These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

Transcatheter aortic valve implantation  

PubMed Central

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

Oliemy, Ahmed

2014-01-01

2

Aortic valve surgery - open  

MedlinePLUS

... remove your aortic valve and sew a new one into place. There are two main types of new valves: Mechanical -- made of man-made materials, such as titanium or carbon. These valves last the longest. You ...

3

Aortic Valve  

MedlinePLUS

... way the extra work may cause symptoms of heart failure, such as shortness of breath. Early on the shortness of breath may be noticeable only with exercise. Later, with the progression of valve disease, a patient could experience shortness of breath with even light ...

4

Sutureless aortic valve replacement  

PubMed Central

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).

Phan, Kevin

2015-01-01

5

[Transcatheter aortic valve replacement].  

PubMed

While transcatheter aortic valve replacement( TAVR) has spread rapidly all over the world for highrisk patients with severe aortic stenosis (AS), SAPIEN XT was approved in Japan in October 2013. Since that, approximately 400 TAVR cases were performed in Japan. In our institute, we have performed 164 cases since first case in Japan in 2009 and have achieved satisfactory early results(30-day mortality:1.2%). At the same time, however, simultaneously various TAVR-related complications including a paravalvular leak, stroke, vascular complications, and coronary obstruction were observed. A reduction in the incidence and severity of these complications had led technical improvements in various new devices(2nd generation TAVR device such as the SAPIEN 3, ACURATE, and JenaValve) and in implantation techniques including repositioning/recapturing features, paravalvular sealing technologies, and prevention of coronary obstruction. Furthermore, there is also increasing experience with special indications for TAVR such as pure aortic valve insufficiency or valve-in-valve techniques. Currently, an increasing number of publications of midterm results demonstrate good prosthetic valve function and durability, with good quality of life and low morbidity after TAVR. There are also some randomized trials such as PARTNER 2 or SURTAVI to investigate potential benefits of TAVR for intermediate-risk patients. These improvements in the TAVR devices promises the expansion of TAVR towards the treatment of lower-risk patients in the near future. PMID:25138938

Sawa, Yoshiki

2014-07-01

6

Aortic valve surgery - minimally invasive  

MedlinePLUS

... remove your aortic valve and sew a new one into place. There are two main types of new valves: Mechanical -- made of man-made materials, such as titanium or carbon. These valves last the longest. You ...

7

Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra  

ClinicalTrials.gov

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

2014-08-08

8

Stentless aortic valves. Current aspects.  

PubMed

The design of stentless valve prostheses is intended to achieve a more physiological flow pattern and superior hemodynamics in comparison to stented valves. First - generation stentless bioprosthesis were the Prima valve, the Freestyle valve and the Toronto stentless porcine valve. The second generation of stentless valves, as the Super stentless aortic porcine valve, need only one suture line. The Sorin Pericarbon Freedom and the Equine 3F heart Valve belong to the third generation of stentless valve pericardial bioprostheses. A stentless valve to replace a full root can be implanted by several surgical techniques: complete or modified subcoronary, root inclusion and full root. The full root technique is accompanied by the lowest incidence of patient-prothesis mismatch. Our own clinical experience reflects more than 3000 stentless valve implantations since April 1996. Randomized study trials showed a hemodynamic advantage for stentless valves, but several could not reach a significant level. Also reported was a significant advantage of stentless bioprostheses concerning transvalvular gradients, effective valve area and quicker regression of the left ventricular mass 6 months after the operation, but at 12 months. Advantages are obvious in patients with a decreased left ventricle ejection fraction of less than 50% and in smaller implanted valve size, concomitant aortic root pathology (e.g. dissection) and aortic valve endocarditis. A survival advantage for stentless bioprostheses in comparison to stented ones has been reported by all studies in the literature. Stentless valves enrich the surgical armamentarium. Time will define the place of stentless valves in the future. PMID:23439732

Ennker, J; Albert, A; Ennker, I C

2012-01-01

9

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

PubMed Central

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

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

2014-01-01

10

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

PubMed

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

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

2015-04-01

11

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

PubMed

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

Yamanaka, Katsuhiro; Okada, Kenji; Okita, Yutaka

2015-04-01

12

Aortic Valve Adaptation to Aortic Root Dilatation  

PubMed Central

Background The 3-dimensional relationship between aortic root and cusp is essential to understand the mechanism of aortic regurgitation (AR) because of aortic root dilatation (ARD). We sought to test the hypothesis that the stretched cusps in ARD enlarge to compensate for ARD. Methods and Results Computed tomography imaged 92 patients (57 with ARD, 29 with moderate to severe AR, 28 without significant AR) and 35 normal controls. Specialized 3-dimensional software measured individual cusp surface areas relative to maximal mid-sinus cross-sectional area and minimal 3-dimensional annular area, coaptation area fraction, and asymmetry of sinus volumes and intercommissural distances. Total open cusp surface area increased (P<0.001) from 7.6±1.4 cm2/m2 in normals to 12.9±2.2 cm2/m2 in AR-negative and 15.2±3.3 cm2/m2 in AR-positive patients. However, the ratio of closed cusp surface area to maximal mid-sinus area, reflecting cusp adaptation, decreased from normals to AR-negative to AR-positive patients (1.38±0.20, 1.15±0.15, 0.88±0.15; P<0.001), creating the lowest coaptation area fraction. Cusp distensibility (closed diastolic versus open area) decreased from 20% in controls and AR-negative patients to 5% in AR-positive patients (P<0.001). Multivariate determinants of AR and coaptation area fraction reflected both sinus size and cusp-to-annular adaptation. ARD was also progressively asymmetrical with root size, and individual cusp surface areas failed to match this asymmetry. Conclusions Aortic cusp enlargement occurs in ARD, but cusp adaptation and distensibility become limited in prominent, asymmetrical ARD, leading to AR. Optimal AR repair tailored to individual patient anatomy can benefit from appreciating valve adaptation and 3-dimensional relationships; understanding cusp adaptation mechanisms may ultimately provide therapeutic opportunities to improve such compensation. PMID:25051951

Kim, Dae-Hee; Handschumacher, Mark D.; Levine, Robert A.; Sun, Byung Joo; Jang, Jeong Yoon; Yang, Dong Hyun; Kang, Joon-Won; Song, Jong-Min; Kang, Duk-Hyun; Lim, Tae-Hwan; Song, Jae-Kwan

2015-01-01

13

Valve thrombosis 7 months after transcatheter aortic valve implantation.  

PubMed

A 77-year old man underwent transcatheter aortic valve implantation for severe aortic stenosis with a 29-mm Edwards-Sapien XT aortic valve bioprosthesis. Periprocedural transesophageal echocardiography and computed tomography showed good positioning and expansion of the prosthesis with only minor transvalvular insufficiency. On a routine checkup 7 months later, echocardiography and computed tomography showed a high transvalvular gradient suggestive of valve thrombosis, which could not be treated with warfarin. Because of rapid deterioration of the patient's clinical condition, an urgent surgical valve replacement was performed 4 weeks after initial notice of the valve thrombosis. The patient's postoperative stay was uneventful. PMID:25193189

Pingpoh, Clarence; Pache, Gregor; Nawras, Diab; Guenkel, Ludwig; Sami, Kueri; Zeh, Wolfgang; Zimmer, Emmanuel; Jander, Nikolaus; Siepe, Matthias; Beyersdorf, Friedhelm

2014-09-01

14

Frailty and aortic valve disease.  

PubMed

Frailty is a common occurrence in elderly persons and is present in approximately half of the patients being screened for transcatheter aortic valve replacement (TAVR) therapy. Accurate assessment of the likelihood of benefit from intervention in the older patient with aortic stenosis is critical with both surgical aortic valve replacement and TAVR now available. Whereas risk algorithms are available that are helpful in predicting outcomes in patients undergoing surgical procedures, measures of frailty are not included in the algorithms. When considering intervention in the elderly patient, the addition of frailty assessment to determine the true risk in this population is essential to determine potential benefit. Gait speed as determined by the 5-m walk test is the most commonly used single test objective measurement of frailty in patients undergoing cardiac surgery and is an independent predictor of mortality and major morbidity. Wider application of this and other objective measures of frailty in the population undergoing TAVR is necessary to determine whether it is predictive in this population also. PMID:23260463

Mack, Michael

2013-03-01

15

Intraoperative tracking of aortic valve plane  

PubMed Central

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. This paper is focused on the issue of aortic valve calcifications tracking in fluoroscopic images. We propose a new method based on the Tracking-Learning-Detection approach, applied to the aortic valve calcifications in order to determine the position of the aortic valve plane in intra-operative TAVI images. This main contribution concerns the improvement of object detection by updating the recursive tracker in which all features are tracked jointly. The approach has been evaluated on four patient databases, providing an absolute mean displacement error less than 10 pixels ? 2mm). Its suitability for the TAVI procedure has been analyzed. PMID:24110703

Nguyen, Duc Long Hung; Garreau, Mireille; Auffret, Vincent; Le Breton, Hervé; Verhoye, Jean-Philippe; Haigron, Pascal

2013-01-01

16

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

Microsoft Academic Search

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

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

1995-01-01

17

Nocardial endocarditis of an aortic valve prosthesis.  

PubMed Central

The organism responsible for endocarditis of a prosthetic aortic valve was identified as Nocardia asteroides. The patient was treated with intravenous amikacin (250 mg four times a day) and intravenous imipenem (1.5 g four times a day). The valve was replaced under this new antibiotic regimen. This is the first report of survival after prosthetic valve nocardiosis. PMID:3555567

Ertl, G; Schaal, K P; Kochsiek, K

1987-01-01

18

Geometry of aortic heart valves. [prosthetic design  

NASA Technical Reports Server (NTRS)

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.

Karara, H. M.

1975-01-01

19

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

PubMed Central

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

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

2013-01-01

20

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

PubMed

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

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

2013-11-01

21

Acute aortic insufficiency due to rupture of an aortic valve commissure.  

PubMed

Myxomatous degeneration generally involves the atrioventricular valves (mitral and tricuspid). Rarely, it may affect the aortic or pulmonary valve. We report a case of an acute severe aortic insufficiency due to a rupture of a commissure of the aortic valve in a patient who had previously undergone mitral valve surgery for myxomatous mitral valve prolapse. PMID:24417221

Kassem, Samer; Polvani, Gianluca; Al Jaber, Emad; Gennari, Marco

2014-07-01

22

Mechanical aortic valve-on-valve replacement in previous Bentall procedure: an alternate technique.  

PubMed

Acute aortic valve regurgitation due to thrombosed prosthetic valve can present as a surgical emergency. This article reports a successful and unusual management of a young pregnant female patient who presented with acute aortic valve regurgitation due to a thrombosed mechanical aortic valve. As the patient had previous multiple cardiac surgeries, the options were limited for repeat aortic valve or aortic root replacement. The patient had caesarean section followed by implantation of a mechanical valve-on-valve in a previously placed composite valved conduit. This technique may be useful for reoperative valve replacement in the setting of a prior mechanical Bentall patient. PMID:25193228

Manoly, Imthiaz; Krishnan, Monica; Hoschtitzky, J Andreas; Hasan, Ragheb

2014-09-01

23

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

PubMed

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

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

2014-10-01

24

Role of Transcatheter Aortic Valve Implantation (TAVI) Versus Conventional Aortic Valve Replacement in the Treatment of Aortic Valve Disease  

PubMed Central

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

2012-01-01

25

EARLY LEFT VENTRICULAR REMODELING AFTER AORTIC VALVE REPLACEMENT  

Microsoft Academic Search

Background: Aortic valve disease is associated with eccentric or concentric left ventricular (LV) hypertrophy and changes in the LV mass. The relationship between LV mass and function and the effect of LV remodeling after aortic valve replacement (AVR), in patients with aortic valve disease needs evaluation, that is largely unknown in our population. The aim of this study was to

Naseem Ahmad; Ahmad Shahbaz; Abdul Ghaffar; Zafar Tufail; Abdul Waheed; Jawad Sajid Khan

2007-01-01

26

Aortic valve disease in Marfan syndrome.  

PubMed

The Marfan syndrome patient undergoes care by many different physicians for the treatment of the varied systems affected by this connective tissue disorder. The most frequent visits are to a cardiologist, with referral to a cardiovascular surgeon who attends to the problems of dilatation and dissection of the ascending aorta. Follow-up is lifelong. Although currently some surgeons prefer to resuspend rather than replace the aortic valve, composite valve graft replacement for aortic root dilatation and aortic valve insufficiency has steadily improved patient outcome. At the same time, the almost daily discoveries of genetic science show great promise in eliminating connective tissue disorders such as Marfan syndrome in the not-too-distant future. PMID:9593547

Safi, H J; Vinnerkvist, A; Bhama, J K; Miller, C C; Koussayer, S; Haverich, A

1998-03-01

27

Stentless aortic valve replacement: an update  

PubMed Central

Although porcine aortic valves or pericardial tissue mounted on a stent have made implantation techniques easier, these valves sacrifice orifice area and increase stress at the attachment of the stent, which causes primary tissue failure. Optimizing hemodynamics to prevent patient–prosthetic mismatch and improve durability, stentless bioprostheses use was revived in the early 1990s. The purpose of this review is to provide a current overview of stentless valves in the aortic position. Retrospective and prospective randomized controlled studies showed similar operative mortality and morbidity in stented and stentless aortic valve replacement (AVR), though stentless AVR required longer cross-clamp and cardiopulmonary bypass time. Several cohort studies showed improved survival after stentless AVR, probably due to better hemodynamic performance and earlier left ventricular (LV) mass regression compared with stented AVR. However, there was a bias of operation age and nonrandomization. A randomized trial supported an improved 8-year survival of patients with the Freestyle or Toronto valves compared with Carpentier–Edwards porcine valves. On the contrary, another randomized study did not show improved clinical outcomes up to 12 years. Freedom from reoperation at 12 years in Toronto stentless porcine valves ranged from 69% to 75%, which is much lower than for Carpentier–Edwards Perimount valves. Cusp tear with consequent aortic regurgitation was the most common cause of structural valve deterioration. Cryolife O’Brien valves also have shorter durability compared with stent valves. Actuarial freedom from reoperation was 44% at 10 years. Early prosthetic valve failure was also reported in patients who underwent root replacement with Shelhigh stentless composite grafts. There was no level I or IIa evidence of more effective orifice area, mean pressure gradient, LV mass regression, surgical risk, durability, and late outcomes in stentless bioprostheses. There is no general recommendation to prefer stentless bioprostheses in all patients. For new-generation pericardial stentless valves, follow-up over 15 years is necessary to compare the excellent results of stented valves such as the Carpentier–Edwards Perimount and Hancock II valves. PMID:21731886

Kobayashi, Junjiro

2011-01-01

28

[Aortic valve replacement with a freestyle stentless valve using the modified subcoronary technique and hemiarch replacement for bicuspid aortic valve and ascending aortic aneurysma; report of a case].  

PubMed

An association between bicuspid aortic valve disease and ascending aortic aneurysma has long been recognized. Root replacement with a composite valve graft for such disease is a well-established technique. But it may involve serious technical difficulties, and may be a more time-consuming procedure than separate valve replacement and graft replacement. We performed an aortic valve replacement with Freestyle stentless valve using the modified subcoronary technique and hemiarch replacement for a 72-year-old man with severe aortic stenosis and ascending aortic aneurysma. Angiographic studies after surgery showed no residual aortic regurgitation (AR) and no deformity of aorta. This technique is an acceptable option for an aortic disease and ascending aneurysma in elderly patients. PMID:12739366

Takemura, T; Shimamura, Y; Sakaguchi, M; Tsuda, Y; Iwasa, S

2003-05-01

29

Minimally Invasive Aortic Valve Replacement  

MedlinePLUS

... the population. No medications as such have been proven to slow that disease path life. Again, it's ... Again, there's no medical therapy that has been proven to slow or reverse the process of aortic ...

30

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

PubMed

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

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

2015-01-01

31

In the era of the valve-in-valve: is transcatheter aortic valve implantation (TAVI) in sutureless valves feasible?  

PubMed Central

Sutureless aortic valve implantation has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to improve surgical outcomes by facilitating less traumatic minimally invasive approaches and reducing cross-clamp and cardiopulmonary bypass duration. However, the absence of sutures may have detrimental effects after sutureless interventions, including paravalvular leakages, valve dislocation, and stent-infolding. Transcatheter aortic valve-in-valve implantation (A-ViV) is emerging as a valuable procedure in patients with dysfunctioning biological aortic valves who are deemed inoperable with conventional surgery. Here we present the first-in-man case of trans-femoral implant of a balloon expandable aortic valve in a leaking sutureless self-expandable valve.

Saia, Francesco; Pellicciari, Giovanni; Phan, Kevin; Ferlito, Marinella; Dall’Ara, Gianni; Di Bartolomeo, Roberto; Marzocchi, Antonio

2015-01-01

32

Aortic regurgitation after transcatheter aortic valve implantation: mechanisms and implications  

PubMed Central

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

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

2013-01-01

33

Basic mechanisms of calcific aortic valve disease.  

PubMed

Calcific aortic valve disease (CAVD) is the most common heart valve disorder. There is no medical treatment to prevent and/or promote the regression of CAVD. Hence, it is of foremost importance to delineate and understand the key basic underlying mechanisms involved in CAVD. In the past decade our comprehension of the underpinning processes leading to CAVD has expanded at a fast pace. Hence, our understanding of the basic pathobiological processes implicated in CAVD might lead eventually to the development of novel pharmaceutical therapies for CAVD. In this review, we discuss molecular processes that are implicated in fibrosis and mineralization of the aortic valve. Specifically, we address the role of lipid retention, inflammation, phosphate signalling and osteogenic transition in the development of CAVD. Interplays between these different processes and the key regulation pathways are discussed along with their clinical relevance. PMID:25085215

Mathieu, Patrick; Boulanger, Marie-Chloé

2014-09-01

34

Gemella morbillorum prosthetic aortic valve endocarditis.  

PubMed

Gemella morbillorum is facultative anaerobic, Gram-positive cocci and are a commensal part of human flora. The reported patient in this case, with a prosthetic bovine aortic valve, presented with fever, poor dental hygiene, new cardiac murmur and signs of congestive heart failure. Blood cultures were positive for a viridans streptococcal species; however, the organism could not be further identified at our institution. Echocardiogram demonstrated a decrease in ejection fraction and vegetation attached to the prosthetic aortic valve associated with a perivalvular abscess. The patient was treated with a 6-week regimen of penicillin G with gentamicin for the first 2?weeks along with cardiac surgery. The results from the 16S rRNA gene sequencing of the viridans streptococcal species were available, which reported the organism as G. morbillorum. This case adds to the literature on G. morbillorum prosthetic valve endocarditis and provides additional evidence to consider infectious endocarditis in the setting of G. morbillorum bacteraemia. PMID:25406216

Shahani, Lokesh

2014-01-01

35

Native Aortic Valve Thrombosis Resembling Papillary Fibroelastoma  

PubMed Central

The differential diagnosis of cardiac mass is important in determining the therapeutic plan and avoiding unnecessary surgical intervention. Non-invasive imaging methods would be useful in the diagnosis of suspected cardiac mass, because they may provide earlier diagnosis and more accurate assessment of cardiac mass. Native aortic valve thrombosis is a rare disorder and difficult to differentiate from a tumor, and in particular, a papillary fibroelastoma. Thus, the clinical decision making with imaging modalities should be performed cautiously. We recently met a female patient who had a aortic valve mass resembling papillary fibroelastoma in normal native valve. The patient underwent a surgical resection and the pathologic finding showed an organized thrombus with no evidence of papillary fibroelastoma. PMID:25309693

Kim, Minkwan; Kim, Suk-Hyun; Moon, Sang Yi; Jeong, Eu Gene; Jung, Eui Han; Nam, Hwa Seong; Choi, Jae-Hyuk

2014-01-01

36

Aortic valve bypass: experience from Denmark†  

PubMed Central

OBJECTIVES In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI). During the last one and a half year, 10 patients otherwise left for medical therapy have been offered this procedure. We present the Danish experiences with the AVB procedure with a focus on patient selection, operative procedure and short-term results. METHODS AVB is performed through a left thoracotomy. A 19-mm Freestyle® valve (Medtronic) is anastomosed to a vascular graft and an apex conduit. The anastomosis to the descending aorta is made prior to connecting the conduit to the apex. In 1 patient, we used an automated coring and apical connector insertion device (Correx®). The device results in a simultaneous coring and insertion of an 18-mm left ventricle connector in the apical myocardium. AVB is routinely performed without circulatory assistance. RESULTS Ten patients have been operated on since April 2011: eight females and 2 males with a median age of 76 (65–91) years. Seven patients had a severely calcified ascending aorta. Three of these had previously had a sternotomy, but did not have an AVR because of porcelain aorta. Six patients had a very small left ventricle outflow tract (<18 mm). The median additive EuroSCORE was 12 (10–15). Seven patients were operated on without circulatory assistance. Two patients had a re-exploration for bleeding and 1 developed a ventricle septum defect 1 month postoperatively and was treated with surgical closure. The median follow-up was 7 (2–15) months and was without mortality. New York Heart Association class was reduced from 2.5 to 2 at the follow-up, but some patients were still in the recovery period. The total valve area (native plus conduit) was 2.2 (1.9–2.5) cm2 and 1.34 (1.03–1.46) cm2/m2, indexed to the body surface area. There was no AV block or stroke. CONCLUSIONS AVB can be performed with low mortality and acceptable results in selected patients. The procedure can be offered to patients rejected for conventional aortic valve replacement and TAVI and results in a larger total valve area than by insertion of standard bioprosthesis. PMID:23529752

Lund, Jens T.; Jensen, Maiken B.; Arendrup, Henrik; Ihlemann, Nikolaj

2013-01-01

37

Effect of transcutaneous aortic valve implantation on the Heyde's syndrome.  

PubMed

The association between aortic valve stenosis and gastrointestinal bleeding, traditionally known as Heyde's syndrome, is the result of a quantitative loss of the highest molecular weight von Willebrand multimers (type 2A von Willebrand syndrome). This results in bleeding from areas of high shear stress such as gastrointestinal angiodysplasias. Correction of this bleeding diathesis after surgical aortic valve replacement has been well described. The effect of transcutaneous aortic valve implantation on Heyde's syndrome has yet to be studied. Herein, we report a patient with severe aortic stenosis, type 2A von Willebrand syndrome, and hemorrhagic shock from gastrointestinal bleeding who underwent successful transcutaneous aortic valve implantation. PMID:25208564

Benton, Stewart Michael; Kumar, Anupam; Crenshaw, Marshall; Fredi, Joseph L

2014-09-15

38

Transcatheter aortic valve insertion (TAVI): a review  

PubMed Central

The introduction of transcatheter aortic valve insertion (TAVI) has transformed the care provided for patients with severe aortic stenosis. The uptake of this procedure is increasing rapidly, and clinicians from all disciplines are likely to increasingly encounter patients being assessed for or having undergone this intervention. Successful TAVI heavily relies on careful and comprehensive imaging assessment, before, during and after the procedure, using a range of modalities. This review outlines the background and development of TAVI, describes the nature of the procedure and considers the contribution of imaging techniques, both to successful intervention and to potential complications. PMID:24258463

Morgan-Hughes, G; Roobottom, C

2014-01-01

39

Mechanobiology of the Aortic Heart Valve Jonathan T. Butcher1  

E-print Network

by actively regulating valve cell biology. Valvular endothelial cells and valvular interstitial cellsReview: 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

Simmons, Craig A.

40

Transaortic transcatheter aortic valve implantation using the Edwards Sapien valve.  

PubMed

Transcatheter aortic valve implantation using Edwards Sapien Valve can be carried out through the ascending aorta. In the majority of patients, the ascending aorta is approached through a partial upper J-sternotomy. The sternotomy extends into the right second or third right intercostal space. The pericardium is opened in midline and the top of the ascending aorta is exposed. Two purse-string sutures are then placed on the ascending aorta and Sapien valve implantation is carried out using the Ascendra delivery system with the valve mounted in a reverse fashion to that of a transapical approach. Owing to the familiarity of the surgeons with exposing the aorta and placing purse-strings for cannulation, this procedure is within the comfort zone of surgeons compared with the transapical approach. Advantages, contra--indications, surgical technique and results are also discussed. PMID:24414720

Bapat, Vinnie Vinayak; Attia, Rizwan

2012-01-01

41

Midterm results of aortic valve repair with the pericardial cusp extension technique in rheumatic valve disease  

Microsoft Academic Search

BackgroundThe encouraging results of valve repair in the atrioventricular valves have influenced a decision about aortic valve (AV) reconstruction. We report our experience with pericardial cusp extension to repair rheumatic AV disease.

Nilgün Bozbuga; Vedat Erentug; Kaan Kirali; Esat Akinci; Ömer Isik; Cevat Yakut

2004-01-01

42

Aortic root dilatation in young men with normally functioning bicuspid aortic valves  

PubMed Central

OBJECTIVE—To evaluate the dimensions of the aortic root in a selected population of young males with isolated normally functioning bicuspid aortic valve.?DESIGN AND SETTING—Echocardiographic and Doppler evaluation of conscripts with bicuspid aortic valve at the time of military pre-enrolment screening in two military hospitals.?SUBJECTS AND METHODS—66 consecutive young men with a normally functioning bicuspid aortic valve were studied to assess aortic size at four aortic levels: annulus, sinuses of Valsalva, supra-aortic ridge, and proximal ascending aorta; 70 consecutive normal young subjects, matched for age and body surface area, were used as controls.?RESULTS—In men with a bicuspid aortic valve, the diameter of the aortic root was significantly larger than in controls at the sinuses (3.16 (0.37) v 2.87 (0.31) cm, p < 0.001), at the supra-aortic ridge (2.64 (0.46) v 2.47 (0.28) cm, p = 0.01), and at the level of the proximal ascending aorta (3.12 (0.48) v 2.69 (0.28) cm, p < 0.001). The prevalence of aortic root dilatation was 7.5% at the annulus (5/66), 19.6% at the sinuses (13/66), 15% at the supra-aortic ridge (10/66), and 43.9% at the ascending aorta (29/66); 32 subjects (48%) had aortic root dimensions comparable with controls, while 34 (52%) had definitely abnormal aortic root dimensions.?CONCLUSIONS—Aortic root enlargement in people with a bicuspid aortic valve occurs independently of haemodynamic abnormalities, age, and body size. However, there appear to be different subgroups of young adults with bicuspid aortic valves, one of which is characterised by aortic dilatation, possibly caused by a congenital abnormality of the aortic wall.???Keywords: bicuspid aortic valve; aortic root dilatation PMID:10377302

Nistri, S; Sorbo, M; Marin, M; Palisi, M; Scognamiglio, R; Thiene, G

1999-01-01

43

Human Aortic Valve Calcification Is Associated With an Osteoblast Phenotype  

Microsoft Academic Search

Background—Calcific aortic stenosis is the third most common cardiovascular disease in the United States. We hypothesized that the mechanism for aortic valve calcification is similar to skeletal bone formation and that this process is mediated by an osteoblast-like phenotype. Methods and Results—To test this hypothesis, we examined calcified human aortic valves replaced at surgery (n22) and normal human valves (n20)

Nalini M. Rajamannan; Malayannan Subramaniam; David Rickard; Stuart R. Stock; Janis Donovan; Margaret Springett; Thomas Orszulak; David A. Fullerton; A. J. Tajik; Robert O. Bonow; Thomas Spelsberg

2010-01-01

44

Morphologic determinants favoring surgical aortic valvuloplasty versus pulmonary autograft aortic valve replacement in children  

Microsoft Academic Search

The pulmonary autograft is being used with increasing frequency to replace the diseased aortic valve in the pediatric population. Attempted surgical aortic valvuloplasty with an unacceptable result and return to cardiopulmonary bypass for aortic valve replacement with a pulmonary autograft results in prolonged bypass time and increased potential for morbidity. Therefore, the ability to predict an unsuccessful outcome for valvuloplasty

Jacques A. M. van Son; V. Mohan Reddy; Michael D. Black; Hiranya Rajasinghe; Gary S. Haas; Frank L. Hanley

1996-01-01

45

Pacemaker implantation after transcatheter aortic valve implantation.  

PubMed

Thirty- to 35% of patients after transcatheter aortic valve implantation undergo implantation of a permanent pacemaker (PPM) because of development of atrioventricular block (AVB) or development of a condition with high risk of progression to AVB. There are insufficient data regarding long-term follow-up on pacing dependency. From February 2009 to July 2011, 191 transcatheter aortic valve implantation procedures were performed at the Rabin Medical Center (125 CoreValve and 66 Edwards SAPIEN). Thirty-two patients (16.7%) received a PPM (30 with CoreValve and 2 with Edwards SAPIEN). Data from the pacemaker clinic follow-up was available in 27 patients. After a mean follow-up of 52 weeks (range, 22 to 103), only 8 (29%) of 27 patients were pacing dependent. The indication of PPM in these 8 patients was complete AVB. In conclusion, in our center, the rate of PPM implantation was 16%, which is lower than that reported in the published works. Only 29% of those patients implanted with PPM were pacemaker dependent. Further studies are necessary to define reliable predictors for long-term pacing. PMID:23998348

Goldenberg, Gustavo; Kusniec, Jairo; Kadmon, Ehud; Golovchiner, Gregory; Zabarsky, Ronit; Nevzorov, Roman; Vaknin, Hana; Assali, Abed; Kornowski, Ran; Haim, Moti; Strasberg, Boris

2013-11-15

46

Percutaneous Transcatheter Aortic Disc Valve Prosthesis Implantation: A Feasibility Study  

SciTech Connect

Purpose: Over the past 30 years there have been experimental efforts at catheter-based management of aortic valve regurgitation with the idea of extending treatment to nonsurgical candidates. A new catheter-based aortic valve design is described.Methods: The new catheter-delivered valve consists of a stent-based valve cage with locking mechanism and a prosthetic flexible tilting valve disc. The valve cage is delivered first followed by deployment and locking of the disc. In acute experiments, valve implantation was done in four dogs.Results: Valve implantation was successful in all four animals. The implanted valve functioned well for the duration of the experiments (up to 3 hr).Conclusion: The study showed the implantation feasibility and short-term function of the tested catheter-based aortic disc valve. Further experimental studies are warranted.

Sochman, Jan [Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague 4 (Czech Republic); Peregrin, Jan H. [Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague 4 (Czech Republic); Pavcnik, Dusan; Timmermans, Hans; Roesch, Josef [Dotter Interventional Institute, Oregon Health Sciences University, 3181 S.W. Jackson Park Road, L342, Portland, Oregon, 97201-3098 (United States)

2000-09-15

47

Percutaneous aortic valve implantation using novel imaging guidance.  

PubMed

Thorough imaging of the aortic valve and related structures is highly important before and during percutaneous valve implantation. However, imaging modalities currently used in the catheterization room, namely, conventional aortography and transesophageal echocardiography are limited in guiding the precise valve placement during the implantation procedure. A novel real-time imaging modality capable of three-dimensional reconstruction of the ascending aorta has recently been introduced (CardioOp-THV, C-THV, Paieon Inc., Park Afek, Israel). We applied this system during a complex procedure of percutaneous aortic valve implantation in a patient with severe aortic tortuosity, large aortic-valve angulation, and asymmetric septal hypertrophy. We found the guidance system very helpful not only for accurate positioning of the valve but also for selecting the optimal projection for valve implantation, selecting the prosthetic valve size, and evaluating the results after deployment. PMID:20552651

Dvir, Danny; Kornowski, Ran

2010-09-01

48

A fatal outcome of thoracic aortic aneurysm in a male patient with bicuspid aortic valve  

PubMed Central

Thoracic aortic aneurysm is often an asymptomatic but potentially lethal disease if its most catastrophic complication – aortic dissection – occurs. Thoracic aortic dissection is associated with a high mortality rate despite ongoing improvement in its management. We report a fatal outcome of thoracic aortic aneurysm in a male patient with bicuspid aortic valve. The patient was qualified for elective surgery of the ascending aorta and aortic valve at the age of 39 but he did not agree to undergo the proposed procedure. Three years later, he experienced acute aortic dissection and died despite a prompt diagnosis and complex management. PMID:24570730

Michalak, Ewa; Micha?owska, Ilona; Szpakowski, Eugeniusz; Konopka, Anna; Klisiewicz, Anna; Teresa Bili?ska, Zofia

2013-01-01

49

[Use of sutureless prosthetic aortic valves in cardiac surgery].  

PubMed

In the last years, an increasing proportion of high-risk patients undergo surgical aortic valve replacement. In order to reduce the risk associated with cross-clamp time or cardioplegic ischemic time, sutureless aortic prostheses have been developed. These bioprosthetic valves are not hand sewn, and this technological advance translates into reduced implantation times, thus improving outcome of patients referred for aortic valve replacement. At present, three sutureless bioprostheses are available on the market: 3f Enable (Medtronic Inc., Minneapolis, Minnesota, USA), Perceval (Sorin Group, Saluggia, Italy) and Intuity (Edwards Lifesciences, Irvine, California, USA). This article provides an overview of the available literature on sutureless aortic valves with the aim to better define current role and future perspectives of sutureless aortic bioprostheses for the treatment of aortic valve stenosis. PMID:24770430

Santarpino, Giuseppe; Fischlein, Theodor

2014-03-01

50

Transcatheter aortic valve implantation with Core Valve: First Indian experience of three high surgical risk patients with severe aortic stenosis  

PubMed Central

The prevalence of aortic stenosis is increasing with aging population. However with multiple co-morbidities and prior procedures in this aging population, more and more patients are being declared unfit for the ‘Gold Standard’ treatment i.e. surgical aortic valve replacement (AVR). Among the patients who are unfit or high risk for aortic valve replacement (AVR) by open heart surgery, transcatheter aortic valve implantation (TAVI) has been proven to be a valuable alternative improving survival and quality of life. We report first Indian experience of Core Valve (Medtronic Inc.) implantation in three high surgical risk patients performed on 22nd and 23rd February 2012. PMID:23993000

Seth, Ashok; Rastogi, Vishal; Kumar, Vijay; Maqbool, Syed; Mustaqueem, Arif; Sekar, V. Ravi

2013-01-01

51

Mathematical modeling of aortic valve dynamics during systole.  

PubMed

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

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

2015-01-21

52

Minimally invasive aortic valve surgery: Cleveland Clinic experience  

PubMed Central

Background Minimally invasive surgery has become a routine approach for aortic valve disease over the last 18 years at the Cleveland Clinic. It is performed in isolation or in combination with other procedures. The objective of this study is to review trends and outcomes in these patients. Methods Cleveland Clinic Cardiovascular Information Registry (CVIR) was searched for aortic valve procedures from 1996 to 2013. All patients undergoing isolated or combined aortic valve operations were included for analysis. The incision type and procedure type were reviewed and trends were evaluated over time. Cleveland Clinic outcomes with minimally invasive approaches to the aortic valve are reviewed. Results A total of 22,766 aortic valve surgical procedures were performed in this 18-year timeframe. Of these, 3,385 (14.9%) were minimally invasive procedures (MIPs) and 2,379 (10.5%) were isolated minimally invasive aortic valves. MIPs increased from 12.4% to 29.6% of the total aortic valve volume over the period of the study. Combined procedures, including concomitant surgery on the aorta, mitral valve, tricuspid valve, and arrhythmia surgery increased over time as well. Overall mortality for primary and reoperative aortic valve operations continues to decline and has consistently been less than 1% for several years. Conclusions A programmed approach to minimally invasive aortic valve surgery (MIAVS) with careful patient selection, appropriate use of preoperative imaging, and selective conversion to sternotomy when necessary, allows for aortic valve replacement (AVR) and a wide range of concomitant procedures to be performed safely in a large number of patients.

Johnston, Douglas R.

2015-01-01

53

Transfemoral transcatheter aortic valve implantation in a patient with a severe aortic stenosis and cardiogenic shock requiring intra-aortic balloon pump support  

PubMed Central

The following paper presents a patient with severe aortic stenosis and severely reduced left ventricular ejection fraction with intra-aortic balloon pump counterpulsation support, who underwent transfemoral aortic valve implantation of a CoreValve prosthesis.

Wilczek, Krzysztof; Przybylski, Roman; ?wi?tkowski, Andrzej; G?owacki, Jan; Kalarus, Zbigniew; Zembala, Marian

2015-01-01

54

Demographic characteristics of patients undergoing aortic valve replacement for stenosis: relation to valve morphology.  

PubMed Central

OBJECTIVE: To determine the relative importance of the different causes of isolated aortic valve stenosis in a surgical series, and to relate these to patient characteristics including the rate of insertion of bypass grafts for coronary artery disease. DESIGN: Survey of the clinical and pathological data on patients undergoing aortic valve replacement for isolated stenosis. SETTING: Tertiary care cardiothoracic surgical unit. PATIENTS AND METHODS: 465 adult patients undergoing aortic valve replacement representing a consecutive series in one surgical unit. Retrospective review of patients records and classification of cause of aortic stenosis based on pathological examination of excised valve cusps. RESULTS: 63.7% patients had calcific bicuspid valves, 26.9% tricuspid calcific valves, and 5.4% rheumatic, 2.6% mixed pathology and 1.5% unicommissural valves. The ratio of males to females for bicuspid valves was 1.85:1 and for tricuspid calcific valves 0.76:1. The mean age of patients with bicuspid valves was 64.9 years compared with 73.4 years for those with tricuspid valves. Some 22.3% of patients with bicuspid valves and 44.8% of those with tricuspid valves had sufficient coronary artery disease to necessitate insertion of coronary bypass grafts. The differential rate of insertion of coronary bypass grafts was independent of age. CONCLUSIONS: Bicuspid calcified aortic valves are the predominant cause of isolated aortic valve stenosis followed by tricuspid calcified aortic valves. The sex and age distribution of bicuspid and tricuspid calcific aortic valve stenosis is different. The higher rate of insertion of vascular grafts in tricuspid calcific aortic valves may indicate that risk factors for atherosclerosis enhance cusp calcification in these patients. Images PMID:8673757

Davies, M. J.; Treasure, T.; Parker, D. J.

1996-01-01

55

Aortic valve tear with severe aortic regurgitation following blunt chest trauma  

PubMed Central

An aortic valve tear associated with aortic regurgitation following blunt chest trauma is seldom seen. In this case, a 55-year-old man sustained a non-penetrating chest injury caused by a sudden fall from 10 meters. This led to a sizable tear in the left coronary cusp associated with severe aortic insufficiency. The case was treated successfully by surgical replacement of the aortic valve with a mechanical prosthesis. PMID:21682925

2011-01-01

56

Assessing the risk of aortic valve replacement for severe aortic stenosis in the transcatheter valve era.  

PubMed

Surgical aortic valve replacement had been the only definitive treatment of severe aortic stenosis before the availability of transcatheter valve technology. Historically, many patients with severe aortic stenosis had not been offered surgery, largely related to professional and patient perception regarding the risks of operation relative to anticipated benefits. Such patients have been labeled as "high risk" or "inoperable" with respect to their suitability for surgery. The availability of transcatheter aortic valve replacement affords a new treatment option for patients previously not felt to be optimal candidates for surgical valve replacement and allows for the opportunity to reexamine the methods for assessing operative risk in the context of more than 1 available treatment. Standardized risk assessment can be challenging because of both the imprecision of current risk scoring methods and the variability in ascertaining risk related to operator experience as well as local factors and practice patterns at treating facilities. Operative risk in actuality is not an absolute but represents a spectrum from very low to extreme, and the conventional labels of high risk and inoperable are incomplete with respect to their utility in clinical decision making. Moving forward, the emphasis should be on developing an individual assessment that takes into account procedure risk as well as long-term outcomes evaluated in a multidisciplinary fashion, and incorporating patient preferences and goals in a model of shared decision making. PMID:24958696

Mathew, Verghese; Greason, Kevin L; Suri, Rakesh M; Leon, Martin B; Nkomo, Vuyisile T; Mack, Michael J; Rihal, Charanjit S; Holmes, David R

2014-10-01

57

Aortic valve leaflet sparing and salvage surgery: evolution of techniques for aortic root reconstruction.  

PubMed

Over the past 20 years, a series of procedures have been designed to reconstruct the aortic root of patients with aortic insufficiency, in whom the pathology and hence the surgery spares the valve leaflets. Such techniques have various names. Usually 'valve sparing' is used in context with chronic aortic dissection or aortic root aneurysm as in patients with Marfan's syndrome. 'Aortic valve salvage' tends to be the term of choice for similar surgical reconstruction in the setting of aortic dissection. 'Aortic valve repair' is often chosen when direct surgical procedures are performed on the leaflets themselves. All of the techniques have evolved based upon an increased understanding of the functional anatomy of the aortic root complex. The different technical approaches, their applications and results need to be understood by the cardiology community. The failure modes for such techniques are specific and different from prosthetic valve failure modes, but are adequately followed with echocardiography. Over two-thirds of patients remain free of re-development of significant aortic insufficiency at 8-10 years following surgery. The overall patient survival is more dependent upon the underlying cardiovascular status of the patient than the surgical technique itself. Perioperative mortalities vary between 0 and 6% and are comparable to composite valve+graft techniques and isolated aortic valve replacement, in which the operative mortality approximates 3.3-4%. Long-term results are good to excellent and spare the patient anticoagulation and prosthetic valve disease. PMID:14643805

Hopkins, Richard A

2003-12-01

58

Transcatheter Aortic Valve Implantation in a Patient with Previous Mitral Valve Replacement  

PubMed Central

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or are unsuitable candidates for open heart surgery. However, concerns exist over treating patients who have previously undergone mitral valve surgery due to the potential interference between the mitral prosthetic valve or ring and the TAVI device. In this case report, we present a patient with symptomatic severe aortic stenosis and previous mechanical mitral valve replacement who was successfully treated with TAVI using a CoreValve. PMID:25278988

Moon, Sung Woo; Ko, Young-Guk; Hong, Geu-Ru; Lee, Sak; Chang, Byung-Chul; Shim, Jae-Kwang; Kwak, Young-Ran

2014-01-01

59

Transcatheter aortic valve implantation in a patient with previous mitral valve replacement.  

PubMed

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or are unsuitable candidates for open heart surgery. However, concerns exist over treating patients who have previously undergone mitral valve surgery due to the potential interference between the mitral prosthetic valve or ring and the TAVI device. In this case report, we present a patient with symptomatic severe aortic stenosis and previous mechanical mitral valve replacement who was successfully treated with TAVI using a CoreValve. PMID:25278988

Moon, Sung Woo; Ko, Young-Guk; Hong, Geu-Ru; Lee, Sak; Chang, Byung-Chul; Shim, Jae-Kwang; Kwak, Young-Ran; Hong, Myeong-Ki

2014-09-01

60

Proteomics of ascending aortic aneurysm with bicuspid or tricuspid aortic valve.  

PubMed

Bicuspid aortic valve is often associated with lesions of the ascending aorta, which differ histologically from those in tricuspid valve patients. We undertook proteomic analyses to assess differences at the proteome level. Aortic samples were collected from 20 patients undergoing aortic valve and/or ascending aortic replacement; 9 had a bicuspid valve: 5 with aortic aneurysm (diameter > 50 mm) and 4 without dilation; 11 had a tricuspid valve: 6 with aortic aneurysm and 5 without dilation. Patients with histologically proven connective tissue disorders were excluded. Samples were dissected, solubilized, and subjected to 2-dimensional gel electrophoresis. Gel patterns showed an average of 580 protein spots in samples from bicuspid valve patients, and 564 spots in those with tricuspid valves. Comparative analysis revealed a correlation coefficient of 0.93 for protein expression in the bicuspid valve group compared to the tricuspid group. Three protein spots were significantly over-expressed and 4 were significantly down-regulated in the bicuspid group compared to the tricuspid group. The lowest correlation in protein expression was between non-dilated aortic tissues. These differences between aortic tissues of bicuspid and tricuspid valve patients suggest that mechanisms of aortic dilation might differ, at least in part, between such patients. PMID:17540984

Matt, Peter; von Orelli, Anne; Bernet, Franziska; Grussenmeyer, Thomas; Lefkovits, Ivan; Zerkowski, Hans-Reinhard

2007-06-01

61

Two Dehiscences of the Aortic Valve Commissure and Cusp with Progressive Acute Aortic Regurgitation  

PubMed Central

A 54-year-old female with acute heart failure due to aortic regurgitation (AR) was admitted to our hospital. Following admission, her condition worsened progressively; thus, surgery was performed prematurely. During surgery, two dehiscences were visualized in the aortic valve commissure between the right and left cusps and the upper part of the left coronary artery ostium. However we scheduled aortic valve replacement (AVR) at first, we made the shift to perform the aortic root replacement for reinforcement of the aortic wall around the left coronary artery ostium. We describe a rare case of two dehiscences at the aortic root, which is the first report.

Nakamura, Kunihide; Nagahama, Hiroyuki; Matsuyama, Masakazu; Endo, George; Nishimura, Masanori

2015-01-01

62

Percutaneous Aortic Valve Implantation Retrograde From the Femoral Artery  

E-print Network

Background—Percutaneous aortic valve implantation by an antegrade transvenous approach has been described but is problematic. Retrograde prosthetic aortic valve implantation via the femoral artery has potential advantages. Percutaneous prosthetic aortic valve implantation via the femoral arterial approach is described and the initial experience reported. Methods and Results—The valve prosthesis is constructed from a stainless steel stent with an attached trileaflet equine pericardial valve and a fabric cuff. After routine aortic balloon valvuloplasty, a 22F or 24F sheath is advanced from the femoral artery to the aorta. A steerable, deflectable catheter facilitates manipulation of the prosthesis around the aortic arch and through the stenotic valve. Rapid ventricular pacing is used to reduce cardiac output while the delivery balloon is inflated to deploy the prosthesis within the annulus. Percutaneous aortic prosthetic valve implantation was attempted in 18 patients (aged 816 years) in whom surgical risk was deemed excessive because of comorbidities. Iliac arterial injury, seen in the first 2 patients, did not recur after improvement in screening and access site management. Implantation was successful in 14 patients. After successful implantation, the aortic valve area increased from 0.60.2 to 1.60.4 cm2. There were no intraprocedural deaths. At follow-up of 7555 days, 16 patients (89%) remained alive. Conclusions—This initial experience suggests that percutaneous transarterial aortic valve implantation is feasible in selected high-risk patients with satisfactory short-term outcomes. (Circulation. 2006;113:842-850.) Key Words: aorta stenosis catheters stents valvuloplasty Symptomatic aortic stenosis is an accepted indication forsurgery, in which valve replacement can both reduce symptoms and extend life.1 Despite this, many patients with severe aortic stenosis do not undergo surgery because of excessive risk, advanced age, or preference. Prognosis with medical management is poor,1 and percutaneous alternatives to surgery have been limited to balloon valvuloplasty with palliation that is modest and short-lived.2,3

John G. Webb; Ronald G. Carere; Md Brad; I. Munt; Christopher E. Buller; Sanjeevan Pasupati Md Samuel Lichtenstein

63

Staged Balloon Aortic Valvuloplasty before Standard Aortic Valve Replacement in Selected Patients with Severe Aortic Valve Stenosis  

PubMed Central

This study evaluated preoperative balloon aortic valvuloplasty (BAV) as a technique to decrease aortic valve replacement (AVR) risk in patients who have severe symptomatic aortic valve stenosis with substantial comorbidity. We report the outcomes of 18 high-risk patients who received BAV within 180 days before AVR from November 1993 through December 2011. Their median age was 78 years (range, 51–93 yr), and there were 11 men (61%). The pre-BAV median calculated Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) was 18.3% (range, 9.4%–50.7%). Preoperative left ventricular ejection fraction measured a median of 0.23 (range, 0.05–0.68), and the median aortic valve area index was 0.4 cm2/m2 (range, 0.2–0.7 cm2/m2). The median interval from BAV to AVR was 28 days (range, 1–155 d). There were no strokes or deaths after BAV; however, 4 patients (22%) required mechanical circulatory support, 3 (17%) required femoral artery operation, and 1 (6%) developed severe aortic valve regurgitation. After BAV, the median STS PROM fell to 9.1% (range, 2.6%–25.7%) (compared with pre-BAV, P <0.001). Echocardiography before AVR showed that the median left ventricular ejection fraction had improved to 0.35 (range, 0.15–0.66), and the aortic valve area index to 0.5 cm2/m2 (range, 0.3–0.7 cm2/m2) (compared with pre-BAV, both P <0.05). All patients received AVR. Operative death occurred in 2 patients (11%), and combined operative death and morbidity in 7 patients (39%). Staged BAV substantially reduces the operative risk associated with AVR in selected patients. PMID:24808774

Altarabsheh, Salah Eldien; Greason, Kevin L.; Schaff, Hartzell V.; Suri, Rakesh M.; Li, Zhuo; Mathew, Verghese; Joyce, Lyle D.; Park, Soon J.; Dearani, Joseph A.

2014-01-01

64

Thalassemia and heart surgery: aortic valve repair after endocarditis.  

PubMed

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

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

2015-01-01

65

Genetic Insights into Bicuspid Aortic Valve Formation  

PubMed Central

Bicuspid aortic valve (BAV) is the most common congenital heart defect, affecting 1-2% of the population. It is generally diagnosed late in adulthood when deterioration of the abnormal leaflet becomes clinically evident. BAV patients have an increased risk of developing serious complications, including stenosis, regurgitation, endocarditis, dilation of the aorta, aortic dissection, and aneurysm. BAV is a heritable trait, but the genetic basis underlying this cardiac malformation remains poorly understood. In the last decade, thanks to studies in animal models as well as genetic and biochemical approaches, a large number of genes that play important roles in heart development have been identified. These discoveries provided valuable insight into cardiac morphogenesis and uncovered congenital-heart-disease-causing genes. This paper will summarize the current knowledge of valve morphogenesis as well as our current understanding of the genetic pathways involved in BAV formation. The impact of these advances on human health including diagnosis of BAV and prevention of cardiovascular complications in individuals with BAV or with a family history of BAV is also discussed. PMID:22701807

Laforest, Brigitte; Nemer, Mona

2012-01-01

66

Coronary Obstruction Following Transcatheter Aortic Valve Implantation  

PubMed Central

Background Transcatheter aortic valve implantation (TAVI) was established as an important alternative for high-risk patients with severe aortic stenosis. However, there are few data in the literature regarding coronary obstruction, that although rare, is a potentially fatal complication. Objective Evaluate this complication in Brazil. Methods We evaluated all patients presenting coronary obstruction from the Brazilian Registry of TAVI. Main baseline and procedural characteristics, management of the complication, and clinical outcomes were collected from all patients. Results From 418 consecutive TAVI procedures, coronary obstruction occurred in 3 cases (incidence of 0.72%). All patients were women, without prior coronary artery bypass grafting (CABG), and with mean age of 85 ± 3 years, logistic EuroSCORE of 15 ± 6% and STS-PROM score of 9 ± 4%. All of the cases were performed with balloon-expandable Sapien XT prosthesis. In one patient, with pre-procedural computed tomography data, coronary arteries presented a low height and a narrow sinus of Valsalva. All patients presented with clinically significant severe maintained hypotension, immediately after valve implantation, and even though coronary angioplasty with stent implantation was successfully performed in all cases, patients died during hospitalization, being two periprocedurally. Conclusion Coronary obstruction following TAVI is a rare but potentially fatal complication, being more frequent in women and with the balloon-expandable prosthesis. Anatomical factors might be related with its increased occurrence, highlighting the importance of a good pre-procedural evaluation of the patients in order to avoid this severe complication. PMID:24652089

Ribeiro, Henrique Barbosa; Sarmento-Leite, Rogério; Siqueira, Dimytri A. A.; Carvalho, Luiz Antônio; Mangione, José Armando; Rodés-Cabau, Josep; Perin, Marco A.; de Brito, Fábio Sandoli

2014-01-01

67

Incidental moderate mitral regurgitation in patients undergoing aortic valve replacement for aortic stenosis: review of guidelines and current evidence.  

PubMed

Recent evidence has shown that moderate mitral regurgitation is common and clinically relevant in patients presenting for surgical and transcatheter aortic valve replacement for aortic stenosis. Prospective multicenter clinical trials are now indicated to resolve the clinical equipoise about whether or not mitral valve intervention also is indicated at the time of aortic valve intervention. Advances in three-dimensional transesophageal echocardiography, transcatheter mitral interventions, and surgical aortic valve replacement, including the advent of sutureless valves, likely will expand the therapeutic possibilities for moderate mitral regurgitation in the setting of aortic valve interventions for severe aortic stenosis. PMID:24508019

Ramakrishna, Harish; Kohl, Benjamin A; Jassar, Arminder S; Augoustides, John G T

2014-04-01

68

Fluid dynamics of aortic valve stenosis  

NASA Astrophysics Data System (ADS)

Aortic valve stenosis, which causes considerable constriction of the flow passage, is one of the most frequent cardiovascular diseases and is the most common cause of the valvular replacements which take place for around 100,000 per year in North America. Furthermore, it is considered as the most frequent cardiac disease after arterial hypertension and coronary artery disease. The objective of this study is to develop an analytical model considering the coupling effect between fluid flow and elastic deformation with reasonable boundary conditions to describe the effect of AS on the left ventricle and the aorta. The pulsatile and Newtonian blood flow through aortic stenosis with vascular wall deformability is analyzed and its effects are discussed in terms of flow parameters such as velocity, resistance to flow, shear stress distribution and pressure loss. Meanwhile we developed analytical expressions to improve the comprehension of the transvalvular hemodynamics and the aortic stenosis hemodynamics which is of great interest because of one main reason. To medical scientists, an accurate knowledge of the mechanical properties of whole blood flow in the aorta can suggest a new diagnostic tool.

Keshavarz-Motamed, Zahra; Maftoon, Nima

2009-11-01

69

Early aortic valve cusp rupture in relapsing polychondritis.  

PubMed

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 treatment. The possibility of cusp rupture with sudden haemodynamic deterioration should be considered in patients with relapsing polychondritis who develop aortic regurgitation. PMID:1575597

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

1992-03-01

70

Mechanical aortic valve without anticoagulation for twenty-three years.  

PubMed

Current guidelines necessitate varying degrees of long-term anticoagulation in patients with mechanical heart valve(s) to prevent thrombotic and embolic complications. We describe a patient with a functioning aortic mechanical valve without anticoagulation for 23 years. A 68-year-old man had an aortic valve (St Jude Medical) replacement in 1984. His native valve was incompetent from infective endocarditis. He discontinued Coumadin three months after the surgery. He presented 23 years later with palpitations for one month. Further work-up revealed a NYHA class I function, normal sinus rhythm, normal sized heart on chest X-ray, normal systolic and diastolic function on echocardiography. Mean transaortic gradient was 19 mmHg and calculated valve area was 1.48 cm(2). Fluoroscopy showed normal excursions of the mechanical aortic valve. Exercise stress test did not show any limitation in effort tolerance or perfusion defects. He was discharged on daily aspirin and clopidogrel. PMID:19017749

Sharma, Shikha; McMurty, Kirk; Chalapathy, Narisety; Ameen, Abdul

2009-02-01

71

Regional structure-function relationships in mouse aortic valve tissue  

PubMed Central

Site-specific biomechanical properties of the aortic valve play an important role in native valve function, and alterations in these properties may reflect mechanisms of degeneration and disease. Small animals such as targeted mutagenesis mice provide a powerful approach to model human valve disease pathogenesis; however, physical mechanical testing in small animals is limited by valve tissue size. Aortic valves are comprised of highly organized extracellular matrix compartmentalized in cusp and annulus regions, which have different functions. The objective of this study was to measure regional mechanical properties of mouse aortic valve tissue using a modified micropipette aspiration technique. Aortic valves were isolated from juvenile, adult and aged adult C57BL/6 wild type mice. Tissue tensile stiffness was determined for annulus and cusp regions using a half-space punch model. Stiffness for the annulus region was significantly higher compared to the cusp region at all stages. Further, aged adult valve tissue had decreased stiffness in both the cusp and annulus. Quantitative histochemical analysis revealed a collagen-rich annulus and a proteoglycan-rich cusp at all stages. In aged adult valves, there was proteoglycan infiltration of the annulus hinge, consistent with observed mechanical differences over time. These findings indicate that valve tissue biomechanical properties vary in wild type mice in a region-specific and age-related manner. The micropipette aspiration technique provides a promising approach for studies of valve structure and function in small animal models, such as transgenic mouse models of valve disease. PMID:20863504

Krishnamurthy, Varun K.; Guilak, Farshid; Narmoneva, Daria A.; Hinton, Robert B.

2010-01-01

72

Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation.  

PubMed

Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care. PMID:25865236

Costopoulos, Charis; Sutaria, Nilesh; Ariff, Ben; Fertleman, Michael; Malik, Iqbal; Mikhail, Ghada W

2015-05-01

73

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

PubMed

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

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

2013-05-01

74

[Surgical treatment for prosthetic valve endocarditis after aortic root replacement].  

PubMed

Aorto-left ventricular continuity destruction due to prosthetic valve endocarditis is rare, but it is one of the fatal complications after aortic root operation. We report a case of surgical treatment for prosthetic valve endocarditis after aortic root replacement. A 47-year-old man, who had undergone aortic root replacement with a composite graft was transferred to our hospital with sudden chest pain and high fever. Enhanced computed tomography showed a large space with contrast enhancement suggesting perivalvular leakage around the artificial composite graft. Emergency operation including aortic root re-replacement and reconstruction of the left ventricular outflow tract was performed successfully. We focused on its technical aspect. PMID:24917287

Kanamori, Taro; Ichihara, Tetsuya; Sakaguchi, Hidehito; Inoue, Takehiko

2014-05-01

75

Transcatheter aortic valve-in-valve implantation of a CoreValve in a degenerated stenotic Sapien heart valve prosthesis.  

PubMed

Treatment options for re-stenotic aortic valve prosthesis implanted by transcatheter technique have not been evaluated systematically. We describe the case of a 75-year-old dialysis patient who was treated by transcatheter aortic valve implantation 3.5 years ago and now presented with severe stenosis of the percutaneous heart valve. The patient was initially treated with a trans-apical implantation of an Edwards Sapien 26 mm balloon expandable valve. The patient remained asymptomatic for 3 years when he presented with increasing shortness of breath and significant calcification of the valve prosthesis on transesophageal echocardiography. Valve-in-valve percutaneous heart valve implantation using a 26-mm CoreValve prosthesis was performed under local anesthesia. The prosthesis was implanted without prior valvuloplasty. Pacing with a frequency of 140/min was applied during placement of the valve prosthesis. Positioning was done with great care using only fluoroscopic guidance with the aim to have the ventricular strut end of the CoreValve prosthesis 5 mm higher than the ventricular strut end of the Edwards Sapien prosthesis. After placement of the CoreValve prosthesis within the Edwards Sapien valve additional valvuloplasty with rapid pacing was performed in order to further expand the CoreValve prosthesis. The final result was associated with a remaining mean gradient of 5 mm Hg and no aortic regurgitation. In conclusion, implantation of a CoreValve prosthesis for treatment of a restenotic Edwards Sapien prosthesis is feasible and is associated with a good functional result. PMID:22707435

Hoffmann, Rainer; Möllmann, Helge; Lotfi, Shahram

2013-12-01

76

Balloon-expandable prostheses for transcatheter aortic valve replacement.  

PubMed

The implantation of a transcatheter heart valve (THV) through a balloon-expandable system played a major role in the early stages of transcatheter aortic valve replacement (TAVR). The technology consists of sewing a foldable biological cardiac valve inside a metallic stent frame, and then crimping the device into a balloon in order to implant the valve at the level of the aortic annulus through balloon inflation. The use of balloon-expandable valves underwent a rapid expansion in the years following the pioneering experience of 2002, and recent large multicenter trials and registries have confirmed the safety and efficacy of TAVR using balloon-expandable valves. The randomized Placement of Aortic Transcatheter Valves (PARTNER) trial showed both the superiority and non-inferiority of TAVR with the balloon-expandable Edwards-Sapien system compared to medical treatment (non-operable patients) and surgical aortic valve replacement (high risk patients), respectively. Balloon-expandable valves have been associated with excellent hemodynamic results (residual mean gradient <15 mm Hg in most cases), though residual paravalvular aortic regurgitation is frequent (trivial or mild in the majority of patients, moderate or severe in <10%). Valve durability studies with up to 5-year follow-up have shown maintained valve hemodynamics over time with only a minimal decrease in valve area and no increase in aortic regurgitation. Future improvements in the balloon-expandable THV technology such as implementing anti-paravalvular leak features (ex. Sapien 3 valve), and showing its efficacy for the treatment of non-high risk patients (ongoing PARTNER II trial) will probably lead to broader use in a lower risk population in the near future. PMID:24838134

Ribeiro, Henrique Barbosa; Urena, Marina; Allende, Ricardo; Amat-Santos, Ignacio J; Rodés-Cabau, Josep

2014-01-01

77

Mitral valve repair versus replacement in simultaneous aortic and mitral valve surgery  

PubMed Central

BACKGROUND: Double valve replacement for concomitant aortic and mitral valve disease is associated with substantial morbidity and mortality. Excellent results with valve repair in isolated mitral valve lesions have been reported; therefore, whether its potential benefits would translate into better outcomes in patients with combined mitral-aortic disease was investigated. METHODS: A retrospective observational study was performed involving 341 patients who underwent aortic valve replacement with either mitral valve repair (n=42) or double valve replacement (n=299). Data were analyzed for early mortality, late valve-related complications and survival. RESULTS: The early mortality rate was 11.9% for valve repair and 11.0% for replacement (P=0.797). Survival (± SD) was 67±11% in mitral valve repair with aortic valve replacement and 81±3% in double valve replacement at five years of follow-up (P=0.187). The percentage of patients who did not experience major adverse valve-related events at five years of follow-up was 83±9% in those who underwent mitral valve repair with aortic valve replacement and 89±2% in patients who underwent double valve replacement (P=0.412). Age >70 years (HR 2.4 [95% CI 1.1 to 4.9]; P=0.023) and renal dysfunction (HR 1.9 [95% CI 1.2 to 3.7]; P=0.01) were independent predictors of decreased survival. CONCLUSIONS: In patients with double valve disease, both mitral valve repair and replacement provided comparable early outcomes. There were no significant differences in valve-related reoperations, anticoagulation-related complications or prosthetic valve endocarditis. Patient-related factors appear to be the major determinant of late survival, irrespective of the type of operation. PMID:24294032

Urban, Marian; Pirk, Jan; Szarszoi, Ondrej; Skalsky, Ivo; Maly, Jiri; Netuka, Ivan

2013-01-01

78

Long-term fate of the aortic root and aortic valve after ascending aneurysm surgery.  

PubMed Central

OBJECTIVE: The authors determined in which patients tube graft replacement could be used. SUMMARY BACKGROUND DATA: Tube graft replacement of ascending aortic aneurysms requires no coronary anastomoses and preserves the native aortic valve, but aortic insufficiency or aortic root aneurysms may develop requiring reoperation. Use of Bentall or Cabrol composite valve graft procedures obviates these problems but requires prosthetic valve replacement and coronary reattachment, both of which are associated with complications. These two procedures have been applied increasingly but because of renewed interest in aortic valve preservation and reconstruction, the authors determined in which patients tube replacement could be used. METHODS: The authors analyzed the fate of 277 patients, mean age 49 +/- 14 years, operated on between 1953 and 1992 by techniques that preserved the aortic root. The most common pathology was atherosclerosis in 104 patients. Perioperative mortality since 1975 was 14%. RESULTS: Fifteen patients required reoperation on the ascending aorta or aortic root; ascending aneurysm reoperation (6 patients); aortic valve replacement (8 patients), and a combined procedure (1 patient). Of these 15 patients, 8 had Marfan's syndrome, 10 had dissections, and 5 had medial degeneration/necrosis. CONCLUSIONS: Simple tube graft replacement of the ascending aorta was a durable technique in patients without Marfan's syndrome or medial degeneration/necrosis and allowed preservation of the native aortic valve in many patients. PMID:8507117

Lawrie, G M; Earle, N; DeBakey, M E

1993-01-01

79

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

NASA Astrophysics Data System (ADS)

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.

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

2010-02-01

80

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

PubMed Central

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

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

2013-01-01

81

Animal Models of Calcific Aortic Valve Disease  

PubMed Central

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

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

2011-01-01

82

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

PubMed Central

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

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

2013-01-01

83

The role of transesophageal echocardiography in aortic valve preserving procedures  

PubMed Central

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

Hall, Terri; Shah, Pallav; Wahi, Sudhir

2014-01-01

84

Asymptomatic traumatic diaphragmatic hernia discovered during an aortic valve replacement.  

PubMed

Asymptomatic traumatic diaphragmatic hernia, which presents in an adult, is an extremely rare entity. We discuss the management of a 63-year-old male with an asymptomatic traumatic diaphragmatic hernia discovered during aortic valve replacement. PMID:24750139

Fukunaga, Naoto; Seo, Hideya; Hamakawa, Hiroshi; Koyama, Tadaaki

2014-07-01

85

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

PubMed Central

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

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

2013-01-01

86

Percutaneous transluminal alcohol septal myocardial ablation after aortic valve replacement  

NASA Technical Reports Server (NTRS)

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.

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

2001-01-01

87

Molecular mechanisms underlying the onset of degenerative aortic valve disease  

Microsoft Academic Search

Morbidity from degenerative aortic valve disease is increasing worldwide, concomitant with the ageing of the general population\\u000a and the habitual consumption of diets high in calories and cholesterol. Immunohistologic studies have suggested that the molecular\\u000a mechanism occurring in the degenerate aortic valve resembles that of atherosclerosis, prompting the testing of HMG CoA reductase\\u000a inhibitors (statins) for the prevention of progression

Daihiko Hakuno; Naritaka Kimura; Masatoyo Yoshioka; Keiichi Fukuda

2009-01-01

88

Transcatheter aortic valve implantation of the direct flow medical aortic valve with minimal or no contrast.  

PubMed

The 18F Direct Flow Medical (DFM) THV has conformable sealing rings, which minimizes aortic regurgitation and permits full hemodynamic assessment of valve performance prior to permanent implantation. During the DISCOVER trial, three patients who were at risk for receiving contrast media, two due to severe CKD and one due to a recent hyperthyroid reaction to contrast, underwent DFM implantation under fluoroscopic and transesophageal guidance without aortography during either positioning or to confirm the final position. Valve positioning was based on the optimal angiographic projection as calculated by the pre-procedural multislice CT scan. Precise optimization of valve position was performed to minimize transvalve gradient and aortic regurgitation. Prior to final implantation, transvalve hemodynamics were assessed invasively and by TEE. The post-procedure mean gradients were 7, 10, 11mm Hg. The final AVA by echo was 1.70, 1.40 and 1.68cm(2). Total aortic regurgitation post-procedure was none or trace in all three patients. Total positioning and assessment of valve performance time was 4, 6, and 12minutes. Contrast was only used to confirm successful percutaneous closure of the femoral access site. The total contrast dose was 5, 8, 12cc. Baseline eGFR and creatinine was 28, 22, 74mL/min/1.73m(2) and 2.35, 2.98, and 1.03mg/dL, respectively. Renal function was unchanged post-procedure: eGFR=25, 35, and 96mL/min/1.73m(2) and creatinine=2.58, 1.99, and 1.03mg/dL, respectively. In conclusion, the DFM THV provides the ability to perform TAVI with minimal or no contrast. The precise and predictable implantation technique can be performed with fluoro and echo guidance. PMID:24721585

Latib, Azeem; Maisano, Francesco; Colombo, Antonio; Klugmann, Silvio; Low, Reginald; Smith, Thomas; Davidson, Charles; Harreld, John H; Bruschi, Giuseppe; DeMarco, Federico

2014-06-01

89

Fluids & Combustion Seminar Biomechanics of the Aortic Valve in the  

E-print Network

Fluids & Combustion Seminar Biomechanics of the Aortic Valve in the LVAD-Assisted Heart Dr. Karen (LVAD) is a pump that is surgically con- nected to the heart and aorta in order to boost systemic blood. Insidious onset and progression of aortic insufficiency or stenosis may occur via geometric or material

Ponce, V. Miguel

90

Transcatheter Aortic Valve Implantation Despite Challenging Vascular Access  

PubMed Central

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.

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

2015-01-01

91

Cofilin is a marker of myofibroblast differentiation in cells from porcine aortic cardiac valves  

E-print Network

Cofilin is a marker of myofibroblast differentiation in cells from porcine aortic cardiac valves M differentiation in cells from porcine aortic cardiac valves. Am J Physiol Heart Circ Physiol 294: H1767­H1778 myofibroblast differentiation in VICs from porcine aortic valves. In normal valves, cells immunostained

Simmons, Craig A.

92

Heart valve surgery - discharge  

MedlinePLUS

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

93

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

PubMed Central

Key Clinical Message The implanted first-generation Björk–Shiley valve in our patient was functioning well before aortic surgery, but we replaced the valve because we confirmed disc erosion 39 years after implantation during the surgery. We judged that the implanted valve was no longer capable of maintaining the patient's life. PMID:25614806

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

2014-01-01

94

Central versus femoral cannulation during minimally invasive aortic valve replacement  

PubMed Central

Minimally invasive aortic valve replacement (AVR) is rapidly becoming the preferred approach for aortic valve procedures in most centers worldwide. While femoral artery cannulation is still the most frequently used form of arterial perfusion strategy during less invasive AVR, some recent studies have showed a possible connection between retrograde perfusion and cerebral complications. In this article, we discuss the possible advantages of central aortic cannulation during right minimally invasive AVR and provide some technical aspects for a safe and efficient cannulation of the ascending aorta through a right minithoracotomy. PMID:25694978

Glauber, Mattia

2015-01-01

95

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

PubMed

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

Finn, Matthew; Green, Philip

2014-01-01

96

Recently patented transcatheter aortic valves in clinical trials.  

PubMed

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

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

2013-12-01

97

Ascending aortic aneurysm and aortic valve disease: what is the most optimal surgical technique?  

PubMed

The merits of separate versus composite valve graft replacement for the treatment of patients with ascending aortic aneurysms or dissections associated with aortic valve disease remain a controversial issue. Considering all available clinical data, the early and late results surprisingly are quite similar between the two procedures. However, patient selection criteria and operative technique are important. In patients with the Marfan syndrome and in those with significantly diseased or destroyed sinuses, composite valve graft replacement is the procedure of choice. The "open" (Carrel button) method of coronary reimplantation is recommended in almost all cases to minimize the risk of late false aneurysm formation. If the aortic leaflets are normal, a valve-sparing aortic root remodeling procedure is a reasonable alternative in certain individuals. Separate valve graft replacement is still a satisfactory option in other (non-Marfan) patients; however, most of the sinuses should be resected, leaving only small tongues of aortic wall surrounding the coronary ostia to reduce the risk of late aortic root aneurysmal degeneration. In patients with complex prosthetic valve endocarditis or multiple paravalvular leaks, homograft aortic root replacement is a good option after radical debridement of all infected or devitalized tissue. PMID:9263342

Yun, K L; Miller, D C

1997-07-01

98

Surgical Management of Aortic Root Dilatation with Advanced Aortic Regurgitation: Bentall Operation versus Valve-sparing Procedure  

PubMed Central

Background Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results The mean follow-up duration was 4.9±3.1 years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of 4.4±2.5 years of echocardiographic follow-up (p<0.001). Conclusion Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures. PMID:22708080

Lim, Ju Yong; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun

2012-01-01

99

Valve prosthesis distortion after cardiac compression in a patient who underwent transcatheter aortic valve implantation (TAVI).  

PubMed

Transcatheter aortic valve implantation (TAVI) has been developed as an alternative to conventional aortic valve replacement for the treatment of symptomatic severe aortic stenosis in high-risk patients. Nevertheless, TAVI has been associated with serious complications such as stroke, vascular injury, renal failure, and arrhythmia. Herein we describe a case of distortion of the Edward-Sapien prosthesis (Edwards Lifesciences, USA), which was mounted on a balloon-expandable stent, after chest compression for cardiac resuscitation in a patient who underwent TAVI for severe aortic stenosis. PMID:22431325

Kim, Eun Kyoung; Choi, Seung Hyuk; Song, Pil Sang; Park, Sung-Ji

2014-02-15

100

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

SciTech Connect

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%.

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

101

Composite valve graft versus separate aortic valve and ascending aortic replacement.  

PubMed

To ascertain if the operative technique has any influence on outcome, the surgical results after aortic root replacement using either a composite valve graft (CVG) or a separate graft and valve (SVG) were analyzed. Eighty-four patients received a CVG, and 36 had SVG replacement. The operative mortality rate was 6% for patients receiving a CVG and 3% for SVG replacement (nonsignificant). Follow-up extended to 21 years (mean 124 +/- 45 months). The type of the procedure (SVG versus CVG) was not a significant predictor of in-hospital mortality, length of hospital stay, subsequent root dilatation (SVG), anastomotic dehiscence and subsequent surgery. The early and long-term results after CVG or SVG were similar, which reflects proper patient selection. PMID:15334026

Brandt, Michael; Abdelkerim, Someia; Clemm, Susanne; Böning, Andreas; Cremer, Jochen

2004-01-01

102

The role of advanced imaging in transcatheter aortic valve implantation  

Microsoft Academic Search

Aortic stenosis, currently the most prevalent valvular heart disease in Europe, is an important public health problem, affecting thousands of patients every year. While surgical\\u000aaortic valve replacement is still considered the “gold standard” treatment, recent innovations in transcatheter valve therapies have offered an attractive alternative: transcatheter\\u000aaortic valve implantation (TAVI). In 2002, Cribier et al. announced the first human

A. Tzikas

2011-01-01

103

Transcatheter Aortic Valve Implantation (TAVI) for Treatment of Aortic Valve Stenosis  

PubMed Central

Background One-year mortality outcomes in the PARTNER trial showed that transcatheter aortic valve implantation (TAVI) was noninferior to surgical aortic valve replacement (sAVR) in patients who were eligible for sAVR (cohort A), and superior to standard treatment in patients who were ineligible for sAVR (cohort B). Objective To update a previous report on the safety, effectiveness, and cost-effectiveness of TAVI, published in 2012. Data Sources A literature search was performed on September 11, 2012, using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published from January 1, 2011, until September 11, 2012. Review Methods Randomized controlled trials investigating TAVI in comparison to sAVR or standard treatment were included for analysis. Results were summarized descriptively. Results At 2-year follow-up, mortality in cohort A was similar between the TAVI and sAVR groups. Rates of stroke/transient ischemic attack, major vascular complications, and moderate/severe paravalvular aortic regurgitation were significantly higher in the TAVI group, but rate of major bleeding was significantly higher in the sAVR group. Mortality in cohort B was significantly lower with transfemoral (TF) TAVI than with standard treatment, but rate of stroke was significantly higher with TF TAVI. TF TAVI resulted in a more rapid improvement in quality of life scores than sAVR, but this difference was not sustained at 6 and 12 months. Patients who underwent transapical TAVI did not have a greater early improvement in quality of life compared to sAVR patients. Compared to standard treatment, TF TAVI resulted in a greater improvement in quality of life scores at all time points. Incremental cost-effectiveness ratios were in favour of TAVI for inoperable patients in the base-case analysis, but varied widely for operable patients. Conclusions The findings of the 2-year follow-up with respect to mortality and adverse events were consistent with those of the 1-year follow-up. TAVI was also associated with improvement in quality of life, although results varied by cohort. Consistent with the 2012 report, TAVI may be cost-effective for patients who are not candidates for surgery. Plain Language Summary Narrowing of 1 of the heart valves (called aortic valve stenosis) makes it difficult for the heart to work properly. Often, patients have surgery to replace the narrowed valve, but surgery is too risky for some. In 2012, Health Quality Ontario published a report on a less invasive treatment option called transcatheter aortic valve implantation (TAVI). This report reviews information published since the 2012 report: the results of a 2-year follow-up of TAVI patients, and studies exploring patients’ quality of life. PMID:23837106

Sehatzadeh, S; Doble, B; Xie, F; Blackhouse, G; Campbell, K; Kaulback, K; Chandra, K; Goeree, R

2013-01-01

104

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

Microsoft Academic Search

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

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

1997-01-01

105

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

PubMed Central

Multiple aorto-cardiac cavity communications is very rare but important complication of prosthetic aortic valve endocarditis. The case below illustrates multiple aorto-cardiac cavity fistula formation following prostethic aortic valve endocarditis presented with slowly progressive symptoms of heart failure. A brief review of surgical reconstruction and the existing literature are presented, including emphasis on pre and intra operative echocardiographic diagnosis and treatment. PMID:25695004

Sabzi, Feridoun; Faraji, Reza

2014-01-01

106

What are the current results of sutureless valves in high-risk aortic valve disease patients?  

PubMed Central

A best evidence topic was written according to a structured protocol. The question addressed was whether sutureless aortic valves have a clinical and haemodynamic benefit in high-risk patients with aortic valve disease. A total of 307 papers were found using the reported searches; of which, six represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. The studies found analysed the outcomes of sutureless aortic valve implantation in high-risk patients undergoing aortic valve replacement. Reported measures included mortality; post-operative complications namely stroke, renal failure, endocarditis and bleeding; valve deployment, cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times; echocardiographic assessment of paravalvular leaks (PVLs) and valve haemodynamics; and symptomatic functional class. Hospital mortality ranged between 3.1 and 12.5% and long-term mortality ranged between 3.1 and 10%. Incidence of PVL was found to be between 0.0 and 11%. Stroke was observed in 0.7%, renal failure in 3.1%, prosthetic valve endocarditis in 2.1–3.1% and major bleeding in 3.1%. The valve deployment time was 9–21 min, CPB time 35–111 min and ACC time 17–70 min. Short-term mean and peak valve gradients were in the ranges of 10–11 and 18–22 mmHg, respectively, reducing to 8–9 and 16.4–19 mmHg, respectively, at follow-up. Owing to the lack of comparative studies analysing the outcomes of sutureless and conventional aortic valves, we compared these results with the recently published PARTNER Trial (Transcatheter vs. Surgical Aortic-Valve Replacement in High-Risk Patients), and it can be shown that the outcomes of sutureless aortic valves compare favourably with conventional valves in terms of mortality, neurological deficit, renal failure and post-operative bleeding. However, there is increased incidence of endocarditis and PVLs, together with raised mean valve gradients, perhaps owing to the mechanical properties and deployment techniques of sutureless aortic valves. PMID:22345058

Sepehripour, Amir H.; Harling, Leanne; Athanasiou, Thanos

2012-01-01

107

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

PubMed Central

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

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

2011-01-01

108

Histologic and immunohistochemical responses after aortic valve allografts in the rat  

Microsoft Academic Search

Background. Human aortic valve allografts elicit a cellular and humoral immune response. It is not clear whether this is important in promoting valve damage. We investigated the changes in morphology, cell populations, and major histocompatibility complex antigen distribution in the rat aortic valve allograft.Methods. Fresh heart valves from Lewis rats were transplanted into the abdominal aorta of DA rats. Valves

Marjorie K Green; Michael D Walsh; Anthony Dare; Patrick G Hogan; Xiao-Ming Zhao; Ian H Frazer; Amolak S Bansal; Mark F O’Brien

1998-01-01

109

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

Microsoft Academic Search

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

David J. R Hildick-Smith; Leonard M Shapiro

2000-01-01

110

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

PubMed Central

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

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

2014-01-01

111

Aortic valve leaflet replacement with bovine pericardium to preserve native dynamic capabilities of the aortic annulus.  

PubMed

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

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

2014-02-01

112

Determination of aortic valve area in valvular aortic stenosis by direct measurement using intracardiac echocardiography: A comparison with the gorlin and continuity equations  

Microsoft Academic Search

Objectives. This study sought to 1) show that intracardiac echocardiography can allow direct measurement of the aortic valve area, and 2) compare the directly measured aortic valve area from intracardiac echocardiography with the calculated aortic valve area from the Gorlin and continuity equations.Background. Intracardiac echocardiography has been used in the descriptive evaluation of the aortic valve; however, direct measurement of

Gary P. Foster; Neil J. Weissman; Michael H. Picard; Phillip J. Fitzpatrick; Samuel J. Shubrooks Jr.; Stuart W. Zarich

1996-01-01

113

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

PubMed

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

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

2015-04-01

114

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

PubMed Central

In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) underwent 2-leaflet reconstruction. Concomitant aortic wrapping with an artificial graft was performed in 63 patients (46.7%). There were no in-hospital deaths and 2 late deaths (1.5%); 6 patients (4.4%) needed valve-related reoperation. The 5-year cumulative survival rate was 98% ± 1.5%, and freedom from valve-related reoperation at 5 years was 92.7% ± 3.6%. In the last available echocardiograms, aortic regurgitation was absent or trivial in 116 patients (85.9%), mild in 16 (11.9%), moderate in 2 (1.5%), and severe in one (0.7%). The mean aortic valve gradient was 10.2 ± 4.5 mmHg, and the mean aortic valve orifice area index was 1.3 ± 0.3 cm2/m2. The 3-leaflet technique resulted in lower valve gradients and greater valve areas than did the 2-leaflet technique. Thus, in patients with BAV, AVRS yielded satisfactory early and midterm results with low mortality rates and low reoperation risk after the initial procedure. PMID:25593520

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

2014-01-01

115

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

PubMed Central

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.

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

116

Retrieval of ruptured valves and their accessories during transcatheter aortic valve replacement.  

PubMed

Transcatheter aortic valve replacement (TAVR) is a safe alternative to surgery in patients with severe aortic stenosis. We report a case of balloon rupture during TAVR with successful retrieval of its remnant and review this complication and its management. PMID:24417302

Negi, Smita I; Loyalka, Pranav; Gregoric, Igor; Kar, Biswajit

2014-03-01

117

Etiology of bicuspid aortic valve disease: Focus on hemodynamics.  

PubMed

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

Atkins, Samantha K; Sucosky, Philippe

2014-12-26

118

Etiology of bicuspid aortic valve disease: Focus on hemodynamics  

PubMed Central

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

Atkins, Samantha K; Sucosky, Philippe

2014-01-01

119

Successful Transcatheter Aortic Valve Implantation for Pure Aortic Regurgitation using a New Second Generation Self-Expanding J-Valve(TM) System - The First in-Man Implantation.  

PubMed

Transcatheter aortic valve implantation (TAVI) has been recognised as an effective treatment option for high-risk or inoperable patients with aortic stenosis. However, experience with TAVI for non-calcified aortic regurgitation is still limited. The new J-Valve(TM) prosthesis is designed for antegrade transapical implantation which is characterised by three U-shape graspers that could facilitate intuitive 'self-positioning' valve implantation and provide axial as well as radial fixation by embracing the native valve leaflets. Here we report the first in-man TAVI procedure of J-Valve(TM) prosthesis in a high risk patient with pure aortic regurgitation. PMID:25465513

Zhu, Da; Hu, Jia; Meng, Wei; Guo, Yingqiang

2015-04-01

120

Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet 1  

Microsoft Academic Search

Objective: To determine the durability of repair of a bicuspid aortic valve with leaflet prolapse, and to identify factors associated with repair failure. Methods: From November 1988 to January 1997, 94 patients with a bicuspid aortic valve and regurgitation from leaflet prolapse had aortic valve repair. In 66 patients, the repair employed triangular resection of the prolapsing leaflet. The remainder

Filip P. Casselman; A. Marc Gillinov; Rami Akhrassa; Vigneshwar Kasirajan; Eugene H. Blackstonea; Delos M. Cosgrovea

2010-01-01

121

Transcatheter aortic valve implantation: prevention and management of complications.  

PubMed

Assessment of elderly patients with severe aortic stenosis and decisions in terms of management strategy (conservative with or without balloon aortic valvuloplasty, transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement) are complex and warrant a multidisciplinary approach involving collaboration between experienced cardiac surgeons, interventional cardiologists, cardiac imaging specialists, anaesthesiologists, geriatricians and a specialised nursing staff. Patient history, comorbid conditions, perioperative risk stratification as well as anatomical and procedural considerations require careful review on an individual, case-by-case basis and have a major impact on treatment allocation. The aims of this article are to provide insights into the fundamental role of appropriate patient screening and selection, and to review the nature, management and prevention of the most important procedural complications associated with the TAVI procedure. PMID:23143126

Stortecky, Stefan; Buellesfeld, Lutz; Wenaweser, Peter; Windecker, Stephan

2012-11-01

122

Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement  

PubMed Central

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

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

2012-01-01

123

Transcatheter aortic valve implantation: from fantasy to reality.  

PubMed

Increased life expectancy has led to the presentation of more complicated patients in old age for the replacement of the aortic valve. The emergence of Transcatheter Aortic Valve Implantation (TAVI) was considered as a significant breakthrough in the management of symptomatic, moribund patients suffering from aortic valve stenosis who had been rejected for surgical intervention. A novel technology often has a long journey from the point at which it is created to its every-day-use. It is now obvious that TAVI practice in multiple institutes around the world has gone beyond the evidence. Serious concerns have been raised questioning the current TAVI practice. Analysis of future TAVI use may assist clinicians and healthcare managers to understand and deploy this technology in accordance with the evidence. PMID:24602509

Shaikhrezai, Kasra; McWilliams, Billy; Brackenbury, Edward T; Prasad, Sai; Yan, Tristan D; Pessotto, Renzo; Zamvar, Vipin; Berg, Geoffrey

2014-01-01

124

Transcatheter aortic valve implantation: from fantasy to reality  

PubMed Central

Increased life expectancy has led to the presentation of more complicated patients in old age for the replacement of the aortic valve. The emergence of Transcatheter Aortic Valve Implantation (TAVI) was considered as a significant breakthrough in the management of symptomatic, moribund patients suffering from aortic valve stenosis who had been rejected for surgical intervention. A novel technology often has a long journey from the point at which it is created to its every-day-use. It is now obvious that TAVI practice in multiple institutes around the world has gone beyond the evidence. Serious concerns have been raised questioning the current TAVI practice. Analysis of future TAVI use may assist clinicians and healthcare managers to understand and deploy this technology in accordance with the evidence. PMID:24602509

2014-01-01

125

Ongoing requirement for pacing post-transcatheter aortic valve implantation and surgical aortic valve replacement  

PubMed Central

OBJECTIVES Transcatheter aortic valve implantation (TAVI) is an established intervention for aortic stenosis. While it is known that the requirement for permanent pacing is higher following CoreValve (Medtronic, Inc., Minneapolis, MN, USA) TAVI than after surgical aortic valve replacement (SAVR), it remains uncertain whether pacing is required in the medium-to-long term. We hypothesized that complete heart block following TAVI is more likely to resolve than that following SAVR. METHODS A retrospective analysis of prospectively collated data on 528 patients undergoing TAVI or SAVR from May 2008 to December 2010 at a cardiac tertiary referral hospital. Demographic data, timing and indication for pacing post-procedure plus follow-up were recorded. Paced patients were compared and analysed by existing initial indication for pacing. RESULTS In total, 31 (5.9%) patients received a pacemaker, and there were limited differences between not paced and paced patient characteristics by procedure type. Of these, a greater proportion were implanted post-TAVI compared with SAVR (17 vs 3.2%, P < 0.001). The mean time to pacemaker follow-up for TAVI and SAVR was 234 and 188 days, P = 0.32, respectively. Fewer patients compared with pacing indication remained in complete heart block at latest follow-up for TAVI (76.5 vs 33.3%, P = 0.02) and SAVR (92.9 vs 58.3%, P = 0.04). Although, there was a trend towards a greater magnitude of TAVI patients regaining atrioventricular nodal conduction, this did not differ significantly from that seen in SAVR patients. CONCLUSIONS In keeping with previous reports, this single-centre experience demonstrates that patients undergoing TAVI have higher rates of pacemaker implantation than those following SAVR. However, pacing indication in the short-to-medium term may not persist for all paced patients post-TAVI and -SAVR with the suggestion that a significant proportion recover atrioventricular conduction, which tended to be greatest in TAVI paced patients. PMID:23620339

Simms, Alexander D.; Hogarth, Andrew J.; Hudson, Elizabeth A.; Worsnop, Victoria L.; Blackman, Daniel J.; O'Regan, David J.; Tayebjee, Muzahir H.

2013-01-01

126

Stentless pericardial valve for acute aortic valve endocarditis with annular destruction.  

PubMed

Surgery for aortic-valve endocarditis is still challenging, particularly in combination with destruction of the annulus. Freedom Solo (Solo) is a bovine stentless prosthesis for aortic valve replacement. It is implanted supra-annularly into the aortic wall with a single suture line, without requiring an 'intact' annulus. Thirteen patients received a Solo for endocarditis with annular destruction. Our results showed a low reinfection rate and no patient-prosthesis mismatch. Our contribution intends to show the feasibility of implantation also in case of complicated anatomical conditions, such as destruction of the annulus. PMID:22526223

Pfeiffer, Steffen; Santarpino, Giuseppe; Fischlein, Theodor

2015-04-01

127

Supra-annular aortic valve replacement with a mechanical prosthesis.  

PubMed

Supra-annular placement of the aortic valve prosthesis is primarily used in small aortic annulus to prevent a patient-prosthesis mismatch. The most important surgical steps are: careful removal of the diseased valve including annular decalcification; assessment of the prosthesis seating to guarantee free movement of leaflets and to prevent obstruction of coronary orifices; implantation with interrupted stitches placed infra-annularly, with the prosthesis being seated in a supra-annular position. If necessary, a sub-annular resection of asymmetric septal hypertrophy should be carried out prior to placement of the prosthesis. PMID:24415215

Turina, Marko

2005-01-01

128

Transfemoral Edwards SAPIEN aortic valve implantation through aortofemoral endograft.  

PubMed

We present the case of an 86-year-old woman with an aortobifemoral endograft and porcelain aorta who underwent transfemoral transcatheter aortic valve implantation (TAVI). A femoral cutdown was performed to the left limb of the endograft, and the needle puncture into the graft required sequential incisions and dilation to allow access of the 18F Edwards SAPIEN expandable eSheath (Edwards Lifesciences, Irvine, CA). A 26-mm Edwards SAPIEN transcatheter aortic valve was then successfully deployed. The cutdown was closed and hemostasis was achieved without any iatrogenic narrowing of the graft. Transfemoral TAVI through surgical cutdown with dilation of a femoral endograft is safe and feasible. PMID:24845556

Chandrasekhar, Jaya; Lam, Buu-Khanh; Glover, Chris

2014-09-01

129

Transaortic transcatheter aortic valve replacement with the Sapien™ valve and the first generations of Ascendra™.  

PubMed

Traditionally, the transcatheter aortic valve replacement is performed through a transapical, a transfemoral or a trans-subclavian approach. Recently, the transaortic approach for transcatheter aortic valve replacement through the distal part of the ascending aorta was successfully implemented in order to avoid peripheral vascular access-related complications and apical life-threatening haemorrhage. The Sapien™ stent valve has great transaortic potential because it can be loaded 'upside down' in different generations of delivery systems. However, because of their health regulatory systems and despite the launch, in 2012, of the latest generation of the Ascendra™ delivery system, the Ascendra+™, specifically designed for transapical and transaortic valve placements, several countries are still using the first generations of Ascendra™ (Ascendra™ 1 and 2). This device was specifically designed for transapical procedures, and retrograde stent-valve positioning through the stenotic aortic valve may be very challenging and risk the integrity of the aorta. We describe the manoeuvre required in order to pass the stenotic aortic valve safely in a retrograde direction using the Sapien™ stent valve and the first generations of Ascendra™. PMID:23766427

Ferrari, Enrico; Berdajs, Denis; Tozzi, Piergiorgio; Prêtre, René

2014-01-01

130

Left main coronary artery occlusion after percutaneous aortic valve implantation.  

PubMed

Left main coronary artery occlusion occurred immediately after transfemoral aortic valve implantation in an 87-year-old woman, which resulted in ventricular fibrillation and hemodynamic collapse. This life-threatening complication was promptly diagnosed with transesophageal echocardiography, which showed the disappearance of diastolic left main coronary artery jet flow and was confirmed with aortic root angiography. After prompt defibrillation, hemodynamic support was obtained with intra-aortic balloon pump and inotropic drugs. Functional recovery and survival were achieved with coronary stenting. This report highlights the importance of an integrated team approach of highly skilled specialists for these novel interventions. PMID:20172163

Bartorelli, Antonio L; Andreini, Daniele; Sisillo, Erminio; Tamborini, Gloria; Fusari, Melissa; Biglioli, Paolo

2010-03-01

131

Stent distortion after sutureless aortic valve implantation: a new complication seen with a novel surgical technique.  

PubMed

In recent years, sutureless aortic valves have grown in popularity. As these valves do not need to be anchored with sutures, shorter cardiac ischaemia and extracorporeal circulation times can potentially be achieved. In addition, the absence of a sewing ring in these valves results in a greater effective orifice area for any given size. Postoperative outcome may be improved using sutureless valves especially when combined with minimally invasive surgical techniques. However, sutureless aortic valves present unique surgical risks. We report 2 cases of delayed distortion of a sutureless aortic valve stent resulting in paravalvular leakage and increased transvalvular gradients. One patient underwent a reoperation with an aortic valve replacement using a standard biological aortic valve, the other patient was treated with balloon dilatation of the aortic valve stent. PMID:25535175

Fleissner, Felix; Molitoris, Ulrich; Shrestha, Malakh; Martens, Andreas

2015-03-01

132

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

Microsoft Academic Search

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

P. Kvidal; R. Bergstrom; T. Malm

2000-01-01

133

Lactococcus garvieae Endocarditis on a Prosthetic Biological Aortic Valve.  

PubMed

Lactococcus garvieae (LG) endocarditis is a rare disease in humans. There are only about 16 reported cases in the world. We report a 76-year-old male patient with LG endocarditis. In depth interview with the patient revealed that 2 weeks prior to admission, he had eaten sushi containing raw fish. Unlike many of the other infections reported, which were on a native mitral valve, our patient's vegetation was on a prosthetic aortic valve. PMID:25295408

Tsur, A; Slutzki, T; Flusser, D

2014-10-01

134

Direct aortic transcatheter valve implantation via mini-thoracotomy using the Medtronic CoreValve.  

PubMed

Transcatheter aortic valve implantation using the Medtronic CoreValve is a well-established procedure. Although previously carried out only through the common femoral artery, today it is possible to perform the procedure through different arterial alternative access sites. A direct aortic approach through the ascending aorta could be carried out via a right anterior mini-thoracotomy in the second intercostal space. The pericardium is opened to expose the aorta. Two purse-string sutures are then placed on the ascending aorta and a standard retrograde CoreValve implantation is performed with the standard delivery system. Advantages, contraindications, surgical technique and results are discussed. PMID:24448561

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

2013-01-01

135

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

Microsoft Academic Search

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

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

2003-01-01

136

Comparison of long term outcome in patients with or without aortic ring abscess treated surgically for aortic valve infective endocarditis  

Microsoft Academic Search

ObjectiveTo assess the long term prognostic significance of aortic valve ring abscess in patients with aortic endocarditis.PatientsA consecutive series of 75 patients who had surgery for aortic infective endocarditis between 1981 and 1989; 35 had aortic ring abscesses (group 1) and 40 did not (group 2). Mean age did not differ between the two groups. Prosthetic valve endocarditis was present

N Danchin; G Retournay; O Stchepinsky; C Selton-Suty; P Voiriot; B Hoen; P Canton; J-P Villemot; P Mathieu; F Cherrier

1999-01-01

137

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

PubMed

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

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

2013-07-15

138

The German Aortic Valve Registry (GARY): in-hospital outcome  

PubMed Central

Background Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis. Methods and results A total of 13 860 consecutive patients undergoing repair for aortic valve disease [conventional surgery and transvascular (TV) or transapical (TA) catheter-based techniques] have been enrolled in this registry during 2011 and baseline, procedural, and outcome data have been acquired. The registry summarizes the results of 6523 conventional aortic valve replacements without (AVR) and 3464 with concomitant coronary bypass surgery (AVR + CABG) as well as 2695 TV AVI and 1181 TA interventions (TA AVI). Patients undergoing catheter-based techniques were significantly older and had higher risk profiles. The stroke rate was low in all groups with 1.3% (AVR), 1.9% (AVR + CABG), 1.7% (TV AVI), and 2.3% (TA AVI). The in-hospital mortality was 2.1% (AVR) and 4.5% (AVR + CABG) for patients undergoing conventional surgery, and 5.1% (TV AVI) and AVI 7.7% (TA AVI). Conclusion The in-hospital outcome results of this registry show that conventional surgery yields excellent results in all risk groups and that catheter-based aortic valve replacements is an alternative to conventional surgery in high risk and elderly patients. PMID:24022003

Hamm, Christian W.; Möllmann, Helge; Holzhey, David; Beckmann, Andreas; Veit, Christof; Figulla, Hans-Reiner; Cremer, J.; Kuck, Karl-Heinz; Lange, Rüdiger; Zahn, Ralf; Sack, Stefan; Schuler, Gerhard; Walther, Thomas; Beyersdorf, Friedhelm; Böhm, Michael; Heusch, Gerd; Funkat, Anne-Kathrin; Meinertz, Thomas; Neumann, Till; Papoutsis, Konstantinos; Schneider, Steffen; Welz, Armin; Mohr, Friedrich W.

2014-01-01

139

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

PubMed Central

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

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

2014-01-01

140

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

PubMed

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

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

2013-03-15

141

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

E-print Network

the in-plane stiffness of the tissue and decreases anisotropy. Tissue replacement valves suffer from poor in-plane response of the natural aortic valve leaflet [4]. The valve is loaded by transleaflet

142

Comparative finite element model analysis of ascending aortic flow in bicuspid and tricuspid aortic valve.  

PubMed

In bicuspid aortic valve (BAV) disease, the role of genetic and hemodynamic factors influencing ascending aortic pathology is controversial. To test the effect of BAV geometry on ascending aortic flow, a finite element analysis was undertaken. A surface model of aortic root and ascending aorta was obtained from magnetic resonance images of patients with BAV and tricuspid aortic valve using segmentation facilities of the image processing code Vascular Modeling Toolkit (developed at the Mario Negri Institute). Analytical models of bicuspid (antero-posterior [AP], type 1 and latero-lateral, type 2 commissures) and tricuspid orifices were mathematically defined and turned into a volumetric mesh of linear tetrahedra for computational fluid dynamics simulations. Numerical simulations were performed with the finite element code LifeV. Flow velocity fields were assessed for four levels: aortic annulus, sinus of Valsalva, sinotubular junction, and ascending aorta. Comparison of finite element analysis of bicuspid and tricuspid aortic valve showed different blood flow velocity pattern. Flow in bicuspid configurations showed asymmetrical distribution of velocity field toward the convexity of mid-ascending aorta returning symmetrical in distal ascending aorta. On the contrary, tricuspid flow was symmetrical in each aortic segment. Comparing type 1 BAV with type 2 BAV, more pronounced recirculation zones were noticed in the latter. Finally, we found that in both BAV configurations, maximum wall shear stress is highly localized at the convex portion of the mid-ascending aorta level. Comparison between models showed asymmetrical and higher flow velocity in bicuspid models, in particular in the AP configuration. Asymmetry was more pronounced at the aortic level known to be more exposed to aneurysm formation in bicuspid patients. This supports the hypothesis that hemodynamic factors may contribute to ascending aortic pathology in this subset of patients. PMID:20618222

Viscardi, Francesca; Vergara, Christian; Antiga, Luca; Merelli, Sabrina; Veneziani, Alessandro; Puppini, Giovanni; Faggian, Giuseppe; Mazzucco, Alessandro; Luciani, Giovanni Battista

2010-12-01

143

Transcatheter aortic valve replacement: current perspectives and future implications.  

PubMed

Transcatheter aortic valve replacement (TAVR) or transcatheter aortic valve implantation (TAVI) has emerged as an attractive treatment strategy for the treatment of patients with severe symptomatic aortic stenosis (AS), particularly those who are inoperable or at high risk for surgical aortic valve replacement. Several multicentre registries and randomised trials have demonstrated the safety and efficacy of this technology in improving the survival as well as functional capacity of patients with AS. Most of the elderly patients with severe AS have multiple non-cardiac comorbidities, which might limit survival and impede the improvement in functional capacity afforded by TAVR. Therefore, optimal patient selection based on precise risk assessment is currently the cornerstone of evaluation of patients for TAVR. Due to the need for a multifaceted approach in patient evaluation, procedural conduct as well as postprocedure management, multidisciplinary heart valve teams have assumed a paramount role in the TAVR process. This review presents the current perspectives in patient selection, risk assessment, procedural considerations and outcomes following TAVR, along with implications for the future. PMID:25410500

Agarwal, Shikhar; Tuzcu, E Murat; Krishnaswamy, Amar; Schoenhagen, Paul; Stewart, William J; Svensson, Lars G; Kapadia, Samir R

2015-02-01

144

Anatomic three-dimensional echocardiographic correlation of bicuspid aortic valve  

Microsoft Academic Search

This study was undertaken to verify the echocardiographic characteristics of bicuspid aortic valve (AV) using 3-dimensional transesophageal echocardiography by comparing the findings with anatomic examination of autopsy specimens from carriers of this condition. Three-dimensional reconstructions of transesophageal echocardiograms were performed on 14 patients with bicuspid AV, and 20 autopsy specimens of bicuspid AVs were analyzed. Echocardiographic images and autopsy material

Nilda Espinola-Zavaleta; Luis Muñoz-Castellanos; Fause Attié; Gunther Hernández-Morales; Carlos Zamora-González; Roy Dueñas-Carbajal; Nuria Granados; Candace Keirns; Jesús Vargas-Barrón

2003-01-01

145

Clinical outcome of aortic valve replacement in the elderly  

Microsoft Academic Search

Since elderly patients are being referred for surgery in increasing numbers, we reviewed the clinical outcome of 459 consecutive patients aged 70 to 89 years, who had aortic valve replacement between 1993 and 2000. We subdivided the study population into three groups: in Group 1 we included patients aged 70–74 years old; in Group 2 patients aged 75–79 years old;

Bruno Chiappini; Marcello Bergonzini; Simona Gallieri; Davide Pacini; Angelo Pierangeli; Roberto Di Bartolomeo; Giuseppe Marinelli

2003-01-01

146

Dysfunction of a 21-mm aortic bioprosthesis treated with percutaneous implantation of a CoreValve prosthesis.  

PubMed

Percutaneous aortic valve replacement is an emerging alternative for high surgical risk patients with native aortic valve stenosis. We describe for the first time a valve-in-valve procedure with a CoreValve prosthesis for the treatment of a severely stenotic degenerated aortic bioprosthesis. PMID:20407385

Giannini, Cristina; De Carlo, Marco; Guarracino, Fabio; Donne, Maria G D; Benedetti, Giovanni; Verunelli, Francesco; Petronio, Anna S

2013-07-01

147

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

Microsoft Academic Search

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

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

148

Sutureless aortic valve replacement through a right minithoracotomy.  

PubMed

During the past decade, interest in the development of less-invasive cardiac valve surgery has undergone a steady increase, with many surgeons having supplanted full sternotomy with minimal-access incisions. While the minimally invasive approaches for the treatment of mitral disease have been standardized, the preferred route for aortic valve replacement (AVR) remains a matter of debate. Although AVR through a right minithoracotomy avoids opening the sternum, it does require a greater surgical ability and may be a challenging procedure, even for expert surgeons. By simplifying the valve implantation, the availability of sutureless prostheses might provide an important incentive for the diffusion of this approach. Herein are reported the details of three patients who received a 3f-Enable sutureless aortic bioprosthesis via a right minithoracotomy. The advantages and possible improvements of this procedure are also discussed. PMID:22645850

Cerillo, Alfredo Giuseppe; Bevilacqua, Stefano; Farneti, Pier Andrea; Concistrè, Giovanni; Glauber, Mattia

2012-03-01

149

Early outcomes of transcatheter aortic valve replacement in patients with severe aortic stenosis: single center experience  

PubMed Central

Introduction Transcatheter aortic valve implantation is a promising alternative to high risk surgical aortic valve replacement. The procedure is mainly indicated in patients with severe symptomatic aortic stenosis who cannot undergo surgery or who are at very high surgical risk. Aim Description early results of our single-center experience with balloon expandable aortic valve implantation. Material and methods Between July 2011 and August 2012, we screened in total 75 consecutive patients with severe aortic stenosis and high risk for surgery. Twenty-one of them were found ineligible for transcatheter aortic valve implantation (TAVI) because of various reasons, and finally we treated a total of 54 patients with symptomatic severe aortic stenosis (AS) who could not be treated by open heart surgery (inoperable) because of high-risk criteria. The average age of the patients was 77.4 ±7.1; 27.8% were male and 72.2% were female. The number of patients in NYHA class II was 7 while the number of patients in class III and class IV was 47. Results The average mortality score of patients according to the STS scoring system was 8.5%. Pre-implantation mean and maximal aortic valve gradients were measured as 53.2 ±14.1 mm Hg and 85.5 ±18.9 mm Hg, respectively. Post-implantation mean and maximal aortic valve gradients were 9.0 ±3.0 and 18.2 ±5.6, respectively (p < 0.0001). The left ventricular ejection fraction was calculated as 54.7 ±14.4% before the operation and 58.0 ±11.1% after the operation (p < 0.0001). The duration of discharge after the operation was 5.29 days, and a statistically significant correlation between the duration of discharge after the operation and STS was found (r = 0385, p = 0.004). Conclusions We consider that with decreasing cost and increasing treatment experience, TAVI will be used more frequently in broader indications. Our experience with TAVI using the Edwards-Sapien XT (Edwards Lifesciences, Irvine, CA) devices suggests that this is an effective and relatively safe procedure for the treatment of severe aortic stenosis in suitable patients. PMID:25061453

Bozkurt, Engin; Kele?, Telat; Durmaz, Tahir; Akçay, Murat; Ayhan, Hüseyin; Bayram, Nihal Akar; Aslan, Abdullah Nabi; Ba?tu?, Serdal; Bilen, Emine

2014-01-01

150

Aortic replacement in the setting of bicuspid aortic valve: How big? How much?  

PubMed

Despite more than a decade of intense investigation, controversy persists regarding appropriate triggers for aortic replacement in the setting of bicuspid aortic valve. The difficulty is that the data are inescapably imperfect. Although we can count individuals with bicuspid valve who suffer dissection, we have an insufficient understanding of the true denominator of individuals at risk to calculate the probability of dissection for an individual patient. In addition, our own decision-making process is subject to "denominator neglect" or focus on the fact of the occurrence of the event rather than on the risk of the occurrence. Furthermore, the data are inherently incomplete given the asymmetric nature of outcomes information. Specifically, although we can see those who did or did not dissect among the patients not undergoing surgery, the converse is not true; the tragedy of prophylactic surgery is that one cannot distinguish those who have benefited through prevention of dissection from those who paid the price of surgery but in whom dissection would never have occurred. Finally, we have data for only some of the critical determinants of dissection. Structural failure occurs when stresses exceed strengths. Aortic diameter gives us some insight into stress but we have little information on the material strength of the aorta. Early indications that patients undergoing aortic valve replacement for bicuspid valve had a significant risk of aortic dissection were followed by laboratory data showing histologic, biochemical, and mechanical abnormalities supporting an aggressive approach to resection; however, more recent clinical studies call this into question. PMID:25218534

Sundt, Thoralf M

2015-02-01

151

Thrombogenic potential of Innovia polymer valves versus Carpentier-Edwards Perimount Magna aortic bioprosthetic valves.  

PubMed

Trileaflet polymeric prosthetic aortic valves (AVs) produce hemodynamic characteristics akin to the natural AV and may be most suitable for applications such as transcatheter implantation and mechanical circulatory support (MCS) devices. Their success has not yet been realized due to problems of calcification, durability, and thrombosis. We address the latter by comparing the platelet activation rates (PARs) of an improved polymer valve design (Innovia LLC) made from poly(styrene-block-isobutylene-block-styrene) (SIBS) with the commercially available Carpentier-Edwards Perimount Magna Aortic Bioprosthetic Valve. We used our modified prothrombinase platelet activity state (PAS) assay and flow cytometry methods to measure platelet activation of a pair of 19 mm valves mounted inside a pulsatile Berlin left ventricular assist device (LVAD). The PAR of the polymer valve measured with the PAS assay was fivefold lower than that of the tissue valve (p = 0.005) and fourfold lower with flow cytometry measurements (p = 0.007). In vitro hydrodynamic tests showed clinically similar performance of the Innovia and Magna valves. These results demonstrate a significant improvement in thrombogenic performance of the polymer valve compared with our previous study of the former valve design and encourage further development of SIBS for use in heart valve prostheses. PMID:20930618

Claiborne, Thomas E; Girdhar, Gaurav; Gallocher-Lowe, Siobhain; Sheriff, Jawaad; Kato, Yasushi P; Pinchuk, Leonard; Schoephoerster, Richard T; Jesty, Jolyon; Bluestein, Danny

2011-01-01

152

Surgical treatment of aortic valve endocarditis: a 26-year experience  

PubMed Central

Objective We have retrospectively analyzed the results of the operations made for aortic valve endocarditis in a single center in 26 years. Methods From June 1985 to January 2011, 174 patients were operated for aortic valve endocarditis. One hundred and thirty-eight (79.3%) patients were male and the mean age was 39.3±14.4 (9-77) years. Twenty-seven (15.5%) patients had prosthetic valve endocarditis. The mean duration of follow-up was 7.3±4.2 years (0.1-18.2) adding up to a total of 1030.8 patient/years. Results Two hundred and eighty-two procedures were performed. The most frequently performed procedure was aortic valve replacement with mechanical prosthesis (81.6%). In-hospital mortality occurred in 27 (15.5%) cases. Postoperatively, 25 (14.4%) patients had low cardiac output and 17 (9.8%) heart block. The actuarial survival rates for 10 and 15 years were 74.6±3.7% and 61.1±10.3%, respectively. In-hospital mortality was found to be associated with female gender, emergency operation, postoperative renal failure and low cardiac output. The long term mortality was significantly associated with mitral valve involvement. Male gender was found to be a significant risk factor for recurrence in the follow-up. Conclusion Surgery for aortic valve endocarditis has significant mortality. Emergency operation, female gender, postoperative renal failure and low cardiac output are significant risk factors. Risk for recurrence and need for reoperation is low. PMID:24896158

Adademir, Taylan; Tuncer, Eylem Yayla; Tas, Serpil; Donmez, Arzu Antal; Polat, Ebru Bal; Tuncer, Altug

2014-01-01

153

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

PubMed Central

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

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

2014-01-01

154

Dynamic evaluation of a quadricuspid aortic valve with coronary computed tomography angiography.  

PubMed

A 35-year-old man presented with 9 years of chronic chest pain and was found to have moderate-to-severe aortic regurgitation on echocardiography. Aortic valve morphology on the initial echocardiogram was deemed normal. Computed tomography angiography was obtained for further evaluation of the aortic root dimension and anatomy. In addition to noninvasive evaluation of the coronary arteries, the higher spatial resolution and volumetric coverage of computed tomography angiography can better define the valvular and aortic anatomy. Reconstruction of retrospectively gated cine images through the aortic valve plane revealed a quadricuspid valve with 4 equal-sized cusps. Incomplete coaptation of the aortic valve cusps was seen during diastole, explaining the marked aortic regurgitation. In addition, a dilated ascending thoracic aorta (4.7 cm) was revealed. On the basis of these findings, the patient was treated surgically with a composite valve graft replacement of his aortic root. PMID:21873907

Cannavale, Giuseppe; Hope, Michael D; Crook, Stephen E S; Elicker, Brett M

2012-05-01

155

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

Microsoft Academic Search

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

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

156

Angina and Coronary Artery Disease in Patients with Aortic valve Disease  

Microsoft Academic Search

The significance of angina pectoris in patients with aortic valve disease (AVD) and the need for coronary arteriography before valve replacement are controversial. The history of chest pain and coronary arteriographic findings were reviewed in 333 patients ? forty years old, with AVD: 142 with aortic stenosis, 87 with mixed AVD and 104 with aortic regurgitation. The prevalence of coronary

Dimitrios Alexopoulos; Genovefa Kolovou; Michalis Kyriakidis; Athanasios Antonopoulos; Stamatios Adamopoulos; Peter Sleight; Pavlos Toutouzas

1993-01-01

157

The importance of echocardiography in transcatheter aortic valve implantation.  

PubMed

Valvular heart diseases cause serious health problems in Turkey as well as in Western countries. According to a study conducted in Turkey, aortic stenosis (AS) is second after mitral valve disease among all valvular heart diseases. AS is frequently observed in elderly patients who have several cardiovascular risk factors and comorbidities. In symptomatic severe AS, surgical aortic valve replacement (AVR) is a definitive treatment. However, in elderly patients with left ventricular dysfunction and comorbidities, the risk of operative morbidity and mortality increases and outweighs the gain obtained from AVR surgery. As a result, almost one-third of the patients with serious AS are considered ineligible for surgery. Transcatheter aortic valve implantation (TAVI) is an effective treatment in patients with symptomatic severe AS who have high risk for conventional surgery. Since being performed for the first time in 2002, with a procedure success rate reported as 95% and a mortality rate of 5%, TAVI has become a promising method. Assessment of vascular anatomy, aortic annular diameter, and left ventricular function may be useful for the appropriate selection of patients and may reduce the risk of complications. Cardiac imaging methods including 2D and 3D echocardiography and multidetector computed tomography are critical during the evaluation of suitable patients for TAVI as well as during and after the procedure. In this review, we describe the role of echocardiography methods in clinical practice for TAVI procedure in its entirety, i.e. from patient selection to guidance during the procedure, and subsequent monitoring. PMID:24028438

Bilen, Emine; Sari, Cenk; Durmaz, Tahir; Kele?, Telat; Bayram, Nihal A; Akçay, Murat; Ayhan, Hüseyin M; Bozkurt, Engin

2014-01-01

158

Improved Quality of Life Two-years Post Transcatheter Aortic Valve Replacement for a Regurgitant Aortic Homograft.  

PubMed

The limited durability of prosthetic cardiac valves together with an aging population will present ongoing management challenges. This paper describes the case of an 82 year-old male with symptomatic severe regurgitation in an aortic homograft which remains successfully treated with Transcatheter Aortic Valve Replacement (TAVR) at two-year follow-up. PMID:25529837

Putrino, Anthony L; Best, Matthew; Yong, Gerald

2015-04-01

159

Emergency percutaneous aortic valve replacement in a patient with a cervical spine fracture secondary to critical aortic stenosis.  

PubMed

An 81 year-old female with severe aortic stenosis was admitted electively to determine her anatomic suitability for trans-catheter aortic valve implantation (TAVI). Transthoracic echocardiogram prior to referral confirmed critical aortic stenosis with a mean transaortic valve gradient of 106mmHg, aortic valve area (AVA) 0.6cm(2) and dimensionless index (DI) 0.18. She reported a significant symptom burden with New York Heart Association Class III dyspnoea, four episodes of syncope in the month prior to admission and exertional chest pain. PMID:25544055

Gutman, Sarah J; Gooley, Robert; Meredith, Ian T

2015-04-01

160

Multimodality imaging of multivalvular endocarditis after transcatheter aortic valve replacement.  

PubMed

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgery for severe aortic stenosis in non-operable and high surgical risk patients. While endocarditis following TAVR is rare, the significant co-morbidities commonly found in this patient population can complicate evaluation and management. A case of TAVR endocarditis initially diagnosed by cardiac computed tomography angiography and confirmed with transesophageal echocardiogram is presented. In addition to demonstrating the appearance of vegetations and perivalvular involvement in endocarditis complicating TAVR, this case illustrates the utility of cardiac CT techniques in imaging suspected TAVR endocarditis. PMID:25740417

Lane, Alison B; Cahill, Michael S; Letizia, Andrew G; Hartzell, Joshua D; Villines, Todd C

2015-01-01

161

Proteus Mediastinitis Causing Fatal Pseudoaneurysm following Aortic Valve Replacement  

PubMed Central

We report an unusual case of Gram-negative mediastinitis following aortic valve replacement via median sternotomy. The patient presented two months after surgery following a urinary tract infection in septic shock with a discharging sternal wound and blood cultures positive for Proteus mirabilis. Imaging revealed a large anterior mediastinal abscess and aortic pseudoaneurysm which subsequently ruptured resulting in fatality. Gram-negative mediastinitis is a rare complication of cardiac surgery that can present late following initial clinical improvement and should be considered when “remote site” infections are present. Computerised Tomography scanning has a role to play in the identification of this. PMID:24369472

Jeffery, John; Tenovici, Alexandra-Alice; D'Costa, Horace

2013-01-01

162

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

Microsoft Academic Search

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

H. D. Tunstall Pedoe

1970-01-01

163

Carotid-access transcatheter aortic valve replacement in a patient with a previous mitral valve replacement.  

PubMed

We describe a case of transcatheter aortic valve replacement (TAVR) using carotid artery access and regional anesthesia in a patient with rheumatic heart disease, previous mitral valve replacement, and multiple co-morbidities. It highlights the role of the multidisciplinary Heart Team and multimodality imaging in reaching and implementing an appropriate management plan in this complex patient group. doi: 10.1111/jocs.12324 (J Card Surg 2015;30:256-259). PMID:24612338

Daly, Michael J; Blair, Paul H; Modine, Thomas; Donnelly, Patrick M; Jeganathan, Reuben; Manoharan, Ganesh; Spence, Mark S

2015-03-01

164

Increased Ascending Aortic Wall Stress in Patients with Bicuspid Aortic Valves  

PubMed Central

Background Patients with bicuspid aortic valves (BAV) are at increased risk of ascending aortic dilatation, dissection, and rupture. We hypothesized that ascending aortic wall stress may be increased in patients with BAV compared to patients with tricuspid aortic valves (TAV). Methods Twenty patients with BAV and 20 patients with TAV underwent electrocardiogram-gated computed tomography angiography. Patients were matched for diameter. The thoracic aorta was segmented, reconstructed, and triangulated to create a mesh. Utilizing a uniform pressure load of 120 mmHg, and isotropic, incompressible, and linear elastic shell elements, finite element analysis was performed to predict 99th-percentile wall stress. Results For patients with BAV and TAV, aortic root diameter was 4.0 ± 0.6 cm and 4.0 ± 0.6 cm (P=0.724), sinotubular junction diameter was 3.6 ± 0.8 cm and 3.6 ± 0.7 cm (P=.736), and maximum ascending aortic diameter was 4.0 ± 0.8 cm and 4.1 ± 0.9 cm (P=.849), respectively. The mean 99th-percentile wall stress in the BAV group was greater than in the TAV group (0.54 ±0.06 megpascals, MPa, versus 0.50 ± 0.09 MPa), though this did not reach statistical significance (p=0.090). When normalized by radius, the 99th-percentile wall stress was greater in the BAV group (0.31 ± 0.06 MPa/cm versus 0.27 ± 0.03 MPa/cm, P=0.013). Conclusions Patients with BAV, regardless of aortic diameter, have increased 99th-percentile wall stress in the ascending aorta. Ascending aortic three-dimensional geometry may account in part for the increased propensity to aortic dilatation, rupture, and dissection in patients with BAV. PMID:21867987

Nathan, Derek P.; Xu, Chun; Plappert, Ted; Desjardins, Benoit; Gorman, Joseph H.; Bavaria, Joseph E.; Gorman, Robert C.; Chandran, Krishnan B.; Jackson, Benjamin M.

2012-01-01

165

Significant mitral regurgitation left untreated at the time of aortic valve replacement: a comprehensive review of a frequent entity in the transcatheter aortic valve replacement era.  

PubMed

Significant mitral regurgitation (MR) is frequent in patients with severe aortic stenosis (AS). In these cases, concomitant mitral valve repair or replacement is usually performed at the time of surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) has recently been considered as an alternative for patients at high or prohibitive surgical risk. However, concomitant significant MR in this setting is typically left untreated. Moderate to severe MR after aortic valve replacement is therefore a relevant entity in the TAVR era. The purpose of this review is to present the current knowledge on the clinical impact and post-procedural evolution of concomitant significant MR in patients with severe AS who have undergone aortic valve replacement (SAVR and TAVR). This information could contribute to improving both the clinical decision-making process in and management of this challenging group of patients. PMID:24681140

Nombela-Franco, Luis; Ribeiro, Henrique Barbosa; Urena, Marina; Allende, Ricardo; Amat-Santos, Ignacio; DeLarochellière, Robert; Dumont, Eric; Doyle, Daniel; DeLarochellière, Hugo; Laflamme, Jerôme; Laflamme, Louis; García, Eulogio; Macaya, Carlos; Jiménez-Quevedo, Pilar; Côté, Mélanie; Bergeron, Sebastien; Beaudoin, Jonathan; Pibarot, Philippe; Rodés-Cabau, Josep

2014-06-24

166

Recurrent pannus formation causing prosthetic aortic valve dysfunction: is excision without valve re-replacement applicable?  

PubMed

Prosthetic valve dysfunction at aortic position is commonly caused by pannus formation. The exact etiology is not known. It arises from ventricular aspect of the prosthesis encroaching its leaflets causing stenosis or it may remain localized causing left ventricular outflow tract obstruction without affecting valve function.The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement.A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve.Management of our case presents several questions, whether recurrence of pannus is caused by sparing the prosthetic valve, is it simply an exaggeration of an inflammatory healing process in certain individuals or is it ideal to re-replace the valve despite a well preserved function. PMID:22747790

Darwazah, Ahmad K

2012-01-01

167

Minimally invasive primary aortic valve surgery: the OLV Aalst experience  

PubMed Central

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.

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

2015-01-01

168

Progress in developing a composite tissue-engineered aortic valve.  

PubMed

This paper reviews the rationale for developing a tissue-engineered aortic valve by building up the complex microstructure from its basic components, and presents recent progress towards that goal. Over the past 4 years, we have been working on engineering the functional components of the composite valve the collagen fiber bundles, the elastin sheets, and the hyaluronan matrix that keeps the tissue hydrated. Most recently, we have been working on optimizing the geometry and material properties of the collagen constructs, by varying their size and aspect ratio, and the types of loading protocols the constructs experience during the culture process. PMID:17281919

Vesely, I; Shi, Y; Dobkin, D; Iyer, R; Soundararajan, A

2005-01-01

169

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

E-print Network

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

Weinberg, Eli J.

170

Risk factors for aortic valve dysfunction in children with discrete subvalvar aortic stenosis.  

PubMed

Aortic regurgitation (AR) is a known complication of discrete subvalvar aortic stenosis (DSS), and its detection often triggers referral for surgery. However, risk factors for aortic valve dysfunction in children with DSS remain incompletely defined. The primary goal of this study was to determine independent risk factors for moderate or severe AR at mid-term follow-up in patients with DSS. Clinical records and echocardiograms of 220 patients with DSS (109 patients had DSS resection and 111 had no surgery) were analyzed. The primary outcome variable was AR grade (based on the width of the vena contracta) at latest follow-up. Age at diagnosis, gender, and duration of follow-up (median 7.2 years, range 1 to 20.4) did not differ significantly between medical and surgical patients. By multivariate analysis, independent risk factors for moderate to severe AR (n = 30) were older age at diagnosis of DSS (odds ratio [OR] for age > or =17 years 5.13, p = 0.024), previous balloon or surgical aortic valvuloplasty (OR 19.6, p <0.001), and a longer follow-up period (OR for 1-year increase 1.15, p = 0.032). Excluding patients with previous surgical or balloon aortic valvuloplasty, a higher maximal Doppler gradient was an independent risk factor for moderate to severe AR (OR for peak gradient > or =50 mm Hg 10.8, p = 0.001). Independent predictors of low-risk patients (none or trivial AR and peak gradient < or =30 mm Hg) included thin and mobile aortic valve leaflets (OR 7.86, p = 0.006) and an associated ventricular septal defect (OR 2.18, p = 0.019). These clinical and echocardiographic variables can be used to stratify risk of aortic valve dysfunction in patients with DSS and aid in timing of surgical resection. PMID:15325929

McMahon, Colin J; Gauvreau, Kimberlee; Edwards, Julia C; Geva, Tal

2004-08-15

171

Minimally invasive aortic valve replacement: the “Miami Method”  

PubMed Central

For patients undergoing aortic valve replacement (AVR), a minimally invasive approach performed via a right anterior thoracotomy is the preferred method at our institution. This method has evolved over a 10-year span, being applied to over 1,500 patients with the commitment of one surgeon seeking to offer a simplistic and reproducible minimally invasive alternative. We believe that this is truly the least invasive approach to the aortic valve since it avoids sternal invasion. By virtue of being less traumatic, the morbidity is diminished and therefore the recovery is enhanced. We believe that this approach is most beneficial in the high risk patient such as the elderly, the obese, those with chronic obstructive pulmonary, chronic kidney disease and those requiring re-operative surgery. This method has proven to be safe and effective in all patients requiring isolated AVR surgery. The only relative exclusion criteria would be a porcelain aorta with the inability to cannulate the patient. PMID:25694981

2015-01-01

172

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

PubMed Central

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

2011-01-01

173

Aortic root re-replacement with cryopreserved aortic homograft in a patient with active composite valve-graft endocarditis.  

PubMed

We describe a repeat aortic root replacement using a cryopreserved aortic homograft in a patient with active composite valve-graft endocarditis and an aortic root abscess. At the second surgery, infected prosthetic material was removed and surrounding tissue was radically debrided. The cryopreserved aortic homograft was positioned using the full root technique with a concomitant coronary bypass graft. The postoperative course was uneventful and the patient continues to thrive 2 years after the repeat operation. PMID:18677092

Shimizu, Hideyuki; Takahashi, Tatsuo; Yamazaki, Masataka; Hasegawa, Naoki; Shin, Hankei; Yozu, Ryohei

2008-06-01

174

Extensive mediastinal lipomatosis in a patient with severe aortic valve stenosis.  

PubMed

Mediastinal lipomatosis is a rare benign condition characterized by a large amount of mature adipose tissue in the mediastinum. We present the case of an 86-year-old male who was admitted to the hospital for analysis of his progressive dyspnea. After careful examination, the patient was diagnosed with severe aortic valve stenosis and extensive mediastinal lipomatosis. This rare coincidence of aortic valve disease and mediastinal lipoma was treated by aortic valve replacement and an extensive debulking procedure. PMID:11888787

Peek, Dirk F; Heijmen, Robin H; Ernst, Sjef M; Schepens, Marc A

2002-03-01

175

System to Guide Transcatheter Aortic Valve Implantations Based on Interventional C-Arm CT Imaging  

Microsoft Academic Search

\\u000a Transcatheter aortic valve implantation is an emerging technique to be applied in patients with aortic valve defects. Angiographic\\u000a and fluoroscopic X-ray imaging with a C-arm system is crucial in these minimally invasive procedures. We describe a prototypical\\u000a system based on the ability to acquire a 3D C-arm CT image during transcatheter aortic valve implantations. It supports the\\u000a physician in measuring

Matthias John; Rui Liao; Yefeng Zheng; Alois Nöttling; Jan Boese; Uwe Kirschstein; Jörg Kempfert; Thomas Walther

2010-01-01

176

Left Apical Aneurysm in a Patient with Severe Aortic Valve Stenosis  

PubMed Central

We report on a very rare case of left ventricular aneurysm in a 77-year-old patient with aortic valve stenosis and without coronary artery disease. The patient underwent conventional aortic valve replacement and left ventricular aneurysmectomy with an uneventful postoperative course. The cause of the left ventricular aneurysm was suspected to be a long history of aortic valve stenosis that led to severe intraventricular hypertension, subsequently asymmetric septum hypertrophy, and finally apical aneurysm.

Drews, Thorsten; Pasic, Miralem; Hetzer, Roland

2014-01-01

177

Cognitive Outcomes following Transcatheter Aortic Valve Implantation: A Systematic Review  

PubMed Central

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

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

2015-01-01

178

Molecular and Cellular Aspects of Calcific Aortic Valve Disease  

PubMed Central

Calcific aortic valve disease (CAVD) increasingly afflicts our aging population. One-third of our elderly have echocardiographic or radiological evidence of aortic valve sclerosis (CAVS), an early and subclinical form of CAVD. Age, gender, tobacco use, hypercholesterolemia, hypertension, and type II diabetes all contribute to the risk of disease that has worldwide distribution. Upon progression to its most severe form --- calcific aortic stenosis (CAS) --- CAVD becomes debilitating and devastating, and 2% of individuals over age 60 suffer from CAS to the extent that surgical intervention is required. No effective pharmacotherapies exist for treating those at risk for clinical progression. It is becoming increasingly apparent that a diverse spectrum of cellular and molecular mechanisms converge to regulate valvular calcium load; this is evidenced not only in histopathologic heterogeneity of CAVD but also from the multiplicity of cell types that can participate in valve biomineralization. In this review, we highlight our current understanding of CAVD disease biology, emphasizing molecular and cellular aspects of its regulation. We end by pointing to important biological and clinical questions that must be answered to enable sophisticated disease staging and the development of new strategies to medically treat CAVD. PMID:23833294

Towler, Dwight A.

2014-01-01

179

Hemodynamic Changes following Aortic Valve Bypass: A Mathematical Approach  

PubMed Central

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 model capable of evaluating the hemodynamic performance following the AVB surgery. A mathematical model that captures the interaction between LV, AS, arterial system, and AVB was developed. This model uses a limited number of parameters that all can be non-invasively measured using patient data. The model was validated using in vivo data from the literature. The model was used to determine the effect of different AVB and AS configurations on flow proportion and pressure of the aortic valve and the AVB. Results showed that the AVB leads to a significant reduction in transvalvular pressure gradient. The percentage of flow through the AVB can range from 55.47% to 69.43% following AVB with a severe AS. LV stroke work was also significantly reduced following the AVB surgery and reached a value of around 1.2 J for several AS severities. Findings of this study suggest: 1) the AVB leads to a significant reduction in transvalvular pressure gradients; 2) flow distribution between the AS and the AVB is significantly affected by the conduit valve size; 3) the AVB leads to a significant reduction in LV stroke work; and 4) hemodynamic performance variations can be estimated using the model. PMID:25881082

Benevento, Emilia; Djebbari, Abdelghani; Keshavarz-Motamed, Zahra; Cecere, Renzo; Kadem, Lyes

2015-01-01

180

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

PubMed Central

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.

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

2015-01-01

181

Prosthetic Valve Endocarditis with Valvular Obstruction after Transcatheter Aortic Valve Replacement  

PubMed Central

Patients with severe aortic stenosis who are at high risk for open-heart surgery might be candidates for transcatheter aortic valve replacement (TAVR). To our knowledge, this is the first report of Streptococcus viridans endocarditis that caused prosthetic valve obstruction after TAVR. A 77-year-old man who had undergone TAVR 17 months earlier was admitted because of evidence of prosthetic valve endocarditis. A transthoracic echocardiogram revealed a substantial increase in the transvalvular peak gradient and mean gradient in comparison with an echocardiogram of 7 months earlier. A transesophageal echocardiogram showed a 1.5-cm vegetation obstructing the valve. Blood cultures yielded penicillin-sensitive S. viridans. The patient was hemodynamically stable and was initially treated with vancomycin because of his previous penicillin allergy. Subsequent therapy with levofloxacin, oral penicillin (after a negative penicillin skin test), and intravenous penicillin eliminated the symptoms of the infection. Transcatheter aortic valve replacement is a relatively new procedure, and sequelae are still being discovered. We recommend that physicians consider obstructive endocarditis as one of these. PMID:25873834

Gitler, Bernard; Lederman, Jeffrey A.; Miller, Donald; Keltz, Theodore N.

2015-01-01

182

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

PubMed Central

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

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

2011-01-01

183

Bicuspid Aortic Valve: Unresolved Issues and Role of Imaging Specialists  

PubMed Central

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.

2015-01-01

184

Contemporary Use of Balloon Aortic Valvuloplasty in the Era of Transcatheter Aortic Valve Implantation  

PubMed Central

The development of transcatheter aortic valve implantation (TAVI) has increased the use of balloon aortic valvuloplasty (BAV) in treating aortic stenosis. We evaluated our use of BAV in an academic tertiary referral center with a developing TAVI program. We reviewed 69 consecutive stand-alone BAV procedures that were performed in 62 patients (mean age, 77 ± 10 yr; 62% men; baseline mean New York Heart Association functional class, 3 ± 1) from January 2009 through December 2012. Enrollment for the CoreValve® clinical trial began in January 2011. We divided the study cohort into 2 distinct periods, defined as pre-TAVI (2009–2010) and TAVI (2011–2012). We reviewed clinical, hemodynamic, and follow-up data, calculating each BAV procedure as a separate case. Stand-alone BAV use increased 145% from the pre-TAVI period to the TAVI period. The mean aortic gradient reduction was 13 ± 10 mmHg. Patients were successfully bridged as intended to cardiac or noncardiac surgery in 100% of instances and to TAVI in 60%. Five patients stabilized with BAV subsequently underwent surgical aortic valve replacement with no operative deaths. The overall in-hospital mortality rate (17.4%) was highest in emergent patients (61%). The implementation of a TAVI program was associated with a significant change in BAV volumes and indications. Balloon aortic valvuloplasty can successfully bridge patients to surgery or TAVI, although least successfully in patients nearer death. As TAVI expands to more centers and higher-risk patient groups, BAV might become integral to collaborative treatment decisions by surgeons and interventional cardiologists. PMID:25425977

Hui, Dawn S.; Shavelle, David M.; Cunningham, Mark J.; Matthews, Ray V.; Starnes, Vaughn A.

2014-01-01

185

Multiscale simulations of the aortic heart valve : applications in disease and surgery  

E-print Network

This thesis presents mathematical models describing the mechanical behavior of the human aortic heart valve over a range of length and time scales. In the human heart, the valves perform the vital function of controlling ...

Weinberg, Eli, 1979-

2008-01-01

186

A Review of Most Relevant Complications of Transcatheter Aortic Valve Implantation  

PubMed Central

Transcatheter aortic valve implantation (TAVI) has emerged for treating aortic stenosis in patients who are poor candidates for surgical aortic valve replacement. Currently, the balloon-expandable Edwards Sapien valve—which is usually implanted via a transfemoral or transapical approach—and the self-expanding CoreValve ReValving system—which is designed for retrograde application—are the most widely implanted valves worldwide. Although a promising approach for high-risk patients, the indication may be expanded to intermediate- and eventually low-risk patients in the future; however, doing so will require a better understanding of potential complications, risk factors for these complications, and strategies to individualize each patient to a different access route and a specific valve. This paper reviews the most relevant complications that may occur in patients who undergo catheter-based aortic valve implantation. PMID:23844292

Michler, Robert E.

2013-01-01

187

Pre- and postoperative imaging of the aortic root for valve-sparing aortic root repair (V-SARR).  

PubMed

Valve-sparing aortic root repair (V-SARR) using the David reimplantation method is an increasingly popular alternative to composite valve graft aortic root replacement in patients with aortic root aneurysms or dissections who wish to avoid anticoagulation. Computed tomography (CT) with retrospective electrocardiograph (ECG)-gating has become routine before and following V-SARR at Stanford. CT allows accurate measurement of aortic dimensions and provides unprecedented three-dimensional (3D) images of the sinuses, the aortic valve cusps, and coronary arteries in patients with the Marfan syndrome (MFS), with a bicuspid aortic valve (BAV), or other aortic diseases. This helps the surgeon to conceptualize the size of the aortic grafts required and how much reduction is necessary proximally (aortic annulus) and distally. These maneuvers are used to reduce the aortic annular diameter (when necessary) and replace the sinuses and ascending aorta (T. David-V, Stanford modification V-SARR). Postoperative ECG-gated CT confirms the reconstructed geometry and reliably detects coronary or other anastomotic problems. PMID:19251178

Fleischmann, Dominik; Liang, David H; Mitchell, R Scott; Miller, D Craig

2008-01-01

188

Bicuspid aortic valves are associated with increased wall and turbulence shear stress levels compared to trileaflet aortic valves.  

PubMed

Congenital bicuspid aortic valves (BAVs) are associated with accelerated disease progression, such as leaflet calcification and ascending aorta dilatation. Although common underlying genetic factors have been implicated in accelerated disease in BAV patients, several studies have suggested that altered hemodynamics also play a role in this disease process. The present study compares turbulence and wall shear stress (WSS) measurements between various BAV and trileaflet aortic valve (TAV) models to provide information for mechanobiological models of BAV disease. BAV and TAV models were constructed from excised porcine aortic valves to simulate parametric variations in BAV stenosis, hemodynamics and geometry. Particle image velocimetry experiments were conducted at physiological pressure conditions to characterize velocity fields in the ascending aorta. The velocity fields were post-processed to calculate turbulence, viscous and wall shear stresses in the ascending aorta. Stenosed BAV models showed the presence of eccentric systolic jets, causing increased WSS. Lower cardiac output resulted in a narrower jet, lower turbulence and lower viscous shear stress (VSS). The specific severe stenosis BAV model studied here showed reduced WSS due to reduction in non-fused leaflet mobility. Dilation of the aorta did not affect any turbulence or VSS, but reduced the WSS. In comparison with BAVs, TAVs have similar VSS values, but much smaller WSS and turbulence levels. These increased turbulence  and WSS levels in BAVs may play a key role in amplifying the biological responses of the ascending aorta wall and valvular leaflets, and support the hemodynamic underpinnings of BAV disease processes. PMID:25262451

Saikrishnan, Neelakantan; Mirabella, Lucia; Yoganathan, Ajit P

2014-09-28

189

Acute bioprosthetic thrombosis immediately after aortic valve replacement.  

PubMed

We present the case of a 72-year-old woman referred for dyspnea and vertigo when admitted to the hospital with a diagnosis of aortic stenosis. She had hypertension with previous deep venous thrombosis with no known hypercoagulable diathesis. She underwent aortic valve replacement with a Carpentier-Magna bioprosthesis without intraoperative complications; selective cardioplegia before aortic wall suture confirmed that coronary ostia were free. After extracorporeal circulation weaning, an episode of ventricular fibrillation occurred; sinus rhythm was restored using 20 J shock. Considering new episodes of ventricular fibrillation, the increasing number of polymorph ectopic ventricular systoles and the worsening of patient condition despite the use of high doses of inotropes, an intra-aortic balloon pump 1: 1 was inserted via the right femoral artery. Echocardiography (ECG) did not show alteration of the bioprosthesis in the presence of severe left ventricular impairment (ejection fraction <30%) with ipokinesia of the anterior-lateral wall and moderate-severe mitral regurgitation. Considering the rapid decline of the patient's condition despite the use of high doses of inotropes and an intra-aortic balloon pump, the aortic wall was reopened to control bioprosthesis. The intraoperative finding was unexpected; a thrombus of length 3-4 cm was found, attached to the prosthetic annulus and protruding into the left main trunk. The thrombus was immediately sucked up to avoid coronary embolization and, after that, the prosthesis was replaced with a Mitroflow 19 (Sorin Group Inc, Mitroflow Division, Vancouver, Canada) bioprosthesis. Probably, an association between factors could induce thrombosis-like aortic sinuses: annulus dimensions, endothelium damage caused during decalcification, tears in the bioprosthetic sewing ring, unknown coagulation diathesis and the structure of the Carpentier-Magna support may have induced this very unusual complication. However, we do not have enough information to establish with certainty the causes of this complication, but discussion of this topic may be useful. PMID:19194176

Patanè, Francesco; Sansone, Fabrizio; Campanella, Antonio; Asteggiano, Francesco; Rinaldi, Mauro

2009-02-01

190

The use of a stentless porcine bioprosthesis to repair an ascending aortic aneurysm in combination with aortic valve regurgitation.  

PubMed Central

Over the years, many surgical methods have evolved for the treatment of ascending aortic aneurysm in combination with aortic valve regurgitation; however, precise guidelines for optimal surgical techniques for varying presentations have not been defined. We describe the use of a stentless porcine bioprosthesis (Medtronic Freestyle) in a patient with an ascending aortic aneurysm and aortic regurgitation. We used the complete root replacement method, and anastomosed a Dacron graft (Hemashield) between the bioprosthetic valve and the native aorta to replace the distal part of the aneurysm. Images PMID:10524742

Akpinar, B; Saniso?lu, I; Konuralp, C; Akay, H; Güden, M; Sönmez, B

1999-01-01

191

[Second use of preserved aortic cusps for bentall procedure after aortic valve replacement with intravalvular implantation technique in aortitis syndrome].  

PubMed

A 44-year-old woman who had undergone aortic valve replacement with intravalvular implantation technique due to aortitis syndrome 13 years before, required Bentall procedure and hemiarch replacement because of the tissue valve dysfunction and the root and ascending aortic aneurysms. The exposed native aortic cusps sandwiched between the felt pledgets and the tissue valve seemed to be useful in reinforcing the proximal anastomosis of the composite graft. A combination of an intravalvular implantation technique and a skirted composite graft technique was applied, and her postoperative course has been uneventful for more than 2 and a half years. PMID:25391469

Kunitomo, Ryuji; Moriyama, Shuji; Tanaka, Mutsuo; Kawasuji, Michio

2014-11-01

192

The influence of the aortic root geometry on flow characteristics of a prosthetic heart valve.  

PubMed

In this paper, performance of aortic heart valve prosthesis in different geometries of the aortic root is investigated experimentally. The objective of this investigation is to establish a set of parameters, which are associated with abnormal flow patterns due to the flow through a prosthetic heart valve implanted in the patients that had certain types of valve diseases prior to the valve replacement. Specific valve diseases were classified into two clinical categories and were correlated with the corresponding changes in aortic root geometry while keeping the aortic base diameter fixed. These categories correspond to aortic valve stenosis and aortic valve insufficiency. The control case that corresponds to the aortic root of a patient without valve disease was used as a reference. Experiments were performed at test conditions corresponding to 70 beats/min, 5.5 L/min target cardiac output, and a mean aortic pressure of 100 mmHg. By varying the aortic root geometry, while keeping the diameter of the orifice constant, it was possible to investigate corresponding changes in the levels of Reynolds shear stress and establish the possibility of platelet activation and, as a result of that, the formation of blood clots. PMID:25661845

Barannyk, Oleksandr; Oshkai, Peter

2015-05-01

193

Extracellular matrix in deoxycholic acid decellularized aortic heart valves  

PubMed Central

Summary Background Only limited information is available regarding the influence of decellularization on the extracellular matrix in heart valves. Within the extracellular matrix proteoglycans (PG) play a central role in the structural organization and physical functioning of valves and in their capability of settling with endothelial and interstitial cells partially myofibroblasts. We have therefore estimated the effects of decellularization using deoxycholic acid on the structure of the extracellular matrix and PG’s in porcine aortic valves. Material/Methods Cupromeronic blue was used, alone or in combination with OsO4/thio-carbo-hydrazide/OsO4 for electron microscopic visualization. For PG and glycosaminoglycan (GAG) investigation a papain digestion was employed in combination with photometric determination using dimethylmethylene blue. Results The results indicate that deoxycholic acid affects the compartmentation of the PG-associated interstitial network not significantly. Compared to controls the PG-rich network was preserved even after deoxycholic acid treatment for 48 h. In parallel to electron microscopy immune assays (ELISA) showed smooth muscle cell ?-actin to be reduced to 0.96%±0.71 and total soluble protein to 6.68%±2.0 (n=3) of untreated controls. Protein loss corresponded well with the observations in electron micrographs of rupture and efflux of cell content. Further signs of lysis were irregular cell contours and loss of the basement membrane. Conclusions Efficient cell-lysis without disintegration or loss of integrity of the interstitial PG network can be achieved by treatment of aortic valves with deoxycholic acid for 48h. This protocol might also be suitable for clinical use to optimize conditions for growth and autologous remodelling of valves. PMID:23207452

Bloch, Oliver; Erdbrügger, Wilhelm; Völker, Wolfgang; Schenk, Alexander; Posner, Steffen; Konertz, Wolfgang; Dohmen, Pascal M.

2012-01-01

194

Intracardiac echocardiography-guided transcatheter aortic valve replacement.  

PubMed

Echocardiographic imaging is an essential component of successful transcatheter aortic valve replacement (TAVR). Currently, transesophageal echocardiography (TEE) is the imaging modality of choice for TAVR. However, a limitation of TEE is the need for general anesthesia and endotracheal intubation in most centers. Additionally, the TEE probe can obscure fluoroscopic views during valve positioning and deployment. Intracardiac echocardiography (ICE) has been used for imaging guidance for structural and valvular intervention, though its use has rarely been reported for primary imaging guidance during TAVR. Recently, a new volumetric three-dimensional intracardiac ultrasound (volume ICE) system has become available with the potential for improved visualization of intracardiac structures. We describe a recent TAVR case that was successfully performed with the use of volume ICE exclusively for imaging guidance. We found that assessment of valve positioning and aortic insufficiency were comparable to that provided by conventional TEE imaging, though there were several important limitations. ICE-guided TAVR may represent an important alternative to TEE for TAVR imaging guidance and possibly allow for less-intensive sedation or anesthesia. © 2014 Wiley Periodicals, Inc. PMID:24478152

Kadakia, Mitul B; Silvestry, Frank E; Herrmann, Howard C

2015-02-15

195

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

PubMed Central

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

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

2013-01-01

196

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

PubMed Central

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

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

1988-01-01

197

Deficient Signaling via Alk2 (Acvr1) Leads to Bicuspid Aortic Valve Development  

PubMed Central

Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly in humans. Despite recent advances, the molecular basis of BAV development is poorly understood. Previously it has been shown that mutations in the Notch1 gene lead to BAV and valve calcification both in human and mice, and mice deficient in Gata5 or its downstream target Nos3 have been shown to display BAVs. Here we show that tissue-specific deletion of the gene encoding Activin Receptor Type I (Alk2 or Acvr1) in the cushion mesenchyme results in formation of aortic valve defects including BAV. These defects are largely due to a failure of normal development of the embryonic aortic valve leaflet precursor cushions in the outflow tract resulting in either a fused right- and non-coronary leaflet, or the presence of only a very small, rudimentary non-coronary leaflet. The surviving adult mutant mice display aortic stenosis with high frequency and occasional aortic valve insufficiency. The thickened aortic valve leaflets in such animals do not show changes in Bmp signaling activity, while Map kinase pathways are activated. Although dysfunction correlated with some pro-osteogenic differences in gene expression, neither calcification nor inflammation were detected in aortic valves of Alk2 mutants with stenosis. We conclude that signaling via Alk2 is required for appropriate aortic valve development in utero, and that defects in this process lead to indirect secondary complications later in life. PMID:22536403

Thomas, Penny S.; Sridurongrit, Somyoth; Ruiz-Lozano, Pilar; Kaartinen, Vesa

2012-01-01

198

Hemodynamic correlates of the normal aortic valve echogram. A study of sound, flow, and motion.  

PubMed

The aortic valve echogram was recorded in open chest dogs simultaneously with aortic flow, acceleration of flow, aortic and left ventricular pressures, and intracardiac phonocardiograms. Comparison of echographic with hemodynamic data showed the following: The aortic valve started its opening with the onset of flow, at the same point that left ventricular pressure exceeded aortic pressure. Complete valve opening preceded peak aortic flow by an average of 43 msec and the cusps started to move toward closure while flow was still accelerating. Final closure of the valve was achieved at the time of zero flow and preceded the aortic second sound by 4-10 msec. The echographically determined "valve orifice area" correlated well with aortic stroke volume (r = 0.94). The intensity of the aortic first sound was related to peak acceleration of aortic flow. The intensity of the second sound was not related to the amplitude of cusp motion but correlated well with the aortic pressure at the time of closure and with peak flow deceleration. PMID:975467

Laniado, S; Yellin, E; Terdiman, R; Meytes, I; Stadler, J

1976-11-01

199

Radiation Induces Osteogenesis in Human Aortic Valve Interstitial Cells  

PubMed Central

Objective Irradiation of the chest or chest wall has been shown to caause calcific aortic stenosis. However, the mechanisms are unknown. Aortic valve interstitial cells (AVICs) have been implicated in the pathogenesis of aortic stenosis; they have been shown to change from the phenotype of a myofibroblast to an osteoblast-like cell. We therefore hypothesized that irradiation of human AVICs induces an osteogenic phenotype. In isolated human AVICs, our purpose was to determine the effect of irradiation on the production of osteogenic factors: (a) bone morphogenetic protein-2 (BMP-2) (b) osteopontin (OPN) (c) alkaline phosphatase (ALP), and (d) the transcription factor Runx2. Methods Human AVICs were isolated from normal aortic valves obtained from explanted hearts of patients undergoing cardiac transplantation (n=4) and grown in culture. The cells were grown to confluence, irradiated with 10 Gy using a cesium-137 irradiator and then lysed 24 hours following irradiation. Cell lysates were analyzed via immunoblot and densitometry for BMP-2, OPN, ALP and Runx2. Statistics were by ANOVA. P < 0.05 was significant. Results Irradiation induced an osteogenic phenotype in human AVICs. Irradiation induced a 2-fold increase in BMP-2, a 7-fold increase in OPN, a 3-fold increase in ALP, and a 2-fold increase in Runx2. Conclusions Radiation induces an osteogenic phenotype in human AVICs. The irradiated cells had significantly increased expression of the osteogenic factors BMP-2, OPN, ALP and Runx2. These data offer mechanistic insight into the pathogenesis of radiation-induced valvular heart disease. PMID:23026565

Nadlonek, Nicole A; Weyant, Michael J; Yu, Jessica A; Cleveland, Joseph C; Reece, T Brett; Meng, Xianzhong; Fullerton, David A.

2012-01-01

200

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

PubMed Central

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

Ganeshan, Arul

2014-01-01

201

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

PubMed

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

Matsumoto, Kazuhisa; Hisashi, Yosuke; Imoto, Yutaka

2015-03-01

202

Periostin Expression is Altered in Aortic Valves in Smad6 Mutant Mice.  

PubMed

Smad6 is known to predominantly inhibit BMP signaling by negatively regulating the BMP signaling process. Therefore, Smad6 mutation potentially provides an important genetic model for investigating the role of BMP signaling in vivo. Periostin is a 90-kDA secreted extracellular matrix (ECM) protein and implicated in cardiac valve progenitor cell differentiation, maturation and adult aortic valve calcification in mice. We have previously reported periostin expression patterns during AV valve development in mice. Because periostin can play critical roles in aortic valve interstitial cell differentiation and can be correlated with adult valve disease pathogenesis, in the present study we specifically focused on periostin expression during outflow tract (OT) development and its expression within the adult mouse valves. We previously reported that periostin expression in valve progenitor cells was altered by exogenously adding BMP-2 in culture. In this study, we investigated whether expression of periostin and other valvulogenic ECM proteins was altered in Smad6-mutant newborn mice in vivo. Periostin protein was localized within OT during embryonic development in mice. At embryonic day (ED) 13.5, robust periostin expression was detected within the developing pulmonary trunk and developing pulmonary and aortic valves. Periostin expression remained intense in pulmonary and aortic valves up to the adult stage. Our immunohistochemical and immunointensity analyses revealed that periostin expression was significantly reduced in the aortic valves in Smad6-/- neonatal hearts. Versican expression was also significantly reduced in Smad6-/- aortic valves, whereas, hyaluronan deposition was not significantly altered in the Smad6-/- neonatal valves. Expression of periostin and versican was less prominently affected in AV valves compared to the aortic valves, suggesting that a cell lineage/origin-dependent response to regulatory molecules may play a critical role in valve interstitial cell development and ECM protein expression. PMID:25383261

Sugi, Yukiko; Kern, Michael J; Markwald, Roger R; Burnside, Jessica L

2012-01-21

203

Simultaneous aortic and tricuspid valve rupture after fall injury  

PubMed Central

Abstract: This case study concerns a patient with disruption of both tricuspid and aortic valves: a previously healthy, adult man, who sustained a 5-meter fall from a building under construction. The mechanism of the injury was acceleration and deceleration, acting in two different phases of the cardiac cycle, i.e. systole and diastole. Simultaneous occurrence of these injuries is exceedingly rare and in a careful literature review, we did not find any such combination of injury. The possible mechanisms of this injury, as well as surgical techniques are discussed. PMID:23511124

Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

2013-01-01

204

Endocarditis of the native aortic valve caused by Lactobacillus jensenii.  

PubMed

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

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

2015-01-01

205

Aortic valve calcification: basic science to clinical practice.  

PubMed

Calcific aortic valve stenosis is the result of regulated cell processes. The histological hallmarks are inflammation and a remodelling of the extracellular matrix leading to bone formation. In the last 15 years the view has changed from it being an unmodifiable degenerative disease to an active biological process regulated by highly conserved ubiquitous cellular pathways. Many mechanisms and risk factors are the same as in atherosclerosis. Thus, statins and angiotensin II antagonists seemed promising treatment options. However, clinical trials failed to support this. This review describes the current understanding of major molecular mechanisms and discusses their role in clinical practice and possible therapy. PMID:18632833

Akat, K; Borggrefe, M; Kaden, J J

2009-04-01

206

Pathogenesis and pathophysiology of aortic valve stenosis in adults.  

PubMed

Aortic stenosis (AS) is the most common form of valvular heart disease. AS of degenerative etiology is predominant. It is a persistent disease associated with the activation of 3 processes: lipid accumulation, inflammation, and calcification. Recent studies suggest that valve calcification is an actively regulated process that involves extracellular matrix remodeling, angiogenesis, and inflammation leading to bone formation. Many mechanisms and risk factors involved in the pathogenesis of AS are similar to those observed in atherosclerosis. The knowledge of these processes may play a significant role in adequate prevention and therapy of patients with AS, especially at an early stage. PMID:22129836

Olszowska, Maria

2011-11-01

207

Evaluation of calcium loss after transcatheter aortic valve implantation  

PubMed Central

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

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

208

Multimodality Molecular Imaging Identifies Proteolytic and Osteogenic Activities in Early Aortic Valve Disease  

Microsoft Academic Search

Background—Visualizing early changes in valvular cell functions in vivo may predict the future risk and identify therapeutic targets for prevention of aortic valve stenosis. Methods and Results—To test the hypotheses that (1) aortic stenosis shares a similar pathogenesis to atherosclerosis and (2) molecular imaging can detect early changes in aortic valve disease, we used in vivo a panel of near-infrared

Elena Aikawa; Matthias Nahrendorf; David Sosnovik; Vincent M. Lok; Farouc A. Jaffer; Masanori Aikawa; Ralph Weissleder

2010-01-01

209

Aortic valve replacement with right thoracotomy in a patient with sternal metastasis from renal carcinoma.  

PubMed

We present a clinical case of severe aortic stenosis in a 73-year-old patient symptomatic for dispnoea class NYHA III-IV. At the physical examination the patient presented a single sternal metastasis of renal carcinoma involving the sternum. Oncological stability prompted us to perform aortic valve replacement. In order to avoid median sternotomy and its complications due to the presence of sternal metastasis we successfully performed aortic valve replacement through a right minithoracotomy. PMID:19848053

Molardi, Alberto; Nicolini, Francesco; Beghi, Cesare; Agostinelli, Andrea; Gherli, Tiziano

2009-08-01

210

Aortic valve replacement in children: Options and outcomes  

PubMed Central

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

Alsoufi, Bahaaldin

2013-01-01

211

Aortic valve replacement in children: Options and outcomes.  

PubMed

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

Alsoufi, Bahaaldin

2014-01-01

212

Bartonella henselae infection of prosthetic aortic valve associated with colitis.  

PubMed

The diagnosis of infective endocarditis can be difficult, particularly with atypical presentation and negative blood cultures. A 61-year-old man with a porcine aortic valve presented with fever, intermittent confusion, diarrhea, and fatigue. In the community clinic setting, a colonoscopy performed for anemia demonstrated colitis. Symptoms progressed for months; elicitation of a history of significant kitten exposure and the finding of an axillary lymph node prompted testing for Bartonella henselae antibodies. High titer antibodies by indirect immunofluorescence assay indicated chronic B. henselae infection. Surgical valve replacement followed by prolonged doxycycline and rifampin led to cure. This case illustrates the complexities of infective endocarditis and is the first description B. henselae endocarditis associated with colitis in an immunocompetent adult. PMID:21702667

Karris, Maile Young; Litwin, Christine M; Dong, Hong S; Vinetz, Joseph

2011-11-01

213

Thrombogenic potential of transcatheter aortic valve implantation with trivial paravalvular leakage  

PubMed Central

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

Siegel, Rolland

2014-01-01

214

Incidental Left Atrial Blood Cyst in a Patient Undergoing Transcatheter Aortic Valve Replacement  

PubMed Central

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.

Shah, Moneal; Hughes-Doichev, Rachel

2015-01-01

215

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

PubMed Central

Background Minimally invasive aortic valve surgery (mini AVR) is a safe and effective treatment option at many hospital centers, but there has not been widespread adoption of the procedure. Critics of mini AVR have called for additional evidence with direct comparison to aortic valve replacement (AVR) via full sternotomy (FS). Methods Our mini AVR approach is through a hemi-sternotomy (HS). We performed a propensity-score matched analysis of all patients undergoing isolated AVR via FS or HS at our institution since 2002, resulting in 552 matched pairs. Baseline characteristics were similar. Operative characteristics, transfusion rates, in-hospital outcomes as well as short and long term survival were compared between groups. Results Median cardiopulmonary bypass and cross clamp times were shorter in the HS group: 106 minutes [inter-quartile ranges (IQR) 87-135] vs. 124 minutes (IQR 90-169), P?0.001, and 76 minutes (IQR 63-97) vs. 80 minutes (IQR 62-114), P?0.005, respectively. HS patients had shorter ventilation times (median 5.7 hours, IQR 3.5-10.3 vs. 6.3 hours, IQR 3.9-11.2, P?0.022), shorter intensive care unit stay (median 42 hours, IQR 24-71 vs. 45 hours, IQR 24-87, P?0.039), and shorter hospital length of stay (median 6 days, IQR 5-8 vs. 7 days, IQR 5-10, P?0.001) compared with the FS group. Intraoperative transfusions were more common in FS group: 27.9% vs. 20.0%, P?0.003. No differences were seen in short or long term survival, or time to aortic valve re-intervention. Conclusions Our study confirms the clinical benefits of minimally invasive AVR via HS, which includes decreased transfusion requirements, ventilation times, intensive care unit and hospital length of stay without compromising short and long term survival compared to conventional AVR via FS. PMID:25694975

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

2015-01-01

216

Aortic Root Replacement with ReImplantation Technique in an Infant with Loeys-Dietz Syndrome and a Bicuspid Aortic Valve  

Microsoft Academic Search

We report on an infant with a Loeys-Dietz Syndrome and a bicuspid aortic valve, who presented with rapid dilatation of the\\u000a aortic root. We performed a valve-sparing aortic root replacement with re-implantation technique using a Dacron graft with\\u000a pseudo-sinuses (Gelweave Valsalva conduit, Vascutek Terumo, Glasgow, Scotland).

Julie Cleuziou; Walter B. Eichinger; Christian Schreiber; Rüdiger Lange

2010-01-01

217

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

PubMed

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

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

2015-03-01

218

Clinical outcome of aortic valve replacement in the elderly.  

PubMed

Since elderly patients are being referred for surgery in increasing numbers, we reviewed the clinical outcome of 459 consecutive patients aged 70 to 89 years, who had aortic valve replacement between 1993 and 2000. We subdivided the study population into three groups: in Group 1 we included patients aged 70-74 years old; in Group 2 patients aged 75-79 years old; and in Group 3 patients aged 80 years old or older. An isolated AVR was performed in 289 patients (63%), concomitant coronary artery bypass graft (CABG) in 168 patients (36.6%), an isolated ventricular septal defect (VSD) closure in one patient (0.2%) and an isolated atrial septal defect (ASD) closure in one patient (0.2%). The overall perioperative mortality rate was 7% (32 patients), without significant differences among the three groups (P=0.88). Our study confirms the good outcome of aortic valve replacement in elderly patients even in octagenarians and only concomitant CABG procedures increase the operative risk, reducing long-term survival (P<0.05). PMID:12958546

Chiappini, Bruno; Bergonzini, Marcello; Gallieri, Simona; Pacini, Davide; Pierangeli, Angelo; Di Bartolomeo, Roberto; Marinelli, Giuseppe

2003-10-01

219

Minimally Invasive Approach for Redo Mitral Valve Replacement: No Aortic Cross-Clamping and No Cardioplegia  

PubMed Central

A 75-year-old woman who had previously undergone a double valve replacement was admitted to Asan Medical Center because of severe bioprosthetic mitral valve dysfunction and tricuspid regurgitation. Under hypothermic fibrillatory arrest without aortic cross-clamping, minimally invasive mitral and tricuspid valve surgery was performed via a right minithoracotomy.

Kim, Hong Rae; Kim, Gwan Sic; Yoo, Jae Suk; Lee, Jae Won

2015-01-01

220

Coronary artery disease and transcatheter aortic valve replacement: current treatment paradigms.  

PubMed

Aortic stenosis is the most common form of valvular heart disease in the elderly population and is often diagnosed in individuals who also have coronary artery disease. Surgical aortic valve replacement has been the standard of care for the treatment of aortic stenosis during the past decades, but the availability of transcatheter aortic valve replacement has now allowed different options for high or extreme surgical risk patients. The management of coronary artery disease in patients undergoing transcatheter aortic valve replacement remains a controversial issue, as available studies in the literature have generated conflicting results. This review offers a comprehensive portrait of coronary artery disease management in the presence of concomitant aortic stenosis and proposes treatment approaches for patients presenting both diseases. PMID:25602597

Paradis, Jean-Michel; Labbé, Benoit; Rodés-Cabau, Josep

2015-05-01

221

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

PubMed Central

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

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

2014-01-01

222

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

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

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

223

Potential drug targets for calcific aortic valve disease  

PubMed Central

Calcific aortic valve disease (CAVD) is a major contributor to cardiovascular morbidity and mortality and, given its association with age, the prevalence of CAVD is expected to continue to rise as global life expectancy increases. No drug strategies currently exist to prevent or treat CAVD. Given that valve replacement is the only available clinical option, patients often cope with a deteriorating quality of life until diminished valve function demands intervention. The recognition that CAVD results from active cellular mechanisms suggests that the underlying pathways might be targeted to treat the condition. However, no such therapeutic strategy has been successfully developed to date. One hope was that drugs already used to treat vascular complications might also improve CAVD outcomes, but the mechanisms of CAVD progression and the desired therapeutic outcomes are often different from those of vascular diseases. We, therefore, discuss the benchmarks that must be met by a CAVD treatment approach, and highlight advances in the understanding of CAVD mechanisms to identify potential novel therapeutic targets. PMID:24445487

Hutcheson, Joshua D.; Aikawa, Elena; Merryman, W. David

2014-01-01

224

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

PubMed

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

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

2014-10-15

225

Transfemoral aortic valve implantation for severe aortic stenosis in a patient with dextrocardia situs inversus.  

PubMed

Transcatheter aortic valve implantation (TAVR) has grown rapidly over the past 10 years. Device and delivery catheter systems have evolved to facilitate the procedure and reduce the risk of associated complications, including those related to vascular access. It is important to understand the utility of the TAVR equipment in patients with more challenging anatomy to select the most appropriate technique for this complex procedure. We report the first case, to our knowledge, of a patient with dextrocardia situs inversus and previous coronary artery bypass grafting who underwent TAVR from the femoral route using the Edwards SAPIEN XT Novaflex+ Transfemoral System (Edwards Lifesciences, Irvine, CA). PMID:24629491

Good, Richard I S; Morgan, Kenneth P; Brydie, Alan; Beydoun, Hussein K; Nadeem, S Najaf

2014-09-01

226

[Composite valve graft replacement in patients with type A aortic dissection--a modified cabrol procedure].  

PubMed

Composite valve graft replacement of the ascending aorta and aortic valve is indicated for a variety of conditions affecting the aortic root. However, a major drawback in this operation is bleeding from the proximal suture line and coronary anastomosis especially in patient with friable root tissue involved by aortic dissection. We describe here a modified technique to take advantage of the aortic button and cabrol techniques to reattach the coronary artery ostia. We have experienced seven patients with the aortic root replacements for type A dissection using the described technique over the past two years. In view of our favorable experience, we recommend this technique especially for patient with acute dissection involving nondilated aortic annulus, in addition to the patients with Marfan syndrome or annulo-aortic ectasia. PMID:9394579

Moriyama, Y; Iguro, Y; Watanabe, S; Masuda, H; Hisatomi, K; Shimokawa, S; Toyohira, H; Taira, A

1997-10-01

227

Unusual complication after aortic valve replacement with the Freedom Solo stentless bioprosthesis.  

PubMed

The case is presented of an unusual complication after aortic valve replacement with a Freedom Solo bioprosthesis. Excision of the aortic valve created a discontinuity of the aortic annulus that was missed intraoperatively and left uncorrected after supra-annular placement of the bioprosthesis; this created a pseudoaneurysm with direct communication to the pericardial cavity. When implanting the Freedom Solo bioprosthesis, care must be taken to exclude the presence of any aortic annular discontinuity. Implantation of the Freedom Solo bioprosthesis is not precluded by this possible complication, provided that any annular disruption is promptly recognized and adequately closed before placement of the supra-annular sutures. PMID:22066371

Celiento, Michele; Scioti, Giovanni; Pratali, Stefano; Guarracino, Fabio; Bortolotti, Uberto

2011-09-01

228

Transapical aortic valve implantation and minimally invasive off-pump bypass surgery  

PubMed Central

Transcatheter aortic valve implantation (TAVI) has gained increasing popularity for high-risk patients with symptomatic aortic valve stenosis. A concomitant coronary artery disease leads to a complicated management and an increased perioperative risk. This case report describes the successful total arterial coronary revascularization of the left anterior descending and the left marginal branch of the circumflex artery utilizing the left internal mammary artery (LIMA) and left radial artery in off-pump technique in combination with the transapical transcatheter aortic valve implantation via minimally invasive anterolateral access in the fifth intercostal space. PMID:24221960

Ahad, Samir; Baumbach, Hardy; Hill, Stephan; Franke, Ulrich F. W.

2014-01-01

229

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

PubMed

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

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

2011-06-01

230

Distal embolization of Edwards SAPIEN prosthesis during transcatheter aortic valve implantation  

PubMed Central

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

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

2013-01-01

231

Minimally invasive transaortic transcatheter aortic valve implantation of the CoreValve prosthesis: the direct aortic approach through a mini-sternotomy.  

PubMed

Transcatheter implantation of the CoreValve bioprosthesis (Medtronic, Minneapolis, MN, USA) can be performed surgically through a minimally invasive approach: using an upper-J mini-sternotomy to the second or third intercostal space, the ascending aorta is exposed at a convenient location. After placing two purse-string sutures on the ascending aorta at least 7 cm above the aortic valve annulus, the CoreValve delivery system is advanced under fluoroscopy to the optimal position and the valve is deployed. Because of the short distance between the access point and the aortic annulus, positioning of the valve can be done more accurately in comparison with the transfemoral approach. We report a brief description of this surgical technique, its indications and limitations and the short-term results of our first series. PMID:24425777

Amrane, Hafid; Porta, Fabiano; Head, Stuart; van Boven, Ad; Kappetein, Arie Pieter

2013-01-01

232

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

PubMed

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

Shrestha, Malakh

2015-03-01

233

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

PubMed Central

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.

2015-01-01

234

Gallium-SPECT in the detection of prosthetic valve endocarditis and aortic ring abscess.  

PubMed

A 52-yr-old man who had a bioprosthetic aortic valve developed Staphylococcus aureus bacteremia. Despite antibiotic therapy he had persistent pyrexia and developed new conduction system disturbances. Echocardiography did not demonstrate vegetations on the valve or an abscess, but gallium scintigraphy using SPECT clearly identified a focus of intense activity in the region of the aortic valve. The presence of valvular vegetations and a septal abscess was confirmed at autopsy. Gallium scintigraphy, using SPECT, provided a useful noninvasive method for the demonstration of endocarditis and the associated valve ring abscess. PMID:1880582

O'Brien, K; Barnes, D; Martin, R H; Rae, J R

1991-09-01

235

Gallium-SPECT in the detection of prosthetic valve endocarditis and aortic ring abscess  

SciTech Connect

A 52-yr-old man who had a bioprosthetic aortic valve developed Staphylococcus aureus bacteremia. Despite antibiotic therapy he had persistent pyrexia and developed new conduction system disturbances. Echocardiography did not demonstrate vegetations on the valve or an abscess, but gallium scintigraphy using SPECT clearly identified a focus of intense activity in the region of the aortic valve. The presence of valvular vegetations and a septal abscess was confirmed at autopsy. Gallium scintigraphy, using SPECT, provided a useful noninvasive method for the demonstration of endocarditis and the associated valve ring abscess.

O'Brien, K.; Barnes, D.; Martin, R.H.; Rae, J.R. (Department of Diagnostic Radiology, Victoria General Hospital Halifax, Nova Scotia (Canada))

1991-09-01

236

Radionuclide angiography in evaluation of left ventricular function following aortic valve replacement  

SciTech Connect

Congestive heart failure in patients surviving aortic valve replacement has been associated with a high late mortality. To determine whether myocardial dysfunction in these patients occurred preoperatively, perioperatively, or during the early postoperative period, 19 consecutive patients undergoing aortic valve replacement using cardioplegia and hypothermia were studied by multiple-gated cardiac blood pool imaging. The resting ejection fractions for 8 patients with aortic stenosis did not show significant changes following operation. The 11 patients with aortic insufficiency has resting preoperative values of 58 +/- 15%, which fell to 38 +/- 18% immediately postoperatively (p less than 0.01), with the late values being 51 +/- 16%. Eight of 18 patients (44%) showed deterioration of regional wall motion immediately after operation, which persisted in 3 during the late evaluation. The occurrence of new perioperative regional wall motion abnormalities and persistent perioperative depression in left ventricular function in some patients suggest the need for further improvement in myocardial protection during cardiopulmonary bypass for aortic valve replacement.

Santinga, J.T.; Kirsh, M.M.; Brady, T.J.; Thrall, J.; Pitt, B.

1981-05-01

237

Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis  

PubMed Central

BACKGROUND Aortic valve calcification (AVC) load measures lesion severity in aortic stenosis (AS) and is useful for diagnostic purposes. Whether AVC predicts survival after diagnosis, independent of clinical and Doppler echocardiographic AS characteristics, has not been studied. OBJECTIVES This study evaluated the impact of AVC load, absolute and relative to aortic annulus size (AVCdensity), on overall mortality in patients with AS under conservative treatment and without regard to treatment. METHODS In 3 academic centers, we enrolled 794 patients (mean age, 73 ± 12 years; 274 women) diagnosed with AS by Doppler echocardiography who underwent multidetector computed tomography (MDCT) within the same episode of care. Absolute AVC load and AVCdensity (ratio of absolute AVC to cross-sectional area of aortic annulus) were measured, and severe AVC was separately defined in men and women. RESULTS During follow-up, there were 440 aortic valve implantations (AVIs) and 194 deaths (115 under medical treatment). Univariate analysis showed strong association of absolute AVC and AVCdensity with survival (both, p < 0.0001) with a spline curve analysis pattern of threshold and plateau of risk. After adjustment for age, sex, coronary artery disease, diabetes, symptoms, AS severity on hemodynamic assessment, and LV ejection fraction, severe absolute AVC (adjusted hazard ratio [HR]: 1.75; 95% confidence interval [CI]: 1.04 to 2.92; p = 0.03) or severe AVCdensity (adjusted HR: 2.44; 95% CI: 1.37 to 4.37; p = 0.002) independently predicted mortality under medical treatment, with additive model predictive value (all, p ? 0.04) and a net reclassification index of 12.5% (p = 0.04). Severe absolute AVC (adjusted HR: 1.71; 95% CI: 1.12 to 2.62; p = 0.01) and severe AVCdensity (adjusted HR: 2.22; 95% CI: 1.40 to 3.52; p = 0.001) also independently predicted overall mortality, even with adjustment for time-dependent AVI. CONCLUSIONS This large-scale, multicenter outcomes study of quantitative Doppler echocardiographic and MDCT assessment of AS shows that measuring AVC load provides incremental prognostic value for survival beyond clinical and Doppler echocardiographic assessment. Severe AVC independently predicts excess mortality after AS diagnosis, which is greatly alleviated by AVI. Thus, measurement of AVC by MDCT should be considered for not only diagnostic but also risk-stratification purposes in patients with AS. PMID:25236511

Clavel, Marie-Annick; Pibarot, Philippe; Messika-Zeitoun, David; Capoulade, Romain; Malouf, Joseph; Aggarval, Shivani; Araoz, Phillip A.; Michelena, Hector I.; Cueff, Caroline; Larose, Eric; Miller, Jordan D.; Vahanian, Alec; Enriquez-Sarano, Maurice

2014-01-01

238

Side-Specific Endothelial-Dependent Regulation of Aortic Valve Calcification  

PubMed Central

Arterial endothelial cells maintain vascular homeostasis and vessel tone in part through the secretion of nitric oxide (NO). In this study, we determined how aortic valve endothelial cells (VEC) regulate aortic valve interstitial cell (VIC) phenotype and matrix calcification through NO. Using an anchored in vitro collagen hydrogel culture system, we demonstrate that three-dimensionally cultured porcine VIC do not calcify in osteogenic medium unless under mechanical stress. Co-culture with porcine VEC, however, significantly attenuated VIC calcification through inhibition of myofibroblastic activation, osteogenic differentiation, and calcium deposition. Incubation with the NO donor DETA-NO inhibited VIC osteogenic differentiation and matrix calcification, whereas incubation with the NO blocker l-NAME augmented calcification even in 3D VIC–VEC co-culture. Aortic VEC, but not VIC, expressed endothelial NO synthase (eNOS) in both porcine and human valves, which was reduced in osteogenic medium. eNOS expression was reduced in calcified human aortic valves in a side-specific manner. Porcine leaflets exposed to the soluble guanylyl cyclase inhibitor ODQ increased osteocalcin and ?-smooth muscle actin expression. Finally, side-specific shear stress applied to porcine aortic valve leaflet endothelial surfaces increased cGMP production in VEC. Valve endothelial-derived NO is a natural inhibitor of the early phases of valve calcification and therefore may be an important regulator of valve homeostasis and pathology. PMID:23499458

Richards, Jennifer; El-Hamamsy, Ismail; Chen, Si; Sarang, Zubair; Sarathchandra, Padmini; Yacoub, Magdi H.; Chester, Adrian H.; Butcher, Jonathan T.

2014-01-01

239

Bicuspid Aortic Valve and Thoracic Aortic Aneurysm: Three Patient Populations, Two Disease Phenotypes, and One Shared Genotype  

PubMed Central

Bicuspid aortic valve (BAV) and thoracic aortic aneurysm (TAA) are two discrete cardiovascular phenotypes characterized by latent progressive disease states. There is a clear association between BAV and TAA; however the nature and extent of this relationship is unclear. There are both distinct and overlapping developmental pathways that have been established to contribute to the formation of the aortic valve and the aortic root, and the mature anatomy of these different tissue types is intimately intertwined. Likewise, human genetics studies have established apparently separate and common contributions to these clinical phenotypes, suggesting complex inheritance and a shared genetic basis and translating 3 patient populations, namely, BAV, TAA, or both, into a common but diverse etiology. A better understanding of the BAV-TAA association will provide an opportunity to leverage molecular information to modify clinical care through more sophisticated diagnostic testing, improved counseling, and ultimately new pharmacologic therapies. PMID:22970404

Hinton, Robert B.

2012-01-01

240

Raman microspectroscopy of human aortic valves: investigation of the local and global biochemical changes associated with calcification in aortic stenosis.  

PubMed

Raman microimaging was applied to study the biochemical composition in the aortic valves obtained from patients with calcific aortic stenosis. This progressive disease affects an increasing number of elderly patients with hyperlipidemia and hypercholesterolemia. Lipid accumulation in the tissue is associated with pathogenesis and progression of cardiac valve calcification. This is in line with our finding that lipid deposits, predominantly composed of cholesterol and its esters, are frequently co-localized with calcium salt deposits, even at an early stage of their development. Overall changes in the biochemical composition of the tissue upon pathology progression are less obvious. Globally, although the cholesterol level rises, the relative lipid-to-protein content decreases. The results broaden the knowledge of biochemical alterations in dysfunctional human aortic valves and may be helpful in designing lipid lowering therapies. PMID:25632409

Czamara, Krzysztof; Natorska, Joanna; Kapusta, Przemys?aw; Baranska, Malgorzata; Kaczor, Agnieszka

2015-03-16

241

Anatomic three-dimensional echocardiographic correlation of bicuspid aortic valve.  

PubMed

This study was undertaken to verify the echocardiographic characteristics of bicuspid aortic valve (AV) using 3-dimensional transesophageal echocardiography by comparing the findings with anatomic examination of autopsy specimens from carriers of this condition. Three-dimensional reconstructions of transesophageal echocardiograms were performed on 14 patients with bicuspid AV, and 20 autopsy specimens of bicuspid AVs were analyzed. Echocardiographic images and autopsy material were correlated. Two variants of bicuspid aorta were identified. In group I the AV had 2 leaflets. This group included 9 (9/14) 3-dimensional echocardiographic studies and 13 (13/20) necropsies. In group II 3 sigmoid leaflets had originally developed and 2 underwent dysplastic fusion, resulting in functionally bicuspid valves. Five (5/14) echocardiographic studies and 7 (7/20) anatomic specimens fell into this category. There was a clear correspondence between anatomic and echocardiographic findings, which leads to the conclusion that 3-dimensional echocardiography is a technique that reliably defines the morphological details of bicuspid AV with the precision of anatomopathologic examination. PMID:12514634

Espinola-Zavaleta, Nilda; Muñoz-Castellanos, Luis; Attié, Fause; Hernández-Morales, Gunther; Zamora-González, Carlos; Dueñas-Carbajal, Roy; Granados, Nuria; Keirns, Candace; Vargas-Barrón, Jesús

2003-01-01

242

Perioperative conduction disturbances after transcatheter aortic valve replacement.  

PubMed

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

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

2013-12-01

243

Atorvastatin inhibits calcification and enhances nitric oxide synthase production in the hypercholesterolaemic aortic valve  

Microsoft Academic Search

Objective: To study in a rabbit model the expression of endothelial nitric oxide synthase (eNOS) in association with the development of calcification of the aortic valve, and to assess the effects of atorvastatin on eNOS expression, nitrite concentration, and aortic valve calcification.Methods: Rabbits (n = 48) were treated for three months: 16, forming a control group, were fed a normal

N M Rajamannan; M Subramaniam; S R Stock; N J Stone; M Springett; K I Ignatiev; J P McConnell; R J Singh; R O Bonow; T C Spelsberg

2005-01-01

244

Quadricuspid aortic valve and single coronary artery in a greater white-toothed shrew, Crocidura russula.  

PubMed

An adult greater white-toothed shrew (Crocidura russula) had both a quadricuspid aortic valve and a single coronary artery arising from the aorta. The shrew was caught on 10 May 1994 in the environs of Málaga, southern Spain. Both congenital anomalies may be potential causes of cardiac dysfunction, but apparently produced no significant cardiac complication in the shrew. This is the first report of a quadricuspid aortic valve in a wild-living mammal. PMID:9359065

Durán, A C

1996-10-01

245

Aorto-right ventricular fistula: a complication of aortic valve replacement.  

PubMed

The occurrence of aorto-right ventricular (aorto-RV) fistula after prosthetic aortic valve replacement is rare. Transthoracic echocardiography (TTE) with color-flow Doppler, transesophageal echocardiography (TEE), or both may be required for diagnosis. A 42-year-old woman sought care for palpitations and dyspnea due to atrial flutter 2 weeks after prosthetic aortic valve replacement and graft replacement of the ascending aorta. TTE and TEE revealed left-to-right shunt due to aorto-RV fistula. PMID:21959192

Najib, Mohammad Q; Ng, Daniel; Vinales, Karyne L; Chaliki, Hari P

2012-01-01

246

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

Microsoft Academic Search

Current methods for assessing the severity of aortic stenosis depend primarily on measures of maximum systolic pressure drop\\u000a at the aortic valve orifice and related calculations such as valve area. It is becoming increasingly obvious, however, that\\u000a the impact of the obstruction on the left ventricle is equally important in assessing its severity and could potentially be\\u000a influenced by geometric

Russell S. Heinrich; Arnold A. Fontaine; Randall Y. Grimes; Aniket Sidhaye; Serena Yang; Kristin E. Moore; Robert A. Levine; Ajit P. Yoganathan

1996-01-01

247

Mini-sternotomy approach for aortic valve replacement in a patient with osteogenesis imperfecta.  

PubMed

Osteogenesis imperfecta (OI) is a heritable disorder of the connective tissue. Cardiovascular involvement is rare, related mainly to aortic valve regurgitation. Open-heart surgery in these patients is associated with increased morbidity and mortality rates as a result of tissue friability and bone brittleness as well as platelet dysfunction. We present a patient with OI who underwent successful aortic valve replacement with a mini-sternotomy approach. PMID:24337243

Dimitrakakis, Georgios; Rathod, Jitendrakumar; von Oppell, Ulrich Otto; Pericleous, Agamemnon; Hutchison, Stephen

2013-01-01

248

Spectral analysis of closing sounds produced by lonescu-Shiley bioprosthetic aortic heart valves  

Microsoft Academic Search

The objective of the paper is to compare the performance of conventional FFT-based and modern parametric methods when extracting,\\u000a from aortic closing sounds produced by lonescu-Shiley bioprosthetic heart valves, three features used in diagnosing valve\\u000a dysfunction. Eight algorithms were tested by adding random noise and truncating 15 simulated aortic closing sounds. The performance\\u000a of each algorithm was evaluated by computing

G. Cloutier; R. Guardo; L.-G. Durand

1987-01-01

249

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

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

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

250

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

E-print Network

of the geometric features such as the diameter, center and orien- tation of the aortic valve annulus (AVA). The method is based on finding an optimal fit for a circular ring mimicking AVA in the aortic root. Moreover, the presented approach provides dynamic tracking of the AVA in CINE MR images. This ap- proach can be used

Deng, Zhigang

251

Aortic Valve Regurgitation that Resolved after a Ruptured Coronary Sinus Aneurysm Was Patched  

PubMed Central

Sinus of Valsalva aneurysms appear to be rare. They occur most frequently in the right sinus of Valsalva (52%) and the noncoronary sinus (33%). More of these aneurysms originate from the right coronary cusp than from the noncoronary cusp. Surgical intervention is usually recommended when symptoms become evident. We report the case of a 34-year-old woman who presented with a congenital, ruptured sinus of Valsalva aneurysm that originated from the noncoronary cusp. Moderate aortic regurgitation was associated with this lesion. Simple, direct patch closure of the ruptured aneurysm resolved the patient's left-to-right shunt and was associated with decreased aortic regurgitation to a degree that valve replacement was not necessary. Only trace residual aortic regurgitation was evident after 3 months, and the patient remained free of symptoms after 6 months. Our observations support the idea that substantial runoff blood flow in the immediate supra-annular region can be responsible for aortic regurgitation in the absence of a notable structural defect in the aortic valve, and that restoring physiologic flow in this region and equalizing aortic-cusp closure pressure can largely or completely resolve aortic insufficiency. Accordingly, valve replacement may not be necessary in all cases of ruptured sinus of Valsalva aneurysms with associated aortic valve regurgitation. PMID:24082388

Nascimbene, Angelo; Joggerst, Steven; Reddy, Kota J.; Cervera, Roberto D.; Ott, David A.; Wilson, James M.; Stainback, Raymond F.

2013-01-01

252

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

E-print Network

Journal of Biomechanics 34 (2001) 1279­1289 A nonlinear anisotropic model for porcine aortic heart of porcine aortic valve leaflet has potentially significant effects on its mechanical behaviour and the failure mechanisms. However, due to its complex nature, testing and modelling the anisotropic porcine

Luo, Xiaoyu

2001-01-01

253

Hemodynamic-Induced Changes in Aortic Valve Area: Implications for Doppler Cardiac Output Determinations  

Microsoft Academic Search

Monitoring cardiac output (CO) by transesophageal echocardiography involves measurements of ascend- ing aortic flow and an initial measurement of aortic valve area (AVA). Hemodynamic-induced changes in AVA are a potential source of error for this simplified method. Our goal was to quantify these changes in AVA and their effects on CO calculations. In 17 anesthe- tized patients, a dobutamine infusion

Pamela E. Gray; Albert C. Perrino

2001-01-01

254

Previous Coronary Artery Bypass Grafting Is Not a Risk Factor for Aortic Valve Replacement  

Microsoft Academic Search

Background. The risk of aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) is controversial. Its magnitude influences the threshold for recommending this procedure and has been cited in arguments regarding the optimal management of mild aortic stenosis at primary CABG. We therefore reviewed our experience with reoperative AVR ± CABG and the primary combined procedure.Methods. Between January

Thoralf M Sundt; Suzan F Murphy; Benico Barzilai; Richard B Schuessler; Eric N Mendeloff; Charles B Huddleston; Michael K Pasque; William A Gay

1997-01-01

255

Pathological anatomy of ventricular septal defect associated with aortic valve prolapse and regurgitation  

Microsoft Academic Search

Summary In an attempt to clarify the pathogenetic morphology of aortic regurgitation (AR) due to prolapse of the aortic valve (prolapsing AR) associated with ventricular septal defect (VSD), 201 specimens from Japanese autopsy series with isolated VSD were examined. Among these hearts, there were 128 cases (64%) of infundibular VSD (IVSD); 29 of them (14%) showed AR due to prolapsed

Masahiko Ando; Atsuyoshi Takao

1986-01-01

256

Receptor activator of nuclear factor ?B ligand and osteoprotegerin regulate aortic valve calcification  

Microsoft Academic Search

Objective. – Recent studies have suggested that valvular calcification in calcific aortic stenosis (AS) may be actively regulated. “Receptor Activator of Nuclear factor ?B Ligand” (RANKL) and osteoprotegerin (OPG) are members of a cytokine system involved in bone turnover and vascular calcification. Their role in calcific AS is not known.Methods and Results. – By immunohistochemistry using human aortic valves, RANKL

Jens J. Kaden; Svetlana Bickelhaupt; Rainer Grobholz; Karl K. Haase; Asl?han Sar?koç; Ref?ka K?l?ç; Martina Brueckmann; Siegfried Lang; Ingrid Zahn; Christian Vahl; Siegfried Hagl; Carl-Erik Dempfle; Martin Borggrefe

2004-01-01

257

Correlation Dimension Analysis of Doppler Signals in Children with Aortic Valve Disorders  

Microsoft Academic Search

In this study, the correlation dimension analysis has been applied to the aortic valve Doppler signals to investigate the\\u000a complexity of the Doppler signals which belong to aortic stenosis (AS) and aortic insufficiency (AI) diseases and healthy\\u000a case. The Doppler signals of 20 healthy subjects, ten AS and ten AI patients were acquired via the Doppler echocardiography\\u000a system that is

Derya Yilmaz; Nihal Fatma Güler

2010-01-01

258

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

PubMed Central

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

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

2014-01-01

259

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

PubMed

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

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

2013-06-21

260

Alternative transarterial access for CoreValve transcatheter aortic bioprosthesis implantation.  

PubMed

Transcatheter aortic valve implantation (TAVI) is used to treat elderly patients with severe aortic stenosis who are considered extremely high-risk surgical candidates. The safety and effectiveness of TAVI have been demonstrated in numerous studies. The self-expanding CoreValve bioprosthesis (Medtronic Inc., Minneapolis, MN, USA) was the first transcatheter aortic valve to be granted the Conformité Européene (CE) mark in May 2007 for retrograde transfemoral implantation. However, TAVI patients are also often affected by severe iliofemoral arteriopathy. In these patients, the retrograde transfemoral approach carries a high risk of vascular injury, making this approach unusable. Alternative arterial access sites, such as the subclavian artery, the ascending aorta, and the carotid artery, have been used for retrograde implantation of the CoreValve bioprosthesis. In the present report, we present the procedural considerations, risks, and benefits of the different types of arterial access used to implant the CoreValve bioprosthesis. PMID:25672856

Bruschi, Giuseppe; De Marco, Federico; Modine, Thomas; Botta, Luca; Colombo, Paola; Mauri, Silvia; Cannata, Aldo; Fratto, Pasquale; Klugmann, Silvio

2015-05-01

261

Endothelial-Derived Oxidative Stress Drives Myofibroblastic Activation and Calcification of the Aortic Valve  

PubMed Central

Aims Oxidative stress is present in and contributes to calcification of the aortic valve, but the driving factors behind the initiation of valve oxidative stress are not well understood. We tested whether the valve endothelium acts as an initiator and propagator of oxidative stress in aortic valve disease. Methods and Results Calcified human aortic valves showed side-specific elevation of superoxide in the endothelium, co-localized with high VCAM1 expression, linking oxidative stress, inflammation, and valve degeneration. Treatment with inflammatory cytokine TNF? increased superoxide and oxidative stress and decreased eNOS and VE-cadherin acutely over 48 hours in aortic valve endothelial cells (VEC) and chronically over 21 days in ex vivo AV leaflets. Co-treatment of VEC with tetrahydrobiopterin (BH4) but not apocynin mitigated TNF?-driven VEC oxidative stress. Co-treatment of ex vivo AV leaflets with TNF?+BH4 or TNF?+peg-SOD rescued endothelial function and mitigated inflammatory responses. Both BH4 and peg-SOD rescued valve leaflets from the pro-osteogenic effects of TNF? treatment, but only peg-SOD was able to mitigate the fibrogenic effects, including increased collagen and ?SMA expression. Conclusions Aortic valve endothelial cells are a novel source of oxidative stress in aortic valve disease. TNF?-driven VEC oxidative stress causes loss of endothelial protective function, chronic inflammation, and fibrogenic and osteogenic activation, mitigated differentially by BH4 and peg-SOD. These mechanisms identify new targets for tailored antioxidant therapy focused on mitigation of oxidative stress and restoration of endothelial protection. PMID:25874717

Farrar, Emily J.; Huntley, Geoffrey D.; Butcher, Jonathan

2015-01-01

262

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

PubMed Central

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

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

2013-01-01

263

Early and late results of aortic valve replacement. A series of 510 patients.  

PubMed

Aortic valve replacement was performed in 510 patients (Björk-Shiley valves in 93%), with concomitant surgical procedures in 146 cases. The patients were grouped according to technique of myocardial protection: Group I (n = 98) selective coronary perfusion, group II (n = 82) topical cooling, and group III (n = 330) cold crystalloid cardioplegia and topical cooling. The early mortality rate was 5.7% overall: Among patients with isolated aortic valve replacement in groups I, II and III it was 8.4, 1.7 and 1.3%, respectively, and among those with additional surgery 40.0, 12.5 and 8.4%. Myocardial infarction and low cardiac output were responsible for 65.5% of the early deaths. Follow-up ranged from 2 months to 16 11/12 years, totalling 2,859 patient years. In patients with isolated aortic valve replacement and Björk-Shiley prosthesis, the incidence of valve-related late complications/100 patient years was 0.49 for thromboembolism, 0.82 for anticoagulant-related haemorrhage and 0.49 for prosthetic valve endocarditis. There was no thrombotic encapsulation in aortic position. Survival at 5 and 10 years was 83% and 72%. Aortic valve replacement is a safe procedure and concomitant operations do not unreasonably increase risks. PMID:1947905

Janatuinen, M J; Vänttinen, E A; Rantakokko, V; Inberg, M V

1991-01-01

264

Unraveling Divergent Gene Expression Profiles in Bicuspid and Tricuspid Aortic Valve Patients with Thoracic Aortic Dilatation: The ASAP Study  

PubMed Central

Thoracic aortic aneurysm (TAA) is a common complication in patients with a bicuspid aortic valve (BAV), the most frequent congenital heart disorder. For unknown reasons TAA occurs at a younger age, with a higher frequency in BAV patients than in patients with a tricuspid aortic valve (TAV), resulting in an increased risk for aortic dissection and rupture. To investigate the increased TAA incidence in BAV patients, we obtained tissue biopsy samples from nondilated and dilated aortas of 131 BAV and TAV patients. Global gene expression profiles were analyzed from controls and from aortic intima-media and adventitia of patients (in total 345 samples). Of the genes found to be differentially expressed with dilation, only a few (<4%) were differentially expressed in both BAV and TAV patients. With the use of gene set enrichment analysis, the cell adhesion and extracellular region gene ontology sets were identified as common features of TAA in both BAV and TAV patients. Immune response genes were observed to be particularly overexpressed in the aortic media of dilated TAV samples. The divergent gene expression profiles indicate that there are fundamental differences in TAA etiology in BAV and TAV patients. Immune response activation solely in the aortic media of TAV patients suggests that inflammation is involved in TAA formation in TAV but not in BAV patients. Conversely, genes were identified that were only differentially expressed with dilation in BAV patients. The result has bearing on future clinical studies in which separate analysis of BAV and TAV patients is recommended. PMID:21968790

Folkersen, Lasse; Wågsäter, Dick; Paloschi, Valentina; Jackson, Veronica; Petrini, Johan; Kurtovic, Sanela; Maleki, Shohreh; Eriksson, Maria J; Caidahl, Kenneth; Hamsten, Anders; Michel, Jean-Baptiste; Liska, Jan; Gabrielsen, Anders; Franco-Cereceda, Anders; Eriksson, Per

2011-01-01

265

Cubic Hermite Bezier spline based reconstruction of implanted aortic valve stents from CT images.  

PubMed

Mechanical forces and strain induced by transcatheter aortic valve implantation are usually named as origins for postoperative left ventricular arrhythmia associated with the technique. No quantitative data has been published so far to substantiate this common belief. As a first step towards quantitative analysis of the biomechanic situation at the aortic root after transapical aortic valve implantation, we present a spline-based method for reconstruction of the implanted stent from CT images and for locally measuring the deformation of the stent. PMID:22254890

Gessat, Michael; Altwegg, Lukas; Frauenfelder, Thomas; Plass, André; Falk, Volkmar

2011-01-01

266

Transapical transcatheter aortic valve implantation in a heart transplant recipient with severely depressed left ventricular function  

PubMed Central

Transcatheter aortic valve implantation (TAVI) is becoming a valuable alternative to surgical aortic valve replacement in non-operable and high-risk surgical patients. As the population of heart donors and recipients ages, the prevalence of degenerative valvular disease after transplantation will increase. The optimal treatment strategy of valvulopathies in these patients with extensive comorbidity is still unknown because of insufficient published experience. We present a heart transplant recipient with renal failure, systolic heart failure and severe aortic stenosis who was successfully treated with transapical TAVI. PMID:23460597

De Praetere, Herbert; Ciarka, Agnieszka; Dubois, Christophe; Herijgers, Paul

2013-01-01

267

[Diagnostic value of mitral and septal echocardiographic changes in aortic valve insufficiency].  

PubMed

116 patients with aortic regurgitation of different severity with and without associated valvular lesions were studied with echocardiography. In all cases the diagnosis was proven by cardiac catheterisation. Typical fluttering of the anterior mitral valve leaflet and the interventricular septum were oftener observed with increasing degree of severity of aortic regurgitation. An associated fluttering of the posterior mitral valve leaflet is described. This is seen with increasing severity of the valvular lesion and in more than 90% of patients with severe aortic regurgitation as it is observed with the anterior mitral leaflet. An isolated fluttering of the interventricular septum was observed in two cases and is also regarded as a specific finding in aortic regurgitation. There was a significant higher pulse pressure in patients with fluttering of the anterior mitral leaflet and/or the interventricular septum than in those cases without fluttering. Fluttering of mitral leaflets in aortic regurgitation was seen even in patients with additional mitral stenosis with and without calcification and after commissurotomy. A premature mitral valve closure was noted in one of 93 cases, an incomplete diastolic aortic valve closure in 29 of 78 cases. The diastolic diameter of the aortic root was mildly increased in 17 patients with pure aortic regurgitation. In 8 patients, mostly with severe aortic regurgitation, the E-F-Slope of the anterior mitral leaflet ranged between 120 and 160 mm/sec. The presented findings do not allow a conclusion regarding the severity of aortic regurgitation. However, they do allow the echocardiographic diagnosis of aortic regurgitation with a high degree of accuracy, in particular in cases of fluttering. PMID:960975

Daniel, W; Walpurger, G; Lichtlen, P

1976-07-01

268

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

PubMed

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

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

269

Minimally invasive aortic valve replacement: 12-year single center experience  

PubMed Central

Background This study reports the single center experience on minimally invasive aortic valve replacement (MIAVR), performed through a right anterior minithoracotomy or ministernotomy (MS). Methods Eight hundred and fifty-three patients, who underwent MIAVR from 2002 to 2014, were retrospectively analyzed. Survival was evaluated using the Kaplan-Meier method. The Cox multivariable proportional hazards regression model was developed to identify independent predictors of follow-up mortality. Results Median age was 73.8, and 405 (47.5%) of patients were female. The overall 30-day mortality was 1.9%. Four hundred and forty-three (51.9%) and 368 (43.1%) patients received biological and sutureless prostheses, respectively. Median cardiopulmonary bypass time and aortic cross-clamping time were 108 and 75 minutes, respectively. Nineteen (2.2%) cases required conversion to full median sternotomy. Thirty-seven (4.3%) patients required re-exploration for bleeding. Perioperative stroke occurred in 15 (1.8%) patients, while transient ischemic attack occurred postoperative in 11 (1.3%). New onset atrial fibrillation was reported for 243 (28.5%) patients. After a median follow-up of 29.1 months (2,676.0 patient-years), survival rates at 1 and 5 years were 96%±1% and 80%±3%, respectively. Cox multivariable analysis showed that advanced age, history of cardiac arrhythmia, preoperative chronic renal failure, MS approach, prolonged mechanical ventilation and hospital stay as well as wound revision were associated with higher mortality. Conclusions MIAVR via both approaches is safe and feasible with excellent outcomes, and is associated with low conversion rate and low perioperative morbidity. Long term survival is at least comparable to that reported for conventional sternotomy AVR.

Solinas, Marco; Farneti, Pier Andrea; Cerillo, Alfredo Giuseppe; Kallushi, Enkel; Santarelli, Filippo; Glauber, Mattia

2015-01-01

270

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

PubMed Central

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

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

2013-01-01

271

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

PubMed Central

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

Ganeshan, Arul

2014-01-01

272

Rate of Change in Aortic Valve Area During a Cardiac Cycle Can Predict the Rate of Hemodynamic Progression of Aortic Stenosis  

Microsoft Academic Search

Background—The ability to predict the rate of hemodynamic progression in an individual patient with valvular aortic stenosis has been elusive. The purpose of the present study was to evaluate whether the rate of change in aortic valve area (AVA) measured during the ejection phase of a cardiac cycle predicts the rate of hemodynamic progression in patients with asymptomatic aortic stenosis.

Steven J. Lester; Doff B. McElhinney; Joseph P. Miller; Juergen T. Lutz; Catherine M. Otto; Rita F. Redberg

2010-01-01

273

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

PubMed Central

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

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

2015-01-01

274

Linear Closure of the Left Ventricular Apex Following Transcatheter-Based Aortic Valve Implantation.  

PubMed

Transcatheter-based aortic valve implantation (TAVI) provides a reliable and attractive alternative to the established gold standard of classic aortic valve replacement in patients with severe comorbidities carrying an unacceptably high perioperative risk. Despite the minimally invasive nature of the transfemoral approach, the transapical route remains an attractive alternative allowing antegrade valve deployment. Purse-string sutures with interrupted Teflon pledgets represent the classic approach for secure closure of the transapical access site. We describe herein a simple yet effective and time-saving linear technique for apical closure following transapical TAVI. PMID:25251669

Sipahi, Nihat Firat; Papadopoulos, Nestoras; Moritz, Anton; Zierer, Andreas

2014-09-24

275

Falsely elevated valve gradients by echocardiography in the 3f aortic bioprosthesis.  

PubMed

The 3f Aortic Bioprosthesis (Medtronic, Inc, Minneapolis, MN) is a stentless aortic valve with a novel design that resembles a "tube within a tube." Although it has the potential for improved durability and hemodynamic performance, long-term data on this valve remain elusive. We present here 3 patients in whom postoperative echocardiography revealed significantly elevated transvalvular gradients of the 3f valve while transcatheter gradients proved to be negligible. By virtue of the unique design of the 3f bioprosthesis, great caution should be taken when interpreting echocardiographically derived gradients. PMID:23816086

Leung Wai Sang, Stephane; Samoukovic, Gordan; Buithieu, Jean; de Varennes, Benoit

2013-07-01

276

Interlayer micromechanics of the aortic heart valve leaflet.  

PubMed

While the mechanical behaviors of the fibrosa and ventricularis layers of the aortic valve (AV) leaflet are understood, little information exists on their mechanical interactions mediated by the GAG-rich central spongiosa layer. Parametric simulations of the interlayer interactions of the AV leaflets in flexure utilized a tri-layered finite element (FE) model of circumferentially oriented tissue sections to investigate inter-layer sliding hypothesized to occur. Simulation results indicated that the leaflet tissue functions as a tightly bonded structure when the spongiosa effective modulus was at least 25 % that of the fibrosa and ventricularis layers. Novel studies that directly measured transmural strain in flexure of AV leaflet tissue specimens validated these findings. Interestingly, a smooth transmural strain distribution indicated that the layers of the leaflet indeed act as a bonded unit, consistent with our previous observations (Stella and Sacks in J Biomech Eng 129:757-766, 2007) of a large number of transverse collagen fibers interconnecting the fibrosa and ventricularis layers. Additionally, when the tri-layered FE model was refined to match the transmural deformations, a layer-specific bimodular material model (resulting in four total moduli) accurately matched the transmural strain and moment-curvature relations simultaneously. Collectively, these results provide evidence, contrary to previous assumptions, that the valve layers function as a bonded structure in the low-strain flexure deformation mode. Most likely, this results directly from the transverse collagen fibers that bind the layers together to disable physical sliding and maintain layer residual stresses. Further, the spongiosa may function as a general dampening layer while the AV leaflets deforms as a homogenous structure despite its heterogeneous architecture. PMID:24292631

Buchanan, Rachel M; Sacks, Michael S

2014-08-01

277

Outcomes of surgical aortic valve replacement: the benchmark for percutaneous therapies.  

PubMed

Historically, many patients with severe senile calcific aortic valve stenosis (AS) were not offered surgery, largely due to the perception that the risks of operation were prohibitive. Such patients have subsequently been formally designated as 'high risk' or 'inoperable' with respect to their suitability for surgical aortic valve replacement (SAVR) in the evolving lexicon of heart valve disease. The recent availability of transcatheter aortic valve replacement (TAVR) represents an alternative treatment option, and permits the opportunity to re-examine algorithms for assessing operative risk. As the experience with TAVR grows, expanded use in new patient populations can be anticipated. While TAVR in high risk AS patients has demonstrated benefits, the emerging indication in intermediate AS is less clear and conclusions will necessarily await the availability of results from ongoing clinical trials. This article will discuss current outcomes for SAVR among high- and intermediate-risk patients with AS as a barometer in assessing the results of nascent percutaneous therapies. PMID:24838137

Bajona, Pietro; Suri, Rakesh M; Greason, Kevin L; Schaff, Hartzell V

2014-01-01

278

Donor-specific immune response after aortic valve allografting in the rat.  

PubMed

The allospecific immune response in rats to a major histocompatibility complex-disparate aortic valve allograft was investigated using three in vitro assays. In each assay, DA strain (RT-1a) rats served as allograft recipient and syngeneic donor, Lewis strain (RT-1l) rats were allogeneic donors, and Buffalo (RT-1b) rats provided third-party control cells. Mixed lymphocyte cultures using spleen cells demonstrated donor-specific stimulation indices of 3.04 +/- 0.44, 4.14 +/- 0.62, and 6.32 +/- 0.60 at 7, 14, and 28 days, respectively, after aortic valve allografting; 8.19 +/- 2.91, 8.51 +/- 1.25, and 10.80 +/- 0.53 after skin allografting; and 1.84 +/- 0.56, 1.82 +/- 0.38, and 1.82 +/- 0.53 after aortic valve isografting. Limiting dilution analysis of splenocytes showed a donor-specific cytotoxic T lymphocyte precursor frequency at 7, 14, and 28 days of 1:6,853, 1:4,714, and 1:1,964 after aortic valve allografting; 1:4,181, 1:1,611, and 1:1,018 after skin allografting; and 1:14,517, 1:11,882, and 1:10,995 after aortic valve isografting. Flow cytometry detected an increase in the level of donor-specific anti-T cell antibodies in both valve and skin allograft recipients but not in isografted animals. Aortic valve allografting from Lewis into DA rats elicits allospecific cellular and humoral immune responses similar in magnitude to skin allografting but somewhat slower in onset. Investigation of the immune response to aortic allografts in humans is warranted, as donor-specific T cells, antibodies, or both may damage the allograft. PMID:8179379

Zhao, X M; Green, M; Frazer, I H; Hogan, P; O'Brien, M F

1994-05-01

279

Analysis of Extracellular Superoxide Dismutase and Akt in Ascending Aortic Aneurysm With Tricuspid or Bicuspid Aortic Valve  

PubMed Central

Ascending aortic aneurysm (AsAA) is a consequence of medial degeneration (MD), deriving from apoptotic loss of smooth muscle cells (SMC) and fragmentation of elastin and collagen fibers. Alterations of extracellular matrix structure and protein composition, typical of medial degeneration, can modulate intracellular pathways. In this study we examined the relevance of extracellular superoxide dismutase (SOD3) and Akt in AsAA pathogenesis, evaluating their tissue distribution and protein levels in ascending aortic tissues from controls (n=6), patients affected by AsAA associated to tricuspid aortic valve (TAV, n=9) or bicuspid aortic valve (BAV, n=9). The results showed a significant reduction of SOD3, phospho-Akt and Akt protein levels in AsAA tissues from patients with BAV, compared to controls, whereas the differences observed between controls and patients with TAV were not significant. The decreased levels of SOD3 and Akt in BAV aortic tissues are associated with decreased Erk1/Erk2 phosphorylation and MMP-9 levels increase. The authors suggest a role of decreased SOD3 protein levels in the progression of AsAA with BAV and a link between ECM modifications of aortic media layer and impaired Erk1/Erk2 and Akt signaling in the late stages of the aortopathy associated with BAV. PMID:25308842

Arcucci, A.; Ruocco, M.R.; Albano, F.; Granato, G.; Romano, V.; Corso, G.; Bancone, C.; De Vendittis, E.; Corte, A. Della

2014-01-01

280

Comparison of results of transcatheter aortic valve implantation in patients with severely stenotic bicuspid versus tricuspid or nonbicuspid valves.  

PubMed

Data on transcatheter aortic valve implantation (TAVI) for severe bicuspid aortic valve (BAV) stenosis and how this compares to that for tricuspid aortic valve (TAV) stenosis are limited. Twenty-one consecutive patients with BAV were treated with the Edwards or CoreValve bioprosthesis from November 2007 to December 2012 at San Raffaele Scientific Institute and Clinical Institute S. Ambrogio, Milan, Italy. Results were compared with a cohort of patients with TAV (n=447) treated with the same bioprostheses over the same period. Procedural 1- and 12-month outcomes were examined as defined by the Valve Academic Research Consortium criteria. Patients with BAV were younger (76.7±7.1 vs 79.8±7.4 years, p=0.06) and with a larger aortic annulus (25.0±1.8 vs 23.6±2.1 mm, p=0.01). Device success (85.7% vs 94.4%, p=0.10) was lower in patients with BAV. Although the 30-day composite safety end point (23.8% vs 21.0%, p=0.76) was similar between the 2 groups, mortality rate at 30 days was higher (14.2% vs 3.6%, p=0.02) in the BAV group. Cardiovascular mortality at 1 year did not differ significantly between the 2 groups (10.5% vs 7.4%, p=0.62). In conclusion, transcatheter aortic valve implantation in high surgical risk patients with severe BAV stenosis appears to be feasible with mid-term cardiovascular mortality similar to that for patients with TAV. Early survival and device success, however, were lower for patients with BAV demonstrating that further studies are required to identify which subset of patients with BAV is best suited for transcatheter treatment. PMID:24581922

Costopoulos, Charis; Latib, Azeem; Maisano, Francesco; Testa, Luca; Bedogni, Francesco; Buchanan, Louise; Naganuma, Toru; Sticchi, Alessandro; Sato, Katsumasa; Miyazaki, Tadashi; Figini, Filippo; Giannini, Francesco; Taramasso, Maurizio; Naim, Charbel; Carlino, Mauro; Chieffo, Alaide; Montorfano, Matteo; Alfieri, Ottavio; Colombo, Antonio

2014-04-15

281

Dynamic Energy Loss Characteristics in the Native Aortic Valve  

NASA Astrophysics Data System (ADS)

Aortic Valve (AV) stenosis if untreated leads to heart failure. From a mechanics standpoint, heart failure implies failure to generate sufficient mechanical power to overcome energy losses in the circulation. Thus energy efficiency-based measures are direct measures of AV disease severity, which unfortunately is not used in current clinical measures of stenosis severity. We present an analysis of the dynamic rate of energy dissipation through the AV from direct high temporal resolution measurements of flow and pressure drop across the AV in a pulsatile left heart setup. Porcine AV was used and measurements at various conditions were acquired: varying stroke volumes; heart rates; and stenosis levels. Energy dissipation waveform has a distinctive pattern of being skewed towards late systole, attributed to the explosive growth of flow instabilities from adverse pressure gradient. Increasing heart rate and stroke volume increases energy dissipation, but does not alter the normalized shape of the dissipation temporal profile. Stenosis increases energy dissipation and also alters the normalized shape of dissipation waveform with significantly more losses during late acceleration phase. Since stenosis produces a departure from the signature dissipation waveform shape, dynamic energy dissipation analysis can be extended into a clinical tool for AV evaluation.

Hwai Yap, Choon; Dasi, Laksmi P.; Yoganathan, Ajit P.

2009-11-01

282

Genetically alike Syrian hamsters display both bifoliate and trifoliate aortic valves  

PubMed Central

The bifoliate, or bicuspid, aortic valve (BAV) is the most frequent congenital cardiac anomaly in man. It is a heritable defect, but its mode of inheritance remains unclear. Previous studies in Syrian hamsters showed that BAVs with fusion of the right and left coronary leaflets are expressions of a trait, the variation of which takes the form of a phenotypic continuum. It ranges from a trifoliate valve with no fusion of the coronary leaflets to a bifoliate root devoid of any raphe. The intermediate stages are represented by trifoliate valves with fusion of the coronary aortic leaflets, and bifoliate valves with raphes. The aim of this study was to elucidate whether the distinct morphological variants rely on a common genotype, or on different genotypes. We examined the aortic valves from 1 849 Syrian hamsters belonging to a family subjected to systematic inbreeding by full-sib mating. The incidence of the different trifoliate aortic valve (TAV) and bifoliate aortic valve (BAV) morphological variants widely varied in the successive inbred generations. TAVs with extensive fusion of the leaflets, and BAVs, accounted for five-sixths of the patterns found in Syrian hamsters considered to be genetically alike or virtually isogenic, with the probability of homozygosity being 0.999 or higher. The remaining one-sixth hamsters had aortic valves with a tricuspid design, but in most cases the right and left coronary leaflets were slightly fused. Results of crosses between genetically alike hamsters, with the probability of homozygosity being 0.989 or higher, revealed no significant association between the valvar phenotypes in the parents and their offspring. Our findings are consistent with the notion that the BAVs of the Syrian hamster are expressions of a quantitative trait subject to polygenic inheritance. They suggest that the genotype of the virtually isogenic animals produced by systematic inbreeding greatly predisposes to the development of anomalous valves, be they bifoliate, or trifoliate with extensive fusion of the leaflets. We infer that the same underlying genotype may account for the whole range of valvar morphological variants, suggesting that factors other than genetic ones are acting during embryonic life, creating the so-called intangible variation or developmental noise, and playing an important role in the definitive anatomic configuration of the valve. The clinical implication from our study is that congenital aortic valves with a trifoliate design, but with fusion of coronary aortic leaflets, may harbour the same inherent risks as those already recognised for BAVs with fusion of right and left coronary leaflets. PMID:22034929

Sans-Coma, Valentín; Fernández, M Carmen; Fernández, Borja; Durán, Ana C; Anderson, Robert H; Arqué, Josep M

2012-01-01

283

Comparison of the effectiveness of transcatheter aortic valve implantation in patients with stenotic bicuspid versus tricuspid aortic valves (from the German TAVI Registry).  

PubMed

Patients with bicuspid aortic valves (BAVs) are considered a relative contraindication to transcatheter aortic valve implantation (TAVI). One of the main reasons is the presumed risk for residual aortic regurgitation (AR). However, case reports and small case series have suggested that TAVI can be successfully performed with acceptable clinical outcomes in high-risk patients with BAV. Within the large German TAVI Registry, we sought to evaluate TAVI in older high-risk patients with BAV. From January 2009 to June 2010, a total of 1,424 patients with severe aortic stenosis undergoing TAVI were prospectively enrolled into the German TAVI Registry. For the present analysis, patients with valve-in-valve procedures were excluded and those with BAV (n = 38, 3%) were compared with those with tricuspid aortic valve (TAV; n = 1357, 97%). Patient characteristics did not markedly differ and procedural success was very high in both groups. There was a higher rate of relevant AR (?II) after TAVI among patients with BAV (25 vs 15%, p = 0.05), whereas pacemakers were more often implanted in patients with TAV (17% vs 35%, p = 0.02). Thirty-day mortality rate was similar in both cohorts (11% vs 11%). In a Cox proportional regression analysis, BAV was not associated with higher 1-year mortality rate (hazard ratio 0.64, 95% confidence interval 0.29 to 1.41). In selected patients with BAV, TAVI can be performed with a satisfactory clinical result. Although the risk for relevant AR seems to be greater among patients with BAV, 30-day and 1-year mortality rates were not elevated compared with patients with TAV. PMID:24342758

Bauer, Timm; Linke, Axel; Sievert, Horst; Kahlert, Philipp; Hambrecht, Rainer; Nickenig, Georg; Hauptmann, Karl Eugen; Sack, Stefan; Gerckens, Ulrich; Schneider, Steffen; Zeymer, Uwe; Zahn, Ralf

2014-02-01

284

Ministernotomy for aortic valve replacement: a study of the preliminary experience  

PubMed Central

Objective The aim of the study was to evaluate the technical feasibility and the postoperative course of aortic valve replacement through a ministernotomy. Setting The Montreal Heart Institute and the Hôpital Lariboisière, Paris, France. Design A case series from 2 institutions. Patients Fifty-one patients who underwent aortic valve replacement through a ministernotomy. The sternal incision was started at the level of the sternal notch extending down to the third or fourth intercostal space with a transverse section of the sternum at this level on both sides or limited to the right side (inverted T or L incision). Thirty-nine patients had aortic stenoses, 6 patients were operated for aortic insufficiency and 6 had mixed disease. The mean (and standard deviation) preoperative left ventricular ejection fraction was 0.56 (0.17). Main outcome measures Cardiac bypass time, complications and outcome. Results The patients received Carbomedics and St. Jude mechanical valves, Hancock and Carpentier–Edwards bioprostheses. Thirty-eight patients were administered antegrade and retrograde cardioplegia, 10 patients ante-grade and 3 retrograde blood cardioplegia only. The mean (and standard error) cardiopulmonary bypass time and aortic cross-clamp time were 104 (38) minutes and 72 (16) minutes respectively. Two patients (4%) died and 2 patients (4%) showed evidence of a stroke after the procedure. Hospital stay averaged 8 (5) days. Conclusion We conclude that aortic valve replacement can be done through a ministernotomy approach with perioperative results similar to those obtained through a conventional sternotomy. PMID:10714256

Bouchard, Denis; Perrault, Louis P.; Carrier, Michel; Ménasché, Philippe; Bel, Alain; Pelletier, L. Conrad

2000-01-01

285

Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An overview  

PubMed Central

Although a small percentage of patients with critical aortic stenosis do not develop left ventricle hypertrophy, increased ventricular mass is widely observed in conditions of increased afterload. There is growing epidemiological evidence that hypertrophy is associated with excess cardiac mortality and morbidity not only in patients with arterial hypertension, but also in those undergoing aortic valve replacement. Valve replacement surgery relieves the aortic obstruction and prolongs the life of many patients, but favorable or adverse left ventricular remodeling is affected by a large number of factors whose specific roles are still a subject of debate. Age, gender, hemodynamic factors, prosthetic valve types, myocyte alterations, interstitial structures, blood pressure control and ethnicity can all influence the process of left ventricle mass regression, and myocardial metabolism and coronary artery circulation are also involved in the changes occurring after aortic valve replacement. The aim of this overview is to analyze these factors in the light of our experience, elucidate the important question of prosthesis-patient mismatch by considering the method of effective orifice area, and discuss surgical timings and techniques that can improve the management of patients with aortic valve stenosis and maximize the probability of mass regression. PMID:16803632

Villa, Emmanuel; Troise, Giovanni; Cirillo, Marco; Brunelli, Federico; Tomba, Margherita Dalla; Mhagna, Zen; Tasca, Giordano; Quaini, Eugenio

2006-01-01

286

Anesthetic management for percutaneous aortic valve implantation: an overview of worldwide experiences.  

PubMed

Transcatheter aortic valve implantation is an emergent technique for high risk patients with aortic stenosis. Transcatheter aortic valve implantation poses significant challenges about its management, due to the procedure itself (i.e. the passage of large stiff sheaths in diseased vessels, the valve dilatation and the prosthesis positioning during a partial cardiac standstill) and the population of elder and high-risk patients who undergo the implantation. Retrograde transfemoral approach is the most popular procedure and a great number of cases is reported. Nevertheless, there is not a consensus regarding the intraoperative anesthesiological strategies, which vary in the different Centers. Sedation plus local anesthesia or general anesthesia are both valid alternatives and can be applied according to patient's characteristics and procedural instances. Most groups started the implantation program with a general anesthesia; indeed, it offers many advantages, mainly regarding the possibility of an early diagnosis and treatment of potential complications, through the use of the transesophageal echocardiography. However, after the initial experiences, many groups began to employ routinely sedation plus local anesthesia for transcatheter aortic valve implantation and their procedural and periprocedural success demonstrates that it is feasible, with many possible advantages. Many aspects about perioperative anesthetic management for transcatheter aortic valve implantation are still to be defined. Aim of this work is to clarify the different management strategies through a review of the available literature published in pubmed till June 2011. PMID:23440259

Ruggeri, L; Gerli, C; Franco, A; Barile, L; Magnano di San Lio, M S; Villari, N; Zangrillo, A

2012-01-01

287

Real-time imaging required for optimal echocardiographic assessment of aortic valve calcification  

PubMed Central

Introduction Aortic valve calcification (AVC), even without haemodynamic significance, may be prognostically import as an expression of generalized atherosclerosis, but techniques for echocardiographic assessment are essentially unexplored. Methods Two-dimensional (2D) echocardiographic recordings (Philips IE33) of the aortic valve in short-axis and long-axis views were performed in 185 consecutive patients within 1 week before surgery for aortic stenosis (n = 109, AS), aortic regurgitation (n = 61, AR), their combination (n = 8) or dilation of the ascending aorta (n = 7). The grey scale mean (GSMn) of the aortic valve in an end-diastolic short-axis still frame was measured. The same frame was scored visually 1–5 as indicating that the aortic valve was normal, thick, or had mild, moderate or severe calcification. The visual echodensity of each leaflet was determined real time applying the same 5-grade scoring system for each leaflet, and the average for the whole valve was calculated. Finally, a similar calcification score for the whole valve based on inspection and palpation by the surgeon was noted. Results Visual assessment of real-time images using the proposed scoring system showed better correlation with the surgical evaluation of the degree of valve calcification (r = 0·83, P<0·001) compared to evaluation of stop frames by visual assessment (r = 0·66, P<0·001) or the GSMn score (r = 0·64, P<0·001). High inter- and intra-observer correlations were observed for real-time visual score (both intraclass correlation coefficient = 0·93). Conclusion Real-time evaluation of the level of AVC is superior to using stop frames assessed either visually or by dedicated computer grey scale measurement software. PMID:23031068

Yousry, Mohamed; Rickenlund, Anette; Petrini, Johan; Gustavsson, Tomas; Prahl, Ulrica; Liska, Jan; Eriksson, Per; Franco-Cereceda, Anders; Eriksson, Maria J; Caidahl, Kenneth

2012-01-01

288

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

PubMed

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

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

289

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

PubMed Central

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

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

2013-01-01

290

Aortic valve disease and treatment: the need for naturally engineered solutions.  

PubMed

The aortic valve regulates unidirectional flow of oxygenated blood to the myocardium and arterial system. The natural anatomical geometry and microstructural complexity ensures biomechanically and hemodynamically efficient function. The compliant cusps are populated with unique cell phenotypes that continually remodel tissue for long-term durability within an extremely demanding mechanical environment. Alteration from normal valve homeostasis arises from genetic and microenvironmental (mechanical) sources, which lead to congenital and/or premature structural degeneration. Aortic valve stenosis pathobiology shares some features of atherosclerosis, but its final calcification endpoint is distinct. Despite its broad and significant clinical significance, very little is known about the mechanisms of normal valve mechanobiology and mechanisms of disease. This is reflected in the paucity of predictive diagnostic tools, early stage interventional strategies, and stagnation in regenerative medicine innovation. Tissue engineering has unique potential for aortic valve disease therapy, but overcoming current design pitfalls will require even more multidisciplinary effort. This review summarizes the latest advancements in aortic valve research and highlights important future directions. PMID:21281685

Butcher, Jonathan T; Mahler, Gretchen J; Hockaday, Laura A

2011-04-30

291

Spatial heterogeneity of endothelial phenotypes correlates with side-specific vulnerability to calcification in normal porcine aortic valves.  

PubMed

Calcific aortic valve sclerosis involves inflammatory processes and occurs preferentially on the aortic side of endothelialized valve leaflets. Although the endothelium is recognized to play critical roles in focal vascular sclerosis, the contributions of valvular endothelial phenotypes to aortic valve sclerosis and side-specific susceptibility to calcification are poorly understood. Using RNA amplification and cDNA microarrays, we identified 584 genes as differentially expressed in situ by the endothelium on the aortic side versus ventricular side of normal adult pig aortic valves. These differential transcriptional profiles, representative of the steady state in vivo, identify globally distinct endothelial phenotypes on opposite sides of the aortic valve. Several over-represented biological classifications with putative relevance to endothelial regulation of valvular homeostasis and aortic-side vulnerability to calcification were identified among the differentially expressed genes. Of note, multiple inhibitors of cardiovascular calcification were significantly less expressed by endothelium on the disease-prone aortic side of the valve, suggesting side-specific permissiveness to calcification. However, coexisting putative protective mechanisms were also expressed. Specifically, enhanced antioxidative gene expression and the lack of differential expression of proinflammatory molecules on the aortic side may protect against inflammation and lesion initiation in the normal valve. These data implicate the endothelium in regulating valvular calcification and suggest that spatial heterogeneity of valvular endothelial phenotypes may contribute to the focal susceptibility for lesion development. PMID:15761200

Simmons, Craig A; Grant, Gregory R; Manduchi, Elisabetta; Davies, Peter F

2005-04-15

292

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

PubMed Central

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

2013-01-01

293

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

PubMed Central

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

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

2014-01-01

294

Elective use of intra-aortic balloon pump during aortic valve replacement in elderly patients to reduce postoperative cardiac complications.  

PubMed

This is a retrospective cohort study to determine if routine intra-aortic balloon pump (IABP) placement prior to aortic valve replacement in elderly patients with severe aortic stenosis without significant coronary artery stenosis reduces cardiac complications. Participants were patients aged ?70 years without significant coronary stenosis, who had severe aortic stenosis, and were undergoing isolated aortic valve replacement. Our primary endpoint was postoperative cardiac morbidity rate as a composite of the adverse cardiac events: elevated creatine kinase with muscle and brain subunits (CK-MB)/CK (>5%), fatal ventricular arrhythmias requiring therapy, or catecholamine index of >10. Eighteen patients had elective IABP insertion prior to surgery, and 16 patients had no planned IABP insertion. One patient died (5.6%) in the elective IABP group (P?=?1.0 compared with the non-IABP group). The overall rate of in-hospital death was 2.9% (1/34). In the non-IABP group, one patient had rescue IABP insertion after surgery (6.3%). The elective IABP group had a significantly lower cardiac morbidity rate than the non-IABP group (44.4 vs. 87.5%, respectively, P?=?0.013). According to multivariate analysis using a logistic European system for cardiac operative risk evaluation value of >10% to define increased morbidity, elective IABP use significantly reduced cardiac morbidity (odds ratio, 0.11; 95% confidence interval, 0.02-0.67; P?=?0.016). Additionally, the elective IABP group was more likely to show low CK-MB/CK than the non-IABP group (4.1?±?1.9% vs. 6.1?±?3.1%, respectively, P?=?0.026). We concluded that among elderly aortic valve replacement patients without significant coronary artery stenosis, elective IABP use may reduce the incidence of major adverse cardiac events. PMID:24256099

Nakahira, Junko; Sawai, Toshiyuki; Minami, Toshiaki

2014-06-01

295

Positive correlation between aortic valve pressure gradient and mitochondrial respiratory chain capacity in hypertrophied human left ventricle  

Microsoft Academic Search

The effect of chronic left ventricular pressure overload on the activities of mitochondrial respiratory chain enzymes was investigated in myocardial biopsies from the left ventricular apex of 13 patients undergoing aortic valve replacement for aortic valve stenosis. Transvalvular pressure gradients measured by left-sided heart catheterization ranged from 52 to 100 mmHg. The specific activity of mitochondrial respiratory chain enzyme complexes

I. Maurer; S. Zierz

1992-01-01

296

Surgical management of life threatening events caused by intermittent aortic insufficiency in a native valve: case report  

Microsoft Academic Search

We describe a case of a patient admitted with apparent life threatening events characterized by hypotension and bradycardia. The patient was ultimately found to have intermittent severe aortic insufficiency. Upon surgical exploration, abnormalities were discovered in the aortic valve, which had a small left coronary cusp with absence of the nodulus of Arantius. Following surgical repair of the valve, aimed

Mary H Martin; Stanton B Perry; James V Prochazka; Frank L Hanley; Norman H Silverman

2010-01-01

297

Absolute and relative risk prediction in patients candidate to isolated aortic valve replacement: should we change our mind?  

Microsoft Academic Search

Objective: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) calculator performance in 30-day outcome prediction after isolated aortic valve replacement (AVR) was evaluated to assess its absolute reliability and usefulness as selection criteria to percutaneous aortic valve implantation (PAVI). Methods: We carried out a retrospective statistical analysis on 379 patients (group 0) consecutively submitted to isolated AVR in the

Gabriele Di Giammarco; Roberto Rabozzi; Bruno Chiappini; Gabriele Tamagnini

2010-01-01

298

Acute left main occlusion secondary to embolisation from an aortic valve prosthesis: Successful treatment with embolectomy and percutaneous coronary intervention  

Microsoft Academic Search

Acute occlusive embolus of the left main coronary artery is a rare and usually catastrophic occurrence. We present a case report of a 59 year old with an aortic valve prosthesis presenting in cardiogenic shock following cessation of warfarin therapy. Angiography demonstrated an acute left main occlusion secondary to emboli from the aortic valve prosthesis. Successful embolectomy was performed by clot

Isuru Ranasinghe; John Yiannikas; David Brieger

2011-01-01

299

Mortality and need for reoperation in patients with mild-to-moderate asymptomatic aortic valve disease undergoing coronary artery bypass graft alone  

Microsoft Academic Search

Background Patients presenting for coronary artery bypass graft (CABG) surgery may have concurrent asymptomatic aortic stenosis (AS) or aortic insufficiency (AI). This retrospective study was performed to evaluate outcomes in patients with aortic valve disease undergoing CABG with or without aortic valve replacement (AVR). Methods Study groups included 414 patients undergoing combined AVR and CABG (AVR-CABG group) and 62 patients

James Hochrein; John C. Lucke; J. Kevin Harrison; Thomas M. Bashore; Walter G. Wolfe; Robert H. Jones; James E. Lowe; William D. White; Donald D. Glower

1999-01-01

300

Minimally invasive aortic valve replacement: the Leipzig experience  

PubMed Central

Background Minimally invasive techniques are progressively challenging traditional approaches in cardiothoracic surgery. Minimally invasive aortic valve replacement (AVR) has become a routine procedure at our institution. Methods We retrospectively analyzed all patients undergoing minimally invasive isolated AVR between January 2003 and March 2014, at our institution. Mean follow-up was 4.7±4.3 years (range: 0-18 years) and was 99.8% complete. Results There were 1,714 patients who received an isolated minimally invasive AVR. The mean (± SD) patient age was 65±12.8 years, ejection fraction 60%±12% and log EuroSCORE 5.3%±5.1%. Mean cross-clamp time was 58±18 minutes and mean cardiopulmonary bypass (CPB) time was 82.9±26.7 minutes. Thirty-day survival was 97.8%±0.4%, and 69.4%±1.7% at 10-years. The multivariate analysis revealed age at surgery [P=0.016; odds ratio (OR), 1.1], length of surgery time (P=0.002; OR, 1.01), female gender (P=0.023; OR, 3.54), preoperative myocardial infarction (MI) (P=0.006; OR, 7.87), preoperative stroke (P=0.001; OR, 13.76) and preoperative liver failure (P=0.015; OR, 10.28) as independent risk factors for mortality. Cox-regression analysis revealed the following predictors for long term mortality: age over 75 years (P<0.001; OR, 3.5), preoperative dialysis (P<0.01; OR, 2.14), ejection fraction less than 30% (P=0.003; OR, 3.28) and urgent or emergency operation (P<0.001; OR, 2.3). Conclusions Minimally invasive AVR can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable. PMID:25694976

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

2015-01-01

301

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

PubMed

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

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

2015-01-01

302

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

Microsoft Academic Search

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

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

2002-01-01

303

Aortic valve replacement for a patient with glucose-6-phosphate dehydrogenase deficiency and autoimmune hemolytic anemia.  

PubMed

Autoimmune hemolytic anemia and deficiency of glucose-6-phosphate deyhdrogenase (G6PD) result in severe hemolysis with different mechanisms. In patients with both pathologies, the effects of cardiopulmonary bypass on red blood cells and thrombocytes demand special care before and after open heart surgery. We evaluated the preoperative management and postoperative care of a patient with severe aortic insufficiency associated with G6PD deficiency and autoimmune hemolytic anemia who underwent aortic valve replacement. PMID:15985145

Tas, Serpil; Donmez, Arzu Antal; Kirali, Kaan; Alp, Mete H; Yakut, Cevat

2005-01-01

304

Spectral analysis of closing sounds produced by lonescu-Shiley bioprosthetic aortic heart valves  

Microsoft Academic Search

The selection of the optimal number of poles (P) and zeros (Q) for parametric spectral analysis of closing sounds produced\\u000a by lonescu-Shiley bioprosthetic aortic heart valves was evaluated in 15 patients. These values were obtained by computing\\u000a the normalised root-mean-square error (NRMSE) function between the aortic closing sounds and the impulse response of the parametric\\u000a models for different values of

G. Cloutier; R. Guardo; L.-G. Durand

1987-01-01

305

Transapical transcatheter aortic valve implantation using the second-generation self-expanding Symetis ACURATE TA valve.  

PubMed

Transapical transcatheter aortic valve implantation (TA-TAVI) is the recognized first choice surgical TAVI access. Expansion of this well-established treatment modality with subsequent broader patient inclusion has accelerated development of second-generation TA-TAVI devices. The Swiss ACURATE TA Symetis valve allows for excellent anatomical positioning, resulting in a very low incidence of paravalvular leaks. The self-expanding stent features an hourglass shape to wedge the native aortic valve annulus. A specially designed delivery system facilitates controlled release aided by tactile operator feedback. The ACURATE TA valve made of three native porcine non-coronary leaflets has received CE approval in September 2011. Since then, this valve is the third most frequently implanted TAVI device with over 1200 implants in Europe and South America. Results from the Symetis ACURATE TA™ Valve Implantation ('SAVI') Registry showed a procedural success rate of 98.0% and a survival rate of 93.2% at 30 days. This presentation provides technical considerations and detailed procedural aspects of device implantation. PMID:25298363

Huber, Christoph; Wenaweser, Peter; Windecker, Stephan; Carrel, Thierry

2014-01-01

306

The Nordic Aortic Valve Intervention (NOTION) trial comparing transcatheter versus surgical valve implantation: study protocol for a randomised controlled trial  

PubMed Central

Background Degenerative aortic valve (AV) stenosis is the most prevalent heart valve disease in the western world. Surgical aortic valve replacement (SAVR) has until recently been the standard of treatment for patients with severe AV stenosis. Whether transcatheter aortic valve implantation (TAVI) can be offered with improved safety and similar effectiveness in a population including low-risk patients has yet to be examined in a randomised setting. Methods/Design This randomised clinical trial will evaluate the benefits and risks of TAVI using the transarterial CoreValve System (Medtronic Inc., Minneapolis, MN, USA) (intervention group) compared with SAVR (control group) in patients with severe degenerative AV stenosis. Randomisation ratio is 1:1, enrolling a total of 280 patients aged 70 years or older without significant coronary artery disease and with a low, moderate, or high surgical risk profile. Trial outcomes include a primary composite outcome of myocardial infarction, stroke, or all-cause mortality within the first year after intervention (expected rates 5% for TAVI, 15% for SAVR). Exploratory safety outcomes include procedure complications, valve re-intervention, and cardiovascular death, as well as cardiac, cerebral, pulmonary, renal, and vascular complications. Exploratory efficacy outcomes include New York Heart Association functional status, quality of life, and valve prosthesis and cardiac performance. Enrolment began in December 2009, and 269 patients have been enrolled up to December 2012. Discussion The trial is designed to evaluate the performance of TAVI in comparison with SAVR. The trial results may influence the choice of treatment modality for patients with severe degenerative AV stenosis. Trial registration ClinicalTrials.gov: NCT01057173 PMID:23302232

2013-01-01

307

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

PubMed

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

Pan, Youlian; Qiao, Aike; Dong, Nianguo

2014-09-16

308

Sutureless aortic valve replacement: a systematic review and meta-analysis  

PubMed Central

Background Sutureless aortic valve replacement (SU-AVR) has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to reduce cross-clamp and cardiopulmonary bypass (CPB) duration and thereby improve surgical outcomes and facilitate a minimally invasive approach suitable for higher risk patients. The present systematic review and meta-analysis aims to assess the safety and efficacy of SU-AVR approach in the current literature. Methods Electronic searches were performed using six databases from their inception to January 2014. Relevant studies utilizing sutureless valves for aortic valve implantation were identified. Data were extracted and analyzed according to predefined clinical endpoints. Results Twelve studies were identified for inclusion of qualitative and quantitative analyses, all of which were observational reports. The minimally invasive approach was used in 40.4% of included patients, while 22.8% underwent concomitant coronary bypass surgery. Pooled cross-clamp and CPB duration for isolated AVR was 56.7 and 46.5 minutes, respectively. Pooled 30-day and 1-year mortality rates were 2.1% and 4.9%, respectively, while the incidences of strokes (1.5%), valve degenerations (0.4%) and paravalvular leaks (PVL) (3.0%) were acceptable. Conclusions The evaluation of current observational evidence suggests that sutureless aortic valve implantation is a safe procedure associated with shorter cross-clamp and CPB duration, and comparable complication rates to the conventional approach in the short-term.

Phan, Kevin; Tsai, Yi-Chin; Niranjan, Nithya; Bouchard, Denis; Carrel, Thierry P.; Dapunt, Otto E.; Eichstaedt, Harald C.; Fischlein, Theodor; Gersak, Borut; Glauber, Mattia; Haverich, Axel; Misfeld, Martin; Oberwalder, Peter J.; Santarpino, Giuseppe; Shrestha, Malakh Lal; Solinas, Marco; Vola, Marco; Yan, Tristan D.

2015-01-01

309

Thrombotic aortic restenosis after transapical SAPIEN valve implantation.  

PubMed

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

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

2014-03-01

310

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

PubMed Central

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

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

2013-01-01

311

Successful thrombectomy for thrombosis of aortic composite valve graft in pregnancy.  

PubMed

Prosthetic heart valve thrombosis in pregnancy is a life-threatening complication whose management remains controversial and particularly difficult because of the additional challenge to save the fetus. Thrombolysis, thrombectomy, or prosthetic replacement are the currently available options. We report the case of a 17-week pregnant patient who was successfully treated by emergency open-heart thrombectomy for thrombosis of an aortic composite valve graft. Pregnancy was carried to term and a healthy baby was vaginally delivered 5 months later. PMID:12683588

Alessandrini, Francesco; Lapenna, Elisabetta; Nasso, Giuseppe; De Bonis, Michele; Possati, Gian Federico

2003-04-01

312

Inhibition of ectonucleotidase with ARL67156 prevents the development of calcific aortic valve disease in warfarin-treated rats.  

PubMed

Calcific aortic valve disease is the most common heart valve disorder. So far, there is no medical treatment for calcific aortic valve disease. The expression of ectonucleotidases, which metabolize nucleotides into phosphate products, may influence the calcification of the aortic valve. In this study, we investigated if the administration of an ectonucleotidase inhibitor, ARL67156 (6-N,N-Diethyl-D-?,?-dibromomethyleneATP trisodium salt), may prevent the calcification of the aortic valve in the warfarin-induced mineralization rat model. Male Wistar rats were treated with warfarin or warfarin+ARL67156 for 28 days. All rats had comprehensive Doppler-echocardiographic studies at 28 day. A gene profiling of ectonucleotidases expressed in aortas of rats was documented by quantitative real-time PCR. The amount of calcium was determined by quantitative method and von Kossa staining. Ex vivo cultures of rat aortas were also used to further assess the effect of ARL67156 on the calcifying process and Akt signaling. Mineralization of the aorta/aortic valve was documented in warfarin-treated rats and was accompanied by the development of aortic stenosis. These changes were paralleled by an increased of ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1). Administration of the ectonucleotidase inhibitor, ARL67156 prevented the development of aortic stenosis by lowering the level of apoptosis and mineralization of the aortic valve/aorta. In addition, ARL67156 normalized the level of pAkt, an important kinase involved in the survival pathway. Inhibition of ectonucleotidase activity prevented the development of calcific aortic valve disease in a rat model. On that account, ectonucleotidase may represent a novel target in the treatment of calcific aortic valve disease. PMID:22659116

Côté, Nancy; El Husseini, Diala; Pépin, Andrée; Bouvet, Céline; Gilbert, Liz-Ann; Audet, Audrey; Fournier, Dominique; Pibarot, Philippe; Moreau, Pierre; Mathieu, Patrick

2012-08-15

313

Networked-based Characterization of Extracellular Matrix Proteins from Adult Mouse Pulmonary and Aortic Valves  

PubMed Central

A precise mixture of extracellular matrix (ECM) secreted by valvular cells forms a scaffold that lends the heart valve the exact mechanical and tensile strength needed for accurate hemodynamic performance. ECM proteins are a key component of valvular endothelial cell (VEC) - valvular interstitial cell (VIC) communication essential for maintenance of the valve structure. This study reports the healthy adult pulmonary and aortic valve proteomes characterized by LC/MS/MS, resulting in 2710 proteins expressed by 1513 genes, including over 300 abundant ECM proteins. Surprisingly, this study defines a distinct proteome for each semilunar valve. Protein-protein networking (PPN) was used as a tool to direct selection of proteomic candidates for biological investigation. Local PPN for nidogen 1 (Nid1), biglycan (Bgn), elastin microfibril interface-located protein 1 (Emilin-1) and milk fat globule-EGF factor 8 protein (Mfge8) were enriched with proteins essential to valve function and produced biological functions highly relevant to valve biology. Immunofluorescent investigations demonstrated that these proteins are functionally distributed within the pulmonary and aortic valve structure, indicative of important contribution to valve function. This study yields new insight into protein expression contributing to valvular maintenance and health and provides a platform for unbiased assessment of protein alterations during disease processes. PMID:21133377

Angel, Peggi M.; Nusinow, David; Brown, Chris B.; Violette, Kate; Barnett, Joey V.; Zhang, Bing; Baldwin, H. Scott; Caprioli, Richard M.

2011-01-01

314

Aortic root replacement using composite valve graft in patients with aortic valve disease and aneurysm of the ascending aorta: twenty years' experience of late results.  

PubMed

The purpose of this study was to evaluate the clinical outcome of composite valve graft replacement in 193 patients with aortic valve disease and aneurysm of the ascending aorta from January 1980 to June 1999. The clinical outcome was compared between the patients diagnosed with Marfan syndrome (M group) and those without Marfan syndrome (non-M group), between those with aortic dissection (AD group) and without dissection (non-AD group), between 2 different techniques for coronary artery reattachment (modified Bentall [mB] and modified Piehler [mP]), and between the time of operation (1980-1989 and 1990-1999). Long-term outcome of this procedure was almost satisfactory with actuarial survival of 71.5 +/- 4.4% at 10 years and freedom from reoperation of 76.5 +/- 4.4% at 10 years. Freedom from cardiovascular events and freedom from reoperation were significantly lower in the M group and AD group than in the non-M and non-AD groups. Also, actuarial survival was significantly higher in the latter 10 years compared with the former 10 years. It was concluded that the improvement of perioperative management and proper selection of the technique for coronary artery reattachment could have improved the clinical outcome. In patients with Marfan syndrome or aortic dissection, there still remains a higher risk of cardiovascular event and future reoperation. Extensive aortic reconstruction or staged operation should be performed in such patients. PMID:12000445

Aomi, Shigeyuki; Nakajima, Masato; Nonoyama, Masaki; Tomioka, Hideyuki; Bonkohara, Yukihiro; Satou, Wataru; Kunii, Yosihito; Endo, Masahiro

2002-05-01

315

Transcatheter aortic valve replacement: focus on sex-related differences in outcomes.  

PubMed

Transcatheter aortic valve replacement (TAVR) has transformed the management of severe aortic stenosis for high-risk and inoperable patients. The 10-year experience in Europe has proven the technology to be safe and effective in select populations. The PARTNER trial, the first prospective, randomized, controlled trial for TAVR, showed the technology to be superior to medical management for inoperable patients and equivalent to surgical aortic valve replacement for high-risk patients. Research in cardiovascular medicine has been dominated by studies on the male sex, due to the incidence of the disease process and partly due to historic predominance of male subjects in research studies. Alternatively, TAVR studies focused on high-risk and inoperable patients who are equally distributed by sex. Although sex-related differences are apparent in their baseline characteristics, outcomes have been mixed, with evidence suggesting that female patients may have a mortality advantage with TAVR. Herein we review the TAVR procedure and devices currently available and focus our discussion on outcomes after transcatheter or surgical aortic valve replacement in patients with severe aortic stenosis. PMID:25752476

Flaherty, Michael P; Grubb, Kendra J

2015-04-01

316

ORAL PRESENTATION Open Access Evaluation of aortic valve stenosis from Phase-  

E-print Network

approaches of aortic valve area (AVA) estimation. Methods We studied 37 consecutive patients with AVS (mean AVA:0,89 +/-0,42 cm2 ) and 12 healthy subjects (mean AVA: 3,19 +/- 0,65 cm2 ) who had the same day maximal velocity (VmaxAo) and AVA. AVA was calculated using: 1) Hakki's formula which is a simplification

Paris-Sud XI, Université de

317

Role of Wnt/?-catenin signaling pathway in the mechanism of calcification of aortic valve.  

PubMed

Aortic valve calcification is a common disease in the elderly, but its cellular and molecular mechanisms are not clear. In order to verify the hypothesis that Wnt/?-catenin signaling pathway is involved in the process of calcification of aortic valve, porcine aortic valve interstitial cells (VICs) were isolated, cultured and stimulated with oxidized low density lipoprotein (ox-LDL) for 48 h to induce the differentiation of VICs into osteoblast-like cells. The key proteins and genes of Wnt/?-catenin signaling pathway, such as glycogen synthase kinase 3? (GSK-3?) and ?-catenin, were detected by using Western blotting and real-time polymerase chain reaction (PCR). The results showed that the VICs managed to differentiate into osteoblast-like cells after the stimulation with ox-LDL and the levels of proteins and genes of GSK-3? and ?-catenin were increased significantly in VICs after stimulation for 48 h (P<0.05). It is suggested that Wnt/?-catenin signaling pathway may play a key role in the differentiation of VICs into osteoblast-like cells and make great contribution to aortic valve calcification. PMID:24496676

Gu, Gang-jian; Chen, Tao; Zhou, Hong-min; Sun, Ke-xiong; Li, Jun

2014-02-01

318

Clinical relevance of intracranial high intensity transient signals in patients following prosthetic aortic valve replacement  

Microsoft Academic Search

Objectives: There has been frequent report on transcranially detected microembolic signals (HITS) following cardiac surgery using extracorporeal bypass support. The clinical relevance of HITS, however, has yet to be clarified. The incidence of thromboembolic events is increased following mechanical heart valve replacement. The purpose of this study was to quantify postoperative HITS after implantation of two types of prosthetic aortic

Theo Kofidis; Stefan Fischer; Rainer Leyh; Helmut Mair; Maria Deckert; Roman Haberl; Axel Haverich; Bruno Reichart

319

Clinical relevance of intracranial high intensity transient signals in patients following prosthetic aortic valve replacement  

Microsoft Academic Search

Objectives: There has been frequent report on transcranially detected microembolic signals (HITS) following cardiac surgery using extracorporeal bypass support. The clinical relevance of HITS, however, has yet to be clarified. The incidence of thromboembolic events is increased following mechanical heart valve replacement. The purpose of this study was to quantify postoperative HITS after implantation of two types of prosthetic aortic

Theo Kofidis; Stefan Fischer; Rainer Leyh; Helmut Mair; Maria Deckert; Roman Haberl; Axel Haverich; Bruno Reichart

2002-01-01

320

Relation of Aortic Valve Calcium to Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort Study).  

PubMed

Although subjects with chronic kidney disease (CKD) are at markedly increased risk for cardiovascular mortality, the relation between CKD and aortic valve calcification has not been fully elucidated. Also, few data are available on the relation of aortic valve calcification and earlier stages of CKD. We sought to assess the relation of aortic valve calcium (AVC) with estimated glomerular filtration rate (eGFR), traditional and novel cardiovascular risk factors, and markers of bone metabolism in the Chronic Renal Insufficiency Cohort (CRIC) Study. All patients who underwent aortic valve scanning in the CRIC study were included. The relation between AVC and eGFR, traditional and novel cardiovascular risk factors, and markers of calcium metabolism were analyzed using both unadjusted and adjusted regression models. A total of 1,964 CRIC participants underwent computed tomography for AVC quantification. Decreased renal function was independently associated with increased levels of AVC (eGFR 47.11, 44.17, and 39 ml/min/1.73 m(2), respectively, p <0.001). This association persisted after adjusting for traditional, but not novel, AVC risk factors. Adjusted regression models identified several traditional and novel risk factors for AVC in patients with CKD. There was a difference in AVC risk factors between black and nonblack patients. In conclusion, our study shows that eGFR is associated in a dose-dependent manner with AVC in patients with CKD, and this association is independent of traditional cardiovascular risk factors. PMID:25791240

Guerraty, Marie A; Chai, Boyang; Hsu, Jesse Y; Ojo, Akinlolu O; Gao, Yanlin; Yang, Wei; Keane, Martin G; Budoff, Matthew J; Mohler, Emile R

2015-05-01

321

Myocardial protection with intermittent cold blood during aortic valve operation: antegrade versus retrograde delivery  

Microsoft Academic Search

BackgroundIntermittent antegrade cold blood cardioplegia is superior to warm blood cardioplegia in patients who have aortic valve operation. This study compared the cardioprotective efficacy of intermittent antegrade and retrograde cold blood cardioplegia with emphasis on metabolic stress in the left and right ventricles.

Attilio A Lotto; Raimondo Ascione; Massimo Caputo; Alan J Bryan; Gianni D Angelini; M-Saadeh Suleiman

2003-01-01

322

The structure and material composition of ossified aortic valves identified using a set of scientific methods  

NASA Astrophysics Data System (ADS)

Degenerative aortic stenosis has become a common and dangerous disease in recent decades. This disease leads to the mineralization of aortic valves, their gradual thickening and loss of functionality. We studied the detailed assessment of the proportion and composition of inorganic and organic components in the ossified aortic valve, using a set of analytical methods applied in science: polarized light microscopy, scanning electron microscopy, X-ray fluorescence, X-ray diffraction, gas chromatography/mass spectrometry and liquid chromatography-tandem mass spectrometry. The sample valves showed the occurrence of phosphorus and calcium in the form of phosphate and calcium carbonate, hydroxyapatite, fluorapatite and hydroxy-fluorapatite, with varying content of inorganic components from 65 to 90 wt%, and with phased development of degenerative disability. The outer layers of the plaque contained an organic component with peptide bonds, fatty acids, proteins and cholesterol. The results show a correlation between the formation of fluorapatite in aortic valves and in other parts of the human bodies, associated with the formation of bones.

Zeman, Antonín; Šmíd, Michal; Havelcová, Martina; Coufalová, Lucie; Ku?ková, Št?pánka; Vel?ovská, Martina; Hynek, Radovan

2013-11-01

323

Association of aortic valve sclerosis with thrombin generation in hypertensive patients  

Microsoft Academic Search

Aortic valve sclerosis (AVS) may predispose to a prothrombotic state, as AVS is predictor of cardiovascular events in hypertensive populations. Thrombin exerts non-thrombotic effects such as vessel tone regulation, progression of atherosclerosis and stimulation of atrial natriuretic peptide (ANP) secretion. We hypothesized that hypertensive patients with AVS may have a persistently activated thrombin generation. We studied 234 asymptomatic never-treated hypertensive

M Iida; M Yamamoto; M Yamazaki; M Sawaguchi; H Honjo; I Kodama; K Kamiya

2008-01-01

324

Rare complication of ventricular septal defect in three patients following transcatheter aortic valve replacement.  

PubMed

Transcatheter aortic valve replacement (TAVR) is a highly-effective but technically challenging procedure. Despite improvement in device technology and operator techniques, complications are common and previously unknown procedural-related complications continue to arise. In this report, we present a case series of three patients with acquired perimembranous ventricular septal defects following transfemoral TAVR with an Edwards SAPIEN prosthesis. PMID:24123754

Patel, Yogesh; Vassileva, Christina; Mishkel, Gregory

2014-02-15

325

Hydrophilic polymer embolism induced acute transcatheter aortic valve thrombosis: a novel complication.  

PubMed

Hydrophilic polymer coated introducer sheaths and medical devices are widely used in interventional cardiology. Despite the potential procedural advantages that these provide, a risk of polymer embolization has been recently reported. We describe the first reported case of hydrophilic polymer induced acute transcatheter aortic valve thrombosis. PMID:24403026

Sanon, Saurabh; Maleszewski, Joseph J; Rihal, Charanjit S

2014-06-01

326

Transcatheter aortic valve replacement: historical perspectives, current evidence, and future directions.  

PubMed

Severe aortic stenosis (AS) results in considerable morbidity and mortality without aortic valve replacement and is expected to increase in prevalence with the aging population. Because AS primarily affects the elderly, many patients with comorbidities are poor candidates for surgical aortic valve replacement (SAVR) and may not be referred. Transcatheter aortic valve replacement (TAVR) has emerged as transformative technology for the management of AS over the past decade. Randomized trials have established the safety and efficacy of TAVR with improved mortality and quality of life compared with medical therapy in inoperable patients, while demonstrating noninferiority and even superiority to SAVR among high-risk operative candidates. However, early studies demonstrated an early penalty of stroke and vascular complications with TAVR as well as increased paravalvular leak as compared with SAVR. Two device platforms have been evaluated and approved for use in the United States: the Edwards SAPIEN and the Medtronic CoreValve. Early studies also suggest cost-effectiveness for TAVR. Ongoing studies are evaluating new iterations of the aforementioned TAVR devices, novel device designs, and applications of TAVR in expanded populations of patients including those with lower risk profiles as well as those with comorbidities that were excluded from early clinical trials. Future improvements in TAVR technology will likely reduce periprocedural and long-term complications. Further studies are needed to confirm device durability over long-term follow-up and explore the applicability of TAVR to broader AS patient populations. PMID:25262249

Horne, Aaron; Reineck, Elizabeth A; Hasan, Rani K; Resar, Jon R; Chacko, Matthews

2014-10-01

327

Bicuspid aortic valve hemodynamics induces abnormal medial remodeling in the convexity of porcine ascending aortas.  

PubMed

The type-I bicuspid aortic valve (BAV), which differs from the normal tricuspid aortic valve (TAV) most commonly by left-right coronary cusp fusion, is frequently associated with secondary aortopathies. While BAV aortic dilation has been linked to a genetic predisposition, hemodynamics has emerged as a potential alternate etiology. However, the link between BAV hemodynamics and aortic medial degeneration has not been established. The objective of this study was to compare the regional wall shear stresses (WSS) in a TAV and BAV ascending aorta (AA) and to isolate ex vivo their respective impact on aortic wall remodeling. The WSS environments generated in the convex region of a TAV and BAV AA were predicted through fluid-structure interaction (FSI) simulations in an aorta model subjected to both valvular flows. Remodeling of porcine aortic tissue exposed to TAV and BAV AA WSS for 48 h in a cone-and-plate bioreactor was investigated via immunostaining, immunoblotting and zymography. FSI simulations revealed the existence of larger and more unidirectional WSS in the BAV than in the TAV AA convexity. Exposure of normal aortic tissue to BAV AA WSS resulted in increased MMP-2 and MMP-9 expressions and MMP-2 activity but similar fibrillin-1 content and microfibril organization relative to the TAV AA WSS treatment. This study confirms the sensitivity of aortic tissue to WSS abnormalities and demonstrates the susceptibility of BAV hemodynamic stresses to focally mediate aortic medial degradation. The results provide compelling support to the important role of hemodynamics in BAV secondary aortopathy. PMID:24599392

Atkins, Samantha K; Cao, Kai; Rajamannan, Nalini M; Sucosky, Philippe

2014-11-01

328

Fatal bacterial endocarditis following aortic valve replacement in a patient being treated with methotrexate.  

PubMed

A 41-year-old man being treated with methotrexate for psoriasis underwent aortic valve replacement. He subsequently developed fulminating bacterial endocarditis. Bacterial endocarditis occurs in 1-2% of cases after prosthetic valve replacement and has a high mortality. The long-term use of methotrexate and similar drugs is increasing in conditions such as psoriasis, rheumatoid arthritis and inflammatory bowel disease. Thus, more patients undergoing heart valve surgery will be taking these preparations for coexisting disease. As methotrexate increases the risk of infection, its perioperative use in these patients requires further evaluation. PMID:10517404

Wilkinson, N M

1999-09-01

329

Computational analysis of an aortic valve jet with Lagrangian coherent structures  

NASA Astrophysics Data System (ADS)

Important progress has been achieved in recent years in simulating the fluid-structure interaction around cardiac valves. An important step in making these computational tools useful to clinical practice is the development of postprocessing techniques to extract clinically relevant information from these simulations. This work focuses on flow through the aortic valve and illustrates how the computation of Lagrangian coherent structures can be used to improve insight into the transport mechanics of the flow downstream of the valve, toward the goal of aiding clinical decision making and the understanding of pathophysiology.

Shadden, Shawn C.; Astorino, Matteo; Gerbeau, Jean-Frédéric

2010-03-01

330

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

PubMed

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

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

331

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

PubMed Central

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

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

2013-01-01

332

Severe aortic valve regurgitation after percutaneous ventricular septal defect closure.  

PubMed

Percutaneous closure of ventricular septal defect is now commonly used. We report a rare case, and especially a rare image of aortic leaflet damage caused by percutaneous ventricular septal device. PMID:22431277

Fouilloux, Virginie; Kreitmann, Bernard

2012-11-15

333

Position Statement for the Operator and Institutional Requirements for a Transcatheter Aortic Valve Implantation (TAVI) Program.  

PubMed

The Cardiac Society of Australia and New Zealand (CSANZ) and the Australia and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) have joined together to provide recommendations for institutions and individual operators to assess their ability to initiate and maintain a transcatheter valve program. Transcatheter aortic valve replacement has been developed as an alternative to traditional surgical replacement of the aortic valve in high risk patients, particularly the frail elderly. The position paper has endorsed the important role of a multi-disciplinary "Heart Team" in selecting patients for TAVI as fundamental to the establishment of a successful program. The paper outlines recommendations for the cardiologist to have a background in structural intervention and the surgeon to have experience in high-risk aortic valve replacement. It is further recommended that TAVI programs be established in high volume cardiac surgical centres where on site valve surgery is performed. The paper is intended to provide guidance to individual operators and prospective institutions considering the establishment of a successful TAVI program. PMID:25488705

Walters, Darren L; Webster, Mark; Pasupati, Sanjeevan; Walton, Antony; Muller, David; Stewart, Jim; Williams, Michael; MacIsaac, Andrew; Scalia, Greg; Wilson, Michael; Gamel, Adam El; Clarke, Andrew; Bennetts, Jayme; Bannon, Paul

2015-03-01

334

Fluid-structure interaction analysis of the flow through a stenotic aortic valve  

NASA Astrophysics Data System (ADS)

In Europe and North America, aortic stenosis (AS) is the most frequent valvular heart disease and cardiovascular disease after systemic hypertension and coronary artery disease. Understanding blood flow through an aortic stenosis and developing new accurate non-invasive diagnostic parameters is, therefore, of primarily importance. However, simulating such flows is highly challenging. In this study, we considered the interaction between blood flow and the valve leaflets and compared the results obtained in healthy valves with stenotic ones. One effective method to model the interaction between the fluid and the structure is to use Arbitrary Lagrangian-Eulerian (ALE) approach. Our two-dimensional model includes appropriate nonlinear and anisotropic materials. It is loaded during the systolic phase by applying pressure curves to the fluid domain at the inflow. For modeling the calcified stenotic valve, calcium will be added on the aortic side of valve leaflets. Such simulations allow us to determine the effective orifice area of the valve, one of the main parameters used clinically to evaluate the severity of an AS, and to correlate it with changes in the structure of the leaflets.

Maleki, Hoda; Labrosse, Michel R.; Durand, Louis-Gilles; Kadem, Lyes

2009-11-01

335

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

PubMed Central

Minimally invasive aortic valve replacement (MIAVR) is defined as an aortic valve replacement (AVR) procedure that involves a small chest wall incision as opposed to conventional full sternotomy (FS). The MIAVR approach is increasingly being used with the aim of reducing the “invasiveness” of the surgical procedure, while maintaining the same efficacy, quality and safety of a conventional approach. The most common MIAVR techniques are ministernotomy (MS) and right anterior minithoracotomy (RT) approaches. Compared with conventional surgery, MIAVR has been shown to reduce postoperative mortality and morbidity, providing faster recovery, shorter hospital stay and better cosmetics results, requires less rehabilitations resources and consequently cost reduction. Despite these advantages, MIAVR is limited by the longer cross-clamp and cardiopulmonary bypass (CPB) times, which have raised some concerns in fragile and high risk patients. However, with the introduction of sutureless and fast deployment valves, operative times have dramatically reduced by 35-40%, standardizing this procedure. According to these results, the MIAVR approach using sutureless valves may be the “real alternative” to the transcatheter aortic valve implantation (TAVI) procedures in high risk patients “operable” patients. Prospective randomized trials are required to confirm this hypothesis. PMID:25694973

Glauber, Mattia; Ferrarini, Matteo

2015-01-01

336

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

PubMed

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

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

2014-05-01

337

Balloon Dilation and Surgical Valvotomy Comparison in Non-critical Congenital Aortic Valve Stenosis.  

PubMed

Percutaneous balloon aortic valvoplasty (BAV) and surgical aortic valvotomy (SAV) are palliative procedures in patients with non-critical congenital valve stenosis. The aim of the study was to evaluate long-term BAV and SAV results after up to 24 years of follow-up. From 1987 to 2013, 74 consecutive interventions were performed in patients with aortic stenosis, and 62 were included in the study (39 BAVs and 23 SAVs). Age of BAV patients was 1.3 months to 17 years, and of SAV patients 1.2 months to 15 years. Although BAV patients were older, there was no difference between groups according to sex, valve function/morphology, and early/late follow-up results, with exception to hospitalization period. Significant pressure gradient reduction and aortic regurgitation increment were registered after procedures. Three patients did not survive early period after surgery. Follow-up period was 7.0 ± 5.4 and 9.0 ± 8.0 years after BAV and SAV, respectively (p = 0.242). Follow-up pressure gradient rose only in the BAV group, and was emphasized after 10-year-follow-up (p = 0.020). Significant aortic insufficiency progression was registered after 15 years of follow-up in both groups (p = 0.007 and p = 0.009, respectively). Mean reintervention-free survival was 12.0 years in the BAV and 14.5 years in the SAV group (p = 0.733), and mean survival without aortic valve replacement was 15.2 and 17.4 years, respectively (p = 0.877). BAV and SAV in patients with congenital aortic stenosis are very comparable in both early and late follow-up results. PMID:25388630

Prijic, Sergej M; Vukomanovic, Vladislav A; Stajevic, Mila S; Bjelakovic, Bojko B; Zdravkovic, Marija D; Sehic, Igor N; Kosutic, Jovan Lj

2015-03-01

338

Disrupted Slit-Robo signalling results in membranous ventricular septum defects and bicuspid aortic valves  

PubMed Central

Aims The mesenchymal cushions lining the early embryonic heart undergo complex remodelling to form the membranous ventricular septum as well as the atrioventricular and semilunar valves in later life. Disruption of this process underlies the most common congenital heart defects. Here, we identified a novel role for Slit-Robo signalling in the development of the murine membranous ventricular septum and cardiac valves. Methods and results Expression of Robo1 and Robo2 receptors and their ligands, Slit2 and Slit3, was present in or adjacent to all cardiac cushions/valves. Loss of Robo1 or both Robo1 and Robo2 resulted in membranous ventricular septum defects at birth, a defect also found in Slit3, but not in Slit2 mutants. Additionally, Robo1;Robo2 double mutants showed thickened immature semilunar and atrioventricular valves as well as highly penetrant bicuspid aortic valves. Slit2 mutants recapitulated the semilunar phenotype, whereas Slit3 mutants displayed thickened atrioventricular valves. Bicuspid aortic cushions were already observed at E12.5 in the Robo1;Robo2 double mutants. Expression of Notch- and downstream Hey and Hes genes was down-regulated in Robo1 mutants, suggesting that reduced Notch signalling in mice lacking Robo might underlie the defects. Luciferase assays confirmed regulation of Notch signalling by Robo. Conclusion Cardiac defects in mutants for Robo or Slit range from membranous ventricular septum defects to bicuspid aortic valves. These ligands and receptors have unique functions during development of specific cardiac cushion derivatives, and the Slit-Robo signalling pathway likely enforces its role by regulating Notch signalling, making these mutants a valuable new model to study cardiac valve formation. PMID:25691540

Mommersteeg, Mathilda T.M.; Yeh, Mason L.; Parnavelas, John G.; Andrews, William D.

2015-01-01

339

Erythrocyte survival in patients with porcine xenograft aortic and mitral valves.  

PubMed

Ten patients with porcine xenograft aortic and mitral valve prostheses were studied three to 36 months (mean 15 months) postoperatively for evidence of hemolysis. Studies included complete blood count, reticulocyte count, red cell indices, percentage of schistocytes on blood smears, bilirubin concentration, lactic dehydrogenase, serum iron, total iron binding capacity, haptoglobin, serum folate and vitamin B12 levels, Coombs' test, methemoglobin reduction test, autologous 51Cr erythrocyte survival, and urinary examination for iron and hemosiderin. All patients were hemodynamically stable. Nine patients had normal valve function and no evidence of hemolysis. One patient with paravalvular aortic regurgitation had mechanical hemolytic anemia with a negative Coombs' test. Porcine valve xenografts do not seem to be associated with hemolysis unless complicated by a paravalvular leak. PMID:7063904

Rao, K R; Patel, A R; Patel, R N; Kumaraiah, V; Towne, W D

1982-03-01

340

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

PubMed Central

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

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

2013-01-01

341

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

PubMed Central

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

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

2013-01-01

342

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

PubMed Central

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

2014-01-01

343

A new type of aortic valved stent with good stability and no influence on coronary artery  

PubMed Central

Background To evaluated the feasibility and safety of new aortic valved stents in transcatheter aortic valve implantation (TAVI) using retrograde approach by in vitro testing and animal implantation. Materials and Methods The fluid passing test, expanding and releasing tests, static and releasing tests in tube were performed for new valved stents. Transvalvular pressure gradient, effective orifice area, pre-implantation and post-implantation regurgitant volume for the new stents were detected. Then, the new stents were implanted in six pigs using retrograde approach. These pigs were euthanized 12 h after the implantation for anatomic evaluation. Results In vitro tests showed that the closure of the new stents leaflets were effective, and stents could be released through catheter, then expanded completely and fixed fast in the tube. The coronary artery flow rates did not changed significantly after implantation (P?>?0.05), while aortic regurgitant volumes were obviously reduced (P?valve leaflets was found (P?>?0.05). In vivo experiments indicated that TAVI was successfully performed in six pigs using retrograde approach. However, one pig was died 10 h after the implantation since the stent was not expanded completely. The leaflets in stents were opening well and no valvular regurgitation was observed in the other five pigs. And thrombosis was not found. Discussion and Conclusion The new type of aortic valved stent designed in this study was characterized with good stability and could avoid the impact caused by valve leaflets on the coronary artery. PMID:24219844

2013-01-01

344

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

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

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

345

Transcatheter aortic valve implantation in a patient with mechanical mitral prosthesis: a lesson learned from an intraventricular clash.  

PubMed

We hereby present the case of a patient with severe aortic stenosis who underwent in her previous medical history a mitral valve replacement with a mechanical valve (Omnicarbon 27), and progressively developed a severe aortic stenosis. This patient was judged inoperable and then scheduled for CoreValve Revalving System implantation. Despite a good positioning of the CoreValve, an acute, severe mitral regurgitation developed soon after implantation as a consequence of the impaired movement of the mitral prosthesis leaflet. A condition of cardiogenic shock quickly developed. A good mitral prosthesis function was restored disengaging the CoreValve from the aortic annulus. After few months, the patients underwent successful Edwards-Sapien valve implantation through the Corevalve. This case strongly demonstrates how much a careful evaluation of the features of the mitral prosthesis and patient anatomy is crucial to select which specific transcatheter bioprosthesis would better perform. PMID:23592397

Testa, Luca; Gelpi, Guido; Bedogni, Francesco

2013-10-01

346

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

PubMed

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

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

2014-06-01

347

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

NASA Technical Reports Server (NTRS)

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.

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

348

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

PubMed Central

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

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

2015-01-01

349

Aortic root replacement with a mechanical valve and prosthetic conduit for the complicated degeneration of the ascending aorta resulting from infective endocarditis.  

PubMed

A 28-year-old man with infective endocarditis of the aortic valve underwent a course of antibiotic therapy, but developed severe aortic root deformity requiring aortic root replacement with a mechanical composite valve conduit. Of note, this patient had undergone a previous aortic valve operation for bicuspid valve stenosis, and indurations and fragility of the aortic root caused by the preceding operation may have contributed to subsequent aortic root deformity during the course of infective endocarditis of the aortic valve. Over the 7-year follow-up period, the patient showed no signs of recurrent infection or new cardiac events. For younger patients with endocarditis, the use of a mechanical valve and prosthetic conduit with sufficient surgical debridement and appropriate antibiotic therapy appears to be a safe and effective treatment strategy. PMID:17954997

Inaba, Hirotaka; Kaneko, Tatsuo; Ezure, Masahiko; Sato, Yasushi; Hasegawa, Yutaka; Shibasaki, Ikuko

2007-10-01

350

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

PubMed

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 V O2 (mL/kg/min) of 19.5?±?4.3 and an actual max V O2 of 15.5?±?3.9, which was 80% of the predicted V O2 . 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

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

2014-01-01

351

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

PubMed Central

Background and Aim. While aortic valve replacement for aortic stenosis can be performed safely in elderly patients, there is a need for hemodynamic and quality of life evaluation to determine the value of aortic valve replacement in older patients who may have age-related activity limitation. Materials and Methods. We conducted a prospective evaluation of patients who underwent aortic valve replacement for aortic stenosis with the Hancock II porcine bioprosthesis. All patients underwent transthoracic echocardiography (TTE) and completed the RAND 36-Item Health Survey (SF-36) preoperatively and six months postoperatively. Results. From 2004 to 2007, 33 patients were enrolled with an average age of 75.3?±?5.3 years (24 men and 9 women). Preoperatively, 27/33 (82%) were New York Heart Association (NYHA) Functional Classification 3, and postoperatively 27/33 (82%) were NYHA Functional Classification 1. Patients had a mean predicted maximum VO2 (mL/kg/min) of 19.5?±?4.3 and an actual max VO2 of 15.5?±?3.9, which was 80% of the predicted VO2. Patients were found to have significant improvements (P ? 0.01) in six of the nine SF-36 health parameters. Conclusions. In our sample of elderly patients with aortic stenosis, replacing the aortic valve with a Hancock II bioprosthesis resulted in improved hemodynamics and quality of life. PMID:25544931

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

2014-01-01

352

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

PubMed Central

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

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

2013-01-01

353

Cardiac allograft aortic dissection: successful repair using a composite valve graft and modified-Cabrol coronary reconstruction.  

PubMed

We report a 55-year-old man, the recipient of a cardiac allograft for ischemic cardiomyopathy 9 years earlier, who presented with progressive aortic root dilation, worsening aortic insufficiency, and an incidentally discovered chronic type A aortic dissection limited to the donor aorta. The patient was taken to the operating room, and the aortic dissection successfully repaired using standard reoperative techniques. This is the sixth case reported in the literature, and only the fourth survivor. To our knowledge, this case represents the first successful repair, of a limited aortic dissection of the donor aorta postcardiac transplantation, using a composite valve graft and modified-Cabrol coronary reconstruction. PMID:16153277

Caffarelli, Anthony D; Fann, James I; Salerno, Christopher T; Johnson, Frances; Jenkins, D Denison; O'Bannon, Laura; Burdon, Thomas A

2005-01-01

354

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

PubMed

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

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

2014-08-22

355

Left ventricular function in patients with ventricular arrhythmias and aortic valve disease  

SciTech Connect

Forty patients having aortic valve replacement were evaluated preoperatively for ventricular arrhythmia and left ventricular ejection fraction. Arrhythmias were classified as complex or simple using the Lown criteria on the 24-hour ambulatory electrocardiogram; ejection fractions were determined by radionuclide gated blood pool analysis and contrast angiography. The ejection fractions determined by radionuclide angiography were 59.1 +/- 13.1% for 26 patients with simple or no ventricular arrhythmias, and 43.9 +/- 20.3% for 14 patients with complex ventricular arrhythmias (p less than 0.01). Ejection fractions determined by angiography, available for 31 patients, were also lower in patients with complex ventricular arrhythmias (61.1 +/- 16.3% versus 51.4 +/- 13.4%; p less than 0.05). Seven of 9 patients showing conduction abnormalities on the electrocardiogram had complex ventricular arrhythmias. Eight of 20 patients with aortic stenosis had complex ventricular arrhythmias, while 2 of 13 patients with aortic insufficiency had such arrhythmias. It is concluded that decreased left ventricular ejection fraction, intraventricular conduction abnormalities, and aortic stenosis are associated with an increased frequency of complex ventricular arrhythmias in patients with aortic valve disease.

Santinga, J.T.; Kirsh, M.M.; Brady, T.J.; Thrall, J.; Pitt, B.

1983-02-01

356

High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization  

Microsoft Academic Search

Purpose  To compare image quality and radiation dose of high-pitch computed tomography angiography(CTA) of the aortic valve-aortic\\u000a root complex with and without prospective ECG-gating compared to a retrospectively ECG-gated standard-pitch acquisition.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  120 patients(mean age 68?±?13 years) were examined using a 128-slice dual-source CT system using prospectively ECG-gated high-pitch(group\\u000a A; n?=?40), non-ECG-gated high-pitch(group B; n?=?40) or retrospectively ECG-gated standard-pitch(C; n?=?40) acquisition

Christoph Karlo; Sebastian Leschka; Robert Paul Goetti; Gudrun Feuchtner; Lotus Desbiolles; Paul Stolzmann; Andre Plass; Volkmar Falk; Borut Marincek; Hatem Alkadhi; Stephan Baumüller

2011-01-01

357

Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events.  

PubMed

Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with symptomatic aortic stenosis at high or prohibitive surgical risk. However, patients undergoing TAVI are also at high risk for both bleeding and stroke complications, and specific mechanical aspects of the procedure itself can increase the risk of these complications. The mechanisms of periprocedural bleeding complications seem to relate mainly to vascular/access site complications (related to the use of large catheters in a very old and frail elderly population), whereas the pathophysiology of cerebrovascular events remains largely unknown. Further, although mechanical complications, especially the interaction between the valve prosthesis and the native aortic valve, may play a major role in events that occur during TAVI, post-procedural events might also be related to a prothrombotic environment or state generated by the implanted valve, the occurrence of atrial arrhythmias, and associated comorbidities. Antithrombotic therapy in the setting of TAVI has been empirically determined, and unfractionated heparin during the procedure followed by dual antiplatelet therapy with aspirin (indefinitely) and clopidogrel (1 to 6 months) is the most commonly recommended treatment. However, bleeding and cerebrovascular events are common; these may be modifiable with optimization of periprocedural and post-procedural pharmacology. Further, as the field of antiplatelet and anticoagulant therapy evolves, potential drug combinations will multiply, introducing variability in treatment. Randomized trials are the best path forward to determine the balance between the efficacy and risks of antithrombotic treatment in this high risk-population. PMID:23583252

Rodés-Cabau, Josep; Dauerman, Harold L; Cohen, Mauricio G; Mehran, Roxana; Small, Eric M; Smyth, Susan S; Costa, Marco A; Mega, Jessica L; O'Donoghue, Michelle L; Ohman, E Magnus; Becker, Richard C

2013-12-24

358

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

SciTech Connect

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.

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

359

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

E-print Network

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 ...

Housman, David E.

360

Stentless aortic valve replacement in the young patient: long-term results  

PubMed Central

Background Stentless aortic valve replacement (SAVR) became a common surgical procedure to treat aortic valve disease, as it offers larger orifice area and improved hemodynamics. The aim of our single-centre retrospective study was to assess long term results of first generation stentless aortic valves in young patients, where mechanical prostheses are considered first line therapy. Methods From 1993 to 2001, 188 (149 male and 39 female) patients (?60 years) underwent SAVR. Indications were in 63.3% stenosis or mixed lesions and in 36.7% isolated regurgitation. Mean age of patients at surgery was 53.1?±?7.1 years. Associated procedures were performed in 60 patients (31.9%). Follow-up data were acquired through telephone interviews. Follow-up was 90.4% complete at a mean of 8.8?±?4.7 years. Total follow-up was 1657.6 patient-years with a maximum of 17 years. Results Overall hospital mortality was 3.2% (2.5% for isolated SAVR). Overall actuarial survival-rate at 10/15 years and freedom from reoperation at 10/14 years were 73.0%?±?3.5%/ 55.8%?±?5.4% and 81.0%?±?3.4%/ 58.0%?±?7.5%, respectively. For isolated SAVR, actuarial survival at 10/15 years and freedom from reoperation at 10/14 years were 70.1%?±?4.4%/ 64.1%?±?4.8% and 83.1%?±?4.0%/ 52.9%?±?9.0%, respectively. Reoperation was performed in 42 patients (22.3%) due to structural valve deterioration and endocarditis. Age (?50 years) and associated procedures did not significantly lower survival and freedom from reoperation, however, small prosthesis sizes (?25 mm) did. Conclusion In patients aged 60 and younger, SAVR provides reliable long-term results especially for larger aortic valves. PMID:23566631

2013-01-01

361

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

PubMed Central

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.

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

2015-01-01

362

Comparison of frequency, risk factors, and time course of postoperative delirium in octogenarians after transcatheter aortic valve implantation versus surgical aortic valve replacement.  

PubMed

Postoperative delirium (PD) after transcatheter aortic valve implantation (TAVI) remains to be explored. We sought to (1) determine the incidence of PD in octogenarians who underwent TAVI or surgical aortic valve replacement (SAVR), (2) identify its risk factors, and (3) describe possible differences in the onset and course of PD between treatment groups. A prospective cohort study of consecutive patients aged ?80 years with severe aortic stenosis who underwent elective TAVI or SAVR (N = 143) was conducted. The incidence of PD was assessed for 5 days using the Confusion Assessment Method (CAM). Risk factors for PD were studied with logistic regression. Patients treated with TAVI were older (p ?0.001), had lower cognitive scores (p = 0.007), and more co-morbidities (p = 0.003). Despite this, significantly fewer (p = 0.013) patients treated with TAVI (44%) experienced PD compared to patients treated with SAVR (66%). Undergoing SAVR (p = 0.02) and having lower cognitive function (p = 0.03) emerged as risk factors for PD, whereas gender, activities of daily living, frailty, atrial fibrillation, and postoperative use of opioids and anxiolytics did not. Patients treated with TAVI and without PD during the first 2 postoperative days were unlikely to experience PD on subsequent days. The onset of PD after SAVR could occur at any time during the postoperative evaluation. In conclusion, SAVR in octogenarian patients with aortic stenosis might be considered as a predisposing factor for PD. Our data also suggest that the onset of PD was more unpredictable after SAVR. PMID:25644851

Eide, Leslie S P; Ranhoff, Anette H; Fridlund, Bengt; Haaverstad, Rune; Hufthammer, Karl Ove; Kuiper, Karel K J; Nordrehaug, Jan Erik; Norekvål, Tone M

2015-03-15

363

Neisseria sicca Endocarditis Complicated by Intracranial and Popliteal Aneurysms in a Patient with a Bicuspid Aortic Valve  

PubMed Central

We report a case of infective endocarditis due to Neisseria sicca complicated by intracranial and popliteal aneurysms and hepatic and splenic infarcts in a patient with a bicuspid aortic valve. No predisposing factor other than poor dental condition was found. The patient fully recovered after antibiotic therapy, aortic and mitral valve replacement, endovascular occlusion of the middle-cerebral artery aneurysm, and surgical treatment of the popliteal artery aneurysm. PMID:23476838

Debellemanière, Guillaume; Chirouze, Catherine; Hustache-Mathieu, Laurent; Fournier, Damien; Biondi, Alessandra; Hoen, Bruno

2013-01-01

364

Neisseria sicca Endocarditis Complicated by Intracranial and Popliteal Aneurysms in a Patient with a Bicuspid Aortic Valve.  

PubMed

We report a case of infective endocarditis due to Neisseria sicca complicated by intracranial and popliteal aneurysms and hepatic and splenic infarcts in a patient with a bicuspid aortic valve. No predisposing factor other than poor dental condition was found. The patient fully recovered after antibiotic therapy, aortic and mitral valve replacement, endovascular occlusion of the middle-cerebral artery aneurysm, and surgical treatment of the popliteal artery aneurysm. PMID:23476838

Debellemanière, Guillaume; Chirouze, Catherine; Hustache-Mathieu, Laurent; Fournier, Damien; Biondi, Alessandra; Hoen, Bruno

2013-01-01

365

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

PubMed Central

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

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

2015-01-01

366

The impact of transcatheter aortic valve implantation on patients' profiles and outcomes of aortic valve surgery programmes: a multi-institutional appraisal†  

PubMed Central

OBJECTIVES The aim of this retrospective multicenter study was to assess how the development of transcatheter aortic valve implantation (TAVI) influenced the characteristics and outcomes of patients undergoing aortic valve procedures. METHODS We reviewed 1395 patients who underwent isolated surgical aortic valve replacement (SAVR) or TAVI in three centres with a high-volume TAVI programme. Patients were divided into two groups: ‘Pre-TAVI’ (395 patients, 28.3%) and ‘Post-TAVI’ (1000 patients, 71.7%) operated on before and after the introduction of TAVI into clinical practice. We evaluated age, logistic EuroSCORE I (LES) and hospital mortality according to time periods and the procedure performed, whether SAVR or TAVI. RESULTS ‘Post-TAVI’ patients were older (78.2 ± 7.8 vs 76.8 ± 6.7 years; P = 0.002) and with a significantly higher LES (17.8 ± 14.7 vs 9.1 ± 9.2%; P < 0.001) than ‘Pre-TAVI’ patients. Hospital mortality was not significantly different between groups (‘Pre-TAVI’ vs ‘Post-TAVI’: 2 vs 3.4%; P = 0.17). Of the 1000 ‘Post-TAVI’ patients, 605 (60.5%) underwent TAVI and 395 (39.5%), SAVR. Patients undergoing TAVI were older (79.9 ± 7.1 vs 75.5 ± 9.2 years; P < 0.001) and with a higher LES (22.9 ± 15.3 vs 9.7 ± 9.3%; P < 0.001) than ‘Post-TAVI’ SAVR patients, but their hospital mortality was similar (3.9 vs 2.5%; P = 0.22). LES was similar between ‘Pre-TAVI’ and ‘Post-TAVI’ SAVR patients (9.1 ± 9.2 vs 9.7 ± 9.3%; P = 0.26). Furthermore, we did not find significant differences in the overall hospital mortality between SAVR and TAVI patients: 2.3 vs 3.9%, P = 0.08. CONCLUSIONS This analysis shows that the development of TAVI has caused an increase in the preoperative risk profile of patients scheduled for aortic valve procedures (SAVR or TAVI) without increasing hospital mortality. PMID:23360714

D'Onofrio, Augusto; Alfieri, Ottavio R.; Cioni, Micaela; Alamanni, Francesco; Fusari, Melissa; Tarzia, Vincenzo; Rizzoli, Giulio; Gerosa, Gino

2013-01-01

367

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

PubMed Central

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

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

2014-01-01

368

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

PubMed Central

Background Mitral regurgitation (MR) is a frequent finding in patients with aortic stenosis (AS). The objective of this study is to assess the change in MR severity following transcatheter aortic valve implantation (TAVI). Methods MR changes were assessed by comparing transthoracic echocardiography before and after the procedure. Results The prosthetic aortic valve was successfully implanted in 65 patients. The number of patients with pre-procedure MR was reduced from 58 (85.3%) to 43 (63.2%) (p < 0.001). Vena contracta width was decreased from 0.47 ± 0.28 to 0.25 ± 0.21, (p = 0.043). About 59.4% (19/32) of those who had moderate to severe MR and 85.7% (12/14) of those with severe MR experienced a significant improvement in MR after the procedure (p < 0.001). Improvement in MR was independent of prosthetic valve type with 54.2% in CoreValve and 43.9% in Edwards SAPIEN, p = 0.424; valve sizes were 25.8 ± 1.9 in those who improved vs. 25.0 ± 1.9 mm in those who did not improve, p = 0.105; femoral approach was 51.2% and apical approach was 41.7%, p = 0.457; MR etiology was 48.1% in organic and 48.6% in functional, p = 0.968; and operative risk was 50.0% in EuroScore >20 and 48.6% in EuroScore <20, p = 0.356. Conclusions TAVI is associated with a significant improvement in MR, especially in severe types. The lack of influence of MR improvement by the etiology of MR, the type of valve implanted, and the operative risk need to be confirmed in a larger multi-center study. PMID:25544817

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

2014-01-01

369

Usefulness of updated valve academic research consortium-2 criteria for acute kidney injury following transcatheter aortic valve implantation.  

PubMed

Acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI) is frequent and associated with adverse outcomes. We aimed to identify the incidence and risk factors for AKI after TAVI using the updated Valve Academic Research Consortium-2 classification criteria. We performed a retrospective analysis of 300 consecutive patients undergoing TAVI using either Edwards SAPIEN XT or CoreValve bioprostheses at our medical center. Change in serum creatinine from base line to 48 to 72 hours after TAVI was used to define AKI stages 1 to 3. The final study cohort included 251 patients. Overall incidence of AKI was 16.7% (42 of 251); of which, stage 1 AKI was 15.1% (38 of 251), stage 2 AKI was 1.6% (4 of 251), and none had stage 3 AKI or required hemodialysis. All-cause mortality at 30 days and 1 year was greater among patients with AKI (9.5% vs 1%, p <0.01% and 25.7% vs 12.3%, p = 0.041, respectively). Despite greater volume of contrast media used in Edwards SAPIEN versus CoreValve (162 ml vs 142 ml, p = 0.02), there was no difference in the incidence of AKI between the 2 valve types (23.7% vs 15.5%, p = 0.238) or when comparing larger (29 to 31 mm) versus smaller size valves (23 to 26 mm; 17.7% vs 16.1%, p = 0.745). AKI was associated with chronic kidney disease, history of peripheral vascular disease, blood transfusion, and higher EuroSCORE (p <0.05 for all). In conclusion, according to the new Valve Academic Research Consortium-2 classification, 1 in every 6 patients in our cohort developed AKI after TAVI (most were stage 1 AKI). AKI was associated with increased mortality. No difference in AKI incidence was observed between different types and sizes of bioprostheses used. PMID:24012024

Konigstein, Maayan; Ben-Assa, Eyal; Abramowitz, Yigal; Steinvil, Arie; Leshem Rubinow, Eran; Havakuk, Ofer; Arbel, Yaron; Halkin, Amir; Keren, Gad; Banai, Shmuel; Finkelstein, Ariel

2013-12-01

370

The effect of glycosaminoglycans and hydration on the viscoelastic properties of aortic valve cusps.  

PubMed

This paper reviews the rationale for developing a tissue-engineered aortic valve by building up the complex microstructure from its basic components, and presents recent progress towards that goal. Over the past 4 years, we have been working on engineering the functional components of the composite valve the collagen fiber bundles, the elastin sheets, and the hyaluronan matrix that keeps the tissue hydrated. Most recently, we have been working on optimizing the geometry and material properties of the collagen constructs, by varying their size and aspect ratio, and the types of loading protocols the constructs experience during the culture process. PMID:17282868

Bhatia, A; Vesely, I

2005-01-01

371

Iatrogenic Left Main Coronary Artery Stenosis Following Aortic and Mitral Valve Replacement  

PubMed Central

Iatrogenic coronary artery disease following prosthetic valve implantation is a rare complication. This may result from mechanical injury in the intraoperative period. The use of balloon tip perfusion catheter presumably provides the initial insult with local vessel wall hypoxia. Once the diagnosis of coronary ostial stenosis is established, the procedure of choice is coronary artery bypass surgery. We report a case of a young lady who underwent aortic and mitral valves replacement for infective endocarditis. She was then diagnosed with ostial left main stem coronary stenosis after presenting with atypical symptoms. The patient eventually underwent coronary artery bypass surgery.

Alsaddah, Jadan; Alkandari, Saad; Younan, Hany

2015-01-01

372

TGF-? mediates early angiogenesis and latent fibrosis in an Emilin1-deficient mouse model of aortic valve disease  

PubMed Central

Aortic valve disease (AVD) is characterized by elastic fiber fragmentation (EFF), fibrosis and aberrant angiogenesis. Emilin1 is an elastin-binding glycoprotein that regulates elastogenesis and inhibits TGF-? signaling, but the role of Emilin1 in valve tissue is unknown. We tested the hypothesis that Emilin1 deficiency results in AVD, mediated by non-canonical (MAPK/phosphorylated Erk1 and Erk2) TGF-? dysregulation. Using histology, immunohistochemistry, electron microscopy, quantitative gene expression analysis, immunoblotting and echocardiography, we examined the effects of Emilin1 deficiency (Emilin1?/?) in mouse aortic valve tissue. Emilin1 deficiency results in early postnatal cell-matrix defects in aortic valve tissue, including EFF, that progress to latent AVD and premature death. The Emilin1?/? aortic valve displays early aberrant provisional angiogenesis and late neovascularization. In addition, Emilin1?/? aortic valves are characterized by early valve interstitial cell activation and proliferation and late myofibroblast-like cell activation and fibrosis. Interestingly, canonical TGF-? signaling (phosphorylated Smad2 and Smad3) is upregulated constitutively from birth to senescence, whereas non-canonical TGF-? signaling (phosphorylated Erk1 and Erk2) progressively increases over time. Emilin1 deficiency recapitulates human fibrotic AVD, and advanced disease is mediated by non-canonical (MAPK/phosphorylated Erk1 and Erk2) TGF-? activation. The early manifestation of EFF and aberrant angiogenesis suggests that these processes are crucial intermediate factors involved in disease progression and therefore might provide new therapeutic targets for human AVD. PMID:25056700

Munjal, Charu; Opoka, Amy M.; Osinska, Hanna; James, Jeanne F.; Bressan, Giorgio M.; Hinton, Robert B.

2014-01-01

373

Recent Advances in Transcatheter Aortic Valve Implantation: Novel Devices and Potential Shortcomings  

PubMed Central

During the past years transcatheter aortic valve implantation (TAVI) has evolved to a standard technique for the treatment of high risk patients suffering from severe aortic stenosis. Worldwide the number of TAVI procedures is increasing exponentially. In this context both the transapical antegrade (TA) and the transfemoral retrograde (TF) approach are predominantly used and can be considered as safe and reproducible access sites for TAVI interventions. As a new technology TAVI is in a constant progress regarding the development of new devices. While in the first years only the Edwards SAPIEN™ and the Medtronic CoreValve™ prostheses were commercial available, recently additional devices obtained CE-mark approval and others have entered initial clinical trials. In addition to enhance the treatment options in general, the main driving factor to further develop new device iterations is to solve the drawbacks of the current TAVI systems: paravalvular leaks, occurrence of AV-blocks and the lack of full repositionability. PMID:24313644

Blumenstein, J.; Liebetrau, C.; Linden, A. Van; Moellmann, H.; Walther, T.; Kempfert, J.

2013-01-01

374

Recent advances in transcatheter aortic valve implantation: novel devices and potential shortcomings.  

PubMed

During the past years transcatheter aortic valve implantation (TAVI) has evolved to a standard technique for the treatment of high risk patients suffering from severe aortic stenosis. Worldwide the number of TAVI procedures is increasing exponentially. In this context both the transapical antegrade (TA) and the transfemoral retrograde (TF) approach are predominantly used and can be considered as safe and reproducible access sites for TAVI interventions. As a new technology TAVI is in a constant progress regarding the development of new devices. While in the first years only the Edwards SAPIEN(TM) and the Medtronic CoreValve(TM) prostheses were commercial available, recently additional devices obtained CE-mark approval and others have entered initial clinical trials. In addition to enhance the treatment options in general, the main driving factor to further develop new device iterations is to solve the drawbacks of the current TAVI systems: paravalvular leaks, occurrence of AV-blocks and the lack of full repositionability. PMID:24313644

Blumenstein, J; Liebetrau, C; Van Linden, A; Moellmann, H; Walther, T; Kempfert, J

2013-11-01

375

Association of Serum Phosphate Levels with Aortic Valve Sclerosis and Annular Calcification: the Cardiovascular Health Study  

PubMed Central

Objectives To evaluate mineral metabolism markers as potential risk factors for calcific aortic valve disease. Background Mineral metabolism disturbances are common among older people and may contribute to cardiac valvular calcification. Associations of serum mineral metabolism markers with cardiac valvular calcification have not been evaluated in a well-characterized general population of older adults. Methods We measured serum levels of phosphate, calcium, parathyroid hormone, and 25-hydroxyvitamin D in 1,938 Cardiovascular Health Study participants who were free of clinical cardiovascular disease and who underwent echocardiography measurements of aortic valve sclerosis (AVS), mitral annular calcification (MAC), and aortic annular calcification (AAC). We used logistic regression models to estimate associations of mineral metabolism markers with AVS, MAC, and AAC after adjustment for relevant confounding variables, including kidney function. Results The respective prevalences of AVS, MAC, and AAC were 54%, 39%, and 44%. Each 0.5 mg/dl higher serum phosphate concentration was associated with a greater adjusted odds of AVS (odds ratio 1.17, 95% confidence interval 1.04 to 1.31, p = 0.01), MAC (odds ratio 1.12, 95% confidence interval 1.00 to 1.26, p =0.05), and AAC (odds ratio 1.12, 95% confidence interval 0.99 to 1.25, p = 0.05). In contrast, serum calcium, parathyroid hormone, and 25-hydroxyvitamin D concentrations were not associated with aortic or mitral calcification. Conclusions Higher serum phosphate levels within the normal range are associated with valvular and annular calcification in a community-based cohort of older adults. Phosphate may be a novel risk factor for calcific aortic valve disease and warrants further study. PMID:21737022

Linefsky, Jason P.; O’Brien, Kevin D.; Katz, Ronit; de Boer, Ian H.; Barasch, Eddy; Jenny, Nancy S.; Siscovick, David S.; Kestenbaum, Bryan

2011-01-01

376

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

PubMed Central

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

2014-01-01

377

Aortic valve area assessed with 320-detector computed tomography: comparison with transthoracic echocardiography.  

PubMed

To evaluate the diagnostic accuracy of aortic valve area (AVA) assessment with 320-detector Computed Tomography (MDCT) compared to transthoracic echocardiography (TTE) in a population with mild to severe aortic valve stenosis. AVA was estimated in 169 patients by planimetry on MDCT images (AVA(MDCT)) and by the continuity equation with TTE (AVA(TTE)). To generate a reference AVA (AVA(REF)) we used the stroke volume from MDCT divided by the velocity time integral from CW Doppler by TTE (according to the continuity equation: stroke volume in LVOT = stroke volume passing the aortic valve). AVA(REF) was used as the reference to compare both measures against, since it bypasses the assumption of LVOT being circular in the continuity equation and the potential placement error of PW Doppler in the LVOT. The mean (±SD) age of the patients was 71 (±9) years, 113 (67%) were males. Mean AVA(TTE) was 0.93 (±0.33) cm(2), mean AVA(MDCT) was 0.99 (±0.36) cm(2) and mean AVA(REF) was 1.00 (±0.39) cm(2). The mean difference between AVA(TTE) and AVA(MDCT) was -0.06 cm(2), p = 0.001, mean difference between AVA(TTE) and AVA(REF) was -0.06 cm(2), p < 0.001, and mean difference between AVA(MDCT) and AVA(REF) was -0.01 cm(2), p = 0.60. Calcification of the aortic valve quantified by Agatston score, significantly decreased the correlation between AVA(MDCT) and AVA(REF), (r low Agatston = 0.90, r high Agatston = 0.57). MDCT measured AVA is slightly larger than AVA measured by TTE (0.06 cm(2)). The accuracy and precision errors on AVA measurements are comparable for MDCT and TTE. Valvular calcification may primarily affect the accuracy of AVA(MDCT). PMID:24126620

Larsen, Linnea Hornbech; Kofoed, Klaus Fuglsang; Carstensen, Helle Gervig; Mejdahl, Mads Rams; Andersen, Mads Jønsson; Kjaergaard, Jesper; Nielsen, Olav Wendelboe; Køber, Lars; Møgelvang, Rasmus; Hassager, Christian

2014-01-01

378

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

PubMed

Calcific aortic valve disease (CAVD) is a progressive pathology characterized by calcification mainly within the cusps of the aortic valve (AV). As CAVD advances, the blood flow and associated hemodynamics are severely altered, thus influencing the mechanical performance of the AV. This study proposes a new method, termed reverse calcification technique (RCT) capable of re-creating the different calcification growth stages. The RCT is based on three-dimensional (3D) spatial computed tomography (CT) distributions of the calcification density from patient-specific scans. By repeatedly subtracting the calcification voxels with the lowest Hounsfield unit (HU), only high calcification density volume is presented. RCT posits that this volume re-creation represents earlier calcification stages and may help identify CAVD initiation sites. The technique has been applied to scans from 12 patients (36 cusps) with severe aortic stenosis who underwent CT before transcatheter aortic valve implantation (TAVI). Four typical calcification geometries and growth patterns were identified. Finite elements (FE) analysis was applied to compare healthy AV structural response with two selected CAVD-RCT configurations. The orifice area decreased from 2.9cm(2) for the healthy valve to 1.4cm(2) for the moderate stenosis case. Local maximum strain magnitude of 0.24 was found on the edges of the calcification compared to 0.17 in the healthy AV, suggesting a direct relation between strain concentration and calcification geometries. The RCT may help predict CAVD progression in patients at early stages of the disease. The RCT allows a realistic FE mechanical simulation and performance of calcified AVs. PMID:25553668

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

2015-02-01

379

Uraemic hyperparathyroidism causes a reversible inflammatory process of aortic valve calcification in rats  

Microsoft Academic Search

Aims Renal failure is associated with aortic valve calcification (AVC). Our aim was to develop an animal model for exploring the pathophysiology and reversibility of AVC, utilizing rats with diet-induced kidney disease. Methods and results Sprague-Dawley rats (n ¼ 23) were fed a phosphate-enriched, uraemia-inducing diet for 7 weeks followed by a normal diet for 2 weeks ('diet group'). These

Mony Shuvy; Suzan Abedat; Ronen Beeri; Haim D. Danenberg; David Planer; Iddo Z. Ben-Dov; Karen Meir; Jacob Sosna; Chaim Lotan

2008-01-01

380

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

PubMed

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

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

2015-05-01

381

Redo aortic valve replacement in a patient with immunoglobulin A deficiency and hemophilia A.  

PubMed

Immunoglobulin A (IgA) deficiency may result in the development of anti-IgA antibodies. Such antibodies may result in anaphylaxis when patients receive standard blood products. Hemophilia A is a deficiency of clotting factor VIII that results in a significant coagulopathy and bleeding in the perioperative period unless precautions are taken. We present a case of successful management of combined hemophilia A and IgA deficiency in a patient undergoing repeated sternotomy for aortic valve replacement. PMID:23816085

Fitzsimons, Michael G; Walton, Ken; Makar, Robert; Dzik, Walter; Kuter, David; Vlahakes, Gus J

2013-07-01

382

Mini-Konno procedure using a 10 mm handmade valve for pulmonary atresia with intact ventricular septum and severe aortic stenosis.  

PubMed

We herein report the case of a neonate with pulmonary atresia with intact ventricular septum, right ventricular hypoplasia and severe aortic stenosis. Repetitive aortic valve surgeries in early infancy resulted in early relapse of the aortic stenosis due to the small aortic annulus, bicuspid configuration and duct-dependent pulmonary circulation. The infant underwent a successful mini-Konno procedure using a 10 mm handmade valve and bidirectional Glenn shunt at 6 months of age. PMID:24336795

Matsuhisa, Hironori; Oshima, Yoshihiro; Tanaka, Akiko; Kamei, Naoya

2014-03-01

383

Aortic valve replacement with frame-supported autologous fascia lata grafts. II. Clinical and laboratory findings.  

PubMed

Thirty-five patients with a frame-supported autologous fascia lata graft implanted in the aortic annulus were investigated 11 to 36 months after operation. The group comprised 7 patients with pure aortic stenosis, 11 with combined stenosis and incompetence and 17 with pure aortic incompetence. Seven patients had concommitant mitral valve disease. The follow-up investigation included ECG, a work test on a bicycle ergometer, dynamic spirometry, roentgenological heart volume determination and haematological "screening tests" for intravascular haemolysis. Concomitant with a marked subjective improvement of the patients, there was a considerable objective improvement, as judged by physical working capacity, ECG signs of left ventricular hypertrophy and heart volume. The serum haptoglobin values were somewhat lower postoperatively (mean value 44 mg%), but no ahaptoglobinaemia occurred. Thus, no definite signs of intravascular haemolysis were noted. No thrombo-embolism occurred within this observation period, despite the fact that none of the patients with isolated aortic valve replacement were treated with anticoagulants. This investigation shows that a frame-supported autologous fascia lata valvular graft in the aorta can function well during a period of up to 3 years. PMID:1179192

Dubiel, W T; Cullhed, I

1975-01-01

384

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

PubMed Central

Background In patients with severe aortic stenosis, left ventricular hypertrophy is associated with increased myocardial stiffness and dysfunction linked to cardiac morbidity and mortality. We aimed at systematically investigating the degree of left ventricular mass regression and changes in left ventricular function six months after transcatheter aortic valve implantation (TAVI) by cardiovascular magnetic resonance (CMR). Methods Left ventricular mass indexed to body surface area (LVMi), end diastolic volume indexed to body surface area (LVEDVi), left ventricular ejection fraction (LVEF) and stroke volume (SV) were investigated by CMR before and six months after TAVI in patients with severe aortic stenosis and contraindications for surgical aortic valve replacement. Results Twenty-sevent patients had paired CMR at baseline and at 6-month follow-up (N=27), with a mean age of 80.7±5.2 years. LVMi decreased from 84.5±25.2 g/m2 at baseline to 69.4±18.4 g/m2 at six months follow-up (P<0.001). LVEDVi (87.2±30.1 ml /m2vs 86.4±22.3 ml/m2; P=0.84), LVEF (61.5±14.5% vs 65.1±7.2%, P=0.08) and SV (89.2±22 ml vs 94.7±26.5 ml; P=0.25) did not change significantly. Conclusions Based on CMR, significant left ventricular reverse remodeling occurs six months after TAVI. PMID:23692630

2013-01-01

385

Left atrial appendage thrombus in a patient in sinus rhythm with endocarditis and a severe aortic valve insufficiency.  

PubMed

A left atrial thrombus is most often associated with atrial fibrillation and/or rheumatic mitral stenosis. It is very infrequently detected in the presence of sinus rhythm. The present report describes the case of a 66-year-old woman who presented with a stroke and was subsequently found to have two potential sources of embolization, including a vegetation on the native aortic valve, with associated severe aortic insufficiency, and a left atrial appendage thrombus despite being in sinus rhythm. To the authors' knowledge, the present report is the first to describe a left atrial thrombus in sinus rhythm associated with aortic valve endocarditis. PMID:18841267

Shanks, M; Cujec, B; Choy, J B

2008-10-01

386

Crystalline ultrastructures, inflammatory elements, and neoangiogenesis are present in inconspicuous aortic valve tissue.  

PubMed

Morbidity from calcific aortic valve disease (CAVD) is increasing. Recent studies suggest early reversible changes involving inflammation and neoangiogenesis. We hypothesized that microcalcifications, chemokines, and growth factors are present in unaffected regions of calcific aortic valves. We studied aortic valves from 4 patients with CAVD and from 1 control, using immunohistochemistry, scanning electron microscopy, and infrared spectrography. We revealed clusters of capillary neovessels in calcified (ECC), to a lesser extent in noncalcified (ECN) areas. Endothelial cells proved constant expression of SDF-1 in ECC, ECN, and endothelial cells from valvular surface (ECS). Its receptor CXCR4 was expressed in ECC. IL-6 expression correlated with CXCR4 staining and presence of lymphocytes. VEGF was expressed by ECS, its receptor by ECC and ECN. Crystalline ultrastructures were found on the surface of histologically noncalcified areas (HNCAs), spectrography revealed calcium hydroxylapatite. Our results demonstrate that crystalline ultrastructures are present in HNCAs, undergoing neoangiogenesis in an inflammatory context. These alterations could be an early witness of disease and an opening to therapy. PMID:21253468

Dorfmüller, P; Bazin, D; Aubert, S; Weil, R; Brisset, F; Daudon, M; Capron, F; Brochériou, I

2010-01-01

387

Crystalline Ultrastructures, Inflammatory Elements, and Neoangiogenesis Are Present in Inconspicuous Aortic Valve Tissue  

PubMed Central

Morbidity from calcific aortic valve disease (CAVD) is increasing. Recent studies suggest early reversible changes involving inflammation and neoangiogenesis. We hypothesized that microcalcifications, chemokines, and growth factors are present in unaffected regions of calcific aortic valves. We studied aortic valves from 4 patients with CAVD and from 1 control, using immunohistochemistry, scanning electron microscopy, and infrared spectrography. We revealed clusters of capillary neovessels in calcified (ECC), to a lesser extent in noncalcified (ECN) areas. Endothelial cells proved constant expression of SDF-1 in ECC, ECN, and endothelial cells from valvular surface (ECS). Its receptor CXCR4 was expressed in ECC. IL-6 expression correlated with CXCR4 staining and presence of lymphocytes. VEGF was expressed by ECS, its receptor by ECC and ECN. Crystalline ultrastructures were found on the surface of histologically noncalcified areas (HNCAs), spectrography revealed calcium hydroxylapatite. Our results demonstrate that crystalline ultrastructures are present in HNCAs, undergoing neoangiogenesis in an inflammatory context. These alterations could be an early witness of disease and an opening to therapy. PMID:21253468

Dorfmüller, P.; Bazin, D.; Aubert, S.; Weil, R.; Brisset, F.; Daudon, M.; Capron, F.; Brochériou, I.

2010-01-01

388

The development of ascending aortic aneurysms after elective aortic valve replacement with St Jude mechanical valve prosthesis in the bicuspid patient: a pilot study.  

PubMed

The association between bicuspid aortic valve (BAV) and ascending aorta aneurysm is well described. Replacement of the ascending aorta is now being considered at 4.5 cm. We identified patients confirmed with BAV who underwent elective aortic valve replacement (AVR) with a mechanical St Jude Bioprosthesis from 1994 to 2000 who were ?65 years of age at the time of surgery. Follow-up imaging was obtained by computed tomography (CT) angiography or echocardiography. A total of 225 patients who underwent AVR were identified; 60 patients had a BAV. Of all, 36 (60%) patients with BAV returned for follow-up imaging of their ascending aorta. Eight patients (22%) had diameters classifiable as aneurysmal (>4.5 cm) that developed within 9.6 ± 4.1 years from implant and requiring surgery. Of all, 7 patients (12%) died within 5.9 ± 2.5 years from their implant date. Lifelong serial monitoring of the ascending aorta for patients with BAV should be the standard of care. PMID:22717597

Cohoon, Kevin P; Foley, Jillian; Dieter, Robert S; Bakhos, Mamdouh; Schwartz, Jeffrey

2013-07-01

389

Acute inferior myocardial infarction in a patient with a prosthetic aortic valve and high international normalized ratio  

PubMed Central

ST elevation acute myocardial infarction in patients with a mechanical prosthetic valve is rare and usually due to inadequate anticoagulation. We present a case of acute inferior myocardial infarction in a patient with a prosthetic aortic valve and high international normalized ratio, which has not been reported previously. PMID:24799934

Sari, Ibrahim; Delil, Kenan; Ileri, Cigdem; Samadov, Fuad

2014-01-01

390

Influence of gender on clinical outcomes following transcatheter aortic valve implantation from the UK transcatheter aortic valve implantation registry and the National Institute for Cardiovascular Outcomes Research.  

PubMed

Gender differences exist in outcomes after percutaneous coronary intervention and coronary artery bypass graft surgery but have yet to be fully explored after transcatheter aortic valve implantation. We aimed to investigate gender differences after transcatheter aortic valve implantation in the UK National Institute for Cardiovascular Outcomes Research registry. A retrospective analysis was performed of Medtronic CoreValve and Edwards SAPIEN implantation in 1,627 patients (756 women) from January 2007 to December 2010. Men had more risk factors: poor left ventricular systolic function (11.9% vs 5.5%, p <0.001), 3-vessel disease (19.4% vs 9.2%, p <0.001), previous myocardial infarction (29.5% vs 13.0%, p <0.001), peripheral vascular disease (32.4% vs 23.3%, p <0.001), and higher logistic EuroSCORE (21.8 ± 14.2% vs 21.0 ± 13.4%, p = 0.046). Thirty-day mortality was 6.3% (confidence interval 4.3% to 7.9%) in women and 7.4% (5.6% to 9.2%) in men and at 1 year, 21.9% (18.7% to 25.1%) and 22.4% (19.4% to 25.4%), respectively. There was no mortality difference: p = 0.331 by log-rank test; hazard ratio for women 0.91 (0.75 to 1.10). Procedural success (96.6% in women vs 96.4% in men, p = 0.889) and 30-day cerebrovascular event rates (3.8% vs 3.7%, p = 0.962) did not differ. Women had more major vascular complications (7.5% vs 4.2%, p = 0.004) and less moderate or severe postprocedural aortic regurgitation (7.5% vs 12.5%, p = 0.001). In conclusion, despite a higher risk profile in men, there was no gender-related mortality difference; however, women had more major vascular complications and less postprocedural moderate or severe aortic regurgitation. PMID:24326271

Al-Lamee, Rasha; Broyd, Christopher; Parker, Jessica; Davies, Justin E; Mayet, Jamil; Sutaria, Nilesh; Ariff, Ben; Unsworth, Beth; Cousins, Jonathan; Bicknell, Colin; Anderson, Jonathan; Malik, Iqbal S; Chukwuemeka, Andrew; Blackman, Daniel J; Moat, Neil; Ludman, Peter F; Francis, Darrel P; Mikhail, Ghada W

2014-02-01

391

Simulation of transcatheter aortic valve implantation: a patient-specific finite element approach.  

PubMed

Until recently, heart valve failure has been treated adopting open-heart surgical techniques and cardiopulmonary bypass. However, over the last decade, minimally invasive procedures have been developed to avoid high risks associated with conventional open-chest valve replacement techniques. Such a recent and innovative procedure represents an optimal field for conducting investigations through virtual computer-based simulations: in fact, nowadays, computational engineering is widely used to unravel many problems in the biomedical field of cardiovascular mechanics and specifically, minimally invasive procedures. In this study, we investigate a balloon-expandable valve and we propose a novel simulation strategy to reproduce its implantation using computational tools. Focusing on the Edwards SAPIEN valve in particular, we simulate both stent crimping and deployment through balloon inflation. The developed procedure enabled us to obtain the entire prosthetic device virtually implanted in a patient-specific aortic root created by processing medical images; hence, it allows evaluation of postoperative prosthesis performance depending on different factors (e.g. device size and prosthesis placement site). Notably, prosthesis positioning in two different cases (distal and proximal) has been examined in terms of coaptation area, average stress on valve leaflets as well as impact on the aortic root wall. The coaptation area is significantly affected by the positioning strategy (- 24%, moving from the proximal to distal) as well as the stress distribution on both the leaflets (+13.5%, from proximal to distal) and the aortic wall (- 22%, from proximal to distal). No remarkable variations of the stress state on the stent struts have been obtained in the two investigated cases. PMID:23402555

Auricchio, F; Conti, M; Morganti, S; Reali, A

2014-01-01

392

Biomarkers in Aortic Stenosis - B.A.S.S.  

ClinicalTrials.gov

Aortic Stenosis; Mitral Valve Replacement; Aortic Valve Replacement; Prosthetic Heart Valve Dysfunction; Aortic Insufficiency; Mitral Insufficiency; Hypertrophic Cardiomyopathy; Tricuspid Regurgitation With Pacemaker/Defibrillator Leads

2013-01-15

393

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

PubMed

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

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

2015-02-01

394

Comparison of aortic root dimensions and geometries before and after transcatheter aortic valve implantation by 2- and 3-dimensional transesophageal echocardiography and multislice computed tomography  

Microsoft Academic Search

BACKGROUND: 3D transesophageal echocardiography (TEE) may provide more accurate aortic annular and left ventricular outflow tract (LVOT) dimensions and geometries compared with 2D TEE. We assessed agreements between 2D and 3D TEE measurements with multislice computed tomography (MSCT) and changes in annular\\/LVOT areas and geometries after transcatheter aortic valve implantations (TAVI). METHODS AND RESULTS: Two-dimensional circular (pixr(2)), 3D circular, and

A. C. T. Ng; V. Delgado; F. van der Kley; M. Shanks; N. R. L. van de Veire; M. Bertini; G. Nucifora; R. J. van Bommel; L. F. Tops; A. de Weger; G. Tavilla; A. de Roos; L. J. Kroft; D. Y. Leung; J. Schuijf; M. J. Schalij; J. J. Bax

2010-01-01

395

Aortic valve replacement: is the stentless xenograft an alternative to the homograft? Early results of a randomized study.  

PubMed

From November 1992 to October 1993 we randomized 101 patients over 60 years of age undergoing elective aortic valve replacement, with or without concomitant coronary artery bypass grafting, to receive either a cryopreserved aortic or pulmonary homograft (n = 38) or a stentless porcine aortic valve xenograft (Edwards Prima 2500) (n = 63). The majority of all valves (92%) were inserted freehand in the subcoronary position. Six homografts (16%) were implanted as a free-root replacement and two xenografts (3%) were used as a mini root. There were four in-hospital deaths (4%), three in the homograft group and one in the xenograft group (homograft, 7.9% versus xenograft, 1.6%; p = not significant). Forty-one patients were followed at 3- to 6-month intervals for 9 +/- 2 months (3 to 14 months) and valve pathology was assessed routinely by means of color flow Doppler echocardiography. Two patients in the homograft group developed new aortic insufficiency grade II; all others remained with trivial or no valve incompetence. The mean gradient remained unchanged to immediate postoperative measurements (homograft, 5 +/- 1 mm Hg versus xenograft, 11 +/- 4 mm Hg; p < 0.001). Despite a slightly higher transvalvular gradient, xenografts achieved excellent initial results when compared to homografts. Ease of implantation and freedom from thromboembolism indicate that xenografts can be an acceptable alternative to homografts, particularly in older patients with small aortic annuli. Long-term studies assessing the durability of the xenograft are necessary for final evaluation. PMID:7646200

Gross, C; Harringer, W; Mair, R; Wimmer-Greinecker, G; Klima, U; Sihorsch, K; Hofmann, R; Beran, H; Brücke, P

1995-08-01

396

Surgical and transcatheter aortic valve procedures. The limits of risk scores.  

PubMed

Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in very high-risk patients with severe aortic stenosis. The present multicenter, retrospective study investigates the accuracy and calibration properties of the EuroSCORE and the age, serum creatinine, and ejection fraction (ACEF) score in selecting a population of patients to be referred to TAVI. The study includes 1053 surgical and 211 transcatheter procedures. The operative mortality rate within the surgical group was 2%. The EuroSCORE and the ACEF score had similar levels of accuracy; the ACEF score was well calibrated and the EuroSCORE overestimated the mortality risk. The observed mortality rate within the transcatheter group was 10.4%. Cut-off values corresponding to a mortality rate of 10% were 26 for the logistic EuroSCORE and 2.5 for the ACEF score: both the EuroSCORE and the ACEF score may be used to refer patients to TAVI. However, they do not consider a number of 'extreme' risk conditions that may justify a transcatheter procedure even in absence of an overall elevated risk score. These risk conditions should be included in a specific risk model for referring patients for TAVI. PMID:20484408

Ranucci, Marco; Guarracino, Fabio; Castelvecchio, Serenella; Baldassarri, Rubia; Covello, Remo Daniel; Landoni, Giovanni

2010-08-01

397

Apical left ventricular false aneurysm after transapical transcatheter aortic valve implantation.  

PubMed

Transcatheter valve implantation (TAVI) is becoming a routine procedure to treat severe symptomatic aortic stenosis. It is associated with complications different from those of conventional aortic valve surgery. We describe an 80-year old man who developed an apical left ventricular (LV) false aneurysm 3 months after transapical TAVI (TA-TAVI) complicated postoperatively by a surgical site infection (SSI). Three months earlier, an Edwards Sapien bioprosthesis no. 29 had been successfully inserted transapically because of severe comorbidities and a very large aortic annulus. His postoperative course was complicated by acute respiratory failure, gastrointestinal bleeding and a surgical site infection of the thoracic incision; Escherichia coli and Klebsiella pneumonia were isolated. After surgical debridement drainage and prolonged antibiotic therapy, the wound healed correctly. His emergency chest computed tomography upon readmission for the acute onset of a beating tumefaction at the TA-TAVI site showed a false aneurysm of the LV apex. The apex was closed directly during emergency surgery. The postoperative course was uneventful. Surgical site infection after TA-TAVI, its frequency, treatment and potential role as an underlying cause of this severe complication are discussed. PMID:24092466

Maillet, Jean-Michel; Sableyrolles, Jean-Louis; Guyon, Phillipe; Bonnet, Nicolas

2014-01-01

398

Apical left ventricular false aneurysm after transapical transcatheter aortic valve implantation  

PubMed Central

Transcatheter valve implantation (TAVI) is becoming a routine procedure to treat severe symptomatic aortic stenosis. It is associated with complications different from those of conventional aortic valve surgery. We describe an 80-year old man who developed an apical left ventricular (LV) false aneurysm 3 months after transapical TAVI (TA-TAVI) complicated postoperatively by a surgical site infection (SSI). Three months earlier, an Edwards Sapien bioprosthesis no. 29 had been successfully inserted transapically because of severe comorbidities and a very large aortic annulus. His postoperative course was complicated by acute respiratory failure, gastrointestinal bleeding and a surgical site infection of the thoracic incision; Escherichia coli and Klebsiella pneumonia were isolated. After surgical debridement drainage and prolonged antibiotic therapy, the wound healed correctly. His emergency chest computed tomography upon readmission for the acute onset of a beating tumefaction at the TA-TAVI site showed a false aneurysm