and less recovery of LV systolic function and a trend toward a lower rate of LV reverse remodeling at 1 year. The development of acute kidney injury and the logistic European System for Cardiac Operative Risk Evaluation score were associated with poor outcomes (all-cause mortality and heart failure) (hazard ratio 6.86, 95% confidence interval 2.51 to 18.74, p <0.0001, and hazard ratio 1.04, 95% confidence interval 1.01 to 1.08, p = 0.021, respectively), but not LBBB. In conclusion, after TAVI, 37% of patients developed new LBBB without more advanced myocardial damage or inflammation biomarkers. LBBB was associated with a higher rate of permanent pacemaker implantation, which negatively affected the recovery of LV systolic function. The development of acute kidney injury, rather than LBBB, increases the 1-year risk for mortality and hospitalization for heart failure. PMID:25937352

  6. Fluid dynamics of the CarboMedics Kinetic bileaflet prosthetic heart valve 1 Presented at the Ninth Annual Meeting of the European Association for Cardiothoracic Surgery, Paris, France, 24–27 September, 1995. 1

    Microsoft Academic Search

    J. Timothy Baldwin; Andy Campbell; Christopher Luck; William Ogilvie; Joe Sauter

    1997-01-01

    Objective: To compare hydrodynamic characteristics of a new bileaflet heart valve, the CarboMedics® Kinetic™ cardiac valve prosthesis, with those of a St. Jude Medical (SJM) heart valve. Methods: Hydrodynamic characteristics were determined in the mitral and aortic positions of a Vivitro Systems pulse duplicator for size 23 Kinetic aortic valves, size 23 SJM aortic valves, size 29 Kinetic mitral valves

  7. Turner syndrome patients with bicuspid aortic valves and renal malformations exhibit abnormal expression of X-linked inhibitor of apoptosis protein (XIAP).

    PubMed

    Jevalikar, Ganesh S; Zacharin, Margaret; White, Mary; Yau, Steven W; Li, Winnie; Ijspeert, Charlotte; Russo, Vincenzo C; Werther, George A; Sabin, Matthew A

    2014-11-12

    Abstract Objective: We analyzed mRNA expression of X-linked inhibitor of apoptosis protein (XIAP) in patients with Turner syndrome (TS) and examined its association with phenotypic features. Subjects and methods: XIAP mRNA expression levels were investigated in 98 patients with TS in total RNA extracted from blood leucocytes by real time quantitative polymerase chain reaction. Results: Levels of XIAP mRNA were significantly lower in patients with bicuspid aortic valves (BAV; n=13) than those without (log XIAP -1.17±0.3 vs. -0.94±0.2, p=0.002). Significantly higher expression of XIAP mRNA was seen in patients with a mosaic karyotype and renal malformations (log XIAP -0.79±0.3 vs. -1.0±0.3, p=0.03). No correlations were seen between XIAP and other manifestations. Conclusion: Abnormal expression of XIAP may be an important underlying mechanism in the development of BAV and renal malformations in TS. However, abnormal XIAP mRNA expression, as determined from peripheral mononuclear cells, does not appear to explain all the somatic and visceral stigmata of TS. PMID:25389989

  8. Efficacy of Stentless Aortic Bioprosthesis Implantation for Aortic Stenosis with Small Aortic Annulus.

    PubMed

    Murashita, Takashi; Okada, Yukikatsu; Kanemitsu, Hideo; Fukunaga, Naoto; Konishi, Yasunobu; Nakamura, Ken; Koyama, Tadaaki

    2014-09-01

    Background?In patients with small aortic annulus, sufficient size of stented aortic bioprosthesis cannot be implanted without additional procedures. In such cases, we use stentless aortic bioprosthesis to obtain sufficient effective orifice area. In this study, we investigated long-term impact of stentless aortic bioprosthesis on clinical outcomes, compared with stented aortic bioprosthesis. Materials and Methods?We retrospectively investigated 140 patients who underwent aortic valve replacement (AVR) with porcine bioprosthesis for severe aortic stenosis between 1999 and 2010. Patients who had moderate or more aortic regurgitation and who underwent concomitant mitral procedures were excluded. A total of 69 patients (49%) were implanted stentless bioprosthesis (Freestyle group; Medtronic Inc, Minneapolis, Minnesota, United States) and 71 patients (51%) were implanted stented bioprosthesis (Mosaic group; Medtronic Inc). Follow-up was complete in 97.9% patients. Median follow-up period was 4.2 years. Results?Patients in Freestyle group had smaller body surface area, smaller aortic annulus diameter, smaller aortic valve area, larger mean pressure gradient, higher peak velocity across aortic valve, larger left ventricular mass index (LVMI), and lower left ventricular ejection fraction (LVEF). Mean size of implanted prosthesis was larger in Freestyle group. In-hospital mortality was 1.4% in Freestyle group and 2.8% in Mosaic group (p?=?0.980). Five-year survival rate was not different between two groups (5-year survival rate was 87.5?±?4.7% in Freestyle group and 84.1?±?7.5% in Mosaic group; log rank, p?=?0.619). Late New York Heart Association functional class was lower in Freestyle group. Late LVMI and LVEF became similar between two groups. Conclusion?Stentless aortic bioprosthesis is superior in left ventricular remodeling after AVR for aortic stenosis and is especially effective for small aortic annulus. PMID:25191762

  9. Symetis valve implantation in failing freestyle with close proximity between coronary Ostia and annulus.

    PubMed

    Nagendran, Jeevan; Catrip, Jorge; Diamantouros, Pantelis; Teefy, Patrick; Kiaii, Bob; Chan, Ian; Goela, Aashish; Holzhey, David M; Chu, Michael W A

    2015-04-01

    Transcatheter treatment of patients with degenerated aortic valve stentless prosthesis and low proximal coronary ostia to the aortic annulus remain a challenge because of the elevated risk for coronary obstruction. Newer generation transcatheter aortic valve devices that engage and pull the aortic valve calcium towards the aortic annulus may be beneficial in these patients. We present a case of successful treatment of a degenerated tubular stentless prosthesis with low coronary ostia with a Symetis Acurate TA prosthesis. PMID:25841857

  10. The Self-Expanding Symetis Acurate Does Not Increase Cerebral Microembolic Load When Compared to the Balloon-Expandable Edwards Sapien Prosthesis: A Transcranial Doppler Study in Patients Undergoing Transapical Aortic Valve Implantation

    PubMed Central

    Erdoes, Gabor; Huber, Christoph; Basciani, Reto; Stortecky, Stefan; Windecker, Stephan; Wenaweser, Peter; Carrel, Thierry; Eberle, Balthasar

    2014-01-01

    Objectives The aim of this study was to quantify potential differences in count, frequency and pattern of high-intensity transient signals (HITS) during transapical transcatheter aortic valve implantation (TA-TAVI), by comparing the Symetis Acurate TA (SA) with the balloon-expandable Edwards Sapien XT (ES) system. Background Recently, the Symetis Acurate TA revalving system has been introduced for TA-TAVI. The Symetis Acurate TA aortic bioprosthesis is self-expanding and is deployed by a specific two-step implantation technique. Whether this novel method increases the load of intraprocedural emboli, detected by transcranial Doppler ultrasound (TCD) as HITS, or not is not clear. Methods Twenty-two patients (n?=?11 in each study arm, median logistic EuroScore 20%, median STS score 7%) displayed continuous TCD signals of good quality throughout the entire TA-TAVI procedure and were included in the final analysis. Data are presented as median with interquartile ranges. Results No significant differences were detected in total procedural or interval-related HITS load (SA: 303 [200; 594], ES: 499 [285; 941]; p?=?0.16). With both devices, HITS peaked during prosthesis deployment (PD), whereas significantly fewer HITS occurred during instrumentation (SA: p?=?0.002; ES: <0.001) or post-implantation PI (SA: p?=?0.007; ES: <0.001). PD-associated HITS amounted to almost half of the total HITS load. One patient suffered new disabling stroke at 30 days. Thirty-day mortality amounted to 13.6% (3 of 22 patients). Conclusions Simplified transapical delivery using the self-expanding SA device does not increase HITS, despite of a two-step deployment technique with more interactions with the native aortic valve, when compared to the balloon-expandable ES valve. The similarity in HITS count, frequency and pattern with the two systems suggests a common mechanism for the release of cerebral microemboli. PMID:25289688

  11. No effect of a homoeopathic combination of Arnica montana and Bryonia alba on bleeding, inflammation, and ischaemia after aortic valve surgery

    PubMed Central

    Cornu, Catherine; Joseph, Pierre; Gaillard, Ségolène; Bauer, Christian; Vedrinne, Catherine; Bissery, Alvine; Melot, Ghislaine; Bossard, Nadine; Belon, Philippe; Lehot, Jean-Jacques

    2010-01-01

    AIMS Arnica montana is a popular homoeopathic treatment with potential haemostatic and anti-inflammatory properties. A homoeopathic combination of A. montana and Bryonia alba was used in aortic valve surgery to evaluate its effectiveness in reducing bleeding, inflammation, pain and myocardial ischaemia. METHODS One day before surgery, 92 adult patients were randomly assigned to a double-blind parallel trial with either homoeopathic granules or a matching placebo until 4 days after surgery. The primary outcome was the volume of blood/liquid in the drains at their removal. The secondary outcomes included postoperative blood/liquid losses at 12 and 24 h as well as C-reactive protein (CRP), pain, temperature and plasma troponin Ic. RESULTS At 12 h and 24 h after surgery, then at drain removal, blood losses in homoeopathy and placebo groups were not statistically significant (362 ± 218, 520 ± 269 and 640 ± 297 ml vs. 456 ± 440, 620 ± 477 and 796 ± 717 ml; P= 0.19, 0.23 and 0.35, respectively). The statistical modelling did not show significantly different patterns of CRP, troponin and body temperature changes or of pain perception. The number of transfused packed red cells was not significantly different either (P= 0.58). Two patients from each group died during the study period and the number of serious adverse events was not statistically different (six in homoeopathy vs. 10 in placebo groups; Fisher's exact test P= 0.41). CONCLUSIONS In the study setting, there was no evidence of effects of A. montana and B. alba combination on bleeding, inflammation, pain or myocardial ischaemia. PMID:20233176

  12. Myocardial structure as a determinant of pre- and postoperative ventricular function and long-term prognosis after valve replacement for aortic stenosis

    Microsoft Academic Search

    O. Lund; L. H. Kristensen; U. Baandrup; O. K. Hansen; T. T. Nielsen; K. Emmertsen; F. T. Jensen; C. Flø; B. S. Rasmussen; H. K. Pilegaard

    1998-01-01

    Background Long-term results after aortic value replace- ment for aortic stenosis can be correlated to a cardiac- related pre-operative risk profile. This predictability indicates that there is a common basis in subtle or overt structural abnormalities of left ventricular myocardium. Methods and Results Forty-nine patients aged 24-82 (mean 61) years, with aortic stenosis had a full wall thickness transmural biopsy

  13. Aortic Valvular Replacement: Clinical Experience With 13 Cases

    PubMed Central

    Grondin, Pierre; Lepage, Gilles; Castonguay, Yves

    1964-01-01

    Acquired aortic disease is now currently corrected by total prosthetic replacement of the aortic valve. Aortic valve replacement was performed in 13 cases at the Montreal Heart Institute in 1963. In the first four cases, Bahnson aortic leaflets were used; in the remaining nine, the Starr-Edwards semirigid aortic valve prosthesis. The surgical technique employed is described. There were two operative deaths and two late deaths. The results have been excellent in all of the survivors but one. They have returned to full-time activities and four of them to strenuous physical work. It is the contention of the authors that aortic valve replacement is a surgical procedure with acceptable risks, offering hope for a near-normal life to patients crippled by severe aortic valvular lesions. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7 PMID:14179061

  14. Mitral Valve Prolapse in Persons with Down Syndrome.

    ERIC Educational Resources Information Center

    Pueschel, Siegfried M.; Werner, John Christian

    1994-01-01

    Examination of 36 home-reared young adults with Down's syndrome found that 20 had abnormal echocardiographic findings. Thirteen had mitral valve prolapse, three had mitral valve prolapse and aortic insufficiency, two had only aortic insufficiency, and two had other mitral valve disorders. Theories of pathogenesis and relationship to exercise and…

  15. Left ventricular hypertrophy in valvular aortic stenosis: mechanisms and clinical implications.

    PubMed

    Rader, Florian; Sachdev, Esha; Arsanjani, Reza; Siegel, Robert J

    2015-04-01

    Valvular aortic stenosis is the second most prevalent adult valve disease in the United States and causes progressive pressure overload, invariably leading to life-threatening complications. Surgical aortic valve replacement and, more recently, transcatheter aortic valve replacement effectively relieve the hemodynamic burden and improve the symptoms and survival of affected individuals. However, according to current American College of Cardiology/American Heart Association guidelines on the management of valvular heart disease, the indications for aortic valve replacement, including transcatheter aortic valve replacement, are based primarily on the development of clinical symptoms, because their presence indicates a dismal prognosis. Left ventricular hypertrophy develops in a sizeable proportion of patients before the onset of symptoms, and a growing body of literature demonstrates that regression of left ventricular hypertrophy resulting from aortic stenosis is incomplete after aortic valve replacement and associated with adverse early postoperative outcomes and worse long-term outcomes. Thus, reliance on the development of symptoms alone without consideration of structural abnormalities of the myocardium for optimal timing of aortic valve replacement potentially constitutes a missed opportunity to prevent postoperative morbidity and mortality from severe aortic stenosis, especially in the face of the quickly expanding indications of lower-risk transcatheter aortic valve replacement. The purpose of this review is to discuss the mechanisms and clinical implications of left ventricular hypertrophy in severe valvular aortic stenosis, which may eventually move to center stage as an indication for aortic valve replacement in the asymptomatic patient. PMID:25460869

  16. Effect of Varying Definitions of Contrast-Induced Acute Kidney Injury and Left Ventricular Ejection Fraction on One-Year Mortality in Patients Having Transcatheter Aortic Valve Implantation.

    PubMed

    Pyxaras, Stylianos A; Zhang, Yuan; Wolf, Alexander; Schmitz, Thomas; Naber, Christoph K

    2015-08-01

    The prognostic relevance of direct contrast toxicity in patients treated with transcatheter aortic valve implantation (TAVI) remains unclear because of the confounding hemodynamic effect of acute left ventricular ejection fraction (LVEF) impairment on kidney function estimation. In addition, different definitions of contrast-induced acute kidney injury (CI-AKI) may have different prognostic stratification potential. In the present study, 240 consecutive patients who underwent TAVI were prospectively enrolled. CI-AKI was defined (1) according to the postprocedural creatinine increase of ?0.3 mg/dl or (2) according to the postprocedural decrease of the creatinine clearance of at least 25%. Primary end point of the study was 1-year all-cause mortality. At a mean follow-up of 1.7 ± 1.4 years, all-cause mortality was significantly higher in the CI-AKI patient group, using both CI-AKI definitions (for (1) and (2) p = 0.025 and p <0.001, respectively). In the Cox regression multivariate analysis, CI-AKI was an independent predictor of mortality (hazard ratio 2.244, 95% CI 1.064 to 4.732, p = 0.034), along with LVEF (hazard ratio 0.974, 95% CI 0.946 to 0.993, p = 0.012). Although LVEF and creatinine values at admission were not significantly associated with CI-AKI, their interaction term significantly defined CI-AKI (p = 0.033). The prognostic accuracy of definition (2) was higher (area under the curve 0.704; p <0.001) as with respect to definition (1) (area under the curve 0.602; p = 0.037) for the primary end point of 1-year mortality. In conclusion, in a nonselected patient population who underwent TAVI, CI-AKI was confirmed as an independent predictor of clinical outcome. Only the interaction between LVEF and baseline creatinine values was found to determine CI-AKI. Definition of CI-AKI based to creatinine clearance values had higher prognostic accuracy in comparison with the CI-AKI definition based on creatinine absolute value changes. PMID:26026866

  17. Aortic Aneurysm

    MedlinePLUS

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms - these occur in the part of the aorta ...

  18. Correlation between Aortic Flow and Coronary Circulation

    Microsoft Academic Search

    T. Akutsu; A. Matsumoto; K. Takahashi

    \\u000a Three bi-leaflet prostheses, the St. Jude Medical (SJM) and the On-X valves with straight leaflets and the MIRA valves with\\u000a curved leaflets were tested in the aortic position under pulsatile-flow condition. Dynamic PIV system, which was employed\\u000a to analyze the flow field affected by the valve-installed orientations, leaflet shapes, and valve designs, and direct measurement\\u000a of the coronary flow using

  19. Non-invasive assessment of aortic stenosis by Doppler ultrasound

    Microsoft Academic Search

    L Hatle; B A Angelsen; A Tromsdal

    1980-01-01

    The peak pressure drop across the aortic valve in aortic stenosis has been measured by Doppler ultrasound. Maximum velocity in the Doppler signal from the aortic jet was recorded using a maximum frequency estimator. With an angle close to zero between ultrasound beam and maximal velocity in the jet, peak pressure drop can be calculated from the maximal velocity measured;

  20. JenaValve.

    PubMed

    Treede, Hendrik; Rastan, Ardawan; Ferrari, Markus; Ensminger, Stephan; Figulla, Hans-Reiner; Mohr, Friedrich-Wilhelm

    2012-09-01

    The JenaValve is a next-generation TAVI device which consists of a well-proven porcine root valve mounted on a low-profile nitinol stent. Feeler guided positioning and clip fixation on the diseased leaflets allow for anatomically correct implantation of the device without rapid pacing. Safety and efficacy of transapical aortic valve implantation using the JenaValve were evaluated in a multicentre prospective study that showed good short and midterm results. The valve was CE-mark released in Europe in September 2011. A post-market registry ensures on-going and prospective data collection in "real-world" patients. The transfemoral JenaValve delivery system will be evaluated in a first-in-man study in the near future. PMID:22995119

  1. Bone Formation and Inflammation in Cardiac Valves

    Microsoft Academic Search

    Emile R. Mohler III; Francis Gannon; Carol Reynolds; Robert Zimmerman; Martin G. Keane; Frederick S. Kaplan

    2010-01-01

    Background—For nearly a century, the mechanical failure of calcified heart valves was attributed to a passive degenerative process. Recently, several case reports described bone formation in surgically excised heart valves and suggested an unexpected process of tissue repair. Methods and Results—We studied the prevalence and pathology of heterotopic ossification in 347 surgically excised heart valves (256 aortic, 91 mitral) in

  2. Aortic root enlargement does not increase the surgical risk and short-term patient outcome?

    Microsoft Academic Search

    Gonçalo F. Coutinho; Pedro M. Correia; Gonçalo Paupério; Ferrão de Oliveira; Manuel J. Antunes

    2011-01-01

    Objective: To analyze the short-term outcome of aortic root enlargement (ARE) using death and adverse events as end points. Methods: From January 1999 through December 2009, 3339 patients were subjected to aortic valve replacement (AVR). A total of 678 were considered to have small aortic roots (SARs) in which an aortic prosthesis size 21mm or smaller was implanted. ARE using

  3. Aneurysms: thoracic aortic aneurysms.

    PubMed

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  4. T EFFECT OF STORAGE ON TENSILE PROPERTIES OF NATURAL HEART VALVE TISSUE

    E-print Network

    Stevenson, Paul

    T EFFECT OF STORAGE ON TENSILE PROPERTIES OF NATURAL HEART VALVE TISSUE Sophia Nishat Mohammad "" Yourheartisyourlanternandyourselfisyourlight. ( IQBAL the poet of the east ) #12;ABSTRACT Aortic homograft valves are the preferred choiceof replacementvalve in aortic valve replacementprocedures.The major drawbackto their use is their availability

  5. The Effects of Propofol Cardioplegia on Blood and Myocardial Biomarkers of Stress and Injury in Patients With Isolated Coronary Artery Bypass Grafting or Aortic Valve Replacement Using Cardiopulmonary Bypass: Protocol for a Single-Center Randomized Controlled Trial

    PubMed Central

    Plummer, Zoe E; Baos, Sarah; Rogers, Chris A; Suleiman, M-Saadeh; Bryan, Alan J; Angelini, Gianni D; Hillier, James; Downes, Richard; Nicholson, Eamonn

    2014-01-01

    Background Despite improved myocardial protection strategies, cardioplegic arrest and ischemia still result in reperfusion injury. We have previously published a study describing the effects of propofol (an anesthetic agent commonly used in cardiac surgery) on metabolic stress, cardiac function, and injury in a clinically relevant animal model. We concluded that cardioplegia supplementation with propofol at a concentration relevant to the human clinical setting resulted in improved hemodynamic function, reduced oxidative stress, and reduced reperfusion injury when compared to standard cardioplegia. Objective The Propofol cardioplegia for Myocardial Protection Trial (ProMPT) aims to translate the successful animal intervention to the human clinical setting. We aim to test the hypothesis that supplementation of the cardioplegic solution with propofol will be cardioprotective for patients undergoing isolated coronary artery bypass graft or aortic valve replacement surgery with cardiopulmonary bypass. Methods The trial is a single-center, placebo-controlled, randomized trial with blinding of participants, health care staff, and the research team. Patients aged between 18 and 80 years undergoing nonemergency isolated coronary artery bypass graft or aortic valve replacement surgery with cardiopulmonary bypass at the Bristol Heart Institute are being invited to participate. Participants are randomly assigned in a 1:1 ratio to either cardioplegia supplementation with propofol (intervention) or cardioplegia supplementation with intralipid (placebo) using a secure, concealed, Internet-based randomization system. Randomization is stratified by operation type and minimized by diabetes mellitus status. Biomarkers of cardiac injury and metabolism are being assessed to investigate any cardioprotection conferred. The primary outcome is myocardial injury, studied by measuring myocardial troponin T. The trial is designed to test hypotheses about the superiority of the intervention within each surgical stratum. The sample size of 96 participants has been chosen to achieve 80% power to detect standardized differences of 0.5 at a significance level of 5% (2-tailed) assuming equal numbers in each surgical stratum. Results A total of 96 patients have been successfully recruited over a 2-year period. Results are to be published in late 2014. Conclusions Designing a practicable method for delivering a potentially protective dose of propofol to the heart during cardiac surgery was challenging. If our approach confirms the potential of propofol to reduce damage during cardiac surgery, we plan to design a larger multicenter trial to detect differences in clinical outcomes. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 84968882; http://www.controlled-trials.com/ISRCTN84968882/ProMPT (Archived by WebCite at http://www.webcitation.org/6Qi8A51BS). PMID:25004932

  6. Causes and histopathology of ascending aortic disease in children and young adults

    PubMed Central

    Jain, Deepali; Dietz, Harry C.; Oswald, Gretchen L.; Maleszewski, Joseph J.; Halushka, Marc K.

    2011-01-01

    Background Ascending aortic diseases (aneurysms, dissections, and stenosis) and associated aortic valve disease are rare but important causes of morbidity and mortality in children and young adults. Certain genetic causes, such as Marfan syndrome and congenital bicuspid aortic valve disease, are well known. However, other rarer genetic and nongenetic causes of aortic disease exist. Methods We performed an extensive literature search to identify known causes of ascending aortic pathology in children and young adults. We catalogued both aortic pathologies and other defining systemic features of these diseases. Results We describe 17 predominantly genetic entities that have been associated with thoracic aortic disease in this age group. Conclusions While extensive literature on the common causes of ascending aortic disease exists, there is a need for better histologic documentation of aortic pathology in rarer diseases. PMID:19926309

  7. Computer-aided design of the human aortic root.

    PubMed

    Ovcharenko, E A; Klyshnikov, K U; Vlad, A R; Sizova, I N; Kokov, A N; Nushtaev, D V; Yuzhalin, A E; Zhuravleva, I U

    2014-11-01

    The development of computer-based 3D models of the aortic root is one of the most important problems in constructing the prostheses for transcatheter aortic valve implantation. In the current study, we analyzed data from 117 patients with and without aortic valve disease and computed tomography data from 20 patients without aortic valvular diseases in order to estimate the average values of the diameter of the aortic annulus and other aortic root parameters. Based on these data, we developed a 3D model of human aortic root with unique geometry. Furthermore, in this study we show that by applying different material properties to the aortic annulus zone in our model, we can significantly improve the quality of the results of finite element analysis. To summarize, here we present four 3D models of human aortic root with unique geometry based on computational analysis of ECHO and CT data. We suggest that our models can be utilized for the development of better prostheses for transcatheter aortic valve implantation. PMID:25238567

  8. Evolution of mechanical heart valves.

    PubMed

    DeWall, R A; Qasim, N; Carr, L

    2000-05-01

    The need for prosthetic heart valves was long recognized but seemed an impossible dream before 1952 when Dr Charles Hufnagel clinically introduced a ball valve that he placed into the descending thoracic aorta for treatment of aortic valvular insufficiency. Fulfillment of that dream became a reality with the advent of extracorporeal circulation in the early 1950s. Development of prosthetic heart valves involved the search for biologically compatible materials and hemologically tolerant designs. Success could not be achieved without the union of these two factors. As there was no satisfactory mechanism to scientifically achieve this goal, trial and error was the method of choice. The development of prosthetic heart valves became the purview of the cardiovascular surgeon who often collaborated with engineers. To distinguish one valve from another each prosthesis often became identified with the surgeon developer. The development of bioprostheses occurred later in the development of artificial heart valves and constitutes a separate subject not covered in this presentation. PMID:10881865

  9. Update of transcatheter valve treatment

    PubMed Central

    Liu, Xian-bao; Wang, Jian-an

    2013-01-01

    Transcatheter valve implantation or repair has been a very promising approach for the treatment of valvular heart diseases since transcatheter aortic valve implantation (TAVI) was successfully performed in 2002. Great achievements have been made in this field (especially TAVI and transcatheter mitral valve repair—MitraClip system) in recent years. Evidence from clinical trials or registry studies has proved that transcatheter valve treatment for valvular heart diseases is safe and effective in surgical high-risk or inoperable patients. As the evidence accumulates, transcatheter valve treatment might be an alterative surgery for younger patients with surgically low or intermediate risk valvular heart diseases in the near future. In this paper, the updates on transcatheter valve treatment are reviewed. PMID:23897785

  10. Unusual mechanism of myocardial infarction in prosthetic valve endocarditis

    PubMed Central

    Atik, Fernando A; Campos, Vanessa G; da Cunha, Claudio R; de Oliveira, Felipe Bezerra Martins; Otto, Maria Estefânia Bosco; Monte, Guilherme U

    2015-01-01

    A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to aortic valve replacement with a stented bioprosthesis. He developed Staphylococcus epidermidis prosthetic valve endocarditis a month later, presenting in the emergency room with acute myocardial infarction. The mechanism of myocardial ischemia was a large aortic root abscess causing left main extrinsic compression. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic to right atrium fistula and coronary artery bypass grafting of the left anterior descending. After a difficult postoperative period with multiple problems, he was eventually discharged home. At 36-month follow-up, he is asymptomatic with no recurrent infection, and the left main coronary artery is widely patent on control chest computed tomography.

  11. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial

    Microsoft Academic Search

    Karl Hammermeister; Gulshan K Sethi; William G Henderson; Frederick L Grover; Charles Oprian; Shahbudin H Rahimtoola

    2000-01-01

    OBJECTIVESThe goal of this study was to compare long-term survival and valve-related complications between bioprosthetic and mechanical heart valves.BACKGROUNDDifferent heart valves may have different patient outcomes.METHODSFive hundred seventy-five patients undergoing single aortic valve replacement (AVR) or mitral valve replacement (MVR) at 13 VA medical centers were randomized to receive a bioprosthetic or mechanical valve.RESULTSBy survival analysis at 15 years, all-cause

  12. Staged hybrid treatment of complex ascending aortic and distal aortic arch pseudoaneurysm after repair of aortic coarctation.

    PubMed

    De Filippo, C; Modugno, P; Inglese, L; Rossi, M; Centritto, E; Sallustio, G; Calvo, E; Spatuzza, P; Testa, N; Alessandrini, F

    2011-06-01

    A 49-year-old operated for aortic coartaction patient presented with thoracic and ascending aortic aneurysm. He was asymptomatic. Angio-magnetic resonance nuclear scan and angiography revealed an ascending aortic aneurysm (5.2 cm), bicuspid aortic valve, 6-cm proximal descending aortic pseudoaneurysm at the site of the previous operation with involvement of the left subclavian artery. Restenosis at the original site of coarctation and aortic arch hypoplasia distally to the brachiocefalic trunk was also found. The operation performed was a "modified Bentall - De Bono". The pseudoaneurysm was not accessible through median sternotomy due to the massive lung adhesions following the previous surgery. The left common carotid artery was explanted from the aortic arch and connected with a graft to the ascending aortic conduit. A proximal neck suitable for landing zone of the endovascular stent-graft was then established. The postoperative course was uneventful. After two weeks, the patient was readmitted. The exclusion of the thoracic descending aortic pseudoaneurysm by endovascular implantation of the stent-graft prosthesis was performed. The left subclavian artery was excluded because left vertebral artery was closed. The patient did not develop hand claudicatio. The procedure was successful. PMID:18948867

  13. Peripartum acute aortic dissection: A case report & review of literature.

    PubMed

    Aziz, Fahad; Penupolu, Sudheer; Alok, Anshu; Doddi, Sujatha; Abed, Mary

    2011-03-01

    Acute aortic dissection is a rare clinical entity that mainly affects patients older than 50 years. It is unusual in younger patients and its presence has been traditionally associated with trauma, Marfan syndrome, bicuspid aortic valve and pregnancy. We present here, a case of a 30 year old pregnant female with acute aortic dissection type A (De Bakey II), without family history of connective tissue diseases and signs of Marfan syndrome. PMID:22263062

  14. Aortic coarctation: the need for lifelong surveillance

    PubMed Central

    Vriend, J.W.J.; Mulder, B.J.M.

    2003-01-01

    Survival of patients with aortic coarctation improved dramatically after surgical repair became available and the number of patients who undergo surgery and reach adulthood is steadily increasing. However, life expectancy is still not as normal as in unaffected peers. Cardiovascular complications are frequent and require indefinite follow-up. Concern falls chiefly into five categories: recoarctation, endocarditis, stenotic and/or incompetent coexisting bicuspid aortic valve, aortic aneurysm formation and systemic hypertension. In this review, these complications, with particular reference to late hypertension, are discussed and strategies for the clinical management of postcoarctectomy patients are described. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696173

  15. Safety valve

    DOEpatents

    Bergman, Ulf C. (Malmoe, SE)

    1984-01-01

    The safety valve contains a resilient gland to be held between a valve seat and a valve member and is secured to the valve member by a sleeve surrounding the end of the valve member adjacent to the valve seat. The sleeve is movable relative to the valve member through a limited axial distance and a gap exists between said valve member and said sleeve.

  16. Neomycin prevents enzyme-mediated glycosaminoglycan degradation in bioprosthetic heart valves

    Microsoft Academic Search

    Devanathan Raghavan; Dan T. Simionescu; Naren R. Vyavahare

    2007-01-01

    Bioprosthetic heart valves (BHVs) derived from glutaraldehyde crosslinked porcine aortic valves are frequently used in heart valve replacement surgeries. However, BHVs have limited durability and fail either due to degeneration or calcification. Glycosaminoglycans (GAGs), one of the integral components of heart valve cuspal tissue, are not stabilized by conventional glutaraldehyde crosslinking. Previously we have shown that valvular GAGs could be

  17. Aortic Stenosis: Changing Disease Concepts

    PubMed Central

    Rashedi, Nina

    2015-01-01

    Aortic stenosis (AS) occurs in almost 10% of adults over age 80 years with a mortality about 50% at 2 years unless outflow obstruction is relieved by aortic valve replacement (AVR). Development of AS is associated with anatomic, clinical and genetic risk factors including a bicuspid valve in 50%; clinical factors that include older age, hypertension, smoking, diabetes and elevated serum lipoprotein(a) [Lp(a)] levels; and genetic factors such as a polymorphism in the Lp(a) locus. Early stages of AS are characterized by focal areas of leaflet thickening and calcification. The rate of hemodynamic progression is variable but eventual severe AS is inevitable once even mild valve obstruction is present. There is no specific medical therapy to prevent leaflet calcification. Basic principles of medical therapy for asymptomatic AS are patient education, periodic echocardiographic and clinical monitoring, standard cardiac risk factor evaluation and modification and treatment of hypertension or other comorbid conditions. When severe AS is present, a careful evaluation for symptoms is needed, often with an exercise test to document symptom status and cardiac reserve. In symptomatic patients with severe AS, AVR improves survival and relieves symptoms. In asymptomatic patients with severe AS, AVR also is appropriate if ejection fraction is < 50%, disease progression is rapid or AS is very severe (aortic velocity > 5 m/s). The choice of surgical or transcatheter AVR depends on the estimated surgical risk plus other factors such as frailty, other organ system disease and procedural specific impediments. PMID:26140146

  18. Transapical transcatheter valve-in-valve replacement for deteriorated mitral valve bioprosthesis without radio-opaque indicators: the "invisible" mitral valve bioprosthesis.

    PubMed

    Rossi, Marco Luciano; Barbaro, Cristina; Pagnotta, Paolo; Cappai, Antioco; Ornaghi, Diego; Belli, Guido; Presbitero, Patrizia

    2015-02-01

    In view of the high number of bioprosthetic valves implanted during the past 30 years, an increasing number of patients are coming to medical attention because of degenerated bioprostheses. Transcatheter aortic valve-in-valve implantation has been described as a less invasive alternative to re-operation to treat severe structural valve deterioration. As far as degenerated mitral valve bioprostheses are concerned, transcatheter transapical mitral valve-in-valve replacement (TMVR) has been less commonly performed, but may also become a viable alternative to re-do replacement surgery. We describe treatment of a degenerated bioprosthetic mitral valve, characterised by complete absence of any radio-opaque landmarks making the TMVR procedure very challenging. PMID:25456504

  19. Regional variation of wall shear stress in ascending thoracic aortic aneurysms.

    PubMed

    Rinaudo, Antonino; Pasta, Salvatore

    2014-06-18

    The development of an ascending thoracic aortic aneurysm is likely caused by excessive hemodynamic loads exerted on the aneurysmal wall. Computational fluid-dynamic analyses were performed on patient-specific ascending thoracic aortic aneurysms obtained from patients with either bicuspid aortic valve or tricuspid aortic valve to evaluate hemodynamic and wall shear parameters, imparting aneurysm enlargement. Results showed an accelerated flow along the outer aortic wall with helical flow in the aneurysm center for bicuspid aortic valve ascending thoracic aortic aneurysms. In a different way, tricuspid aortic valve ascending thoracic aortic aneurysms exhibited normal systolic flow without substantial secondary pattern. Analysis of wall shear parameters evinced a high and locally varying wall shear stress on the outer aortic wall and high temporal oscillations in wall shear stress (oscillatory shear index) on either left or right side of aneurysmal aorta. These findings may explain the asymmetric dilatation typically observed in ascending thoracic aortic aneurysms. Simulations of a hypertensive scenario revealed an increase in wall shear stress upon 44% compared to normal systemic pressure models. Computational fluid-dynamics-based analysis may allow identification of wall shear parameters portending aneurysm dilatation and hence guide preventative intervention. PMID:24942163

  20. Tracheo-Bronchial Obstruction and Esophageal Perforation after TEVAR for Thoracic Aortic Rupture

    PubMed Central

    Fukui, Daisuke; Tanaka, Haruki; Komatsu, Kazunori; Ohtsu, Yoshinori; Terasaki, Takamitsu; Wada, Yuko; Takano, Tamaki; Koike, Shoichiro; Amano, Jun

    2014-01-01

    A 67-year-old man was referred to our hospital for an ascending aortic aneurysm, thoracoabdominal aortic aneurysm and aortic regurgitation. Graft repair of the thoracic aortic arch and aortic valve replacement was given priority and completed, however he developed descending aortic rupture before the second scheduled surgery, and endovascular stent grafting was performed. He subsequently developed tracheobronchial obstruction and esophageal perforation. The patient underwent urgent esophagectomy and enterostomy with continuity later reestablished. However, he died of sepsis 5 months after surgery. Despite the less invasive nature of endovascular treatment, esophageal perforation can nevertheless occur and postoperative vigilance is well warranted. PMID:25593630

  1. Warfarin Causes Rapid Calcification of the Elastic Lamellae in Rat Arteries and Heart Valves

    E-print Network

    Price, Paul A.

    Warfarin Causes Rapid Calcification of the Elastic Lamellae in Rat Arteries and Heart Valves Paul A of the elastic lamellae in the media of major arteries and in aortic heart valves in the rat. Aortic, and 5 weeks of treatment. By 5 weeks, the highly focal calcification of major arteries could be seen

  2. Minimally immunogenic decellularized porcine valve provides in situ recellularization as a stentless bioprosthetic valve

    Microsoft Academic Search

    Shigemitsu Iwai; Kei Torikai; Chris M. Coppin; Yoshiki Sawa

    2007-01-01

    Currently used bioprosthetic valves have several limitations such as calcification and functional deterioration, and revitalization\\u000a through cellular ingrowth is impossible. To overcome these obstacles, we have developed a minimally immunogenic tissue-engineered\\u000a valve that consists of an unfixed, decellularized porcine valve scaffold capable of being spontaneously revitalized in vivo\\u000a after implantation. Porcine aortic root tissue was decellularized using detergents such as

  3. Leakage test during mitral valve repair.

    PubMed

    Watanabe, Taiju; Arai, Hirokuni

    2014-11-01

    Mitral valve repair is the preferred surgical treatment for mitral regurgitation. Cardiac surgeons must increasingly pursue high-quality mitral valve repair, which ensures excellent long-term outcomes. Intraoperative assessment of a competency of the repaired mitral valve before closure of the atrium is an important step in accomplishing successful mitral valve repair. Saline test is the most simple and popular method to evaluate the repaired valve. In addition, an "Ink test" can provide confirmation of the surface of coaptation, which is often insufficient in the assessment of saline test. There are sometimes differences between the findings of the leakage test in an arrested heart and the echocardiographic findings after surgery. Assessment of the mitral valve in an arrested heart may not accurately reflect its function in a contractile heart. Assessment of the valve on the beating heart induced by antegrade or retrograde coronary artery perfusion can provide a more physiological assessment of the repaired valve. Perfusion techniques during beating heart surgery mainly include antegrade coronary artery perfusion without aortic cross-clamping, and retrograde coronary artery perfusion via the coronary sinus with aortic cross-clamping. It is the most important point for the former approach to avoid air embolism with such precaution as CO2 insufflation, left ventricular venting, and transesophageal echocardiography, and for the latter approach to maintain high perfusion flow rate of coronary sinus and adequate venting. Leakage test during mitral valve repair increasingly takes an important role in successful mitral valve reconstruction. PMID:25156036

  4. Valve Disease

    MedlinePLUS

    ... a prosthetic valve. Prosthetic valves can either be mechanical (made from materials such as plastic, carbon, or ... or biological (made from human or animal tissue). Mechanical valves increase the risk of blood clots forming ...

  5. Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm)

    PubMed Central

    Elefteriades, John A; Sang, Adam; Kuzmik, Gregory; Hornick, Matthew

    2015-01-01

    Recent studies have confirmed a close association between various medical conditions (intracranial aneurysm, abdominal aortic aneurysm, temporal arteritis, autoimmune disorder, renal cysts), certain aortic anatomic variants (bovine aortic arch, direct origin of left vertebral artery from aortic arch, bicuspid aortic valve), and family history of aneurysm disease with thoracic aortic aneurysm and dissection. This paper reviews these associations. We propose to capitalise on these associations as powerful and expanding opportunities to diagnose the virulent but silent disease of thoracic aortic aneurysm. This can be accomplished by recognition of this ‘guilt by association’ with the other conditions. Thus, patients with associated diseases and anatomic variants should be investigated for silent aortic aneurysms. Such a paradigm holds substantial potential for reducing death from the silent killer represented by thoracic aortic aneurysm disease. PMID:25932333

  6. Endocarditis of the mitral valve posteromedial papillary muscle.

    PubMed

    Moorjani, Narain; Saad, Rasheed; Gallagher, Patrick; Livesey, Steven

    2014-03-01

    A 36-year-old intravenous drug abuser presented with an aortic root abscess and partial rupture of the posteromedial papillary muscle. Following aortic and mitral valve replacement, histological and microbiological analysis of the papillary muscle demonstrated methicillin-sensitive Staphylococcus aureus infection. PMID:24152175

  7. Long axis excursion in aortic stenosis

    PubMed Central

    Takeda, S; Rimington, H; Smeeton, N; Chambers, J

    2001-01-01

    OBJECTIVES—To examine long axis excursion in patients with all grades of aortic stenosis and preserved transverse systolic function, and to compare long axis excursion in symptomatic with that in asymptomatic severe aortic stenosis.?DESIGN—Prospective comparative study.?SETTING—Regional cardiothoracic centre.?PATIENTS—78 patients with all grades of aortic stenosis and normal fractional shortening and ejection fraction were studied. There were two comparison groups, 10 age matched normal subjects and 14 patients with aortic stenosis and fractional shortening < 26%.?METHODS—Aortic valve function and left ventricular mass were assessed echocardiographically. M mode measurements of long axis excursion at the septal and lateral sides of the mitral annulus were taken.?RESULTS—There were significant differences between the groups in long axis excursion at both the septal (p < 0.0001) and lateral sides of the mitral annulus (p = 0.002 by analysis of variance). Long axis excursion was independently related to both left ventricular mass index (p = 0.001) and the grade of aortic stenosis (p = 0.002). Comparing patients with severe aortic stenosis with and without symptoms, there were significant differences in effective orifice area (p = 0.02 ) and long axis excursion at the lateral side of the mitral annulus (p = 0.04), but not in fractional shortening, ejection fraction, or peak or mean pressure difference.?CONCLUSION—In patients with aortic stenosis, long axis excursion is reduced even in the presence of normal fractional shortening or ejection fraction. It is lower in patients with symptomatic compared with asymptomatic severe aortic stenosis and may be of use in predicting the onset of symptoms.???Keywords: aortic stenosis; long axis excursion; symptoms PMID:11410562

  8. Acute Aortic Syndromes and Thoracic Aortic Aneurysm

    PubMed Central

    Ramanath, Vijay S.; Oh, Jae K.; Sundt, Thoralf M.; Eagle, Kim A.

    2009-01-01

    Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. PMID:19411444

  9. Automatic measurement of aortic annulus diameter in 3-dimensional Transoesophageal echocardiography

    PubMed Central

    2014-01-01

    Background Transcatheter aortic valve implantation involves percutaneously implanting a biomechanical aortic valve to treat severe aortic stenosis. In order to select a proper device, precise sizing of the aortic valve annulus must be completed. Methods In this paper, we describe a fully automatic segmentation method to measure the aortic annulus diameter in patients with aortic calcification, operating on 3-dimensional transesophageal echocardiographic images. The method is based on state estimation of a subdivision surface representation of the left ventricular outflow tract and aortic root. The state estimation is solved by an extended Kalman filter driven by edge detections normal to the subdivision surface. Results The method was validated on echocardiographic recordings of 16 patients. Comparison against two manual measurements showed agreements (mean ±SD) of -0.3±1.6 and -0.2±2.3 mm for perimeter-derived diameters, compared to an interobserver agreement of -0.1±2.1 mm. Conclusions With this study, we demonstrated the feasibility of an efficient and fully automatic measurement of the aortic annulus in patients with aortic disease. The algorithm robustly measured the aortic annulus diameter, providing measurements indistinguishable from those done by cardiologists. PMID:25200865

  10. Aortic valvular tophus: identification by X-ray diffraction of urate and calcium phosphates.

    PubMed Central

    Gawoski, J M; Balogh, K; Landis, W J

    1985-01-01

    A typical gouty tophus with birefringent, dichroic, needle shaped crystals was found in a resected calcified aortic valve on routine histological examination. The patient, an elderly man, had a long history of gout. X-ray diffraction confirmed the presence of sodium acid urate monohydrate and identified hydroxyapatite and whitlockite in the accompanying dystrophic calcification of the aortic valves. Previous reports indicate that gouty tophi of the cardiac valves are rare: of the nine cases reported, eight occurred in the mitral valve. Images PMID:4031099

  11. Transcaval access for TAVR across a polyester aortic graft.

    PubMed

    Lederman, Robert J; O'Neill, William W; Greenbaum, Adam B

    2015-06-01

    Transcaval access to the aorta allows transcatheter aortic valve replacement in patients without other good access options. The resulting aorto-caval fistula is closed with a nitinol cardiac occluder device. There is no experience traversing a synthetic aortic graft to perform transcaval access and closure. We describe a patient who underwent successful traversal of a polyester aortic graft using radiofrequency energy applied from the tip of a guidewire, to allow retrograde transcatheter aortic valve replacement from a femoral vein, along with details of our technique. The patient did well and was discharged home after 3 days. There was residual aorto-caval fistulous flow immediately after implantation of a polyester-seeded nitinol muscular ventricular septal defect occluder device, but this fistula spontaneously occluded within one month. © 2015 Wiley Periodicals, Inc. PMID:25510917

  12. Multiple valve surgery for a patient with presternal oesophageal reconstruction.

    PubMed

    Hamamoto, Masaki; Kobayashi, Taira; Ozawa, Masamichi

    2015-08-01

    A 73-year old woman presented with progressive exertional dyspnoea. Echocardiography revealed severe regurgitation of the aortic, mitral and tricuspid valves, indicating the need for multiple valve surgery. The patient had a past history of oesophageal cancer that had been treated with chemoradiotherapy followed by oesophagectomy with presternal reconstruction using a gastric tube and a pedicled jejunum covered by the rectus abdominal muscle flap. She underwent aortic and mitral valve replacement with prostheses and tricuspid ring annuloplasty through a lower partial median sternotomy to avoid injury to the cervical oesophagus and a pedicled jejunum placed on the sternal manubrium. PMID:26059876

  13. [Coronary artery bypass grafting and replacement of aortic root and ascending aorta; report of a case].

    PubMed

    Nakamura, Koki; Murakami, Mikiko; Asai, Tomohiro; Saito, Yosuke; Yamaguchi, Hiromi

    2006-08-01

    An 87-year-old man was referred to our hospital for chest oppression and syncope attack due to aortic stenosis. Further examination revealed severe aortic stenosis (pressure gradient of 107 mmHg, aortic valve area of 0.75 cm2), ascending aortic aneurysm (60 mm in diameter) and triple-vessel disease of coronary arteries. Therefore, a surgical operation was indicated electively. Under cardiopulmonary bypass with normothermia, coronary artery bypass grafting (CABG) was performed. Then the aortic root and the ascending aorta were replaced with a Freestyle valve (27 mm) and a woven Dacron graft (30 mm Hemashield with 1 branch), respectively. Duration of cardiopulmonary bypass and aortic cross-clamp was 267 and 203 minutes, respectively. Postoperative course was uneventful. On the 14th postoperative day, he underwent coronary and graft angiography, which showed all the grafts were patent with good flow. He was successfully discharged on the 19th postoperative day. PMID:16922444

  14. Aortic root abscess: Multimodality imaging with computed tomography and gallium-67 citrate single-photon emission computed tomography\\/computed tomography hybrid imaging

    Microsoft Academic Search

    Eric T. McWilliams; Arash Yavari; Vivek Raman

    2011-01-01

    Culture negative endocarditis and aortic root abscess can prove difficult diagnostic challenges. Computed tomography can be extremely useful in this setting. We report a case of an aortic root abscess 3 months after elective aortic valve replacement in which cardiac CT and hybrid imaging with Gallium-67 SPECT complemented workup with transesophageal echocardiography in establishing the diagnosis of an abscess.

  15. Initial Experience of Two National Centers in Transcatheter Aortic Prosthesis Implantation

    PubMed Central

    Lluberas, Sebastián; Abizaid, Alexandre; Siqueira, Dimytri; Ramos, Auristela; Costa, J. Ribamar; Arrais, Magaly; Kambara, Antônio; Bihan, David Le; Sousa, Amanda; Sousa, J. Eduardo

    2014-01-01

    Background Transcatheter aortic valve implantation is an effective alternative to surgical treatment of severe aortic stenosis in patients who are inoperable or at high surgical risk. Objectives To report the immediate and follow-up clinical and echocardiographic results of the initial experience of transcatheter aortic valve implantation. Methods From 2009 June to 2013 February, 112 patients underwent transcatheter aortic valve implantation. Results Mean age was 82.5 ± 6.5 years, and the logistic EuroSCORE was 23.6 ± 13.5. Procedural success was 84%. After the intervention, a reduction in the mean systolic gradient was observed (pre: 54.7 ± 15.3 vs. post: 11.7 ± 4.0 mmHg; p < 0.01). Cerebrovascular accidents occurred in 3.6%, vascular complications in 19% and permanent pacemaker was required by 13% of the patients. Thirty-day mortality and at follow-up of 16 ± 11 months was 14% and 8.9% respectively. The presence of chronic obstructive pulmonary disease was the only predictor of mortality at 30 days and at follow-up. During follow up, aortic valve area and mean systolic gradient did not change significantly. Conclusions Transcatheter aortic valve implantation is an effective and safe procedure for the treatment of aortic stenosis in high-surgical risk or inoperable patients. The presence of chronic obstructive pulmonary disease was the only independent predictor of mortality identified both in the first month post-intervention and at follow-up. PMID:24844875

  16. Non-invasive assessment by Doppler ultrasound of 155 patients with bioprosthetic valves: a comparison of the Wessex porcine, low profile Ionescu-Shiley, and Hancock pericardial bioprostheses

    Microsoft Academic Search

    I A Simpson; I J Reece; A B Houston; I Hutton; D J Wheatley; S M Cobbe

    1986-01-01

    One hundred and fifty five patients with 167 bioprosthetic valves (68 Wessex porcine, 54 Hancock pericardial, and 45 low profile Ionescu-Shiley pericardial valves) were studied by Doppler ultrasound. Valve gradients were calculated from the mitral and aortic flow velocities by the modified Bernoulli equation. Mean mitral gradients were significantly smaller across the Ionescu-Shiley valves than across the Wessex porcine or

  17. The role of imaging in aortic dissection and related syndromes.

    PubMed

    Baliga, Ragavendra R; Nienaber, Christoph A; Bossone, Eduardo; Oh, Jae K; Isselbacher, Eric M; Sechtem, Udo; Fattori, Rossella; Raman, Subha V; Eagle, Kim A

    2014-04-01

    Aortic aneurysm and acute aortic syndrome are not uncommon conditions. Management of acute aortic dissection and related syndromes requires a multidisciplinary approach with input from the patient, clinician, imager, surgeon, and anesthesiologist. This requires an integrated evaluation of pathophysiology, anatomy, and severity to enable appropriate therapy. This review includes discussion of essential anatomy of the aortic valve and the aorta that determines the candidacy for surgical repair. It also includes discussion of various imaging modalities, particularly echocardiography, cardiac computed tomography, and cardiac magnetic resonance angiography. The relative benefits and demerits of each of these techniques are reviewed. This paper is intended to help guide management decisions for patients with acute aortic dissection and related syndromes. PMID:24742892

  18. Valves Module

    NSDL National Science Digital Library

    The Center for the Advancement of Process Technology presents this free sample module on valves in the process industries. The interactive resource includes 55 screens and will help learners with both the details of valve systems and the process technician's role in valve operation and maintenance.

  19. Spatiotemporal complexity of the aortic sinus vortex

    NASA Astrophysics Data System (ADS)

    Moore, Brandon; Dasi, Lakshmi Prasad

    2014-07-01

    The aortic sinus vortex is a classical flow structure of significant importance to aortic valve dynamics and the initiation and progression of calcific aortic valve disease. We characterize the spatiotemporal characteristics of aortic sinus vortex dynamics in relation to the viscosity of blood analog solution as well as heart rate. High-resolution time-resolved (2 kHz) particle image velocimetry was conducted to capture 2D particle streak videos and 2D instantaneous velocity and streamlines along the sinus midplane using a physiological but rigid aorta model fitted with a porcine bioprosthetic heart valve. Blood analog fluids used include a water-glycerin mixture and saline to elucidate the sensitivity of vortex dynamics to viscosity. Experiments were conducted to record 10 heart beats for each combination of blood analog and heart rate condition. Results show that the topological characteristics of the velocity field vary in timescales as revealed using time bin-averaged vectors and corresponding instantaneous streamlines. There exist small timescale vortices and a large timescale main vortex. A key flow structure observed is the counter vortex at the upstream end of the sinus adjacent to the base (lower half) of the leaflet. The spatiotemporal complexity of vortex dynamics is shown to be profoundly influenced by strong leaflet flutter during systole with a peak frequency of 200 Hz and peak amplitude of 4 mm observed in the saline case. While fluid viscosity influences the length and timescales as well as the introduction of leaflet flutter, heart rate influences the formation of counter vortex at the upstream end of the sinus. Higher heart rates are shown to reduce the strength of the counter vortex that can greatly influence the directionality and strength of shear stresses along the base of the leaflet. This study demonstrates the impact of heart rate and blood analog viscosity on aortic sinus hemodynamics.

  20. Heart valve surgery

    MedlinePLUS

    Valve replacement; Valve repair; Heart valve prosthesis; Mechanical valves, Prosthetic valves ... place. The main types of new valves are: Mechanical -- made of man-made materials, such as metal ( ...

  1. Influence of three mechanical bileaflet prosthetic valve designs on the three-dimensional flow field inside a simulated aorta

    Microsoft Academic Search

    Toshinosuke Akutsu; Akira Matsumoto

    2010-01-01

    The current design of the bileaflet valve, the leaflets of which open outside first, differs significantly from the natural\\u000a valve whose leaflets open center first. This difference generates a completely different flow field in the bileaflet valve\\u000a compared to that in the natural heart valve. In a previous study, it was demonstrated that the valve design greatly affects\\u000a the aortic

  2. Valve-in-valve in the tricuspid position for a stenosed bioprosthesis.

    PubMed

    Beckerman, Ziv; Cohen, Oved; Agmon, Yoram; Bolotin, Gil

    2013-04-01

    The strategy of transcatheter valve-in-valve implantation into failing mitral and aortic bioprosthetic valves is a documented approach. It allows one to avoid performing a high-risk repeat cardiac surgery in elderly patients with multiple comorbidities. Tricuspid valve-in-valve implantation has been documented only a few times in the literature. We report the case of a 65-year-old woman with a failing bioprosthetic tricuspid valve who had undergone 3 prior open heart operations. We attempted a transatrial transcatheter approach and successfully deployed a 29-mm Edwards Sapien balloon-expandable bioprosthesis into a severely stenotic tricuspid bioprosthesis. This case demonstrates the technical feasibility and safety of this approach. PMID:23625484

  3. Fast valve

    DOEpatents

    Van Dyke, William J. (Grafton, VA)

    1992-01-01

    A fast valve is disclosed that can close on the order of 7 milliseconds. It is closed by the force of a compressed air spring with the moving parts of the valve designed to be of very light weight and the valve gate being of wedge shaped with O-ring sealed faces to provide sealing contact without metal to metal contact. The combination of the O-ring seal and an air cushion create a soft final movement of the valve closure to prevent the fast air acting valve from having a harsh closing.

  4. Characterisation of elastin and collagen in aortic bioprostheses

    Microsoft Academic Search

    V. Samouillan; A. Lamure; E. Maurel; J. Dandurand; C. Lacabanne; F. Ballarin; M. Spina

    2000-01-01

    Porcine aortic valves used as cardiac valve bioprostheses are well adapted to physiological functions in the short term, but\\u000a they lack long-term durability. Several multi-step extractions have been performed to obtain a perfectly acellular matrix.\\u000a A new physical methodology is proposed to evaluate the resulting fibrous protein damage after biochemical extraction (TRI-COL\\u000a and SDS). Thermal analysis techniques are adapted to

  5. Depressurization valve

    DOEpatents

    Skoda, G.I.

    1989-03-28

    A depressurization valve for use in relieving completely the pressure in a simplified boiling water reactor is disclosed. The normally closed and sealed valve is provided with a valve body defining a conduit from an outlet of a manifold from the reactor through a valve seat. A closing valve disk is configured for fitting to the valve seat to normally close the valve. The seat below the disk is provided with a radially extending annulus extending a short distance into the aperture defined by the seat. The disk is correspondingly provided with a longitudinally extending annulus that extends downwardly through the aperture defined by the seat towards the high pressure side of the valve body. A ring shaped membrane is endlessly welded to the seat annulus and to the disk annulus. The membrane is conformed over the confronted surface of the seat and disk in a C-sectioned configuration to seal the depressurization valve against the possibility of weeping. The disk is held to the closed position by an elongate stem extending away from the high pressure side of the valve body. The stem has a flange configured integrally to the stem for bias by two springs. The first spring acts from a portion of the housing overlying the disk on the stem flange adjacent the disk. This spring urges the stem and attached disk away from the seat and thus will cause the valve to open at any pressure. A second spring-preferably of the Belleville variety-acts on a latch plate surrounding and freely moving relative to the end of the stem. This second spring overcomes the bias of the first spring and any pressure acting upon the disk. This Belleville spring maintains through its spring force the valve in the closed position. At the same time, the latch plate with its freedom of movement relative to the stem allows the stem to thermally expand during valve temperature excursion.

  6. Haemophilus parainfluenzae prosthetic valve endocarditis complicated by septic emboli to brain

    PubMed Central

    Liang, J J; Swiecicki, P L; Killu, A M; Sohail, M R

    2013-01-01

    A 51-year-old man with a history of injection drug use presented to the emergency roomwith fevers, chills and headaches. Five months earlier, he had undergone bioprosthetic aortic valve replacement for infective endocarditis owing to Corynebacterium auricumosum involving a bicuspid aortic valve. Blood cultures obtained during current hospitalisation grew Haemophilus parainfluenzae and patient underwent a transesophageal echocardiogram that revealed a large mitral valve vegetation. Owing to persistent headache and right lower extremity weakness, MRI of the brain was performed which demonstrated multifocal, acute infarctions secondary to septic embolisation. He was initiated on parenteral antibiotics and experienced no further neurological setbacks. After 2?weeks of antibiotic therapy, he underwent bioprosthetic aortic and mitral valve replacement, aortic root debridement and replacement, and reconstruction of the intravalvular fibrosa without complication. He was discharged to a skilled nursing facility to complete six more weeks of intravenous ceftriaxone. PMID:23737586

  7. Flow Behavior in the Left Heart Ventricle Following Apico-Aortic Bypass Surgery

    NASA Astrophysics Data System (ADS)

    Shahriari, Shahrokh; Jeyhani, Morteza; Labrosse, Michel; Kadem, Lyes

    2013-11-01

    Apico-aortic bypass (AAB) surgery is an alternative for transcatheter aortic valve implantation (TAVI) to reduce left ventricle (LV) overload in patients with severe aortic stenosis (AS). It consists in connecting the apex of the LV to the descending thoracic aorta with a valved conduit. Postoperative flow assessments show that two thirds of the outflow is conducted from the LV apex to the conduit, while only one third crosses the native aortic valve. In this study, we performed high speed particle image velocimetry (PIV) measurements of flow pattern within an in vitro elastic model of LV in the presence of a very severe AS, before and after AAB. Results indicate that AAB effectively relieves the LV outflow obstruction; however, it also leads to abnormal ventricular flow patterns. Normal LV flow dynamics is characterized by an emerging mitral jet flow followed by the development of a vortical flow with velocities directed towards the aortic valve, while measurements in the presence of AAB show systolic flow bifurcating to the apical conduit and to the aortic valve outflow tract. This study provides the first insight into the LV flow structure after AAB including outflow jets and disturbed stagnation regions.

  8. Cine MR imaging in aortic stenosis.

    PubMed

    de Roos, A; Reichek, N; Axel, L; Kressel, H Y

    1989-01-01

    The potential of cine magnetic resonance (MR) imaging for the assessment of aortic stenosis (AS) was investigated in 17 patients. The severity of AS was graded by continuous wave Doppler ultrasound as severe in 10 of 17 patients and as moderate in the remaining 7 patients. Cine MR demonstrated a flow disturbance proximal and/or distal to the aortic valve plane in all 17 patients. This flow disturbance was seen as a signal void with four typical features: (a) a high-velocity jet phenomenon distal to the valve plane during systole, closely related to the stenotic orifice (8 of 17); (b) a turbulent systolic signal void in continuity with the jet, which propagated for a variable extent into the aorta (17 of 17); (c) a signal void just proximal to the valve plane during systolic ejection, reflecting prestenotic acceleration of blood flow (5 of 17); and (d) a void at the valve plane due to valvular calcifications (14 of 17). The following features or a combination thereof appeared to correlate with more severe grades of AS as visualized on cine MR display: (a) identification of narrow high-velocity jet phenomenon; (b) extensive propagation of the turbulent signal void into the aorta; and (c) presence of a prestenotic acceleration effect. Assessment of the severity of AS with cine MR is still limited. However, cine MR can identify the presence of AS and several flow phenomena that correlate with more severe degrees of stenosis. PMID:2524509

  9. Svensson class IV Ascending aortic dissection, often confused with penetrating ulcer.

    PubMed

    Mitsomoy, Michel Francklyn; Alexoiu, Valerica; Kirsch, Matthias

    2015-01-01

    TWe present the case of a 64 years old male patient who had recently suffered an infective aortic valve endocarditis (Streptococcus agalactiae) complicated by embolic arthritis of the right hip. Initial echocardiography revealed moderate aortic insufficiency developed on a tricuspid aortic valve with a small vegetation (5 mm × 4 mm) on the left coronary cusp. Furthermore, an aneurysmal dilatation of the ascending aorta (maximal diameter, 54 mm) was noted. Other heart valves and left ventricular function were considered normal. The patient completed a 4 weeks course of antibiotherapy, and the right hip arthritis was treated by drainage and synovectomy. The patient was subsequently referred to surgery on an outpatient basis for the aneurysm of the ascending aorta. Preoperative computed tomography showed localized aortic dissection of the tubular ascending aorta characterized by an intimal tear without medial hematoma but excentric bulging of the aortic wall. This lesion was initially considered a penetrating ulcer of the aortic wall The operative specimen allowed to make differential diagnosis with a penetrating aortic ulcer by showing that the lesion did not develop within an atherosclerotic plaque. However, downstream extension of the dissection was probably limited by the presence of transmural calcifications on its distal side. The patient underwent successful complete aortic root replacement using a stentless Freestyle bioprosthesis with Dacron graft extension as reported previously. PMID:25859316

  10. In vitro study of the aortic interleaflet triangle reshaping.

    PubMed

    Vismara, R; Leopaldi, A M; Mangini, A; Romagnoni, C; Contino, M; Antona, C; Fiore, G B

    2014-01-22

    Aortic interleaflet triangle reshaping (AITR) is a surgical approach to aortic valve incontinence that involves placing three stitches at half of the interleaflet triangles height. In this work, the relationship between the actual stitch height and valve functioning, and the safety margin that the surgeon can rely on in applying the stitches were systematically investigated in vitro. AITR surgery was applied to six swine aortic roots placing the stitches empirically at 50%, 60% and 75% of the triangle heights. Then the actual stitch heights were measured and the hydrodynamic performances were evaluated with a pulsatile hydrodynamic mock loop. Actual stitch heights were 45±2%, 61±4% and 79±6%. As compared to untreated conditions, the 50% configuration induced a significant variation in the effective orifice area. With stitches placed at 60%, the mean systolic pressure drop increased significantly with respect to the untreated case, but no significant changes were recorded with respect to the 50% configuration. At 75%, all the hydrodynamic parameters of systolic valve functioning worsened significantly. Summarizing, the AITR technique, when performed in a conservative manner did not induce significant alterations in the hydrodynamics of the aortic root in vitro, while more aggressive configurations did. The absence of a statistically significant difference between the 50% and 60% configurations suggests that there is a reasonably limited risk of inducing valve stenosis in the post-op scenario due to stitch misplacement. PMID:24360769

  11. The use of autologous fascia lata for cardiac valve replacement: preliminary results.

    PubMed

    Trimble, A S; Metni, F N

    1971-10-01

    Since November 1969, 53 patients have been operated on at the Toronto General Hospital for cardiac valve replacement with valves fashioned from autologous fascia lata. Sixty-three such valves have been inserted, including single aortic and mitral, double and triple valve replacements. The preliminary results indicate that operative mortality, considering the status of the patient submitted to the procedure, is comparable to that of plastic prosthetic valve replacement at this centre. Early follow-up confirms that anticoagulation is unnecessary and thromboembolism can be avoided with this form of valve substitution. PMID:5096910

  12. Earthquake relief valve

    Microsoft Academic Search

    1989-01-01

    A shock actuated shut-off valve is described, comprising: a valve, having an open position and a closed position, rotatably mounted within a valve body; a valve stem connected to the valve; an elongated handle having a valve stem engagement end and a ball detent engagement end, the valve stem engagement end connected to the valve stem; means for urging the

  13. Low flow low gradient aortic stenosis: clinical pathways.

    PubMed

    Sathyamurthy, I; Jayanthi, K

    2014-01-01

    Aortic stenosis patients with severe LV dysfunction and low cardiac output present with relatively low transvalvular gradients. It is difficult to distinguish them from aortic sclerosis and LV dysfunction with low cardiac output. The former condition is severe AS with LV dysfunction and latter is primarily a contractile dysfunction. Dobutamine stress echocardiogram is key to diagnosis. AS with LV dysfunction associated with preserved contractile reserve benefit from valve replacement and those without contractile reserve needs critical evaluation on a case to case basis. Patients of AS with LV dysfunction with associated coronary artery disease need coronary angiograms to decide regarding need for valve replacement with bypass surgery. A subset of AS patients have low flow, low mean gradients with preserved ejection fraction in whom one must evaluate global hemodynamic load to assess ventriculo-arterial impedence. In this review an approach to the clinical pathways for assessment of low flow, low gradient aortic stenosis has been discussed. PMID:25634403

  14. Abdominal Aortic Aneurysms: Treatments

    MedlinePLUS

    ... Minimally Invasive Treatments Snapshots Multimedia Multimedia Archive Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  15. Glutaraldehyde-fixed kangaroo aortic wall tissue: histology, crosslink stability and calcification potential.

    PubMed

    Neethling, W M L; Hodge, A J; Glancy, R

    2003-07-15

    Stentless aortic heart valve substitutes, manufactured from biological tissues, are fixed with glutaraldehyde to cross-link collagen, reduce antigenicity, and sterilize the tissue. Despite improved cross linking, reduced antigenicity, and various anticalcification measures, the aortic wall tissue present in these prostheses tends to calcify. The aim of this study was to assess the morphology, collagen cross-link stability, and calcification potential of glutaraldehyde-preserved kangaroo aortic wall tissue as opposed to porcine aortic wall tissue. Porcine and kangaroo aortic wall tissues were fixed in 0.625% buffered glutaraldehyde. Histology and cross-link stability were examined. Calcification potential was determined in the subcutaneous rat model. Kangaroo aortic wall tissue was significantly (p < 0.01) less calcified than porcine aortic wall tissue (26.67 +/- 6.53 versus 41.959 +/- 2.75 microg/mg tissue) at 8 weeks. In conclusion, the histological differences between kangaroo and porcine aortic wall tissue correlate well with the reduced calcification potential of kangaroo aortic wall tissue. The reduced calcification potential could result in improved long-term durability of stentless kangaroo heart valves as bioprostheses. PMID:12808595

  16. Depressurization valve

    DOEpatents

    Skoda, George I. (Santa Clara, CA)

    1989-01-01

    A depressurization valve for use in relieving completely the pressure in a simplified boiling water reactor is disclosed. The normally closed and sealed valve is provided with a valve body defining a conduit from an outlet of a manifold from the reactor through a valve seat. A closing valve disk is configured for fitting to the valve seat to normally close the valve. The seat below the disk is provided with a radially extending annulus extending a short distance into the aperture defined by the seat. The disk is correspondingly provided with a longitudinally extending annulus that extends downwardly through the aperture defined by the seat towards the high pressure side of the valve body. A ring shaped membrane is endlessly welded to the seat annulus and to the disk annulus. The membrane is conformed over the confronted surface of the seat and disk in a C-sectioned configuration to seal the depressurization valve against the possibility of weeping. The disk is held to the closed position by an elongate stem extending away from the high pressure side of the valve body. The stem has a flange configured integrally to the stem for bias by two springs. The first spring acts from a portion of the housing overlying the disk on the stem flange adjacent the disk. This spring urges the stem and attached disk away from the seat and thus will cause the valve to open at any pressure. A second spring--preferably of the Belleville variety--acts on a latch plate surrounding and freely moving relative to the end of the stem. This second spring overcomes the bias of the first spring and any pressure acting upon the disk. This Belleville spring maintains through its spring force the valve in the closed position. At the same time, the latch plate with its freedom of movement relative to the stem allows the stem to thermally expand during valve temperature excursion. The latch plate in surrounding the stem is limited in its outward movement by a boss attached to the stem at the end of the stem remote from the disk. The latch plate is held normally closed by three radial latches spaced at 120.degree. around the periphery of the plate.

  17. Nuclear radiation actuated valve

    DOEpatents

    Christiansen, David W. (Kennewick, WA); Schively, Dixon P. (Richland, WA)

    1985-01-01

    A nuclear radiation actuated valve for a nuclear reactor. The valve has a valve first part (such as a valve rod with piston) and a valve second part (such as a valve tube surrounding the valve rod, with the valve tube having side slots surrounding the piston). Both valve parts have known nuclear radiation swelling characteristics. The valve's first part is positioned to receive nuclear radiation from the nuclear reactor's fuel region. The valve's second part is positioned so that its nuclear radiation induced swelling is different from that of the valve's first part. The valve's second part also is positioned so that the valve's first and second parts create a valve orifice which changes in size due to the different nuclear radiation caused swelling of the valve's first part compared to the valve's second part. The valve may be used in a nuclear reactor's core coolant system.

  18. Valve assembly

    SciTech Connect

    Marshala, D.L.

    1986-12-16

    This patent describes a subsurface pump actuated by a reciprocatable sucker rod for producing well liquids from a subsurface reservoir involving a piston adapted to reciprocate within a cylinder immersed in the reservoir, the piston being provided with a traveling valve. The improvement described here comprises valve means connected to the sucker tod for lifting a body of fluid during upstrokes of the sucker rod, the valve means comprising: a barrel assembly having an internal bore and comprising: a lower barrel member; and an upper barrel assembly connected to the lower barrel and having a beveled seating surface with at least one fluid port therethrough.

  19. Artificial neural networks in computer-assisted classification of heart sounds in patients with porcine bioprosthetic valves

    Microsoft Academic Search

    Z. Guo; L.-G. Durand; H. C. Lee; L. Allard; M.-C. Grenier; P. D. Stein

    1994-01-01

    The paper describes the design, training and testing of a three-layer feedforward back-propagation neural network for the\\u000a classification of bioprosthetic valve closure sounds. Forty-seven patients with a porcine bioprosthetic valve inserted in\\u000a the aortic position were involved in the study. Twenty-four of them had a normal bioprosthetic valve, and the other 23 had\\u000a a degenerated valve. Five features extracted from

  20. Biomechanical properties of the Marfan's aortic root and ascending aorta before and after personalised external aortic root support surgery.

    PubMed

    Singh, S D; Xu, X Y; Pepper, J R; Treasure, T; Mohiaddin, R H

    2015-08-01

    Marfan syndrome is an inherited systemic connective tissue disease which may lead to aortic root disease causing dilatation, dissection and rupture of the aorta. The standard treatment is a major operation involving either an artificial valve and aorta or a complex valve repair. More recently, a personalised external aortic root support (PEARS) has been used to strengthen the aorta at an earlier stage of the disease avoiding risk of both rupture and major surgery. The aim of this study was to compare the stress and strain fields of the Marfan aortic root and ascending aorta before and after insertion of PEARS in order to understand its biomechanical implications. Finite element (FE) models were developed using patient-specific aortic geometries reconstructed from pre and post-PEARS magnetic resonance images in three Marfan patients. For the post-PEARS model, two scenarios were investigated-a bilayer model where PEARS and the aortic wall were treated as separate layers, and a single-layer model where PEARS was incorporated into the aortic wall. The wall and PEARS materials were assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall corresponding to the patients' pulse pressure was applied. Results from our FE models with patient-specific geometries show that peak aortic stresses and displacements before PEARS were located at the sinuses of Valsalva but following PEARS surgery, these peak values were shifted to the aortic arch, particularly at the interface between the supported and unsupported aorta. Further studies are required to assess the statistical significance of these findings and how PEARS compares with the standard treatment. PMID:26054807

  1. Quantification of Structural Compliance of Aged Human and Porcine Aortic Root Tissues

    PubMed Central

    Li, Kewei; Wang, Qian; Pham, Thuy; Sun, Wei

    2014-01-01

    The structural compliance of the aortic root has a significant implication for valve procedures such as transcatheter aortic valve implantation and valve-sparing aortic root replacement. However, a detailed quantification of human aortic roots structural compliance, particularly in different regions has been incomplete. In this study, the structural properties of human aortic roots (81 ± 8.74 years, n=10) were characterized and compared with those of porcine ones (6–9 months, n=10) using a vessel pressure-inflation test. The test involves tracking three-dimensional deformation of the markers affixed on the different surface regions of the aortic roots, including the three sinuses: the non-coronary sinus (NCS), the left coronary sinus (LCS) and the right coronary sinus (RCS), and at three regions along the longitudinal direction of each sinus: the upper sinus (US), the middle sinus (MS) and the lower sinus (LS), and the ascending aorta (AA) region above the