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Sample records for valve aortic valve

  1. Aortic Valve

    MedlinePLUS

    ... arteries . WHAT OPTIONS EXIST FOR THE REPLACEMENT OF ARTIFICIAL VALVES? Unlike the mitral valve which can often ... proceed with surgery, choices regarding the type of artificial valve ( prosthesis ) used should be considered. In broad ...

  2. Bicuspid aortic valve

    MedlinePLUS

    ... that may show a bicuspid aortic valve include: Magnetic resonance imaging (MRI) of the heart Ultrasound of ... defects, other tests may include: Chest x-rays Magnetic resonance imaging (MRI) Test of the electrical activity ...

  3. [Transcatheter aortic valve replacement].

    PubMed

    Sawa, Yoshiki

    2014-07-01

    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

  4. Symptomatic unicuspid aortic valve.

    PubMed

    Jamil, Gohar; Dabbas, Walaa Said; Khan, Mahmuneer; Jamil, Mujgan

    2015-01-01

    A 22-year-old man with typical angina was seeking medical attention at primary health clinics for a couple of months. Owing to his young age and the absence of coronary artery disease risk factors, he was assured of no serious problem. Proper examination at a referral centre revealed weak peripheral pulses with diminished and delayed carotid upstroke. A normal S1 with a soft S2 were audible. A 3/6 late peaking systolic murmur was best heard in the aortic area radiating to the neck. Symptomatic bicuspid aortic valve disease was suspected. Diagnosis of unicuspid aortic valve was established by transoesophageal and three-dimensional echocardiography. The valve was successfully replaced with a mechanical prosthesis. The patient remains asymptomatic at 1?year follow-up. PMID:26678693

  5. Aortic valve surgery - open

    MedlinePLUS

    ... have this type of valve. Biological, made of human or animal tissue. These valves may last 10 ... surgery Infection of the new valve Kidney failure Memory loss and loss of mental clarity, or "fuzzy ...

  6. Valve thrombosis 7 months after transcatheter aortic valve implantation.

    PubMed

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

    2014-09-01

    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

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

    PubMed Central

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

    2012-01-01

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

  8. Emergency Transcatheter Aortic Valve Implantation for Acute and Early Failure of Sutureless Perceval Aortic Valve.

    PubMed

    Durand, Eric; Tron, Christophe; Eltchaninoff, Hélène

    2015-09-01

    We report the case of a 78-year-old woman admitted for cardiogenic shock related to acute and early failure (severe aortic regurgitation) of a Perceval sutureless aortic bioprosthesis (Sorin Group, Saluggia, Italy). Clinical stability was achieved using rescue transfemoral transcatheter aortic valve-in-valve implantation with an Edwards SAPIEN 3 prosthesis (Edwards Lifesciences, Irvine, CA). To our knowledge, we report herein the first case of successful valve-in-valve implantation using a SAPIEN 3 transcatheter heart valve in a sutureless bioprosthetic aortic valve with acute and early deterioration. PMID:26095935

  9. Geometry of aortic heart valves. [prosthetic design

    NASA Technical Reports Server (NTRS)

    Karara, H. M.

    1975-01-01

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

  10. Prosthetic Valve Escaping During Transcatheter Aortic Valve Implantation.

    PubMed

    Furukawa, Nobuyuki; Scholtz, Werner; Scholtz, Smita; Faber, Lothar; Ensminger, Stephan; Gummert, Jan; Börgermann, Jochen

    2015-01-01

    We performed transapical transcatheter aortic valve implantation on an 87-year-old woman with severe aortic valve stenosis. Because of the narrow left ventricular outflow tract, annular positioning of the prosthetic valve proved challenging. During positioning, the prosthetic valve was accidentally dislodged from the balloon catheter and dropped into the left ventricle. Attempted catheter retrieval was unsuccessful. We therefore converted to open surgery without delay. After aortotomy, to our surprise, the prosthesis could not be found, neither in the left ventricle nor in the ascending aorta. Transesophageal echocardiography failed to reveal the location of the missing prosthesis. Fluoroscopy finally displayed the prosthesis in the descending aorta at the level of the left atrium. We proceeded with aortic and mitral valve replacement and closed the sternum. Under fluoroscopic guidance, the prosthetic valve was secured to the wall of the abdominal aorta in an infrarenal position by dilatation with a balloon catheter. This case shows that we should be alert to septum hypertrophy or a narrow left ventricular outflow tract during transapical aortic valve implantation. In such anatomical situations, we recommend advancing the sheath of the application system directly below the annular plane and positioning the prosthesis from this point. PMID:26650617

  11. Transfemoral aortic valve implantation in severe aortic stenosis patients with prior mitral valve prosthesis

    PubMed Central

    Sar?, Cenk; Ba?tu?, Serdal; Kasapkara, Hac? Ahmet; Durmaz, Tahir; Kele?, Telat; Akçay, Murat; Aslan, Abdullah Nabi; Bayram, Nihal Akar; Bozkurt, Engin

    2015-01-01

    Introduction Transcatheter aortic valve implantation for severe symptomatic aortic stenosis in patients with a previous mitral valve prosthesis is technically challenging, and pre-procedural comprehensive assessment of these patients before transcatheter aortic valve implantation is vital for an uncomplicated and successful procedure. Aim We want to share our experience with transcatheter aortic valve implantation in patients with a preexisting functional mitral valve prosthesis and describe a series of important technical and pre-procedural details. Material and methods At our center, 135 patients with symptomatic severe aortic stenosis were treated with transcatheter aortic valve implantation. Six of them with a preexisting mitral valve prosthesis received an Edwards SAPIEN XT valve through the transfemoral route. Results Transcatheter aortic valve implantation was performed successfully in all 6 patients without any deformation of the cobalt-chromium/steel stents of the aortic valve bioprosthesis. Also no distortion or malfunction in the mitral valve prosthesis was observed after the procedure. There were no complications during the hospitalization period. Post-procedural echocardiography revealed no or mild aortic paravalvular regurgitation and normal valve function in all the patients. In addition, serial echocardiographic examination demonstrated that both the stability and function of the aortic and mitral prosthetic valves were normal without any deterioration in the gradients and the degree of the regurgitation at long-term follow-ups. Conclusions Our experience confirms that transcatheter aortic valve implantation is technically feasible in patients with previous mitral valve replacement but comprehensive evaluation of patients by multimodal imaging techniques such as transesophageal echocardiography and multislice computed tomography is mandatory for a successful and safe procedure. PMID:26677380

  12. Nanobacteria-associated calcific aortic valve stenosis.

    PubMed

    Jelic, Tomislav M; Chang, Ho-Huang; Roque, Rod; Malas, Amer M; Warren, Stafford G; Sommer, Andrei P

    2007-01-01

    Calcific aortic valve stenosis is the most common valvular disease in developed countries, and the major reason for operative valve replacement. In the US, the current annual cost of this surgery is approximately 1 billion dollars. Despite increasing morbidity and mortality, little is known of the cellular basis of the calcifications, which occur in high-perfusion zones of the heart. The case is presented of a patient with calcific aortic valve stenosis and colonies of progressively mineralized nanobacteria in the fibrocalcific nodules of the aortic cusps, as revealed by transmission electron microscopy. Consistent with their outstanding bioadhesivity, nanobacteria might serve as causative agents in the development of calcific aortic valve stenosis. PMID:17315391

  13. Valve-in-valve transcatheter aortic valve implantation: the new playground for prosthesis-patient mismatch.

    PubMed

    Faerber, Gloria; Schleger, Simone; Diab, Mahmoud; Breuer, Martin; Figulla, Hans R; Eichinger, Walter B; Doenst, Torsten

    2014-06-01

    Transcatheter aortic valve implantation (TAVI) has become an established procedure for patients with aortic valve stenosis and significant comorbidities. One option offered by this technique is the implantation of a transcatheter valve inside a surgically implanted bioprosthesis. Many reports address the feasibility but also the pitfalls of these valve-in-valve (VIV) procedures. Review articles provide tables listing which valve sizes are appropriate based on the size of the initially implanted bioprosthesis. However, we previously argued that the hemodynamic performance of a prosthetic tissue valve is in large part a result of the dimensions of the bioprosthesis in relation to the patient's aortic outflow dimensions. Thus, the decision if a VIV TAVI procedure is likely to be associated with a favorable hemodynamic result cannot safely be made by looking at premade sizing tables that do not include patient dimensions and do not inquire about the primary cause for bioprosthetic valve stenosis. Prosthesis-patient mismatch (PPM) may therefore be more frequent than expected after conventional aortic valve replacement. Importantly, it may be masked by a potentially flawed method assessing its relevance. Such PPM may therefore impact significantly on hemodynamic outcome after VIV TAVI. Fifteen percent of currently published VIV procedures show only a minimal reduction of pressure gradients. We will address potential pitfalls in the current determination of PPM, outline the missing links for reliable determination of PPM, and present a simplified algorithm to guide decision making for VIV TAVI. PMID:24612128

  14. Acute aortic insufficiency due to avulsion of aortic valve commissure.

    PubMed

    Cunha, Claudio Ribeiro da; Santos, Paulo César; Atik, Fernando Antibas; de Conti, Daniel Oliveira

    2012-01-01

    A 66-year-old male patient, prior hypertension, a history of orthopnea, palpitations and chest pain of sudden onset, which was diagnosed as spontaneous avulsion of aortic valve commissure and consequent aortic insufficiency progressing to acute left heart failure refractory to medical treatment. The patient underwent early surgical replacement of the aortic valve by a bioprosthesis, and presented satisfactory postoperative course. Currently, four years after the event, still in attendance in functional class I. PMID:22729316

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

    PubMed

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

    2014-07-01

    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

  16. Urgent reoperative transapical valve-in-valve shortly after a transapical aortic valve implantation.

    PubMed

    Ferrari, Enrico; Locca, Didier; Marcucci, Carlo; Jeanrenaud, Xavier

    2014-10-01

    Urgent reoperative transapical aortic valve-in-valve has never been proposed as a treatment option in case of a failed transcatheter aortic valve implantation (TAVI) or in case of worsening of an existing paravalvular leak, if this complication occurs right after, or a few days after, the primary transapical aortic valve implantation. Experienced surgeons should argue that after a transapical TAVI, the apex is damaged and fragile, with a high risk of irreparable ventricular tears and life-threatening bleeding if a second transapical procedure is scheduled during the acute phase. Nevertheless, if the patient is inoperable and the vascular status, including the ascending aorta, limits alternative accesses, the urgent reoperative transapical valve-in-valve becomes an alternative. We illustrate, for the first time ever, our experience with an 81-year old female patient who underwent a transapical (TA) TAVI with a Sapien XT 23 mm. The day after the procedure, the patient haemodynamically worsened in combination with a worsening of a known (grade 1-2) paravalvular leak. Thus, on postoperative day two, an urgent transapical valve-in-valve was performed, and a second Sapien XT 23 mm was placed, with an excellent haemodynamic result and absence of leak. The redo apical access did not appear very complicated and the postoperative recovery was uneventful. PMID:24292266

  17. Transcatheter Aortic Valve Replacement: Imaging Techniques for Aortic Root Sizing.

    PubMed

    Wichmann, Julian L; Varga-Szemes, Akos; Suranyi, Pal; Bayer, Richard R; Litwin, Sheldon E; De Cecco, Carlo N; Mangold, Stefanie; Muscogiuri, Giuseppe; Fuller, Stephen R; Vogl, Thomas J; Steinberg, Daniel H; Schoepf, U Joseph

    2015-11-01

    Transcatheter aortic valve replacement (TAVR) is an increasingly used alternative to surgical aortic valve replacement in patients with severe aortic stenosis and prohibitive perioperative risk. Several studies have shown an improved clinical outcome and lower rate of complications with TAVR in this patient population. Furthermore, TAVR has shown promising results in patients at elevated risk from surgical aortic valve replacement. Because of the endovascular nature of this technique, comprehensive preprocedural assessment of the aortic root and vascular access path is crucial. Although echocardiography is still commonly performed to assess the aortic root, cross-sectional imaging modalities are increasingly used given their superior results in the diagnostic accuracy of TAVR measurements. In particular, computed tomography (CT) is gaining an increasing role in pre-TAVR imaging because of fast 3-dimensional assessment of aortic root anatomy and improvements in clinical outcome after TAVR when CT is used for pre-TAVR planning. However, different algorithms exist for matching valve size to the aortic root and left ventricular outflow tract, and these measurements may substantially impact valve prosthesis selection and postinterventional complication rates. Cardiac magnetic resonance may play a role especially in post-TAVR assessment, as it provides both anatomic information and blood flow dynamics. This article reviews multimodality imaging approaches to pre-TAVR aortic root size assessment, provides an overview of the impact on post-TAVR complications and clinical outcome, and describes recent techniques to reduce contrast material volume in TAVR assessment with CT. PMID:26164166

  18. Collagen Bundle Orientation Explains Aortic Valve Leaflet Coaptation

    E-print Network

    Collagen Bundle Orientation Explains Aortic Valve Leaflet Coaptation Peter E. Hammer1 , Christina A. The aortic valve owes its strength and durability to a network of collagen fibers within the leaflets and quantified the macroscopically visible pattern of collagen fibers in seven porcine aortic valves

  19. Computational model of aortic valve surgical repair using grafted pericardium

    E-print Network

    1 Computational model of aortic valve surgical repair using grafted pericardium Peter E. Hammer1, aortic valve repair, membrane, surgical planning, leaflet graft, pericardium ABSTRACT Aortic valve reconstruction using leaflet grafts made from autologous pericardium is an effective surgical treatment for some

  20. Percutaneous Transcatheter Aortic Disc Valve Prosthesis Implantation: A Feasibility Study

    SciTech Connect

    Sochman, Jan

    2000-09-15

    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.

  1. The Effects of Positioning of Transcatheter Aortic Valve on Fluid Dynamics of the Aortic Root

    PubMed Central

    Su, Jimmy L; Kheradvar, Arash

    2015-01-01

    Transcatheter aortic valve implantation is a novel treatment for severe aortic valve stenosis. Due to the recent use of this technology and the procedural variability, there is very little data that quantifies the hemodynamic consequences of variations in valve placement. Changes in aortic wall stresses and fluid retention in the sinuses of Valsalva can have a significant effect on the clinical response a patient has to the procedure. By comprehensively characterizing complex flow in the sinuses of Valsalva using Digital Particle Image Velocimetry and an advanced heart flow simulator, various positions of a deployed transcatheter valve with respect to a bioprosthetic aortic valve (valve-in-valve) were tested in vitro. Displacements of the transcatheter valve were axial and directed below the simulated native valve annulus. It was determined that for both blood residence time and aortic Reynolds stresses, it is optimal to have the annulus of the transcatheter valve deployed as close to the aortic valve annulus as possible. PMID:25010918

  2. Minimally invasive reoperative aortic valve replacement.

    PubMed

    Mikus, Elisa; Calvi, Simone; Tripodi, Alberto; Dozza, Luca; Lamarra, Mauro; Del Giglio, Mauro

    2015-01-01

    The operative mortality associated with repeat heart valve surgery is supposedly higher than the mortality associated with the primary operation. However, controversy still surrounds the risk factors and optimal surgical approach for patients requiring repeat cardiac surgery, particularly for those requiring aortic valve replacements (AVR). While the standard approach generally utilizes full sternotomy and peripheral cannulation, alternative approaches such as minimally invasive sternotomy may play an increasingly important role in this field. This study compares the advantages and disadvantages of a minimally invasive approach in redo AVR with the standard approach, highlighting difficulties and potential solutions. PMID:25694980

  3. Minimally invasive reoperative aortic valve replacement

    PubMed Central

    Calvi, Simone; Tripodi, Alberto; Dozza, Luca; Lamarra, Mauro; Del Giglio, Mauro

    2015-01-01

    The operative mortality associated with repeat heart valve surgery is supposedly higher than the mortality associated with the primary operation. However, controversy still surrounds the risk factors and optimal surgical approach for patients requiring repeat cardiac surgery, particularly for those requiring aortic valve replacements (AVR). While the standard approach generally utilizes full sternotomy and peripheral cannulation, alternative approaches such as minimally invasive sternotomy may play an increasingly important role in this field. This study compares the advantages and disadvantages of a minimally invasive approach in redo AVR with the standard approach, highlighting difficulties and potential solutions. PMID:25694980

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

    PubMed

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

    2014-10-01

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

  5. [Aortic valve stenosis: transcatheter aortic valve implantation (TAVI) – transarterial or transapical approach].

    PubMed

    Sack, S; Schelp, M K; Poppe, S; Weber, M; Krüger, T; Geith, S; Lieber, M; Schleger, S; Eichinger, W; Menne, J

    2011-03-01

    The calcified aortic stenosis is the dominating valve disease. Patients affected are most common elderly people in the 8 (th) or 9 (th) decade of their life who often show associated comorbidities like reduced left ventricular function, impaired renal function, pulmonary hypertension, and further diseases (Diabetes mellitus, stroke, COPD). In many cases perioperative morbidity and mortality are too high for surgical valve replacement and up to 30 % of patients are rejected. Nevertheless, prognosis of aortic stenosis is worse if the typical symptoms like dyspnea on exertion, syncope, and angina occur. The transcatheter aortic valve implantation is a new method treating this particular group of patients. The aortic valve bioprothesis consists of a balloon-expandable stent or a self-expandable frame, in which a valve of bovine or porcine pericardium is incorporated. The implantation is performed by retrograde access via the femoral or subclavian artery; the balloon-expandable prosthesis can also be implanted by transapical approach. Recently, the PARTNER trial and other studies demonstrate a high implantation success rate and better survival in comparison to standard therapy but exhibit also cerebral vascular and peripheral vascular complications. A further reduction of the available delivery systems and new types of valves which are under experimental tests and clinical evaluation contribute to this development. PMID:21344357

  6. Transcatheter Aortic and Mitral Valve Implantation (TAMVI) in Native Rheumatic Valves.

    PubMed

    Akujuo, Adanna C; Dellis, Sophia L; Britton, Lewis W; Bennett, Edward V

    2015-11-01

    A 68-year-old female with moderate to severe aortic stenosis and severe mitral stenosis, deemed too high risk for surgery (STS mortality risk?=?12.3%) with a porcelain aorta, was successfully treated with a transcatheter aortic and mitral valve implantation (TAMVI) via a transapical approach. A 23?mm Sapien valve (Edwards Lifesciences, Irvine, CA, USA) was placed in the aortic position and a 29?mm inverted Sapien valve (Edwards Lifesciences) in the mitral position. PMID:26347492

  7. Transcatheter aortic valve insertion (TAVI): a review

    PubMed Central

    Morgan-Hughes, G; Roobottom, C

    2014-01-01

    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

  8. Thrombocytosis following splenectomy and aortic valve replacement for idiopathic thrombocytopaenic purpura with bicuspid aortic valve

    PubMed Central

    Katiyar, Sarika; Ganjsinghani, Payal Kamlesh; Jain, Rajnish Kumar

    2015-01-01

    Idiopathic thrombocytopaenic purpura (ITP) patients are at high risk for complications during and after cardiac surgeries involving cardiopulmonary bypass. The main clinical problem of primary ITP is an increased risk of bleeding although bleeding may not always be present. More recently, thrombosis has become appreciated as another potential complication of the procedure. We report a 22-year-old female patient with ITP with bicuspid aortic valve and splenomegaly, who underwent uncomplicated aortic valve replacement and splenectomy simultaneously. She was readmitted with chest pain due to coronary thrombosis following splenectomy which made the management difficult. We describe our experience in managing this patient who presented with thrombotic complication rather than bleeding in post-operative period and the challenges met in maintaining appropriate anticoagulation for aortic valve replacement as well as thrombosis, post-splenectomy PMID:26379295

  9. Iatrogenic mitral valve chordal rupture during placement of an inflatable and repositionable percutaneous aortic valve prosthesis.

    PubMed

    D'Ancona, Giuseppe; Ince, Hüseyin; Ortak, Jasmin; Stoeckicht, Yannik; Kische, Stephan

    2015-03-01

    A case is reported of iatrogenic mitral valve chordal rupture occurring during transcatheter aortic valve implantation (TAVI) with an inflatable and repositionable valve (Direct Flow; Direct Flow Medical, Santa Rosa, CA, USA). The specific implantation technique requires initial valve advancement into the left ventricular cavity, valve inflation within the ventricular cavity, and a final finely tuned valve upward pulling through the left ventricular outflow tract until contact with the aortic annulus is achieved. During this phase of the procedure, entangling with the mitral subvalvular apparatus should be excluded, to avoid inadvertent tissue tearing and consequent mitral valve malfunction. The present patient underwent TAVI but then developed symptomatic severe mitral valve regurgitation resulting from chordal rupture. The condition was successfully treated percutaneously by implanting a Mitra-Clip. PMID:26204679

  10. A Case of Iatrogenic Chordal Rupture after Transcatheter Aortic Valve Implantation Procedure Requiring a Second Valve.

    PubMed

    Cincin, Altug; Tigen, Kursat; Sari, Ibrahim; Sunbul, Murat; Kartal, Fatih; Basaran, Yelda

    2015-01-01

    Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic option for high-risk aortic stenosis. Malposition of the prosthesis and severe residual aortic regurgitation are known complications of the procedure, which might require a second valve implantation. Although the implantation of a second valve seems to be an effective method, very few data are available describing this technique. Herein is reported a case of iatrogenic chordal rupture in a TAVI procedure which required a second valve implantation due to dislodgment of the first prosthesis. PMID:26182632

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

    PubMed

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

    2015-04-01

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

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

    E-print Network

    Benevento, Emilia

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

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

    PubMed Central

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

    2015-01-01

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

  14. Mathematical modeling of aortic valve dynamics during systole.

    PubMed

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

    2015-01-21

    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

  15. Current status of surgical treatment for aortic valve stenosis.

    PubMed

    Wollersheim, Laurens W; Li, Wilson W; de Mol, Bas A

    2014-09-01

    In this review, we discuss the current surgical treatment for aortic valve stenosis. Surgical strategy for treatment of aortic valve stenosis is based on the risk profile of the patient. We reviewed the existing literature and present the current state of the art of these various approaches, taking into account clinical outcomes, quality of life, costs, and learning curve. PMID:24980691

  16. In vivo hemodynamic characteristics of porcine stentless aortic valves.

    PubMed

    Jin, X Y; Westaby, S

    2001-10-01

    The objective of this study was to elucidate the relationship of aortic pressure gradient (mPG) and effective orifice area (EOA) with mean systolic flow rate of left ventricle in patients who received a stentless aortic valve. Two hundred thirteen patients (age: 73 +/- 6 years, 123 men and 90 women) who received a Freestyle stentless valve in subcoronary position for aortic valve diseases were studied. EOA, mPG, and systolic aortic flow rate were determined by Doppler echocardiography at 1 and 20 months after implant. With follow-up, there was a 13% increase in EOA and a 30% decrease in mPG, both P <.01. Although systolic aortic flow did not change, the intercept of EOA-flow relationship increased significantly at late follow-up (0.56 +/- 0.13 v 0.11 +/- 0.13, P <.01). Multiple regression analysis showed that systolic aortic flow accounted for 54%, and mPG for only 27%, variation of EOA. Linear relationship between EOA and systolic aortic flow provides a comprehensive approach to describe stentless valve performance, when mean valve pressure gradient appears to be flow independent. These hemodynamic features distinguish stentless valves from stented or mechanical prosthesis. Ultimately, the variations in aortic root anatomy, surgical experience and their interactions are likely to become major determinants of in vivo performance of stentless aortic valves. PMID:11805952

  17. Heart valve surgery

    MedlinePLUS

    ... Aortic stenosis Congenital heart valve disease Mitral regurgitation - acute Mitral regurgitation - chronic Mitral stenosis Mitral valve prolapse Pulmonary valve stenosis Tricuspid regurgitation Tricuspid valve stenosis

  18. Futility, Benefit, and Transcatheter Aortic Valve Replacement

    PubMed Central

    Lindman, Brian R.; Alexander, Karen P.; O'Gara, Patrick T.; Afilalo, Jonathan

    2015-01-01

    Transcatheter aortic valve replacement (TAVR) is a transformative innovation that provides treatment for high or prohibitive surgical risk patients with symptomatic severe aortic stenosis (AS) who were previously either not referred for or denied operative intervention. Trials have demonstrated improvements in survival and symptoms after TAVR compared to medical therapy, however there remains a sizable group of patients who die or lack improvement in quality of life soon after TAVR. This raises important questions about the need to identify and acknowledge the possibility of futility in some patients considered for TAVR. In this very elderly population, a number of factors in addition to traditional risk stratification need to be considered including multimorbidity, disability, frailty, and cognition in order to assess the anticipated benefit of TAVR. Consideration by a multidisciplinary heart valve team with broad areas of expertise is critical for assessing likely benefit from TAVR. Moreover, these complicated decisions should take place with clear communication around desired health outcomes on behalf of the patient and provider. The decision that treatment with TAVR is futile should include alternative plans to optimize the patient's health state or, in some cases, discussions related to end of life care. We review issues to be considered when making and communicating these difficult decisions. PMID:24954571

  19. Coronary Obstruction Following Transcatheter Aortic Valve Implantation

    PubMed Central

    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

    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

  20. The living aortic valve: From molecules to function

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-08-01

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

  2. [Left Ventricular Rupture during Both Mitral and Aortic Valve Replacements].

    PubMed

    Kurumisawa, Soki; Aizawa, Kei; Takazawa, Ippei; Sato, Hirotaka; Muraoka, Arata; Ohki, Shinnichi; Saito, Tsutomu; Kawahito, Koji; Misawa, Yoshio

    2015-05-01

    A 73-year-old woman on hemodialysis was transferred to our hospital for surgical treatment of heart valve disease. She required both mitral and aortic valve replacement with mechanical valves, associated with tricuspid annuloplasty. After aortic de-clamping, a massive hemorrhage from the posterior atrioventricular groove was observed. Under repeated cardiac arrest, the left atrium was reopened, the implanted mitral prosthetic valve was removed and a type I left ventricular rupture (Treasure classification) was diagnosed. The lesion was directly repaired with mattress stitches and running sutures, using reinforcement materials such as a glutaraldehyde-treated bovine pericardium. To avoid mechanical stress by the prosthetic valve on the repaired site, a mechanical valve was implanted using a translocation method. The patient suffered from aspiration pneumonia and disuse atrophy for 3 months. However, she was doing well at 1 year post-operation. PMID:25963782

  3. Drug delivery in aortic valve tissue engineering.

    PubMed

    Jana, Soumen; Simari, Robert D; Spoon, Daniel B; Lerman, Amir

    2014-12-28

    Over the last 50 years medicine and technology have progressed to the point where it has become commonplace to safely replace damaged or diseased heart valves with mechanical and biological prostheses. Despite the advancements in technology current valve substitutes continue to have significant limitations with regards to thrombogenicity, durability, and inability to grow or remodel. In an attempt to overcome the limitations of currently available valve prosthesis, heart valve tissue engineering has emerged as a promising technique to produce biological valve substitutes. Currently, the field of tissue engineering is focused on delivering complex matrices which include scaffolds and cells separately or together to the damaged site. Additional functional enhancement of the matrices by exposing encoded biological signals to their residing cells in a controlled manner has the potential to augment the tissue engineering approach. This review provides an overview of the delivery of biological reagents to guide and regulate heart valve tissue engineering. PMID:25459428

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

    PubMed

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

    2014-06-01

    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

  5. Fatal Bioprosthetic Aortic Valve Endocarditis Due to Cardiobacterium valvarum?

    PubMed Central

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

    2007-01-01

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

  6. Rare Mycotic Aneurysm of the Mitral Valve without Aortic Valve Involvement.

    PubMed

    Zarrini, Parham; Elboudwarej, Omeed; Luthringer, Daniel; Siegel, Robert

    2015-09-01

    Mycotic aneurysms can be a rare, but serious complication of infectious endocarditis. We report the case of a 20-year-old woman who presented with fever and malaise from streptococcal bacteremia and found to have vegetation on the anterior leaflet of the mitral valve. On follow-up visit, the patient was noted to have a mycotic aneurysm of the anterior mitral valve without aortic involvement. Her clinical course was complicated by mitral valve chordal rupture, severe mitral regurgitation, and dyspnea from severe mitral regurgitation for which she underwent successful surgical repair of the mitral valve. PMID:25881967

  7. Left Main Coronary Artery Obstruction by Dislodged Native-Valve Calculus after Transcatheter Aortic Valve Replacement

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2014-08-01

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

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  10. Paravalvular leak closure for persisting aortic regurgitation after implantation of the CoreValve transcatheter valve.

    PubMed

    Poliacikova, Petra; Hildick-Smith, David

    2014-07-01

    Significant aortic regurgitation after TAVI results in lack of symptomatic and prognostic benefit from the procedure and generally requires intervention. While most of the regurgitations can be successfully targeted with standard techniques, occasional patients have restrictive calcification resistant to post-dilatation and significant regurgitation persists. We present a case of refractory aortic regurgitation successfully treated with percutaneous paravalvular leak closure. An 81-year-old man with symptomatic severe aortic stenosis underwent a transfemoral CoreValve TAVI in December 2009. He had significant aortic regurgitation refractory to medical and interventional therapy including balloon post-dilatation, valve repositioning and valve-in-valve reimplantation. Aortic regurgitation remained severe and therefore in early 2013, we proceeded with an attempted percutaneous closure of the residual paraprosthetic leak. Using 6-French femoral access and a Terumo wire, the defect was successfully crossed with a 4-French Multipurpose catheter and an 8 mm Amplatzer Vascular Plug 4 device (St. Jude Medical) was deployed through this catheter, resulting in abolition of aortic regurgitation on aortography and TOE, with associated excellent clinical response. Refractory paravalvular aortic regurgitation post CoreValve implantation can be successfully treated using the Amplatzer Vascular Plug 4 device. PMID:24130146

  11. The role of multimodality imaging in the selection of patients for aortic valve repair.

    PubMed

    Regeer, Madelien V; Versteegh, Michel I M; Marsan, Nina Ajmone; Bax, Jeroen J; Delgado, Victoria

    2016-01-01

    Aortic valve sparing surgery for aortic regurgitation and/or aortopathy serves as an alternative to aortic valve and root replacement. One of the advantages of aortic valve sparing surgery over conventional replacement is that there is no need for life-long anticoagulation, which is particularly attractive in young patients who may receive a mechanical prosthesis otherwise. However, successful aortic valve repair requires high expertise. At present, reparability is determined intraoperatively by direct surgical inspection. Preoperative imaging techniques might improve the patient selection for aortic valve repair. The mechanism of aortic regurgitation, aortic valve morphology and calcification and aortic root dimensions are all of importance when aortic valve repair is considered. The present review focuses on the role of imaging techniques in determining aortic valve reparability. PMID:26536524

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

    PubMed Central

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

    1999-01-01

    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

  13. Calcific aortic valve disease: Is it another face of atherosclerosis?

    PubMed

    Sathyamurthy, I; Alex, Shaji

    2015-01-01

    Calcific aortic valve disease (CAVD) is the most common valvular heart disease in the elderly. As life expectancy increases, prevalence of CAVD is expected to rise. CAVD is characterized by progressive dystrophic calcification of aortic cusps. In the initial stages, the pathogenesis is similar to atherosclerosis, characterized by basement membrane disruption, inflammation, cell infiltration, lipid deposition, and calcification. Presence of osteopontin in calcified aortic valves suggests pathological calcification and bone formation in these calcified valves. Historical, experimental, genetic, and clinical evidences suggest that CAVD and atherosclerosis share the same pathological sequences with common risk factors. Understanding the two faces of atherosclerosis, the vascular and valvular, will help us to prevent progression of aortic sclerosis to aortic stenosis, by controlling modifiable risk factors and by initiating statin therapy in them. However, the knowledge about these preventive measures and drugs is scanty. In this review article, an attempt is made to unfurl the relation between atherosclerosis and CAVD. PMID:26432749

  14. The role of transesophageal echocardiography in aortic valve preserving procedures

    PubMed Central

    Hall, Terri; Shah, Pallav; Wahi, Sudhir

    2014-01-01

    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

  15. The role of transesophageal echocardiography in aortic valve preserving procedures.

    PubMed

    Hall, Terri; Shah, Pallav; Wahi, Sudhir

    2014-01-01

    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

  16. Transcatheter repair of aortic leaflet perforation in a patient with prior surgical bicuspid aortic valve repair.

    PubMed

    Lim, Wayland; Smith, Thomas; Rogers, Jason H

    2015-11-15

    A 47-year-old male underwent surgery for functional bicuspid aortic valve severe regurgitation with a fused right and left coronary cusp. The patient presents nine years after surgical bicuspid aortic valve repair with symptomatic severe aortic regurgitation, diagnosed by TEE and MRI, caused primarily from a perforation located at the base of the surgically fused coronary cusps. The patient had a minimally dilated aortic root that did not yet necessitate surgical intervention. We present a novel percutaneous bicuspid aortic valve perforation repair that potentially decreases the number of surgical operations the patient must undergo during his lifetime. © 2015 Wiley Periodicals, Inc. PMID:25914034

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

    PubMed Central

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

    2014-01-01

    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

  18. [Transcatheter-based aortic valve implantation. Present and future technologies].

    PubMed

    Sack, Stefan; Schofer, Joachim

    2009-08-01

    The calcified aortic stenosis is the dominating valve disease. Patients affected are most common elderly people in the 8th or 9th decade of their life who often show associated comorbidities like reduced left ventricular function, impaired renal function, pulmonary hypertension, and further diseases (diabetes mellitus, stroke, chronic obstructive pulmonary disease). In many cases perioperative morbidity and mortality are too high for surgical valve replacement and patients are rejected. Nevertheless, prognosis of aortic stenosis is worse, if the typical symptoms like dyspnea on exertion, syncope, and angina occur. The transcatheter aortic valve implantation is an alternative treatment for this particular group of patients. The aortic valve bioprosthesis consists of a balloon-expandable stent or a self-expandable frame, in which a valve of bovine or porcine pericardium is incorporated. The implantation is performed by retrograde access via the femoral artery; the balloon-expandable prosthesis can also be implanted by transapical approach. Alternatively, the subclavian artery is chosen for access. More frequently, the implantation is performed in analgosedation with the patient awake that favors the transfemoral approach. A further reduction of the available prosthesis and new types of valves which are under current experimental tests and clinical evaluation contribute to this development. PMID:19711031

  19. Aortic cusp extension for surgical correction of rheumatic aortic valve insufficiency in children.

    PubMed

    Kalangos, Afksendiyos; Myers, Patrick O

    2013-10-01

    Surgical management of aortic insufficiency in the young is problematic because of the lack of an ideal valve substitute. Potential advantages of aortic valve repair include low incidences of thromboembolism and endocarditis, avoiding conduit replacements, the maintenance of growth potential, and improved quality of life. Aortic valve repair is still far from fulfilling the three key factors that have allowed the phenomenal development of mitral valve repair (standardization, reproducibility, and stable long-term results); however, techniques of aortic valve repair have been refined, and subsets of patients amenable to repair have been identified. We have focused on the oldest technique of aortic valve repair, cusp extension, focusing on children with rheumatic aortic insufficiency. Among 77 children operated from 2003 to 2007, there was one early death from ventricular failure and one late death from sudden cardiac arrhythmia. During a mean follow-up of 12.8 ± 5.9 years, there were 16 (20.5%) reoperations on the aortic valve, at a median of 3.4 years (range, 2 months to 18.3 years) from repair. Freedom from aortic valve reoperation was 96.2% ± 2.2% at 1 year, 94.9% ± 2.5% at 2 years, 88.5% ± 3.6% at 5 years, 81.7% ± 4.4% at 10 years, 79.7% ± 4.8% at 15 years, and 76.2% ± 5.7% at 20 years. Although aortic cusp extension is technically more demanding, it remains particularly more suitable in the context of evolving rheumatic aortic insufficiency in children with a small aortic annulus as a bridge surgical approach to late aortic valve replacement with a larger valvular prosthesis. PMID:24327632

  20. A planning system for transapical aortic valve implantation

    NASA Astrophysics Data System (ADS)

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

    2009-02-01

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

  1. A Quantitative Study of Simulated Bicuspid Aortic Valves

    NASA Astrophysics Data System (ADS)

    Szeto, Kai; Nguyen, Tran; Rodriguez, Javier; Pastuszko, Peter; Nigam, Vishal; Lasheras, Juan

    2010-11-01

    Previous studies have shown that congentially bicuspid aortic valves develop degenerative diseases earlier than the standard trileaflet, but the causes are not well understood. It has been hypothesized that the asymmetrical flow patterns and turbulence found in the bileaflet valves together with abnormally high levels of strain may result in an early thickening and eventually calcification and stenosis. Central to this hypothesis is the need for a precise quantification of the differences in the strain rate levels between bileaflets and trileaflet valves. We present here some in-vitro dynamic measurements of the spatial variation of the strain rate in pig aortic vales conducted in a left ventricular heart flow simulator device. We measure the strain rate of each leaflet during the whole cardiac cycle using phase-locked stereoscopic three-dimensional image surface reconstruction techniques. The bicuspid case is simulated by surgically stitching two of the leaflets in a normal valve.

  2. Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge

    PubMed Central

    Losenno, Katie L.; Goodman, Robert L.; Chu, Michael W. A.

    2012-01-01

    The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of bicuspid aortic valve disease with associated ascending aortic aneurysms. PMID:23198270

  3. Tropheryma whipplei aortic valve endocarditis, cured without surgical treatment

    PubMed Central

    2012-01-01

    Background Culture-negative endocarditis due to Tropheryma whipplei is a rare disease. Mostly the diagnosis is made by histologic examination of resected heart valve tissue. Case presentation In this case report, we described a patient with a classical Whipple’s disease. Transesophageal echocardiography (TEE) showed a vegetation on noncoronary cusp of the aortic valve. Whipple’s disease was confirmed by positive Tropheryma whipplei polymerase chain reaction (PCR) in EDTA blood and a duodenal biopsy with positive periodic acid-Schiff stain (PAS) macrophages. Conclusion Due to timely diagnosis, our patient was treated with antibiotics without valve replacement. PMID:23110725

  4. Computational model of aortic valve surgical repair using grafted pericardium.

    PubMed

    Hammer, Peter E; Chen, Peter C; del Nido, Pedro J; Howe, Robert D

    2012-04-30

    Aortic valve reconstruction using leaflet grafts made from autologous pericardium is an effective surgical treatment for some forms of aortic regurgitation. Despite favorable outcomes in the hands of skilled surgeons, the procedure is underutilized because of the difficulty of sizing grafts to effectively seal with the native leaflets. Difficulty is largely due to the complex geometry and function of the valve and the lower distensibility of the graft material relative to native leaflet tissue. We used a structural finite element model to explore how a pericardial leaflet graft of various sizes interacts with two native leaflets when the valve is closed and loaded. Native leaflets and pericardium are described by anisotropic, hyperelastic constitutive laws, and we model all three leaflets explicitly and resolve leaflet contact in order to simulate repair strategies that are asymmetrical with respect to valve geometry and leaflet properties. We ran simulations with pericardial leaflet grafts of various widths (increase of 0%, 7%, 14%, 21% and 27%) and heights (increase of 0%, 13%, 27% and 40%) relative to the native leaflets. Effectiveness of valve closure was quantified based on the overlap between coapting leaflets. Results showed that graft width and height must both be increased to achieve proper valve closure, and that a graft 21% wider and 27% higher than the native leaflet creates a seal similar to a valve with three normal leaflets. Experimental validation in excised porcine aortas (n=9) corroborates the results of simulations. PMID:22341628

  5. The current status of transcutaneous aortic valve implantation.

    PubMed

    Volodarsky, Igor; Shimoni, Sara; George, Jacob

    2014-10-01

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

  6. Transcatheter aortic valve implantation: from fantasy to reality

    PubMed Central

    2014-01-01

    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

  7. First transcatheter aortic valve implantation for severe pure aortic regurgitation in Asia

    PubMed Central

    Chiam, Paul Toon-Lim; Ewe, See Hooi; Chua, Yeow Leng; Lim, Yean Teng

    2014-01-01

    Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients with symptomatic severe aortic stenosis (AS), and an alternative to open aortic valve replacement for patients at high surgical risk. TAVI has also been performed in several groups of patients with off-label indications such as severe bicuspid AS, and as a valve-in-valve therapy for a degenerated surgical bioprosthesis. Although TAVI with CoreValve® prosthesis is technically challenging, and global experience in the procedure is limited, the procedure could be a treatment option for well-selected patients with severe pure aortic regurgitation (AR). Herein, we report Asia's first case of TAVI for severe pure AR in a patient who was at extreme surgical risk, with good clinical outcome at six months. PMID:24570320

  8. Transfemoral Edwards SAPIEN aortic valve implantation through aortofemoral endograft.

    PubMed

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

    2014-09-01

    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

  9. Prosthetic Valve Endocarditis with Valvular Obstruction after Transcatheter Aortic Valve Replacement

    PubMed Central

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

    2015-01-01

    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

  10. [Remote results of reimplantation of the aortic valve in patients with ascending aortic aneurysm accompanied by aortic insufficiency].

    PubMed

    Cherniavski?, A M; Al'sov, S A; Sirota, D A; Khvan, D S; Liashenko, M M; Ponomarev, D N; Kadyrbaev, D Zh

    2015-01-01

    Valve-sparing operations on the aorta has recently been gaining ever increasing popularity due to more detailed study of physiology of the aortic root, as well as promising mid- and long-term results. The world practice uses various techniques making it possible to remove both ascending aortic aneurysm and aortic valve insufficiency. The authors herein describe and analyse their experience in performing reimplantation of the aortic valve in patients with ascending aortic aneurysm and concomitant aortic insufficiency. Specialists of the clinic of the Novosibirsk Scientific Research Institute for Circulatory Pathology during the period from 2003 to 2013 performed a total of 77 operations of reimplantation of the aortic valve in patients with ascending aortic aneurysm and pronounced aortic valve insufficiency. The majority of patients were men (57 males and 20 females), mean age 53.1±12.2 years (range 21-72). 80% of cases had NYHA functional class II-III circulatory insufficiency (degree 2.3±0.7). Preoperative examination revealed in the majority of patients (97.4%) moderate-to-severe aortic valve insufficiency and ascending aortic aneurysm. All patients underwent reimplantation of the aortic valve. The duration of artificial circulation amounted to 202.4±33 minutes, with the average time of aortic occlusion being 164±28 min. Accompanying procedures (annuloplasty of the mitral valve and/or coronary aortic bypass grafting) were performed in 12 (15.6%) cases. Additional plasty of valvular cusps was carried out in 9 (11.7%) patients, with rethoracotomy required in 5 (6.4%) cases due to haemorrhage. The average period of follow up amounted to 53.3±8.5 (3-115) months. During this time total survival amounted to 91%, with freedom from aortic valve prosthetic repair equalling 93%. The obtained findings suggest that aortic valve reimplantation into the prosthesis is a safe intervention and associated with a comparatively low level of operative lethality. Moderate aortic insufficiency at discharge is a predicting factor for repeat surgical intervention, i.e. prosthetic repair of the aortic valve. No association between the preoperative degree of aortic insufficiency, root diameter and durability of the reimplanted valve was revealed. PMID:25757177

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

    PubMed Central

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

    2013-01-01

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

  12. Quadricuspid Aortic Valve Defined by Echocardiography and Cardiac Computed Tomography

    PubMed Central

    Karlsberg, Daniel W.; Elad, Yaron; Kass, Robert M.; Karlsberg, Ronald P.

    2012-01-01

    A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Echocardiography showed severe aortic regurgitation and a probable quadricuspid aortic valve. In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement. Surgical photographs and in-vitro anatomic pathology exam reveal the accuracy and precision that preoperative Cardiac CT provided in this rare case of a quadricuspid aortic valve. While there have been isolated reports of quadricuspid diagnosis with Cardiac CT, we report the correlation between echocardiography, Cardiac CT, and similar appearance at surgery with confirmed pathology and interesting post-processed rendered images. Cardiac CT may be an alternative to invasive coronary angiography for non-coronary cardiothoracic surgery with the advantage of providing detailed morphological dynamic imaging and the ability to define the coronary arteries non-invasively. The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role. PMID:22442640

  13. Quadricuspid aortic valve defined by echocardiography and cardiac computed tomography.

    PubMed

    Karlsberg, Daniel W; Elad, Yaron; Kass, Robert M; Karlsberg, Ronald P

    2012-01-01

    A 54 year old female presented with lower extremity edema, fatigue, and shortness of breath with physical findings indicative of advanced aortic insufficiency. Echocardiography showed severe aortic regurgitation and a probable quadricuspid aortic valve. In anticipation of aortic valve replacement, cardiac computed tomography (Cardiac CT) was performed using 100 kV, 420 mA which resulted in 6 mSv of radiation exposure. Advanced computing algorithmic software was performed with a non-linear interpolation to estimate potential physiological movement. Surgical photographs and in-vitro anatomic pathology exam reveal the accuracy and precision that preoperative Cardiac CT provided in this rare case of a quadricuspid aortic valve. While there have been isolated reports of quadricuspid diagnosis with Cardiac CT, we report the correlation between echocardiography, Cardiac CT, and similar appearance at surgery with confirmed pathology and interesting post-processed rendered images. Cardiac CT may be an alternative to invasive coronary angiography for non-coronary cardiothoracic surgery with the advantage of providing detailed morphological dynamic imaging and the ability to define the coronary arteries non-invasively. The reduced noise and striking depiction of the valve motion with advanced algorithms will require validation studies to determine its role. PMID:22442640

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

    NASA Astrophysics Data System (ADS)

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

    2010-02-01

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

  15. First trans-axillary implantation of Edwards Sapien valve to treat an incompetent aortic bioprosthesis.

    PubMed

    Sharp, Andrew S P; Michev, Iassen; Colombo, Antonio

    2010-03-01

    There exist case reports of using transcatheter aortic valves to treat dysfunctional surgically implanted aortic bioprosthesis. There are also case series reported of transaxillary implantation of the CoreValve device to treat aortic stenosis. In this article, we report the successful implantation an Edwards Sapien 23 mm transcatheter aortic valve through the left axillary artery, in a patient with a functioning LIMA graft in order to treat a severely regurgitant Freestyle 23 mm aortic bioprosthesis. PMID:20088013

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

    PubMed

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

    2015-02-01

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

  17. Quadricuspid aortic valves in Syrian hamsters and their formation according to current knowledge on valvulogenesis.

    PubMed

    López-García, Alejandro; Carmen Fernández, M; Durán, Ana Carmen; Sans-Coma, Valentín; Fernández, Borja

    2015-02-01

    Occurrence of quadricuspid aortic valves has been reported in humans, in nine dogs and in a greater white-toothed shrew. Moreover, two cases of developing aortic valves with four anticipated leaflets have been described in Syrian hamster embryos. Currently, however, no case of quadricuspid aortic valve in adult hamsters has been recorded. The aim here is to present four adults of this rodent species, two of them with unequivocally quadricuspid aortic valves and the other two with quadricuspid-like aortic valves. The four anomalous aortic valves were detected among 4,190 Syrian hamsters examined in our laboratory, representing an incidence of 0.09%. None of the affected hamsters showed apparent signs of disease. The present findings are considered on the light of current empirical knowledge about the morphogenesis of quadricuspid and bicuspid aortic and pulmonary valves. Quadricuspid aortic valves result from the partition of one of the normal mesenchymal cushions which normally give rise to normal (tricuspid) valves, while quadricuspid-like valves might be the product of a combined mechanism of fusion and partition of the cushions at the onset of the valvulogenesis. The presence of aortic valves with four leaflets in ancient mammalian lineages such as insectivors and rodents suggest that quadricuspid aortic valves, although showing almost certainly a low incidence, may be widespread among the different groups of mammals, including domestic animals. PMID:25854086

  18. Risk factors for paravalvular leak after transcatheter aortic valve implantation

    PubMed Central

    Bujak, Kamil; Regu?a, Rafa?; Chodór, Piotr; Osadnik, Tadeusz

    2015-01-01

    Many studies have shown that transcatheter aortic valve implantation (TAVI) improves outcomes in patients with severe aortic stenosis in whom a classical surgical procedure cannot be performed due to the high risk. As one of the most frequent periprocedural complications of TAVI, paravalvular leak significantly affects the short- and long-term prognosis for patients undergoing implantation. In this paper, we analyze the most significant anatomical and procedural predictors of paravalvular leak after TAVI. PMID:26336489

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

    PubMed

    Lu, Shu-Ju; Wang, Shiao-Pei

    2015-06-01

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

  20. Perinatal Changes in Mitral and Aortic Valve Structure and Composition

    PubMed Central

    Stephens, Elizabeth H.; Post, Allison D.; Laucirica, Daniel R.; Grande-Allen, K. Jane

    2015-01-01

    At birth, the mechanical environment of valves changes radically as fetal shunts close and pulmonary and systemic vascular resistances change. Given that valves are reported to be mechanosensitive, we investigated remodeling induced by perinatal changes by examining compositional and structural differences of aortic and mitral valves (AVs, MVs) between 2-day-old and 3rd fetal trimester porcine valves using immunohistochemistry and Movat pentachrome staining. Aortic valve composition changed more with birth than the MV, consistent with a greater change in AV hemodynamics. At 2 days, AV demonstrated a trend of greater versican and elastin (P = 0.055), as well as greater hyaluronan turnover (hyaluronan receptor for endocytosis, P = 0.049) compared with the 3rd-trimester samples. The AVs also demonstrated decreases in proteins related to collagen synthesis and fibrillogenesis with birth, including procollagen I, prolyl 4-hydroxylase, biglycan (all P ? 0.005), and decorin (P = 0.059, trend). Both AVs and MVs demonstrated greater delineation between the leaflet layers in 2-day-old compared with 3rd-trimester samples, and AVs demonstrated greater saffron-staining collagen intensity, suggesting more mature collagen in 2-day-old compared with 3rd-trimester samples (each P < 0.05). The proportion of saffron-staining collagen also increased in AV with birth (P < 0.05). The compositional and structural changes that occur with birth, as noted in this study, likely are important to proper neonatal valve function. Furthermore, normal perinatal changes in hemodynamics often do not occur in congenital valve disease; the corresponding perinatal matrix maturation may also be lacking and could contribute to poor function of congenitally malformed valves. PMID:20536360

  1. 6-Month aortic valve implantation of an off-the-shelf tissue-engineered valve in sheep.

    PubMed

    Syedain, Zeeshan; Reimer, Jay; Schmidt, Jillian; Lahti, Matthew; Berry, James; Bianco, Richard; Tranquillo, Robert T

    2015-12-01

    Diseased aortic valves often require replacement, with over 30% of the current aortic valve surgeries performed in patients who will outlive a bioprosthetic valve. While many promising tissue-engineered valves have been created in the lab using the cell-seeded polymeric scaffold paradigm, none have been successfully tested long-term in the aortic position of a pre-clinical model. The high pressure gradients and dynamic flow across the aortic valve leaflets require engineering a tissue that has the strength and compliance to withstand high mechanical demand without compromising normal hemodynamics. A long-term preclinical evaluation of an off-the-shelf tissue-engineered aortic valve in the sheep model is presented here. The valves were made from a tube of decellularized cell-produced matrix mounted on a frame. The engineered matrix is primarily composed of collagen, with strength and organization comparable to native valve leaflets. In vitro testing showed excellent hemodynamic performance with low regurgitation, low systolic pressure gradient, and large orifice area. The implanted valves showed large-scale leaflet motion and maintained effective orifice area throughout the duration of the 6-month implant, with no calcification. After 24 weeks implantation (over 17 million cycles), the valves showed no change in tensile mechanical properties. In addition, histology and DNA quantitation showed repopulation of the engineered matrix with interstitial-like cells and endothelialization. New extracellular matrix deposition, including elastin, further demonstrates positive tissue remodeling in addition to recellularization and valve function. Long-term implantation in the sheep model resulted in functionality, matrix remodeling, and recellularization, unprecedented results for a tissue-engineered aortic valve. PMID:26409002

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

    PubMed

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

    2014-02-01

    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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2015-03-01

    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

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

    E-print Network

    Weinberg, Eli, 1979-

    2008-01-01

    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 ...

  7. Redo aortic valve surgery versus transcatheter valve-in-valve implantation for failing surgical bioprosthetic valves: consecutive patients in a single-center setting

    PubMed Central

    Wottke, Michael; Deutsch, Marcus-André; Krane, Markus; Piazza, Nicolo; Lange, Ruediger; Bleiziffer, Sabine

    2015-01-01

    Background Due to a considerable rise in bioprosthetic as opposed to mechanical valve implantations, an increase of patients presenting with failing bioprosthetic surgical valves in need of a reoperation is to be expected. Redo surgery may pose a high-risk procedure. Transcatheter aortic valve-in-valve implantation is an innovative, less-invasive treatment alternative for these patients. However, a comprehensive evaluation of the outcome of consecutive patients after a valve-in-valve TAVI [transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV)] as compared to a standard reoperation [surgical aortic valve redo-operation (SAV-in-SAV)] has not yet been performed. The goal of this study was to compare postoperative outcomes after TAV-in-SAV and SAV-in-SAV in a single center setting. Methods All SAV-in-SAV and TAV-in-SAV patients from January 2001 to October 2014 were retrospectively reviewed. Patients with previous mechanical or transcatheter valves, active endocarditis and concomitant cardiac procedures were excluded. Patient characteristics, preoperative data, post-procedural complications, and 30-day mortality were collected from a designated database. Mean values ± SD were calculated for all continuous variables. Counts and percentages were calculated for categorical variables. The Chi-square and Fisher exact tests were used to compare categorical variables. Continuous variables were compared using the t-test for independent samples. A 2-sided P value <0.05 was considered statistically significant. Results A total of 102 patients fulfilled the inclusion criteria, 50 patients (49%) underwent a transcatheter valve-in-valve procedure, while 52 patients (51%) underwent redo-surgery. Patients in the TAV-in-SAV group were significantly older, had a higher mean logistic EuroSCORE and exhibited a lower mean left ventricular ejection fraction than patients in the SAV-in-SAV group (78.1±6.7 vs. 66.2±13.1, P<0.001; 27.4±18.7 vs. 14.4±10, P<0.001; and 49.8±13.1 vs. 56.7±15.8, P=0.019 respectively). Postoperative pacemaker implantation and chest tube output were higher in the SAV-in-SAV group compared to the TAV-in-SAV group [11 (21%) vs. 3 (6%), P=0.042 and 0.9±1.0 vs. 0.6±0.9, P=0.047, respectively]. There was no significant difference in myocardial infarction, stroke or dialysis postoperatively. Thirty-day mortality was not significantly different between the two groups [TAV-in-SAV2 (4%) vs. SAV-in-SAV0, P=0.238]. Kaplan-Meier (KM) 1-year survival was significantly lower in the TAV-in-SAV group than in the SAV-in-SAV group (83% vs. 96%, P<0.001). Conclusions The present investigation shows that both groups, irrespective of different baseline comorbidities, show very good early clinical outcomes. While redo surgery is still the standard of care, a subgroup of patients may profit from the transcatheter valve-in-valve procedure. PMID:26543594

  8. Transcatheter Valve-in-Valve and Valve-in-Ring for Treating Aortic and Mitral Surgical Prosthetic Dysfunction.

    PubMed

    Paradis, Jean-Michel; Del Trigo, Maria; Puri, Rishi; Rodés-Cabau, Josep

    2015-11-01

    Bioprosthetic valve use has increased significantly. Considering their limited durability, there will remain an ongoing clinical need for repairing or replacing these prostheses in the future. The current standard of care for treating bioprosthetic valve degeneration involves redo open-heart surgery. However, repeat cardiac surgery may be associated with significant morbidity and mortality. With the rapid evolution of transcatheter heart valve therapies, the feasibility and safety of implanting a transcatheter heart valve within a failed tissue valve has been established. We review the historical perspective of transcatheter valve-in-valve therapy, as well as the main procedural challenges and clinical outcomes associated with this new less invasive treatment option. PMID:26516006

  9. A second-time percutaneous aortic-valve implantation for bioprosthetic failure

    PubMed Central

    Codner, Pablo; Assali, Abid; Vaknin Assa, Hana; Kornowski, Ran

    2015-01-01

    Key Clinical Message We report a case of an 84-year-old man with a history of surgical aortic-valve replacement for chronic aortic regurgitation (AR) who later developed severe prosthetic valve AR. Subsequent treatment with a Corevalve® was unsuccessful with severe AR seen at 3 years after the valve-in-valve procedure. The patient was then successfully treated with a second catheter-based Corevalve® implantation. PMID:26401281

  10. Asymptomatic Strut Fracture in DeBakey-Surgitool Aortic Valves

    PubMed Central

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

    1990-01-01

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

  11. Simultaneous transapical aortic and mitral valve-in-valve implantation for double prostheses dysfunction: case report and technical insights.

    PubMed

    D'Onofrio, Augusto; Zucchetta, Fabio; Gerosa, Gino

    2014-09-01

    Transcatheter "Valve-in-Valve" implantation (ViV) has shown promising results in high-risk patients suffering from structural valve deterioration (SVD) of a previously implanted heart valve bioprosthesis. We present a case of a 68-year-old woman with a history of three previous cardiac operations on the aortic and mitral valve. At the time of admission she was severely symptomatic due to a simultaneous SVD of a 23 mm aortic and of a 29 mm mitral St. Jude Biocor bioprosthesis. Because of the history of several cardiac operations and to her comorbidities, the patient was considered with an extremely high surgical risk profile and was therefore scheduled for double concomitant mitral and aortic ViV. Through a trans-apical approach, the patient underwent 23 and 29 mm Edwards Sapien XT implantation in the aortic and mitral bioprosthesis, respectively. The procedure was uneventful as well as the following hospital stay. At 6-months follow-up the patient is in NYHA class I. Echocardiography shows that the aortic bioprosthesis has no leak and the mean gradient is 20 mm Hg while the mitral valve has mild leak and maximum and mean gradients are 21 and 10 mm Hg, respectively. The three main technical aspects that should be carefully considered in double concomitant ViV are: sequence of valve deployment (whether to implant the mitral or the aortic valve first), choice of access and valve sizing. In conclusion, double simultaneous trans-apical mitral and aortic ViV is technically feasible. © 2014 Wiley Periodicals, Inc. PMID:24677811

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

    PubMed

    Hell, M; Achenbach, S; Arnold, M

    2015-06-01

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

  13. Imaging to select and guide transcatheter aortic valve implantation

    PubMed Central

    Zamorano, José Luis; Gonçalves, Alexandra; Lang, Roberto

    2014-01-01

    Transcatheter aortic valve implantation (TAVI) is indicated for patients with severe aortic stenosis and high or prohibitive surgical risk. Patients’ selection requires clinical and anatomical selection criteria, being the later determined by multimodality imaging evaluation. Echocardiography, multislice computed tomography (MSCT), angiography, and cardiovascular magnetic resonance (CMR) are the methods available to determine the anatomical suitability for the procedure. Imaging assists in the selection of bioprosthesis type, prosthetic sizing and in the decision of the best vascular access. In this review, we present our critical appraisal on the use of imaging to best patients’ selection and procedure guidance in TAVI. PMID:24459198

  14. Transcatheter aortic valve implantation complicated by acute pericardial tamponade

    PubMed Central

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

    2014-01-01

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

  15. Transcatheter aortic valve implantation complicated by acute pericardial tamponade.

    PubMed

    Mo?e?ska, Olga; Suwalski, Piotr; Pawlak, Agnieszka; Kulawik, Tomasz; Byczkowska, Katarzyna; Gil, Robert J

    2014-01-01

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

  16. Left Apical Aneurysm in a Patient with Severe Aortic Valve Stenosis

    PubMed Central

    Drews, Thorsten; Pasic, Miralem; Hetzer, Roland

    2014-01-01

    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. PMID:25798350

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

    PubMed

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

    2015-01-01

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

  18. Calcific aortic valve disease: A consensus summary from the Alliance of Investigators on Calcific Aortic Valve Disease

    PubMed Central

    Yutzey, Katherine E.; Demer, Linda L.; Body, Simon C.; Huggins, Gordon S.; Towler, Dwight A.; Giachelli, Cecilia M.; Hofmann-Bowman, Marion A.; Mortlock, Douglas P.; Rogers, Melissa B.; Sadeghi, Mehran M.; Aikawa, Elena

    2014-01-01

    Calcific Aortic Valve Disease (CAVD) is increasingly prevalent worldwide with significant morbidity and mortality. Therapeutic options beyond surgical valve replacement are currently limited. In 2011, the National Heart Lung and Blood Institute assembled a working group on aortic stenosis. This group identified CAVD as an actively regulated disease process in need of further study. As a result, the Alliance of Investigators on CAVD was formed to coordinate and promote CAVD research, with the goals of identifying individuals at risk, developing new therapeutic approaches, and improving diagnostic methods. The group is composed of cardiologists, geneticists, imaging specialists, and basic science researchers. This report reviews the current status of CAVD research and treatment strategies with identification of areas in need of additional investigation for optimal management of this patient population. PMID:25189570

  19. Extracellular matrix in deoxycholic acid decellularized aortic heart valves

    PubMed Central

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

    2012-01-01

    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

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

    PubMed

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

    2015-06-01

    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

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

    PubMed Central

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

    2013-01-01

    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

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

    PubMed Central

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

    2015-01-01

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

  3. Comparison of transcatheter aortic valve and surgical bioprosthetic valve durability: A fatigue simulation study.

    PubMed

    Martin, Caitlin; Sun, Wei

    2015-09-18

    Transcatheter aortic valve (TAV) intervention is now the standard-of-care treatment for inoperable patients and a viable alternative treatment option for high-risk patients with symptomatic aortic stenosis. While the procedure is associated with lower operative risk and shorter recovery times than traditional surgical aortic valve (SAV) replacement, TAV intervention is still not considered for lower-risk patients due in part to concerns about device durability. It is well known that bioprosthetic SAVs have limited durability, and TAVs are generally assumed to have even worse durability, yet there is little long-term data to confirm this suspicion. In this study, TAV and SAV leaflet fatigue due to cyclic loading was investigated through finite element analysis by implementing a computational soft tissue fatigue damage model to describe the behavior of the pericardial leaflets. Under identical loading conditions and with identical leaflet tissue properties, the TAV leaflets sustained higher stresses, strains, and fatigue damage compared to the SAV leaflets. The simulation results suggest that the durability of TAVs may be significantly reduced compared to SAVs to about 7.8 years. The developed computational framework may be useful in optimizing TAV design parameters to improve leaflet durability, and assessing the effects of underexpanded, elliptical, or non-uniformly expanded stent deployment on TAV durability. PMID:26294354

  4. In vitro Models of Aortic Valve Calcification: Solidifying a System

    PubMed Central

    Bowler, Meghan A.; Merryman, W. David

    2014-01-01

    Calcific aortic valve disease (CAVD) affects 25% of people over 65, and the late-stage stenotic state can only be treated with total valve replacement, requiring 85,000 surgeries annually in the US alone [1]. As CAVD is an age-related disease, many of the affected patients are unable to undergo the open-chest surgery that is its only current cure. This challenge motivates the elucidation of the mechanisms involved in calcification, with the eventual goal of alternative preventative and therapeutic strategies. There is no sufficient animal model of CAVD, so we turn to potential in vitro models. In general, in vitro models have the advantages of shortened experiment time and better control over multiple variables compared to in vivo models. As with all models, the hypothesis being tested dictates the most important characteristics of the in vivo physiology to recapitulate. Here, we collate the relevant pieces of designing and evaluating aortic valve calcification so that investigators can more effectively draw significant conclusions from their results. PMID:25249188

  5. Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

    PubMed Central

    Sza?a?ski, Przemys?aw; Zembala, Micha?; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecie?, Anna; Zembala, Marian

    2015-01-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures. PMID:26336491

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

    E-print Network

    Weinberg, Eli J.

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

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

    PubMed

    Barannyk, Oleksandr; Oshkai, Peter

    2015-05-01

    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

  8. Suboptimal geometrical implantation of biological aortic valves provokes functional deficits.

    PubMed

    Kuehnel, Ralf-Uwe; Wendt, Max O; Jainski, Ute; Hartrumpf, Martin; Pohl, Manfred; Albes, Johannes M

    2010-06-01

    Endovascular valves have become a valid option for patients not qualifying for conventional surgery. Biological valves mounted in a stent are currently used. After implantation, however, geometrical distortion of the valve can occur. We tested whether biological valves suitable for transcatheter implantation exhibit hemodynamic deficits after deployment in a distorted position. Two types of valves [bovine pericardium (BP) and porcine cusps], of 21 and 23 mm diameter, respectively were investigated. Mean transvalvular gradient (TVG), effective orifice area (EOA), and regurgitation fraction (REG) were measured prior to and after the 20% distortion of the original diameter. All valves exhibited an increase of TVG and reduction of EOA whereas REG increased only in BP valves after distortion. The 21 mm valves demonstrated a more pronounced alteration than the 23 mm valves. Even moderately distorted implantation of a biological valve results in a marked functional alteration. The susceptibility of pericardial valves is higher than that of porcine valves probably owing to better coaptation properties of native cusps even under deformed conditions when compared to valves constructed with pericardium. Care should therefore be taken during implantation of endovascular valves in order to avoid fixed hemodynamic deficits. Native valves may preferably be used as they demonstrate a more robust behavior regarding suboptimal implantation. PMID:20233809

  9. Valve Sparing Aortic Root Replacement in Children with Loeys-Dietz Syndrome.

    PubMed

    Sim, Hyung-Tae; Seo, Dong Ju; Yu, Jeong Jin; Baek, Jae Suk; Goo, Hyn Woo; Park, Jeong-Jun

    2015-08-01

    Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder that is characterized by aggressive arterial and aortic disease, often involving the formation of aortic aneurysms. We describe the cases of two children with LDS who were diagnosed with aortic root aneurysms and successfully treated by valve-sparing aortic root replacement (VSRR) with a Valsalva graft. VSRR is a safe and suitable operation for children that avoids prosthetic valve replacement. PMID:26290839

  10. Valve Sparing Aortic Root Replacement in Children with Loeys-Dietz Syndrome

    PubMed Central

    Sim, Hyung-Tae; Seo, Dong Ju; Yu, Jeong Jin; Baek, Jae Suk; Goo, Hyn Woo; Park, Jeong-Jun

    2015-01-01

    Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disorder that is characterized by aggressive arterial and aortic disease, often involving the formation of aortic aneurysms. We describe the cases of two children with LDS who were diagnosed with aortic root aneurysms and successfully treated by valve-sparing aortic root replacement (VSRR) with a Valsalva graft. VSRR is a safe and suitable operation for children that avoids prosthetic valve replacement. PMID:26290839

  11. Dynamic heart phantom with functional mitral and aortic valves

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  12. Age-related changes in aortic valve hemostatic protein regulation

    PubMed Central

    Balaoing, Liezl R.; Post, Allison D.; Liu, Huiwen; Minn, Kyung Taeck; Grande-Allen, K. Jane

    2015-01-01

    Objective While valvular endothelial cells (VECs) have unique responses compared to vascular ECs, valvular regulation of hemostasis is not well understood. Heart valves remodel throughout a person's lifetime, resulting in changes in extracellular matrix (ECM) composition and tissue mechanical properties that may affect VEC hemostatic function. This work assessed VEC regulation of hemostasis in situ and in vitro as a function of specimen age. Approach and Results Porcine aortic valves (PAV) were assigned into one of three age groups: YNG (6 weeks), ADT (6 months), or OLD (2 years). Histology of valves showed that secreted thrombotic/anti-thrombotic proteins localize at the valve endothelium, and tissue interior. Gene expression and immunostains for von Willebrand factor (VWF), tissue factor pathway inhibitor, and tissue plasminogen activator in YNG PAVECs was higher than in OLD, while plasminogen activator inhibitor-1 levels in OLD were higher than in YNG and ADT. Histamine stimulated YNG PAVECs released higher concentrations of VWF proteins than OLD, while the fraction of cleaved VWF-140 fragments were not different between age groups. A CAVD in vitro model using valvular interstitial cells (VICs) confirmed that VWF in culture significantly increased VIC nodule formation and calcification. Conclusions Hemostatic protein regulation in AV tissues and VECs changes with age. The presence of VWF and other potential hemostatic proteins increase VIC calcification in vitro. Therefore, the increased capacity of elderly valves to sequester the hemostatic proteins, together with age-associated loss of ECM organization warrants investigation into potential roles for these proteins in the formation of calcific nodules. PMID:24177329

  13. [Extracardiac Aorto-right Atrial Fistula after Aortic Valve Replacement].

    PubMed

    Matsumoto, Kazuhisa; Yotsumoto, Goichi; Yamamoto, Hiroyuki; Hisashi, Yosuke; Tao, Koji; Mukaihara, Kosuke; Shigehisa, Yoshiya; Matsuba, Tomoyuki; Moriyama, Yukinori; Imoto, Yutaka

    2015-08-01

    The development of a fistula between the aorta and the right atrium is a relatively rare but well-documented complication after cardiac surgery and proximal aortic dissection, and has a high mortality rate if it is not diagnosed adequately and surgically treated without delay. We report a rare case of extracardiac aorta-right atrial fistula. An 86-year-old woman underwent aortic valve replacement via median sternotomy. Two weeks after surgery, the upper median skin incision reopened, which exposed the sternum and revealed purulent discharge inside the wound. Wound and blood cultures were positive for methicillin-resistant Staphylococcus aureus. The wound was treated, and healed in approximately 2 weeks. Six weeks after surgery, the patient suddenly presented with dyspnea because of heart failure.Extracardiac aorto-right atrial fistula was confirmed by computed tomography. During surgery, we found an extracardiac fistula formed in the hematoma between the sites where the aortic vent suture was tied and the caval cannula was removed. The infection seemed to have contributed to the development of the fistula and may have persisted in the ascending aorta or artificial valve, which may have led to cerebral hemorrhage resulting in death 4 months later. PMID:26329705

  14. A Case of Severe Unicuspid Aortic Valve Stenosis: Valve Repair With Tricuspidization in an Adult.

    PubMed

    Tokue, Masahide; Hara, Hidehiko; Sahara, Naohiko; Yamazaki, Kenji; Yamashita, Hiromasa; Takahashi, Kei; Ozaki, Shigeyuki; Sugi, Kaoru; Nakamura, Masato

    2015-10-01

    A 33-year-old male was referred to our institute with acute heart failure. The patient was found to have a unicuspid aortic valve (UAV) and severe aortic stenosis. He had been followed at a local university hospital during childhood. However, he stopped visiting the outpatient clinic after becoming an adult. His condition subsequently worsened, and he ultimately presented to our hospital with cardiogenic shock. In Japan, some adult congenital heart disease (ACHD) patients continue to be followed by pediatric cardiologists, though the patterns of practice are variable. This report describes the case of a patient who became lost to follow-up in early adulthood. We thus focus on this ACHD case as an example of the effects of inadequate communication among doctors and the need to establish better ACHD management protocols for treating this patient population. PMID:26467883

  15. The role of balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation

    PubMed Central

    Wilczek, Krzysztof; Pres, Damian; Krajewski, Adam; Polo?ski, Lech; Zembala, Marian; G?sior, Mariusz

    2015-01-01

    Balloon aortic valvuloplasty is recommended in patients not suitable for transcatheter aortic valve implantation/aortic valve replacement (TAVI/AVR) or when such interventions are temporarily contraindicated. The number of performed balloon aortic valvuloplasty (BAV) procedures has been increasing in recent years. Valvuloplasty enables the selection of individuals with severe left ventricular dysfunction or with symptoms of uncertain origin resulting from concomitant disorders (including chronic obstructive pulmonary disease [COPD]) who can benefit from destination therapy (AVR/TAVI). Thanks to improved equipment, the number of adverse effects is now lower than it was in the first years after the advent of BAV. Valvuloplasty can be safely performed even in unstable patients, but long-term results remain poor. In view of the limited availability of TAVI in Poland, it is reasonable to qualify patients for BAV more often, as it is a relatively safe procedure improving the clinical condition of patients awaiting AVR/TAVI. PMID:26336471

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

    PubMed

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

    2012-09-01

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

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

    PubMed

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

    2015-01-01

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

  18. Continuous flow left ventricular assist device implantation concomitant with aortic arch replacement and aortic valve closure in a patient with end-stage heart failure associated with bicuspid aortic valve.

    PubMed

    Akiyama, Masatoshi; Hosoyama, Katsuhiro; Kumagai, Kiichiro; Kawamoto, Shunsuke; Saiki, Yoshikatsu

    2015-12-01

    Left ventricular assist device (LVAD) implantation has become an established treatment for patients with end-stage heart failure as a bridge to cardiac transplantation. During LVAD implantation, some patients require concomitant surgeries, including tricuspid valve repair, aortic valve repair or replacement, and patent foramen ovale closure. However, concomitant aortic surgeries are rare in patients requiring LVAD implantation. We successfully performed total arch replacement with an open distal technique, aortic valve closure, and continuous flow LVAD implantation simultaneously. PMID:25957796

  19. Aortic valve orifice equation independent of valvular flow intervals: application to aortic valve area computation in aortic stenosis and comparison with the Gorlin formula.

    PubMed

    Seitz, W; Oppenheimer, L; McIlroy, M; Nelson, D; Operschall, J

    1986-12-01

    An orifice equation is derived relating the effective aortic valve area, A, the average aortic valve pressure gradient, dP, the stroke volume, SV, and the heart frequency, FH, through considerations of momentum conservation across the aortic valve. This leads to a formula consistent with Newton's second law of motion. The form of the new equation is A = (7.5 X 10(-5)) SV FH2/Pd, where A, VS, FH and Pd are expressed in cm2, ml, s-1 and mmHg, respectively. Aortic valve areas computed with the new orifice equation are found to correlate with those computed by the Gorlin formula in conditions of resting haemodynamic states at a level of r = 0.86, SE = 0.25 cm2, N = 120. The results suggest that the new formula may be considered as an independent orifice equation having a similar domain of validity as the Gorlin formula. The new equation offers the possibility of deriving additional useful haemodynamic relationships through combination with established cardiological formulas and applying it in a noninvasive Doppler ultrasonic or echocardiographic context. PMID:3830201

  20. Transcatheter Aortic Valve Implantation - Yesterday, Today and Tomorrow.

    PubMed

    Gooley, R; Cameron, J D; Meredith, I T

    2015-12-01

    Since the first transcatheter aortic valve implantation (TAVI) was performed by Alain Cribier and colleagues in 2002 [1], the technology has garnered global support with more than 200,000 devices implanted. The rapid adoption of this technology has been driven by the need for a less invasive treatment modality in a cohort of patients often denied conventional surgical valve replacement due to an unacceptably high perioperative risk, whether real or perceived [2]. This, together with evidence that the technology confers morbidity and mortality advantages compared to medical therapy [3,4] and at least equivalent outcomes to surgical valve replacement [5,6] in select cohorts, has seen clinical approval in more than 50 countries. The last 13 years has seen an evolution of practises and equipment affecting almost every aspect of the TAVI procedure from pre-procedural assessment to device design and post-procedural care. The almost exponential rate of change has both benefits and risks. Benefits, in that impactful changes are translated into clinical practice very rapidly, but risks, in that meaningful comparative research studies potentially lag behind and can be outmoded by the time they are published. This instability may in turn delay regulatory review and approval processes that are based on such studies. The aim of this review is to provide an overview of the evolution of TAVI, its current clinical position and likely future directions. PMID:26344347

  1. Potential drug targets for calcific aortic valve disease

    PubMed Central

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

    2014-01-01

    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

  2. Transcatheter aortic valve repair, imaging, and electronic imaging health record.

    PubMed

    Schoenhagen, Paul; Falkner, Juergen; Piraino, David

    2013-01-01

    Degenerative aortic stenosis (AS) is a common valvular pathology in developed nations. Secondary to advanced age and often multiple co-morbidities, a significant percentage of patients are not considered surgical candidates. For these high-risk patients, transcatheter aortic valve replacement (TAVR) is a rapidly emerging less-invasive treatment alternative. Because of the lack of direct exposure and visualization of the operative field, pre-procedural planning and intra-procedural guidance relies on imaging. Large 3-dimensional data files are acquired, which are reconstructed on advanced workstations during review and interpretation. Optimally, the imaging data is organized into a comprehensive digital file as an integral part of the electronic health record (EHR) following the patient. This manuscript will discuss the role of image data management in the context of TAVR. PMID:23250656

  3. Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis.

    PubMed

    Arabkhani, Bardia; Mookhoek, Aart; Di Centa, Isabelle; Lansac, Emmanuel; Bekkers, Jos A; De Lind Van Wijngaarden, Rob; Bogers, Ad J J C; Takkenberg, Johanna J M

    2015-09-01

    Valve-sparing aortic root techniques have progressively gained ground in the treatment of aortic root aneurysm and aortic insufficiency. By avoiding anticoagulation therapy they offer a good alternative to composite graft replacement. This systematic review describes the reported outcome of valve-sparing aortic root replacement, focusing on the remodeling and reimplantation technique. A systematic literature search on the characteristics of and outcomes after valve-sparing aortic root replacement revealed 1,659 articles. The inclusion criteria were a focus on valve-sparing aortic root replacement in adults with aortic root aneurysm, presentation of survival data, and inclusion of at least 30 patients. Data were pooled by inverse variance weighting and analyzed by linear regression. Of 1,659 articles published between January 1, 2000, and January 1, 2014, 31 were included (n = 4,777 patients). The mean age at operation was 51 ± 14.7 years, and 14% of patients had a bicuspid aortic valve. The reimplantation technique was used in 72% and remodeling in 27% (1% other). No clinical advantage in terms of survival and reoperation of one technique over the other was found. Cusp repair was performed in 33%. Pooled early mortality was 2% (n = 103). During follow-up (21,716 patient-years), 262 patients died (survival 92%), and 228 (5%) underwent reoperation, mainly valve replacement. Major adverse valve-related events were low (1.66% patient-years). Preoperative severe aortic valve regurgitation showed a trend toward higher reoperation rate. Remodeling and reimplantation techniques show comparable survival and valve durability results, providing a valid alternative to composite valve replacement. The heterogeneity in the data underlines the need for a collaborative effort to standardize outcome reporting. PMID:26228603

  4. The power of disruptive technological innovation: Transcatheter aortic valve implantation.

    PubMed

    Berlin, David B; Davidson, Michael J; Schoen, Frederick J

    2015-11-01

    We sought to evaluate the principles of disruptive innovation, defined as technology innovation that fundamentally shifts performance and utility metrics, as applied to transcatheter aortic valve implantation (TAVI). In particular, we considered implantation procedure, device design, cost, and patient population. Generally cheaper and lower performing, classical disruptive innovations are first commercialized in insignificant markets, promise lower margins, and often parasitize existing usage, representing unattractive investments for established market participants. However, despite presently high unit cost, TAVI is less invasive, treats a "new," generally high risk, patient population, and is generally done by a multidisciplinary integrated heart team. Moreover, at least in the short-term TAVI has not been lower-performing than open surgical aortic valve replacement in high-risk patients. We conclude that TAVI extends the paradigm of disruptive innovation and represents an attractive commercial opportunity space. Moreover, should the long-term performance and durability of TAVI approach that of conventional prostheses, TAVI will be an increasingly attractive commercial opportunity. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B: 1709-1715, 2015. PMID:25545639

  5. Practical update on imaging and transcatheter aortic valve implantation

    PubMed Central

    Feltes, Gisela; Núñez-Gil, Iván J

    2015-01-01

    After very rapid advances in the development of the technique and devices, transcatheter aortic valve implantation (named TAVI or TAVR), is today a reality that is here to stay. It has become the minimally-invasive treatment option for high-risk and non-surgical patients with severe symptomatic aortic stenosis. Requiring the participation of a multidisciplinary team for its implementation, cardiac imaging plays an important role. From pre-assessment to determine the suitability of the patient, the access site, the type of device, to the guidance during the procedure, and ultimately the long term monitoring of the patient. Correct selection of the patient and device, correct placement of the stent-valve and early detection of complications are of paramount importance for procedural success and for patient outcome. Each technique has advantages and disadvantages, being the cardiologist who will determine the best approach according to the type of patient and the expertise of the center in each one of them. This article summarizes the last contributions of the most common used imaging techniques, in each step of the procedure. PMID:25914787

  6. Distal embolization of Edwards SAPIEN prosthesis during transcatheter aortic valve implantation

    PubMed Central

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

    2013-01-01

    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

  7. Stented within a stentless aortic valve. A simple surgical solution for the replacement of a stentless aortic bioprosthesis.

    PubMed

    Panagiotou, Matthew; Kogerakis, Nektarios; Crockett, James R; Economidou, Stella

    2010-01-01

    Stentless aortic bioprostheses are designed to offer better hemodynamics, less mechanical stress to the leaflets and as a result less degeneration. Although encouraging results are reported, little evidence has been published regarding reoperations of stentless valves. We are reporting a case of a structural valve dysfunction of an O'Brien-Angell stentless prosthesis, which could not be extracted during reoperation without damaging the aortic root. We are presenting a simple, quick and effective surgical solution, the surgical 'valve within a valve' technique for the avoidance of a redo complex root procedure. PMID:19805504

  8. Cardiac amyloidosis as a potential risk factor for transapical transcatheter aortic valve implantation.

    PubMed

    Monticelli, Fabio C; Kunz, Sebastian N; Keller, Thomas; Bleiziffer, Sabine

    2014-09-01

    Transcatheter aortic valve implantation via transarterial or transapical access is an alternative therapy to treat high-risk patients with severe symptomatic aortic stenosis. Despite growing experience, procedural complications may still occur. We herein report an 86-year-old female patient with fatal left ventricular rupture after transapical transcatheter aortic valve implantation with an Edwards Sapien prosthesis due to severe cardiac amyloidosis. PMID:24641304

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

    SciTech Connect

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

    1991-09-01

    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.

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

    PubMed

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

    2014-09-01

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

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

    PubMed Central

    Weinberg, Eli J.; Schoen, Frederick J.; Mofrad, Mohammad R. K.

    2009-01-01

    The aortic heart valve undergoes geometric and mechanical changes over time. The cusps of a normal, healthy valve thicken and become less extensible over time. In the disease calcific aortic stenosis (CAS), calcified nodules progressively stiffen the cusps. The local mechanical changes in the cusps, due to either normal aging or pathological processes, affect overall function of the valve. In this paper, we propose a computational model for the aging aortic valve that connects local changes to overall valve function. We extend a previous model for the healthy valve to describe aging. To model normal/uncomplicated aging, leaflet thickness and extensibility are varied versus age according to experimental data. To model calcification, initial sites are defined and a simple growth law is assumed. The nodules then grow over time, so that the area of calcification increases from one model to the next model representing greater age. Overall valve function is recorded for each individual model to yield a single simulation of valve function over time. This simulation is the first theoretical tool to describe the temporal behavior of aortic valve calcification. The ability to better understand and predict disease progression will aid in design and timing of patient treatments for CAS. PMID:19536285

  12. Side-Specific Endothelial-Dependent Regulation of Aortic Valve Calcification

    PubMed Central

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

    2014-01-01

    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

  13. Bioengineering strategies for polymeric scaffold for tissue engineering an aortic heart valve: an update.

    PubMed

    Morsi, Yosry S

    2014-09-01

    The occurrence of dysfunctional aortic valves is increasing every year, and current replacement heart valves, although having been shown to be clinically successful, are only short-term solutions and suffer from many agonizing long-term drawbacks. The tissue engineering of heart valves is recognized as one of the most promising answers for aortic valve disease therapy, but overcoming current shortcomings will require multidisciplinary efforts. The use of a polymeric scaffold to guide the growth of the tissue is the most common approach to generate a new tissue for an aortic heart valve. However, optimizing the design of the scaffold, in terms of biocompatibility, surface morphology for cell attachments and the correct rate of degradation is critical in creating a viable tissue-engineered aortic heart valve. This paper highlights the bioengineering strategies that need to be followed to construct a polymeric scaffold of sufficient mechanical integrity, with superior surface morphologies, that is capable of mimicking the valve dynamics in vivo. The current challenges and future directions of research for creating tissue-engineered aortic heart valves are also discussed. PMID:25262629

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

    PubMed Central

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

    2014-01-01

    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

  15. Sudden cardiac arrest during emergency caesarean delivery in a 31-year-old woman, due to accelerated structural valve degeneration of an aortic valve bioprosthesis.

    PubMed

    O'Sullivan, Crochan John; Bühlmann Lerjen, Eva; Pellegrini, Daniela; Eberli, Franz Robert

    2015-01-01

    The choice of prosthetic valve to implant in women of childbearing age requiring a valve replacement is challenging. Mechanical valves mandate the use of oral anticoagulation (OAC) for the prevention of thromboembolic complications, but the use of OAC during pregnancy can lead to maternal and fetal complications, in particular, warfarin embryopathy. Conversely, the use of bioprosthetic valves during pregnancy eliminates the need for OAC, but can instead be associated with accelerated structural valve degeneration. We present the case of a 31-year-old woman with a bioprosthetic valve in the aortic position, who developed undetected accelerated structural valve degeneration 5.5?years following implantation of a Mitroflow bioprosthetic aortic valve, and who suffered a catastrophic complication during emergency caesarean delivery as a result. PMID:26568057

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed Central

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

    2015-01-01

    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

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

    PubMed

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

    2014-07-01

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

  19. Transcatheter aortic valve implantation in surgically repaired double outlet right ventricle.

    PubMed

    Keswani, Amit; Verma, Anil; Dann, Kristen; Ventura, Laurie; Lucas, Victor; Shah, Sangeeta; Ramee, Stephen

    2014-01-01

    A 52-year-old male patient, with a medical history of surgically repaired double outlet right ventricle presented with severe aortic stenosis (AS) and hepatitis C with cirrhosis, presented with New York Heart Association Class IV heart failure. During evaluation for a liver transplant, he was deemed a poor surgical candidate due to his aortic valve disease and cirrhosis with model for end-stage liver disease score of 14. Transthoracic echocardiogram showed severe AS with a mean gradient of 62 mm Hg and calculated aortic valve area of 0.74 cm(2) with a normal ejection fraction of 65%. The patient underwent transfemoral implantation of a 23-mm Edwards Sapien commercial heart valve with significant mean gradient reduction across the aortic valve from 62 to 13 mm Hg. The patient was observed in the coronary care unit and discharged home 2 days postprocedure with his clinical symptoms greatly improved. PMID:23865720

  20. 3D Bioprinting of Heterogeneous Aortic Valve Conduits with Alginate/Gelatin Hydrogels

    PubMed Central

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

    2013-01-01

    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

  1. Transcatheter ACURATE-TA Aortic Valve Implantation in a Patient With a Previous Mechanical Mitral Valve.

    PubMed

    Bagur, Rodrigo; Kiaii, Bob; Teefy, Patrick J; Diamantouros, Pantelis; Harle, Christopher; Goela, Aashish; Chan, Ian; Chu, Michael W A

    2015-11-01

    Transcatheter aortic valve implantation (TAVI) in the presence of a mechanical mitral valve (MMV) prosthesis is still challenging because of the rigid mitral frame within the aortomitral curtain. Moreover, low-lying coronary ostia represent a hazardous problem of coronary obstruction, especially in narrow or porcelain aortic roots. The present case demonstrates the successful management of 2 challenging anatomical issues, the rigid cage of the MMV and the low-lying left main coronary ostium (LMCO), with the implantation of the ACURATE-TA bioprosthesis (Symetis SA, Ecublens, Switzerland). It also highlights the importance of having multiple TAVI devices in order to choose the ideal transcatheter aortic bioprosthesis to fit the unique anatomical presentation of the patient. PMID:26522576

  2. Is lower base rate detrimental to transcatheter aortic valve implantation patients requiring pacemakers?

    PubMed

    Shurrab, Mohammed; Singarajah, Theepana; Wijeysundera, Harindra C; Haj-Yahia, Saleem; Newman, David; Crystal, Eugene; Lashevsky, Ilan

    2015-11-01

    Sudden cardiac death related to polymorphic ventricular tachycardia/ventricular fibrillation has been well reported post atrioventricular junction ablation. The practice of faster pacing rate immediately after atrioventricular junction ablation is well recognized to decrease the risk of sudden cardiac death. We propose that this practice (faster pacing rate) be implemented in patients who need permanent pacemakers secondary to transcatheter aortic valve implantation (or even surgical aortic valve interventions). PMID:26414946

  3. Intermittent premature mitral valve closure in combined acute severe aortic and mitral regurgitation.

    PubMed

    Dianzumba, S B; Montello, N J; Joyner, C R

    1984-11-01

    We have described the clinical, hemodynamic, and echocardiographic features of torn aortic cusps with mitral valve fenestration in a patient with infective endocarditis. Hemodynamic studies showed left atrial pressure intermittently exceeding left ventricular end-diastolic pressure. This phenomenon corresponded with intermittent premature mitral valve closure, which may serve as a marker for M-mode echocardiographic diagnosis in combined severe acute aortic and mitral regurgitation. PMID:6494970

  4. Mitral Valve Repair

    MedlinePLUS

    ... a Thoracic Surgeon? Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Mitral Valve Replacement Aortic Valve Mitral Valve Repair Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Other Types of Surgery Clinical ...

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

    PubMed

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

    2015-06-01

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

  6. iTRAQ proteomic analysis of extracellular matrix remodeling in aortic valve disease.

    PubMed

    Martin-Rojas, Tatiana; Mourino-Alvarez, Laura; Alonso-Orgaz, Sergio; Rosello-Lleti, Esther; Calvo, Enrique; Lopez-Almodovar, Luis Fernando; Rivera, Miguel; Padial, Luis R; Lopez, Juan Antonio; Cuesta, Fernando de la; Barderas, Maria G

    2015-01-01

    Degenerative aortic stenosis (AS) is the most common worldwide cause of valve replacement. The aortic valve is a thin, complex, layered connective tissue with compartmentalized extracellular matrix (ECM) produced by specialized cell types, which directs blood flow in one direction through the heart. There is evidence suggesting remodeling of such ECM during aortic stenosis development. Thus, a better characterization of the role of ECM proteins in this disease would increase our understanding of the underlying molecular mechanisms. Aortic valve samples were collected from 18 patients which underwent aortic valve replacement (50% males, mean age of 74 years) and 18 normal control valves were obtained from necropsies (40% males, mean age of 69 years). The proteome of the samples was analyzed by 2D-LC MS/MS iTRAQ methodology. The results showed an altered expression of 13 ECM proteins of which 3 (biglycan, periostin, prolargin) were validated by Western blotting and/or SRM analyses. These findings are substantiated by our previous results demonstrating differential ECM protein expression. The present study has demonstrated a differential ECM protein pattern in individuals with AS, therefore supporting previous evidence of a dynamic ECM remodeling in human aortic valves during AS development. PMID:26620461

  7. iTRAQ proteomic analysis of extracellular matrix remodeling in aortic valve disease

    PubMed Central

    Martin-Rojas, Tatiana; Mourino-Alvarez, Laura; Alonso-Orgaz, Sergio; Rosello-Lleti, Esther; Calvo, Enrique; Lopez-Almodovar, Luis Fernando; Rivera, Miguel; Padial, Luis R.; Lopez, Juan Antonio; Cuesta, Fernando de la; Barderas, Maria G.

    2015-01-01

    Degenerative aortic stenosis (AS) is the most common worldwide cause of valve replacement. The aortic valve is a thin, complex, layered connective tissue with compartmentalized extracellular matrix (ECM) produced by specialized cell types, which directs blood flow in one direction through the heart. There is evidence suggesting remodeling of such ECM during aortic stenosis development. Thus, a better characterization of the role of ECM proteins in this disease would increase our understanding of the underlying molecular mechanisms. Aortic valve samples were collected from 18 patients which underwent aortic valve replacement (50% males, mean age of 74 years) and 18 normal control valves were obtained from necropsies (40% males, mean age of 69 years). The proteome of the samples was analyzed by 2D-LC MS/MS iTRAQ methodology. The results showed an altered expression of 13 ECM proteins of which 3 (biglycan, periostin, prolargin) were validated by Western blotting and/or SRM analyses. These findings are substantiated by our previous results demonstrating differential ECM protein expression. The present study has demonstrated a differential ECM protein pattern in individuals with AS, therefore supporting previous evidence of a dynamic ECM remodeling in human aortic valves during AS development. PMID:26620461

  8. Modified lipoprotein-derived lipid particles accumulate in human stenotic aortic valves.

    PubMed

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

    2013-01-01

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

  9. Trends in mechanical aortic valve replacement surgery in a large, multi-surgeon, single hospital practice

    PubMed Central

    Fedakar, Ali; Adademir, Taylan; Salihi, Salih; Boyac?o?lu, Kamil; Özbek, Babürhan; Ta?ar, Mehmet; Balkanay, Mehmet

    2014-01-01

    Introduction In recent decades, new high-performance prostheses have been invented for use with small aortic annuli, and they have helped avoid patient prosthesis mismatch (PPM) without the need for aortic annular enlargement. The purpose of this study is to examine the trends in mechanical aortic valve replacement surgery in a large, multi-surgeon, single hospital practice. Material and methods Between January 1999 and January 2008, 1337 consecutive patients underwent aortic valve replacement (AVR) with or without concomitant aortic annulus enlargement. Patients with aortic dissections and patients undergoing Bentall and Ross procedures were excluded from the analysis. Patients were grouped according to the used aortic valve size. The data were collected and analyzed retrospectively. Results The mean age of the subjects was 54.37 ± 17.35 (range: 10-84), and 881 of them were men (65.8%). The number of aortic root enlargement procedures decreased over the years (p < 0.05); particularly, the decline of the Nicks procedures was statistically significant (p < 0.05). In 2008, the most frequently used valve size was 23, which stands in contrast with the smaller size preferred in 1999 (p < 0.05). The primary pathophysiology leading to aortic valve replacement, i.e. aortic stenosis, did not change over the years (p > 0.05). Although the use of combined surgery increased in time, there was no statistical relationship with any increase in mortality rates (p > 0.05). Conclusions This study showed that avoiding the procedure of aortic root enlargement and implanting high-performance prostheses with larger valves is safe. PMID:26336451

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

    PubMed Central

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

    2012-01-01

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

  11. Repair of a Mycotic Coronary Artery Aneurysm with an Intact Prosthetic Aortic Valve.

    PubMed

    Ogawa, Mitsugu; Bell, David; Marshman, David

    2016-01-01

    We describe the case of a 75-year-old man with a mycotic right coronary artery aneurysm without evidence of prosthetic valve endocarditis. Eight years previously he had undergone coronary artery bypass surgery and aortic valve replacement. He presented with methicillin resistant staphylococcus aureus septicaemia after a prolonged hospital admission. Further investigation revealed a large mycotic right coronary artery aneurysm prompting urgent surgical repair. This case, of a mycotic coronary artery aneurysm in an atherosclerotic native coronary artery, is an extremely rare entity, which is further complicated by the presence of a prosthetic aortic valve. PMID:26475646

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

    PubMed Central

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

    2015-01-01

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

  13. INTERLAYER MICROMECHANICS OF THE AORTIC HEART VALVE LEAFLET

    PubMed Central

    Buchanan, Rachel M.; Sacks, Michael S.

    2014-01-01

    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, 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

  14. Transapical transcatheter aortic valve replacement in patients with cardiogenic shock

    PubMed Central

    D'Ancona, Giuseppe; Pasic, Miralem; Buz, Semih; Drews, Thorsten; Dreysse, Stephan; Kukucka, Marian; Hetzer, Roland; Unbehaun, Axel

    2012-01-01

    Transcatheter aortic valve implantation (TAVI) has been introduced to treat patients at high risk for conventional surgery; however, cardiogenic shock is considered a contraindication for TAVI. The aim of the present study was to evaluate early and intermediate mortality of patients in cardiogenic shock undergoing TAVI as a rescue procedure. Patients in cardiogenic shock underwent transapical TAVI with Edwards SAPIEN (Edwards Lifesciences, Irvine, CA, USA) prosthetic valves. Preoperative, perioperative and 1-year follow-up data were analysed. Analysis included 358 patients. Preoperative cardiogenic shock was present in 21 (5.9%) patients. EuroSCORE (cardiogenic shock 73.1 ± 18.9% vs. non-cardiogenic shock 36.0 ± 18.7%; P < 0.0001) and Society of Thoracic Surgeons score (cardiogenic shock 50.8 ± 28.1% vs. non-cardiogenic shock 16.7 ± 12.2%; P < 0.0001) were significantly higher in the cardiogenic shock group, and left ventricular ejection fraction (cardiogenic shock 26.0 ± 13.1% vs. no-cardiogenic shock 51.4 ± 13.0%; P < 0.0001) was significantly lower. Thirty-day mortality was significantly higher in the cardiogenic shock group (cardiogenic shock 19% vs. non-cardiogenic shock 5%; P = 0.02) and 1-year survival significantly lower (cardiogenic shock 46% vs. no-cardiogenic shock 83%; P < 0.0001). At Cox regression, EuroSCORE was the sole determinant for follow-up mortality (odds ratio = 1.02; P = 0.04). TAVI in patients who are in cardiogenic shock is feasible. Although the early and late outcomes are encouraging, a structured strategy should be developed and further experience is needed. PMID:22232233

  15. Interlayer micromechanics of the aortic heart valve leaflet.

    PubMed

    Buchanan, Rachel M; Sacks, Michael S

    2014-08-01

    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

  16. Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement

    PubMed Central

    Bagur, Rodrigo; Webb, John G.; Nietlispach, Fabian; Dumont, Éric; De Larochellière, Robert; Doyle, Daniel; Masson, Jean-Bernard; Gutiérrez, Marcos J.; Clavel, Marie-Annick; Bertrand, Olivier F.; Pibarot, Philippe; Rodés-Cabau, Josep

    2010-01-01

    Aims Very few data exist on the occurrence of acute kidney injury (AKI) associated with transcatheter aortic valve implantation (TAVI). The objectives of the present study were (i) to determine the incidence, predictive factors, and prognostic value of AKI following TAVI, and (ii) to compare the occurrence of AKI in TAVI vs. surgical aortic valve replacement (SAVR) in patients with pre-procedural chronic kidney disease (CKD). Methods and results A total of 213 patients (mean age 82 ± 8 years) undergoing TAVI for the treatment of severe aortic stenosis were included in the study. Acute kidney injury was defined as a reduction of >25% in estimated glomerular filtration rate (eGFR) within 48 h following the procedure or the need for haemodialysis during index hospitalization. Those patients with pre-procedural CKD (eGFR <60 mL/min/1.73 m2, n = 119) were compared with 104 contemporary patients with CKD who underwent isolated SAVR. The incidence of AKI following TAVI was 11.7%, with 1.4% of the patients requiring haemodialysis. Predictive factors of AKI were hypertension (OR: 4.66; 95% CI: 1.04–20.87), chronic obstructive pulmonary disease (OR: 2.64, 95% CI: 1.10–6.36), and peri-operative blood transfusion (OR: 3.47, 95% CI: 1.30–9.29). Twenty-one patients (9.8%) died during index hospitalization, and the logistic EuroSCORE (OR: 1.03 for each increase of 1%; 95% CI: 1.01–1.06) and occurrence of AKI (OR: 4.14, 95% CI: 1.42–12.13) were identified as independent predictors of postoperative mortality. Patients with CKD who underwent TAVI were older, had a higher logistic EuroSCORE and lower pre-procedural eGFR values compared with those who underwent SAVR (P < 0.0001 for all). The incidence of AKI was lower (P = 0.001; P = 0.014 after propensity score adjustment) in CKD patients who underwent TAVI (9.2%, need for haemodialysis: 2.5%) compared with those who underwent SAVR (25.9%, need for haemodialysis: 8.7%). Conclusion Acute kidney injury occurred in 11.7% of the patients following TAVI and was associated with a greater than four-fold increase in the risk of postoperative mortality. Hypertension, chronic obstructive pulmonary disease, and blood transfusion were predictive factors of AKI. In those patients with pre-procedural CKD, TAVI was associated with a significant reduction of AKI compared with SAVR. PMID:20037180

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

    PubMed Central

    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

    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

  18. Safety valve

    DOEpatents

    Bergman, Ulf C. (Malmoe, SE)

    1984-01-01

    The safety valve contains a resilient gland to be held between a valve seat and a valve member and is secured to the valve member by a sleeve surrounding the end of the valve member adjacent to the valve seat. The sleeve is movable relative to the valve member through a limited axial distance and a gap exists between said valve member and said sleeve.

  19. Reliability and Identification of Aortic Valve Prolapse in the Horse

    PubMed Central

    2013-01-01

    Background The objectives were to determine and assess the reliability of criteria for identification of aortic valve prolapse (AVP) using echocardiography in the horse. Results Opinion of equine cardiologists indicated that a long-axis view of the aortic valve (AoV) was most commonly used for identification of AVP (46%; n=13). There was consensus that AVP could be mimicked by ultrasound probe malignment. This was confirmed in 7 healthy horses, where the appearance of AVP could be induced by malalignment. In a study of a further 8 healthy horses (5 with AVP) examined daily for 5 days, by two echocardiographers standardized imaging guidelines gave good to excellent agreement for the assessment of AVP (kappa>0.80) and good agreement between days and observers (kappa >0.6). The technique allowed for assessment of the degree of prolapse and measurement of the prolapse distance that provided excellent agreement between echocardiographers, days and observers (kappa/ICC>0.8). Assessments made using real-time zoomed images provided similar measurements to the standard views (ICC=0.9), with agreement for the identification of AVP (kappa>0.8). Short axis views of the AoV were used for identification of AVP by fewer respondents (23%), however provided less agreement for the identification of AVP (kappa>0.6) and only adequate agreement with observations made in long axis (kappa>0.5), with AVP being identified more often in short axis (92%) compared to long axis (76%). Orthogonal views were used by 31% of respondents to identify the presence of AVP, and 85% to identify cusp. Its identification on both views on 4 days was used to categorise horses as having AVP, providing a positive predictive value of 79% and negative predictive value of 18%. Only the non-coronary cusp (NCC) of the AoV was observed to prolapse in these studies. Prolapse of the NCC was confirmed during the optimisation study using four-dimensional echocardiography, which concurred with the findings of two-dimensional echocardiography. Conclusions This study has demonstrated reliable diagnostic criteria for the identification and assessment of AVP that can be used for longitudinal research studies to better define the prevalence and natural history of this condition. PMID:23311963

  20. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI)

    PubMed Central

    Michel, Jonathan; Bleiziffer, Sabine; Tassani, Peter; Martin, Klaus

    2015-01-01

    Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and high perioperative risk. With growing experience, further development of the devices, and the expansion to “intermediate-risk” patients, there is increasing interest in performing this procedure under conscious sedation (TAVI-S) rather than the previously favoured approach of general anesthesia (TAVI-GA). The proposed benefits of TAVI-S include; reduced procedure time, shorter intensive care unit (ICU) length of stay, reduced need for intraprocedural vasopressor support, and the potential to perform the procedure without the direct presence of an anesthetist for cost-saving reasons. To date, no randomized trial data exists. We reviewed 13 non-randomized studies/registries reporting data from 6,718 patients undergoing TAVI (3,227 performed under sedation). Patient selection, study methods, and endpoints have differed considerably between published studies. Reported rates of in-hospital and longer-term mortality are similar for both groups. Up to 17% of patients undergoing TAVI-S require conversion to general anesthesia during the procedure, primarily due to vascular complications, and urgent intubation is frequently associated with hemodynamic instability. Procedure related factors, including hypotension, may compound preexisting age-specific renal impairment and enhance the risk of acute kidney injury. Hypotonia of the hypopharyngeal muscles in elderly patients, intraprocedural hypercarbia, and certain anesthetic drugs, may increase the aspiration risk in sedated patients. General anesthesia and conscious sedation have both been used successfully to treat patients with severe AS undergoing TAVI with similar reported short and long-term mortality outcomes. The authors believe that the significant incidence of complications and unplanned conversion to general anesthesia during TAVI-S mandates the start-to-finish presence of an experienced cardiac anesthetist in order to optimize patient outcomes. Good quality randomized data is needed to determine the optimal anesthetic regimen for patients undergoing TAVI. PMID:26543597

  1. Isolated right atrial compression as a late sequela of aortic valve replacement.

    PubMed Central

    Grishkin, B A; Catalano, P W; Watts, M A

    1994-01-01

    Isolated right atrial compression occurred 31 months after aortic valve replacement. Aortic bleeding contained by adjacent pericardium produced a pseudoaneurysm and local atrial tamponade. Transthoracic echocardiography could not distinguish the extracardiac hematoma from an intra-atrial thrombus, temporarily misleading investigators. Images PMID:8000271

  2. How to perform transcaval access and closure for transcatheter aortic valve implantation.

    PubMed

    Lederman, Robert J; Babaliaros, Vasilis C; Greenbaum, Adam B

    2015-12-01

    Transcaval, or caval-aortic, access is a promising approach for fully percutaneous transcatheter aortic valve implantation in patients without good conventional access options. This tutorial review provides step-by-step guidance to planning and executing the procedure, along with approaches to remedy complications. © 2015 Wiley Periodicals, Inc. PMID:26356244

  3. Multiple Embolic Aortic Valve Endocarditis with Small Patent Ductus Arteriosus in Adult

    PubMed Central

    Kim, Seon Hee; Kim, Min Su; Kim, Sang-pil; Choi, Jung Hyun

    2014-01-01

    A 50-year-old female was admitted to Pusan National University Hospital with complaints of fatigue and sweating. Echocardiography showed a small patent ductus arteriosus (PDA) and highly mobile vegetations on the aortic valve. Emergency operation was performed due to the high risk of embolization and severe aortic regurgitation. When the pulmonary artery opened, we found unexpected fresh vegetation. The tissue of the PDA was fragile and infected. We successfully removed the infected tissue, closed the PDA with a patch, and replaced the aortic valve with a mechanical prosthesis. PMID:24782964

  4. Severe aortic valve stenosis in the elderly: high prevalence of sleep-related breathing disorders

    PubMed Central

    Keymel, Stefanie; Hellhammer, Katharina; Zeus, Tobias; Merx, Marc; Kelm, Malte; Steiner, Stephan

    2015-01-01

    Background Aortic valve stenosis is common in the elderly, with a prevalence of nearly 3% in patients aged 75 years or older. Despite the fact that sleep-related breathing disorders (SRBD) are thought to be associated with cardiac disease, little is known about their prevalence in this patient cohort. The purpose of this study was to evaluate the prevalence of SRBD in older patients with aortic valve stenosis admitted for transcatheter aortic valve implantation. Methods Forty-eight consecutive patients (mean age 81±6 years; 37.5% male) with symptomatic aortic valve stenosis and considered for transcatheter aortic valve replacement were screened for SRBD. Sleep studies were performed by in-hospital unattended cardiorespiratory polygraphy measuring nasal air flow, chest and abdominal efforts, as well as oxygen saturation and body position. The patients were divided in subgroups dependent on the documented apnea–hypopnea index (AHI; no SRBD was defined as an AHI of <5 events/hour; mild SRBD as AHI 5–15 events/hour, and moderate to severe SRBD as AHI ?15 events/hour). Results Thirty-seven patients (77%) had SRBD defined as an AHI of ?5 events/hour. Eleven patients had an unremarkable investigation, with AHI <5 events/hour (mean 3.0±1.3 events/hour). Among patients with sleep apnea, 19 patients had mild SRBD, with an AHI of 5–15 events/hour (mean 9.9±3.4 events/hour) and 18 patients had moderate to severe SRBD (mean 26.6±11.3 events/hour). Mainly, obstructive apneas were found. Subgroups were not different regarding EuroSCORE (European System for Cardiac Operative Risk Evaluation) or aortic valve area. Also, no correlations were found between AHI and the additive or logistic EuroSCORE or aortic valve area. Significant correlations were found for AHI and N-terminal of the prohormone brain natriuretic peptide (r=0.53; P=0.003) and for AHI and glomerular filtration rate (r=?0.39; P=0.007). Conclusion SRBD is common in elderly patients with symptomatic aortic valve stenosis admitted for transcatheter aortic valve replacement. Interestingly, this finding is not reflected by the currently used risk scores. Further randomized studies are needed to evaluate the clinical significance of concomitant SRBD in the management of severe aortic stenosis. PMID:26379430

  5. Aortic dilatation with bicuspid aortic valves: cusp fusion correlates to matrix metalloproteinases and inhibitors

    PubMed Central

    Ikonomidis, John S.; Ruddy, Jean Marie; Benton, Stewart M.; Arroyo, Jazmine; Brinsa, Theresa A.; Stroud, Robert E.; Zeeshan, Ahmed; Bavaria, Joseph E.; Gorman, Joseph H.; Gorman, Robert C.; Spinale, Francis G.; Jones, Jeffrey A.

    2012-01-01

    Background Congenital bicuspid aortic valves (BAVs) result from fusion of two valve cusps, resulting in left-noncoronary (L-N), right-left (R-L), and right-noncoronary (R-N) morphologies. BAVs predispose to ascending thoracic aortic aneurysms (ATAAs). This study hypothesized that ATAAs with each BAV morphology group possess unique signatures of matrix metalloproteinases (MMPs) and endogenous tissue inhibitors (TIMPs). Methods ATAA tissue from 46 BAV patients was examined for MMP/TIMP abundance and global MMP activity compared to normal aortic specimens (n=15). Proteolytic balance was calculated as the ratio of MMP abundance to a composite TIMP score (TS). Results were stratified by valve morphology group (L-N (n=6), R-L (n=31), and R-N(n=9)). Results The BAV specimens (p<0.05 vs. normal aorta, 100%) displayed elevated global MMP activity (273±63%), MMP-9 (263±47%), and decreased MMP -7 (56±10%), -8 (58±11%), TIMP -1 (63±7%) and -4 (38±3%). The R-L group showed increased global MMP activity (286±89%) and MMP-9 (267±55%) with reduced MMP -7 (45±7%) -8 (68±15%), TIMP -1 (58±7%) and -4 (35±3%). The L-N group showed elevated global MMP activity (284±71%), and decreased MMP-8 (37±17%) and TIMP-4 (48±14). In the R-N group, MMP -7 (46±13%) and -8 (36±17%), and TIMP -1 (59±10) and -4 (42±5%) were decreased. The R-L group demonstrated an increased proteolytic balance for MMP-1, MMP-9, and MMP-12 relative to L-N and R-N. Conclusion Each BAV morphology group possesses a unique signature of MMPs and TIMPs. MMP/TIMP score ratios suggest that the R-L group may be more aggressive, justifying earlier surgical intervention. PMID:22206960

  6. Determination of oxidation state of iron in normal and pathologically altered human aortic valves

    NASA Astrophysics Data System (ADS)

    Czapla-Masztafiak, J.; Lis, G. J.; Gajda, M.; Jasek, E.; Czubek, U.; Bolecha?a, F.; Borca, C.; Kwiatek, W. M.

    2015-12-01

    In order to investigate changes in chemical state of iron in normal and pathologically altered human aortic valves X-ray absorption spectroscopy was applied. Since Fe is suspected to play detrimental role in aortic valve stenosis pathogenesis the oxidation state of this element has been determined. The experimental material consisted of 10 ?m sections of valves excised during routine surgery and from autopsies. The experiment was performed at the MicroXAS beamline of the SLS synchrotron facility in Villigen (Switzerland). The Fe K-edge XANES spectra obtained from tissue samples were carefully analyzed and compared with the spectra of reference compounds containing iron in various chemical structures. The analysis of absorption edge position and shape of the spectra revealed that both chemical forms of iron are presented in valve tissue but Fe3+ is the predominant form. Small shift of the absorption edge toward higher energy in the spectra from stenotic valve samples indicates higher content of the Fe3+ form in pathological tissue. Such a phenomenon suggests the role of Fenton reaction and reactive oxygen species in the etiology of aortic valve stenosis. The comparison of pre-edge regions of XANES spectra for control and stenotic valve tissue confirmed no differences in local symmetry or spin state of iron in analyzed samples.

  7. Design and Physical Characterization of a Synchronous Multivalve Aortic Valve Culture System

    PubMed Central

    Durst, Christopher A.; Grande-Allen, K. Jane

    2015-01-01

    For many tissues, cyclic mechanical stimulation is considered necessary to maintain the normal morphology in vitro. The aim of this study was to design and evaluate a simple bioreactor system capable of medium-term (more than 2 weeks) culture of native and engineered aortic valves. The system consists of three pistons in separate cylindrical chambers that are simultaneously driven through the culture medium by a crank and cam assembly. The faces of these pistons have unidirectional valves mounted in opposing orientations that permit flow from one side of the face to the other. A custom designed stent was employed to secure either native or engineered trileaflet valves to the pistons. Computational fluid dynamics and finite element modeling was used to assist selection of materials and components in the system. Finally, sterility testing using base culture medium was performed to verify the ability of the system to retain sterile conditions. The current design permits the cyclic opening and closing of three aortic valves, however this device can be modified to accommodate up to 12 valves simultaneously. This new bioreactor system has applications not only for development of tissue-engineered valves, but for also studying disease models in the aortic valve. PMID:19953323

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

    PubMed

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

    2015-07-16

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

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

    PubMed

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

    2014-09-01

    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

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

    PubMed Central

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

    2013-01-01

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

  11. Transcatheter aortic valve-in-valve implantation for severe bioprosthetic stenosis after Bentall operation using a homograft in a patient with Behçet's disease.

    PubMed

    Joo, Hyung Joon; Hong, Soon Jun; Yu, Cheol Woong

    2015-03-01

    A 43-year-old man presented with severe aortic stenosis. Eight years previously, he had undergone primary surgical aortic valve replacement (AVR) for severe aortic regurgitation, but one year later developed cardiac arrest and complete atrioventricular block as a result of non-bacterial thrombotic endocarditis with severe valvular dehiscence. Following the diagnosis of prosthetic valve failure caused by Behçet's disease, the patient underwent a Bentall operation using 23 mm aortic homograft with permanent pacemaker implantation and coronary artery bypass grafting. Subsequently, he was stable with steroid administration and azathioprine for seven years after the second operation, but recently suffered from severe dyspnea and chest pain. Echocardiography revealed the development of severe aortic stenosis. A preprocedural evaluation demonstrated a porcelain aorta with severe calcification in the previous homograft valve on computed tomography, and critical stenosis at the ostium of the left circumflex artery on coronary angiography. After percutaneous coronary intervention for the ostium of the left circumflex artery, a transcatheter AVR was successfully performed using a 26 mm Edwards SAPIEN XT valve. The patient recovered without any complications after the procedure. This is the first report of a successful transcatheter aortic valve-in valve implantation for severe homograft aortic stenosis after a Bentall operation, using a homograft, in a patient with Behçet's disease. PMID:26204689

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

    PubMed Central

    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

    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

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

    SciTech Connect

    Fetterly, K; Mathew, V

    2014-06-01

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

  14. Effect of gallium on in vitro aortic valve cusp mineralization - EDXRF studies

    NASA Astrophysics Data System (ADS)

    Wróbel, A.; Goncerz, G.; Kunz, J.; Podolec, P.; Rokita, E.

    2004-01-01

    The present studies were designed to determine the effect of gallium on the aortic valve cusp mineralization. The studies were conducted on aortic valves collected at autopsy from 35 donors. Each sample was incubated for 21 days in the mineralization-promoting medium, containing Ga at concentrations ranging from 0.0 to 8.0 ?g/ml. The elemental compositions of the samples were measured using energy dispersive X-ray fluorescence (EDXRF) method. The concentrations of 14 elements were determined: Mg, Al, S, Cl, K, Ca, Mn, Fe, Ni, Cu, Zn, Ga, Br and Sr. Calcium contents and Ca/P ratios were considered as markers of the mineralization process. The aortic valves could be divided into two groups depending on the advancement of the mineralization process. The first group in which the process progressed and the second one which was resistant to mineralization. Ga was accumulated in both groups. The results demonstrated that Ga reduced the aortic valve mineralization in dose-dependent manner in the first group and did not influence the mineralization in the mineralization-resistant aortic valves.

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

    PubMed

    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

    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

  16. A Rare Case of Aortic Valve Thrombosis in Patient with Idiopathic Hypereosinophilic Syndrome.

    PubMed

    Grolla, Elisabetta; Dalla Vestra, Michele; Bonanni, Luca; Cutolo, Ada; Rigo, Fausto

    2015-01-01

    Idiopathic hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia and eosinophil-mediated organ-system damage. Cardiac thrombosis and thromboembolic complications represent common causes of morbidity and mortality and usually involve cardiac ventricles or mitral and prosthetic valves, while the involvement of the aortic valve is extremely rare in HES. Here we report peculiar multimodality images of an atypical case of extended thrombosis of the aortic valve, complicated by myocardial ischemia and asymptomatic cerebral ischemia, likely due to thrombus embolization, occurring in a 48-year-old man with HES. Prompt anticoagulant and steroid therapy lead to rapid and complete resolution of the thrombotic lesions, allowing preserving the native valve and preventing further embolic events. PMID:26435854

  17. A Rare Case of Aortic Valve Thrombosis in Patient with Idiopathic Hypereosinophilic Syndrome

    PubMed Central

    Grolla, Elisabetta; Dalla Vestra, Michele; Bonanni, Luca; Cutolo, Ada; Rigo, Fausto

    2015-01-01

    Idiopathic hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia and eosinophil-mediated organ-system damage. Cardiac thrombosis and thromboembolic complications represent common causes of morbidity and mortality and usually involve cardiac ventricles or mitral and prosthetic valves, while the involvement of the aortic valve is extremely rare in HES. Here we report peculiar multimodality images of an atypical case of extended thrombosis of the aortic valve, complicated by myocardial ischemia and asymptomatic cerebral ischemia, likely due to thrombus embolization, occurring in a 48-year-old man with HES. Prompt anticoagulant and steroid therapy lead to rapid and complete resolution of the thrombotic lesions, allowing preserving the native valve and preventing further embolic events. PMID:26435854

  18. Novel Use of an Apical-Femoral Wire Rail to Assist With Transfemoral Transcatheter Aortic Valve Replacement

    PubMed Central

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

    2015-01-01

    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

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

    NASA Technical Reports Server (NTRS)

    Karara, H. M.

    1974-01-01

    The cooperative effort towards the development of a tri-leaflet prosthetic heart valve is described. The photogrammetric studies were conducted on silicone rubber molds. Information on data acquisition and data reduction phases is given, and certain accuracy aspects of the project are explained. The various outputs which are discussed include digital models, profiles, and contour maps.

  20. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events following transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis.

    PubMed

    Panchal, Hemang B; Ladia, Vatsal; Desai, Saurabh; Shah, Tejaskumar; Ramu, Vijay

    2013-09-15

    The purpose of this meta-analysis was to compare postprocedural mortality and major adverse cardiovascular and cerebrovascular events between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic stenosis. Seventeen studies (n = 4,659) comparing TAVI (n = 2,267) and SAVR (n = 2,392) were included. End points were baseline logistic European System for Cardiac Operative Risk Evaluation score, all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, transient ischemic attack, and major bleeding events. Mean differences or risk ratios with 95% confidence intervals were computed, and p values <0.05 were considered significant. The population was matched for risk between the 2 groups on the basis of logistic European System for Cardiac Operative Risk Evaluation score for all outcomes except 30-day all-cause mortality, which had a high-risk population in the TAVI group (p = 0.02). There was no significant difference found in all-cause mortality at 30 days (p = 0.97) and at an average of 85 weeks (p = 0.07). There was no significant difference in cardiovascular mortality (p = 0.54) as well as the incidence of myocardial infarction (p = 0.59), stroke (p = 0.36), and transient ischemic attack (p = 0.85) at averages of 86, 72, 66, and 89 weeks, respectively. Compared with patients who underwent TAVI, those who underwent SAVR had a significantly higher frequency of major bleeding events (p <0.0001) at mean follow-up of 66 weeks. In conclusion, TAVI has similar cardiovascular and all-cause mortality to SAVR at early and long-term follow-up. TAVI is superior to SAVR for major bleeding complications and noninferior to SAVR for postprocedural myocardial infarctions and cerebrovascular events. TAVI is a safe alternative to SAVR in selected high-risk elderly patients with severe aortic stenosis. PMID:23756547

  1. [Patch plasty of intraoperative acute aortic dissection in a patient with severe aortic valve stenosis;report of a case].

    PubMed

    Motoki, Tatsuo; Nakayama, Taisuke; Shirasaka, Tomonori; Kurushima, Atsushi; Ohtani, Takashi; Fukumura, Yoshiaki

    2015-05-01

    Intraoperative aortic dissection is a rare complication, but is associated with a high mortality. We report a case of 79-year-old woman with severe aortic valve stenosis who underwent aortic valve replacement(AVR). After cardiopulmonary bypass(CPB) was established, aortic dissection started at the inflow cannulation site. Because hemodynamics were stable, we performed AVR as scheduled. After declamping, excessive bleeding from the arterial cannulation site continued. CPB was reestablished by placing the arterial cannula in the left femoral artery. The ascending aorta was opened at the site of cannulation under deep hypothermic circulatory arrest. The entry tear was successfully repaired by entry resection and Hemashield patch plasty. The postoperative course was uneventful, and the patient was discharged on the 22nd postoperative day. Patch plasty may be useful for the management of intraoperative aortic dissection. PMID:25963785

  2. Minimally invasive aortic valve replacement: the Leipzig experience

    PubMed Central

    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

    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

  3. Improvement in renal functions with transcatheter aortic valve implantation

    PubMed Central

    Kele?, Telat; Ayhan, Hüseyin; Durmaz, Tahir; Sar?, Cenk; Aslan, Abdullah Nabi; Erdo?an, Kemal E?ref; Kasapkara, Hac? Ahmet; Bilen, Emine; Bayram, Nihal Akar; Akçay, Murat; Bozkurt, Engin

    2013-01-01

    Background & Objectives In recent years, emerging transcatheter aortic valve implantation (TAVI) has become an alternative for surgery. However, with advanced age, several co-morbid factors together with contrast agent usage can cause deterioration in renal function and increase in the risk of acute kidney injury (AKI) with poor prognosis in patients with AKI. Therefore, many patients cannot benefit from this treatment. In this study, we aim to examine the effects of TAVI on renal functions. Methods and Results Seventy patients, mean age of 77.6 years, underwent TAVI between July 2011 and December 2012. Estimated glomerular filtration rate (eGFR) was calculated by using the Cockcroft and Gault Formula. Patients were monitored for 48 h for urine output. Stage 1 AKI, according to the VARC-2 AKIN system, developed in only five (7.1%) of the patients after the procedure. There was a statistically significant increase between the mean 1st month eGFRs before (68.2 vs. 61.0, P < 0.01) and after (68.2 vs. 63.6, P < 0.05) the TAVI in the cohort. After TAVI (48.5 mL/min, P < 0.01) and the 1st month (52.1 mL/min, P < 0.01), the eGFR of the 36 (51.4%) patients diagnosed with chronic kidney disease before the procedure showed a statistically significant increase in renal functions. The hospital mortality rate was higher in the group which developed AKI (P < 0.01). First month eGFR showed a more statistically significant increase than pre-TAVI eGFR (62.8 and 69.8, P < 0.05, respectively) in AKI developing patients and this difference - though statistically not significant - continued into the sixth month. Conclusions In this study, we showed that the treatment of aortic stenosis through TAVI allows improvement of renal functions, and that AKI rates will be lower with careful patient selection, proper pre-procedural hydration, and careful use of contrast agent. PMID:24454323

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

    PubMed Central

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

    2000-01-01

    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

  5. Surgical treatment for double-valve destruction after balloon aortic valvuloplasty in a patient with porcelain aorta.

    PubMed

    Hashimoto, Makoto; Fukui, Toshihiro; Takanashi, Shuichiro

    2015-08-01

    We report a rare case of surgical treatment for double-valve destruction after balloon aortic valvuloplasty in a 90-year old female with severe aortic calcification. The patient underwent aortic balloon valvuloplasty for symptomatic aortic stenosis, resulting in severe aortic regurgitation because of injury to the right coronary cusp of the aortic valve and severe mitral regurgitation because of rupture of the chordae tendineae. She became haemodynamically unstable and required treatment with mechanical ventilation and assisted circulation. Urgent surgical treatment was planned. The patient's porcelain aorta increased the difficulty of surgery, but the procedure was carefully planned, and aortic valve replacement and mitral valve repair were performed successfully without major complications. The patient had a satisfactory postoperative course and was transferred to another hospital for rehabilitation on the 8th postoperative day. PMID:25187531

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

    SciTech Connect

    Sochman, Jan Peregrin, Jan H.; Rocek, Miloslav; Timmermans, Hans A.; Pavcnik, Dusan; Roesch, Josef

    2006-02-15

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

  7. 4D optical coherence tomography of aortic valve dynamics in a murine mouse model ex vivo

    NASA Astrophysics Data System (ADS)

    Schnabel, Christian; Jannasch, Anett; Faak, Saskia; Waldow, Thomas; Koch, Edmund

    2015-07-01

    The heart and its mechanical components, especially the heart valves and leaflets, are under enormous strain during lifetime. Like all highly stressed materials, also these biological components undergo fatigue and signs of wear, which impinge upon cardiac output and in the end on health and living comfort of affected patients. Thereby pathophysiological changes of the aortic valve leading to calcific aortic valve stenosis (AVS) as most frequent heart valve disease in humans are of particular interest. The knowledge about changes of the dynamic behavior during the course of this disease and the possibility of early stage diagnosis could lead to the development of new treatment strategies and drug-based options of prevention or therapy. ApoE-/- mice as established model of AVS versus wildtype mice were introduced in an ex vivo artificially stimulated heart model. 4D optical coherence tomography (OCT) in combination with high-speed video microscopy were applied to characterize dynamic behavior of the murine aortic valve and to characterize dynamic properties during artificial stimulation. OCT and high-speed video microscopy with high spatial and temporal resolution represent promising tools for the investigation of dynamic behavior and their changes in calcific aortic stenosis disease models in mice.

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

    PubMed Central

    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

    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. PMID:25870805

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

    PubMed

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

    2015-03-15

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

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

    PubMed Central

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

    2015-01-01

    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

  11. Total ellipse of the heart valve: the impact of eccentric stent distortion on the regional dynamic deformation of pericardial tissue leaflets of a transcatheter aortic valve replacement.

    PubMed

    Gunning, Paul S; Saikrishnan, Neelakantan; Yoganathan, Ajit P; McNamara, Laoise M

    2015-12-01

    Transcatheter aortic valve replacements (TAVRs) are a percutaneous alternative to surgical aortic valve replacements and are used to treat patients with aortic valve stenosis. This minimally invasive procedure relies on expansion of the TAVR stent to radially displace calcified aortic valve leaflets against the aortic root wall. However, these calcium deposits can impede the expansion of the device causing distortion of the valve stent and pericardial tissue leaflets. The objective of this study was to elucidate the impact of eccentric TAVR stent distortion on the dynamic deformation of the tissue leaflets of the prosthesis in vitro. Dual-camera stereophotogrammetry was used to measure the regional variation in strain in a leaflet of a TAVR deployed in nominal circular and eccentric (eccentricity index = 28%) orifices, representative of deployed TAVRs in vivo. It was observed that (i) eccentric stent distortion caused incorrect coaptation of the leaflets at peak diastole resulting in a 'peel-back' leaflet geometry that was not present in the circular valve and (ii) adverse bending of the leaflet, arising in the eccentric valve at peak diastole, caused significantly higher commissure strains compared with the circular valve in both normotensive and hypertensive pressure conditions (normotension: eccentric = 13.76 ± 2.04% versus circular = 11.77 ± 1.61%, p = 0.0014, hypertension: eccentric = 15.07 ± 1.13% versus circular = 13.56 ± 0.87%, p = 0.0042). This study reveals that eccentric distortion of a TAVR stent can have a considerable impact on dynamic leaflet deformation, inducing deleterious bending of the leaflet and increasing commissures strains, which might expedite leaflet structural failure compared to leaflets in a circular deployed valve. PMID:26674192

  12. Association of Aortic Phenotypes and Mechanical Function With Left Ventricular Diastolic Function in Subjects With Normally Functioning Bicuspid Aortic Valves and Comparison to Subjects With Tricuspid Aortic Valves.

    PubMed

    Lee, Soo Youn; Shim, Chi Young; Hong, Geu-Ru; Seo, Jiwon; Cho, Iksung; Cho, In Jeong; Chang, Hyuk-Jae; Ha, Jong-Won; Chung, Namsik

    2015-11-15

    A bicuspid aortic valve (BAV) is often associated with dilation or aneurysm of the ascending aorta (AA) despite of absence of significant valve dysfunction. Bicuspid aortopathy and consequent aortic stiffness may adversely affect left ventricular (LV) diastolic function. This study aimed to investigate the impact of global and regional aortic mechanical function on LV diastolic function in subjects with BAV. Fifty-six subjects with BAV (45 men, mean age 52 ± 13 years) without significant valve dysfunction and 56 age- and gender-matched controls with tricuspid aortic valve were studied. The aortic phenotypes were classified into 3 groups: normal shape, predominant dilatation of the sinus of Valsalva, and predominant dilatation of the AA. Structural and functional parameters of the AA and LV were measured using 2-dimensional echocardiography. Global aortic mechanical function was assessed by radial artery tonometry. The subjects with BAV showed a higher incidence of a predominant AA phenotype (53.6% vs 17.9%, p <0.001), larger indexed aortic diameters, increased augmentation index, lower pulse pressure amplification, lower early diastolic mitral annular (e') velocity, and higher E/e' than those with tricuspid aortic valve . The e' velocity and E/e' varied with different aortic phenotypes in subjects with BAV. Correlations between e' velocity and parameters of aortic stiffness were stronger in subjects with BAV than those in controls. Multiple regression analysis revealed that augmentation index normalized for a heart rate of 75 beats/min was an independent determinant of e' velocity (? = -0.24, p = 0.044) and E/e' (? = 0.30, p = 0.018) in subjects with BAV even after controlling for confounding factors. LV diastolic function is closely related to aortic phenotype and mechanical alteration in subjects with BAV. PMID:26409638

  13. Bicuspid aortic valve aortopathy in adults: Incidence, etiology, and clinical significance.

    PubMed

    Michelena, Hector I; Corte, Alessandro Della; Prakash, Siddharth K; Milewicz, Dianna M; Evangelista, Artur; Enriquez-Sarano, Maurice

    2015-12-15

    Bicuspid aortic valve is the most common congenital heart defect and is associated with an aortopathy manifested by dilatation of the ascending thoracic aorta. The clinical consequences of this aortopathy are the need for periodic monitoring of aortic diameters, elective prophylactic surgical aortic repair, and the occurrence of aortic dissection or rupture. This review describes the current knowledge of BAV aortopathy in adults, including incidence, pathophysiologic insights into its etiology, contemporary hypothesis-generating observations into its complications, and recommendations for monitoring and intervention. PMID:26310986

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

    PubMed Central

    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

    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

  15. Three-Dimensional Evaluation of Aortic Valve Annular Shape in Children With Bicuspid Aortic Valves and/or Aortic Coarctation Compared With Controls.

    PubMed

    Chamberland, Christen R; Sugeng, Lissa; Abraham, Sharon; Li, Fangyong; Weismann, Constance G

    2015-11-01

    Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality, occurring in 1% to 2% of the general population. Adults with degenerative aortic valve (AV) disease have been shown to have an elliptical shaped AV annulus. The goal of this study was to investigate the shape of the aortic annulus in children with BAV, coarctation of the aorta (CoA) with or without BAV, and normal controls with trileaflet AVs using 3-dimensional echocardiography (3DE). We reviewed echocardiograms of children with isolated BAV (n = 40), CoA (n = 26), and controls (n = 40) that included 3DE of the AV. Eccentricity index (EI) was defined as the ratio between the smaller and larger annular dimension. ?D was defined as the difference between the larger and smaller annular dimension. Patients with BAV had an eccentric AV annulus compared with controls (BAV EI 0.85 ± 0.05 and control EI 0.96 ± 0.03; p <0.001). Subjects with CoA also had a more eccentric annulus than controls regardless of AV morphology (CoA 0.84 ± 0.06; p <0.001). EI was not associated with somatic growth parameters or gender. Among all patients with BAV, AV dysfunction was associated with fusion of the right and noncoronary (R-N) cusps (p <0.001), but there was no association between valve dysfunction and EI. ?D was higher in both the BAV and CoA groups compared with the control group (BAV 3.4 ± 1.9 mm, CoA 2.8 ± 1.8 mm, and control 0.6 ± 0.4 mm; p <0.001 each). Although there was no significant correlation of ?D with age in the control group during childhood, ?D increased with age in the BAV and CoA groups. In conclusion, children with BAV and/or CoA have an elliptical shaped AV annulus by 3DE, which is independent of age, gender, or body surface area. AV annular eccentricity may lead to inaccurate measurement of AV annular size if measured by 2DE alone. Considering AV annular eccentricity when balloon sizing the annulus before valvuloplasty may help improve interventional results in some patients. PMID:26375172

  16. Use of Circular Foldable Nitinol Blades for Resecting Calcified Aortic Heart Valves

    NASA Astrophysics Data System (ADS)

    Hauck, Florian; Wendt, Daniel; Stühle, Sebastian; Kawa, Emilia; Wendt, Hermann; Müller, Wiebke; Thielmann, Matthias; Kipfmüller, Brigitte; Vogel, Bernd; Jakob, Heinz

    2009-08-01

    The use of percutaneous aortic valve implantation is limited, as the native calcified valve is left in situ. A new device has been developed for resecting calcified aortic valves, using collapsible nickel-titanium blades: laser-cut T-structures of Nitinol sheet-material (Ni51Ti49 at.%) have been grinded on a high-speed milling cutter to produce cutting edges which have been given the shape of half-circles afterwards. These have been connected to each other and to struts by using rivets which also serve as articulating axes for the cutting ring. The blades are folded around these axes and retreated into a tube to be inserted in the heart through the calcified valve leaflets. Once released, the cutting edges regain their ring-shape. By combining rotation of the ring with a translating movement against a second ring of slightly greater diameter on the instrument, a punching process is created which cuts the calcified valve leaflets and leaves a circular annulus, where a prosthesis can be fixed. In vitro cutting of artificially calcified valves ( n = 6) resulted in a resection time of t = 22 ± 6.29 s with a maximum turning moment of M = 2.4 ± 1.27 Nm, proving the function and the feasibility of the concept.

  17. On the bending properties of porcine mitral, tricuspid, aortic, and pulmonary valve leaflets.

    PubMed

    Brazile, Bryn; Wang, Bo; Wang, Guangjun; Bertucci, Robbin; Prabhu, Raj; Patnaik, Sourav S; Butler, J Ryan; Claude, Andrew; Brinkman-Ferguson, Erin; Williams, Lakiesha N; Liao, Jun

    2015-01-01

    The atrioventricular valve leaflets (mitral and tricuspid) are different from the semilunar valve leaflets (aortic and pulmonary) in layered structure, ultrastructural constitution and organization, and leaflet thickness. These differences warrant a comparative look at the bending properties of the four types of leaflets. We found that the moment-curvature relationships in atrioventricular valves were stiffer than in semilunar valves, and the moment-curvature relationships of the left-side valve leaflets were stiffer than their morphological analog of the right side. These trends were supported by the moment-curvature curves and the flexural rigidity analysis (EI value decreased from mitral, tricuspid, aortic, to pulmonary leaflets). However, after taking away the geometric effect (moment of inertia I), the instantaneous effective bending modulus E showed a reversed trend. The overall trend of flexural rigidity (EI: mitral > tricuspid > aortic > pulmonary) might be correlated with the thickness variations among the four types of leaflets (thickness: mitral > tricuspid > aortic > pulmonary). The overall trend of the instantaneous effective bending modulus (E: mitral < tricuspid < aortic < pulmonary) might be correlated to the layered fibrous ultrastructures of the four types of leaflets, of which the fibers in mitral and tricuspid leaflets were less aligned, and the fibers in aortic and pulmonary leaflets were highly aligned. We also found that, for all types of leaflets, moment-curvature relationships are stiffer in against-curvature (AC) bending than in with-curvature bending (WC), which implies that leaflets tend to flex toward their natural curvature and comply with blood flow. Lastly, we observed that the leaflets were stiffer in circumferential bending compared with radial bending, likely reflecting the physiological motion of the leaflets, i.e., more bending moment and movement were experienced in radial direction than circumferential direction. PMID:25955006

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

    PubMed Central

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

    2015-01-01

    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

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

    PubMed

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

    2015-01-01

    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

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

    PubMed Central

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

    2013-01-01

    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

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

    PubMed

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

    2014-06-01

    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

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

    PubMed

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

    2014-10-01

    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

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

    NASA Astrophysics Data System (ADS)

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

    2013-11-01

    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.

  4. Distribution of Mitral Annular and Aortic Valve Calcium as Assessed by Unenhanced Multidetector Computed Tomography.

    PubMed

    Koshkelashvili, Nikoloz; Codolosa, Jose N; Goykhman, Igor; Romero-Corral, Abel; Pressman, Gregg S

    2015-12-15

    Aging is associated with calcium deposits in various cardiovascular structures, but patterns of calcium deposition, if any, are unknown. In search of such patterns, we performed quantitative assessment of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a broad clinical sample. Templates were created from gated computed tomography (CT) scans depicting the aortic valve cusps and mitral annular segments in relation to surrounding structures. These were then applied to CT reconstructions from ungated, clinically indicated CT scans of 318 subjects, aged ?65 years. Calcium location was assigned using the templates and quantified by the Agatston method. Mean age was 76 ± 7.3 years; 48% were men and 58% were white. Whites had higher prevalence (p = 0.03) and density of AVC than blacks (p = 0.02), and a trend toward increased MAC (p = 0.06). Prevalence of AVC was similar between men and women, but AVC scores were higher in men (p = 0.008); this difference was entirely accounted for by whites. Within the aortic valve, the left cusp was more frequently calcified than the others. MAC was most common in the posterior mitral annulus, especially its middle (P2) segment. For the anterior mitral annulus, the medial (A3) segment calcified most often. In conclusion, AVC is more common in whites than blacks, and more intense in men, but only in whites. Furthermore, calcium deposits in the mitral annulus and aortic valve favor certain locations. PMID:26517948

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

    PubMed Central

    2013-01-01

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

  6. Relation of aortic valve calcium to chronic kidney disease (from the Chronic Renal Insufficiency Cohort Study).

    PubMed

    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

    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 m2, 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

  7. Increased systolic load causes adverse remodeling of fetal aortic and mitral valves.

    PubMed

    Tibayan, Frederick A; Louey, Samantha; Jonker, Sonnet; Espinoza, Herbert; Chattergoon, Natasha; You, Fanglei; Thornburg, Kent L; Giraud, George

    2015-12-15

    While abnormal hemodynamic forces alter fetal myocardial growth, little is known about whether such insults affect fetal cardiac valve development. We hypothesized that chronically elevated systolic load would detrimentally alter fetal valve growth. Chronically instrumented fetal sheep received either a continuous infusion of adult sheep plasma to increase fetal blood pressure, or a lactated Ringer's infusion as a volume control beginning on day 126 ± 4 of gestation. After 8 days, mean arterial pressure was higher in the plasma infusion group (63.0 mmHg vs. 41.8 mmHg, P < 0.05). Mitral annular septal-lateral diameter (11.9 mm vs. 9.1 mm, P < 0.05), anterior leaflet length (7.7 mm vs. 6.4 mm, P < 0.05), and posterior leaflet length (P2; 4.0 mm vs. 3.0 mm, P < 0.05) were greater in the elevated load group. mRNA levels of Notch-1, TGF-?2, Wnt-2b, BMP-1, and versican were suppressed in aortic and mitral valve leaflets; elastin and ?1 type I collagen mRNA levels were suppressed in the aortic valves only. We conclude that sustained elevated arterial pressure load on the fetal heart valve leads to anatomic remodeling and, surprisingly, suppression of signaling and extracellular matrix genes that are important to valve development. These novel findings have important implications on the developmental origins of valve disease and may have long-term consequences on valve function and durability. PMID:26354842

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

    PubMed Central

    2013-01-01

    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

  9. Surgical treatment of late aortic prosthetic valve endocarditis: 19 years’ experience

    PubMed Central

    Yayla, Tuncer Eylem; Serpil, Tas; Bal, Polat Ebru; Antal, Dönmez Arzu; Adnan, Ak; Mustafa, Akbulut; Bulbul, Serhat; Aksut, Mehmet; Altug, Tuncer

    2014-01-01

    Aim of the study We retrospectively analyzed the results of operations conducted for aortic prosthetic valve endocarditis in a single center over 19 years. Material and methods From February 1992 to January 2011, we performed operations on 27 patients with aortic prosthetic valve endocarditis. Seventeen patients (63.0%) were male, and the mean age was 39.1 ± 14.2 (16-67) years. Blood cultures were positive in 11 patients (40.7%), and the most commonly identified microorganism was Streptococcus (7 patients, 25.9%). The mean duration of follow-up was 8.6 ± 4.7 years (0.5-18.2), adding up to a total of 136.9 patient/years. Results Forty procedures were performed on these 27 patients. The most commonly performed procedure was aortic valve replacement with a prosthetic valve – 16 patients (59.3%). Fifteen patients were operated on during the active phase of infection. In-hospital mortality was observed in 11 patients (40.7%). Postoperatively, 12 patients (44.4%) had low cardiac output, 3 (11.1%) suffered from a heart block; none of them required permanent pacemaker implantation. The actuarial survival for 1 and 5 years was 55.6 ± 9.6% and 47.6 ± 9.7%, respectively. Conclusions Prosthetic valve endocarditis of the aortic valve is a challenging situation for the surgeon. The surgical treatment carries a high mortality rate and long-term survival is low. Among the survivors, however, recurrence and the need for reoperation are unlikely. PMID:26336408

  10. Plug valve

    DOEpatents

    Wordin, John J. (Shelley, ID)

    1989-01-01

    An improved plug valve wherein a novel shape for the valve plug and valve chamber provide mating surfaces for improved wear characteristics. The novel shape of the valve plug is a frustum of a body of revolution of a curved known as a tractrix, a solid shape otherwise known as a peudosphere.

  11. 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

    2014-01-01

    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

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

    PubMed

    Flaherty, Michael P; Grubb, Kendra J

    2015-04-01

    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

  13. Preferential short cut or alternative route: the transaxillary access for transcatheter aortic valve implantation

    PubMed Central

    Deuschl, Florian; Conradi, Lenard; Lubos, Edith; Schirmer, Johannes; Reichenspurner, Hermann; Blankenberg, Stefan; Treede, Hendrik; Schäfer, Ulrich

    2015-01-01

    Transcatheter aortic valve implantation (TAVI) has gained widespread acceptance as a treatment option for patients at high risk for conventional aortic valve replacement. The most commonly used access site for TAVI is the common femoral artery. Yet, in a significant number of patients the transfemoral access is not suitable due to peripheral vascular disease of the lower extremity. In these cases the transaxillary approach can serve as an alternative implantation route. By considering the anatomical requirements and providing an adequate endovascular “safety-net” during the procedure the transaxillary TAVI approach results in excellent procedural and clinical outcome. However, whether the transaxillary access for TAVI is superior to other non-transfemoral approaches (e.g., transapical or direct aortic) needs to be studied in the future in a prospective randomized trial. PMID:26543600

  14. Management of the patient for transcatheter aortic valve implantation in the perioperative period.

    PubMed

    Huffmyer, Julie; Tashjian, Jessica; Raphael, Jacob; Jaeger, J Michael

    2012-03-01

    Aortic stenosis is a prevalent valvular disease among aging patients, and surgical correction is the most definitive treatment. Yet many elderly patients are deemed to be "inoperable" or at excessive risk to undergo open surgical aortic valve replacement (AVR). Transcatheter aortic valve implantation (TAVI), either through a transfemoral or transapical approach, has become a potential option for these high-risk patients. Although TAVI technology will continue to be developed and perfected, most studies at this time reveal that symptoms are improved and that 1-year morbidity and mortality are similar to those for open surgical AVR. Anesthetic management for patients undergoing TAVI involves maintaining hemodynamic stability during periods of rapidly changing conditions and providing echocardiographic guidance and assessment. Postoperative care includes a variety of challenges such as managing pain control, monitoring for potential complications, and providing hemodynamic management. PMID:22275350

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

    PubMed Central

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

    2015-01-01

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

  16. Experimental validation of Doppler echocardiographic measurement of volume flow through the stenotic aortic valve.

    PubMed

    Otto, C M; Pearlman, A S; Gardner, C L; Enomoto, D M; Togo, T; Tsuboi, H; Ivey, T D

    1988-08-01

    In aortic stenosis, evaluation of aortic valve area by the continuity equation assumes that the volume of flow through the stenotic valve can be measured accurately in the left ventricular outflow tract. To test the accuracy of Doppler volume-flow measurement proximal to a stenotic valve, we developed an open-chest canine model in which the native leaflets were sutured together to create variable degrees of acute aortic stenosis. Left ventricular and aortic pressures were measured with micromanometer-tipped catheters. Volume flow was controlled and varied by directing systemic venous return through a calibrated roller pump and back to the right atrium. Because transaortic volume flow will not equal roller pump output when there is coexisting aortic insufficiency (present in 67% of studies), transaortic flow was measured by electromagnetic flowmeter with the flow probe placed around the proximal descending thoracic aorta, just beyond the ligated arch vessels. In 12 adult, mongrel dogs (mean weight, 25 kg), the mean transaortic pressure gradient ranged from 2 to 74 mm Hg, and transaortic volume flow ranged from 0.9 to 3.2 l/min. In four dogs, electromagnetic flow that was measured distal to the valve was accurate compared with volume flow determined by timed collection of total aortic flow into a graduated cylinder (n = 24, r = 0.97, electromagnetic flow = 0.87 Direct +0.13 l/min). In eight subsequent dogs, electromagnetic flow was compared with transaortic cardiac output measured by Doppler echocardiography in the left ventricular outflow tract as circular cross-sectional area [pi(D/2)2] x left ventricular outflow tract velocity-time integral x heart rate.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2969311

  17. Aortic root compliance influences hemolysis in mechanical heart valve prostheses: an in-vitro study.

    PubMed

    Linde, Torsten; Hamilton, Kathrin F; Navalon, Elena Cuenca; Schmitz-Rode, Thomas; Steinseifer, Ulrich

    2012-07-01

    Mechanical heart valve prostheses are known to activate coagulation and cause hemolysis. Both are particularly dependent on the leaflet dynamics, which in turn depends on the flow field in the aortic root influenced by the aortic root geometry and its compliance. Compliance reduction of large vessels occurs in aging patients, both in those who have atherosclerotic diseases and those who do not. In this study we investigated the correlation between hemolysis and the compliance of the proximal aorta in a novel, pulsatile in vitro blood tester using porcine blood. Two mechanical heart valves, the St Jude Medical (SJM) bileaflet valve and a trileaflet valve prototype (Triflo) were tested for hemolysis under physiological conditions (120/80 mm Hg, 4.5 l/min, 70 bpm) and using two different tester setups: with a stiff aorta and with a compliant aorta. Valve dynamics were subsequently analyzed via high-speed videos. In the tests with the Triflo valve, the free plasma hemoglobin increased by 13.4 mg/dl for the flexible and by 19.3 mg/dl for the stiff setup during the 3-hour test. The FFT spectra and closing speed showed slight differences for both setups. Free plasma hemoglobin for the SJM valve was up by 22.2 mg/dl in the flexible and 42.7 mg/dl in the stiff setup. Cavitation induced by the higher closing speed might be responsible for this, which is also indicated by the sound spectrum elevation above 16 kHz. PMID:22669587

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

    SciTech Connect

    Sochman, Jan; Peregrin, Jan H.; Pulda, Zdenek; Pavcnik, Dusan; Uchida, Barry T.; Timmermans, Hans A.; Roesch, Josef

    2010-04-15

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

  19. A three-dimensional co-culture model of the aortic valve using magnetic levitation.

    PubMed

    Tseng, Hubert; Balaoing, Liezl R; Grigoryan, Bagrat; Raphael, Robert M; Killian, T C; Souza, Glauco R; Grande-Allen, K Jane

    2014-01-01

    The aortic valve consists of valvular interstitial cells (VICs) and endothelial cells (VECs). While these cells are understood to work synergistically to maintain leaflet structure and valvular function, few co-culture models of these cell types exist. In this study, aortic valve co-cultures (AVCCs) were assembled using magnetic levitation and cultured for 3 days. Immunohistochemistry and quantitative reverse-transcriptase polymerase chain reaction were used to assess the maintenance of cellular phenotype and function, and the formation of extracellular matrix. AVCCs stained positive for CD31 and ?-smooth muscle actin (?SMA), demonstrating that the phenotype was maintained. Functional markers endothelial nitric oxide synthase (eNOS), von Willebrand factor (VWF) and prolyl-4-hydroxylase were present. Extracellular matrix components collagen type I, laminin and fibronectin also stained positive, with reduced gene expression of these proteins in three dimensions compared to two dimensions. Genes for collagen type I, lysyl oxidase and ?SMA were expressed less in AVCCs than in 2-D cultures, indicating that VICs are quiescent. Co-localization of CD31 and ?SMA in the AVCCs suggests that endothelial-mesenchymal transdifferentiation might be occurring. Differences in VWF and eNOS in VECs cultured in two and three dimensions also suggests that the AVCCs possibly have anti-thrombotic potential. Overall, a co-culture model of the aortic valve was designed, and serves as a basis for future experiments to understand heart valve biology. PMID:24036238

  20. Late pericardial tamponade after aortic and mitral valve replacement.

    PubMed

    Huwer, H; Volkmer, I; Dyckmans, J

    1988-02-01

    A report is presented on a patient who developed a pericardial tamponade on the 11th postoperative day after double valve replacement. Instead of classical signs of tamponade, however, the signs of posterior wall infarction were most prominent. The administration of nitrate resulted in deterioration of the circulatory situation, but the ST elevation in supraventricular tachycardia occurring from time to time regressed. As before the operation, coronary angiography showed normal conditions, and valve function was normal. The contrast-medium imaging of the right ventricle suggested a compression from ventral, and the right ventricular and right atrial pressures corresponded to a tamponade situation: in rethoracotomy, a blood coagulum roughly the size of a fist was found ventral to the right ventricle. After clearing the hematoma, there was an immediate improvement of the circulatory situation, and the ECG alterations regressed. Enzyme alterations in terms of myocardial infarction did not occur. We explained the symptoms as follows: The coagulum compressed the outflow tract of the right ventricle and thus caused on the one hand the hemodynamic situation of tamponade and on the other hand an extreme vagotonia with consecutive bradycardia and ST elevation. PMID:3376091

  1. Check valve

    DOEpatents

    Upton, H.A.; Garcia, P.

    1999-08-24

    A check valve for use in a GDCS of a nuclear reactor and having a motor driven disk including a rotatable armature for rotating the check valve disk over its entire range of motion is described. In one embodiment, the check valve includes a valve body having a coolant flow channel extending therethrough. The coolant flow channel includes an inlet end and an outlet end. A valve body seat is located on an inner surface of the valve body. The check valve further includes a disk assembly, sometimes referred to as the motor driven disc, having a counterweight and a disk shaped valve. The disk valve includes a disk base having a seat for seating with the valve body seat. The disk assembly further includes a first hinge pin member which extends at least partially through the disk assembly and is engaged to the disk. The disk valve is rotatable relative to the first hinge pin member. The check valve also includes a motor having a stator frame with a stator bore therein. An armature is rotatably positioned within the stator bore and the armature is coupled to the disk valve to cause the disk valve to rotate about its full range of motion. 5 figs.

  2. Check valve

    DOEpatents

    Upton, Hubert Allen (Morgan Hill, CA); Garcia, Pablo (Stanford, CA)

    1999-08-24

    A check valve for use in a GDCS of a nuclear reactor and having a motor driven disk including a rotatable armature for rotating the check valve disk over its entire range of motion is described. In one embodiment, the check valve includes a valve body having a coolant flow channel extending therethrough. The coolant flow channel includes an inlet end and an outlet end. A valve body seat is located on an inner surface of the valve body. The check valve further includes a disk assembly, sometimes referred to as the motor driven disc, having a counterweight and a disk shaped valve. The disk valve includes a disk base having a seat for seating with the valve body seat. The disk assembly further includes a first hinge pin member which extends at least partially through the disk assembly and is engaged to the disk. The disk valve is rotatable relative to the first hinge pin member. The check valve also includes a motor having a stator frame with a stator bore therein. An armature is rotatably positioned within the stator bore and the armature is coupled to the disk valve to cause the disk valve to rotate about its full range of motion.

  3. 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

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

    2013-01-01

    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

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

    E-print Network

    Housman, David E.

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

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

    PubMed Central

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

    2013-01-01

    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

  6. Use of a ventricular septal defect occluder for apical closure in transapical aortic valve replacement.

    PubMed

    Ferrari, Enrico; Locca, Didier; Berdajs, Denis; Marcucci, Carlo; Gronchi, Fabrizio; Lavanchy, Jerome; Prêtre, René; Tozzi, Piergiorgio

    2015-01-01

    During transapical transcatheter aortic valve replacement (TA-TAVR), the apical closure remains a challenge for the surgeon, having the risk for ventricular tear and massive bleeding. Apical closure devices are already under clinical evaluation, but only a few can lead to a full percutaneous TA-TAVR. We describe the successful use of a 9-mm myocardial occluder (ventricular septal defect occluder) that was used to seal the apex after a standard TA-TAVR (using the Sapien XT 23-mm transcatheter valve and the Ascendra + delivery system). The placement of the nonmodified myocardial occluder was performed through the Ascendra + delivery system, with a very small amount of blood loss and an acceptable sealing of the apical tear. This approach is feasible and represents a further step toward true-percutaneous transapical heart valve procedures. Modified apical occluders are under evaluation in animal models. PMID:25621876

  7. Caval-Aortic Access to Allow Transcatheter Aortic Valve Replacement in Patients Otherwise Ineligible: Initial Human Experience

    PubMed Central

    Greenbaum, Adam B.; O’Neill, William W.; Paone, Gaetano; Guerrero, Mayra E.; Wyman, Janet F.; Cooper, R. Lebron; Lederman, Robert J.

    2014-01-01

    Objectives We describe the first use of caval-aortic access and closure to enable transcatheter aortic valve replacement (TAVR) in patients who lacked other access options. Caval-aortic access refers to percutaneous entry into the abdominal aorta from the femoral vein through the adjoining inferior vena cava. Background TAVR is attractive in high risk or inoperable patients with severe aortic stenosis. Available transcatheter valves require large introducer sheaths, which risk major vascular complications or preclude TAVR altogether. Caval-aortic access has been successful in animals. Methods We performed a single center retrospective review of procedural and 30-day outcomes of prohibitive-risk patients undergoing TAVR via caval-aortic access. Results Between July 2013 and January 2014, 19 patients underwent TAVR via caval-aortic access. 79% were women. Caval-aortic access and tract closure was successful in all 19; TAVR was successful in 17. Six patients suffered modified VARC-2 major vascular complications, two (11%) of whom required intervention. Most (79%) required blood transfusion. There were no deaths attributable to caval-aortic access. Through 111 (39–229) days of follow up, there were no post-discharge complications related to tract creation or closure. All patients had persistent aorto-caval flow immediately post procedure. Of 16 who underwent repeat imaging after the first week, 15 (94%) had complete closure of the residual aorto-caval tract. Conclusions Percutaneous transcaval venous access to the aorta allows TAVR in otherwise ineligible patients, and may offer a new access strategy for other applications requiring large transcatheter implants. PMID:24814495

  8. Challenges in valve-in-valve therapy

    PubMed Central

    Noorani, Alia; Radia, Rahee

    2015-01-01

    At present, the majority of surgical heart valves (SHVs) implanted are bioprosthetic valves. Over time however, these are prone to structural deterioration, which may manifest as valvular stenosis, regurgitation or a combination of the two. Re-operation is the current standard of care for these patients but this itself carries a significant risk of mortality and morbidity. As a natural extension of transcatheter aortic valve implantation (TAVI), now an evidence based solution for severe aortic stenosis in high-risk patients, valve-in-valve (VIV) therapy is evolving into an alternative option in selected patients with structural biological valvular deterioration in all four-valve positions. The first of these VIV procedures was performed in Germany in 2007, for failing aortic valve prosthesis and later, reported in other positions. As with any novel emerging therapy, there is a learning curve to the procedure and the operator must be aware of the potential challenges. In this review we describe some of these challenges with the aim of providing awareness as well as guidance on attaining a successful outcome. PMID:26543595

  9. Valve Disease

    MedlinePLUS

    ... the need for heart valve surgery. Percutaneous Interventions Balloon valvuloplasty is a procedure that may be used ... procedure works on valves in the same way balloon angioplasty does on the arteries. Like angioplasty, it ...

  10. Prognostic Impact of Tricuspid Regurgitation in Patients Undergoing Aortic Valve Surgery for Aortic Stenosis

    PubMed Central

    Mascherbauer, Julia; Kammerlander, Andreas A.; Marzluf, Beatrice A.; Graf, Alexandra; Kocher, Alfred; Bonderman, Diana

    2015-01-01

    Background The prognostic significance of tricuspid regurgitation (TR) and right ventricular (RV) function in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis (AS) is unknown. The aim of the present study was to evaluate the impact of TR and RV systolic dysfunction on early and late mortality in this setting. Methods This was a prospective single-center observational study. 465 consecutive patients who were referred to AVR for severe AS were investigated. Significant TR was defined as TR?moderate by transthoracic echocardiography. Results At baseline, significant TR was present in 26 (5.6%) patients. Patients with TR presented with a higher EuroSCORE I (p = 0.001), a higher incidence of previous cardiac surgery (p<0.001), pulmonary hypertension (p = 0.003), more dilated RVs (p = 0.001), and more frequent RV dysfunction (p = 0.001). Patients were followed for an average of 5.2 (±2.8 SD) years. By multivariable Cox regression analysis TR (p = 0.014), RV dysfunction (p = 0.046), age (p = 0.001) and concomitant coronary artery bypass graft surgery (CABG, p = 0.003) were independently associated with overall mortality. By Kaplan-Meier analysis, survival rates were significantly worse in patients with significant than with non-significant TR (log rank p = 0.001). Conclusions TR, RV dysfunction, age, and concomitant CABG are associated with outcome in patients undergoing AVR for severe AS. This finding underlines the importance of a thorough echocardiographic evaluation with particular consideration of the right heart in these patients. PMID:26291082

  11. Leaflet stress and strain distributions following incomplete transcatheter aortic valve expansion.

    PubMed

    Abbasi, Mostafa; Azadani, Ali N

    2015-10-15

    Transcatheter aortic valve replacement (TAVR) is an established treatment alternative to surgical valve replacement in high-risk patients with severe symptomatic aortic stenosis. The current guidelines for TAVR are to upsize transcatheter aortic valve (TAV) relative to the native annulus to secure the device and minimize paravalvular leakage. Unlike surgical stented bioprosthetic valves where leaflets are attached to a rigid frame, TAVs must expand to fit within the native annulus. Fully-expanded circular TAVs have consistent leaflet kinematics; however, subtle variations in the degree of stent expansion may affect leaflet coaptation. The objective of this study was to determine the impact of incomplete TAV expansion on leaflet stress and strain distributions. In this study, we developed finite element models of a 23mm homemade TAV expanded to diameters ranging from 18 to 23mm in 1mm increments. Through dynamic finite element simulations, we found that leaflet stress and strain distributions were dependent on the diameter of the inflated TAV. After complete expansion of the TAV to 23mm, high stress and strain regions were observed primarily in the commissures during diastole. However, 2-3mm incomplete TAV stent expansion induced localized high stress regions within the TAV commissures, while 4-5mm incomplete stent expansion induced localized high stress regions within the belly of the TAV leaflets during the diastolic phase of the cardiac cycle. Increased mechanical stress and flexural deformation on TAV leaflets due to incomplete stent expansion may lead to accelerated tissue degeneration and diminished long-term valve durability. PMID:26338100

  12. Efficacy and follow-up of transcatheter aortic valve implantation in patients with radiation-induced aortic stenosis

    PubMed Central

    Dijos, Marina; Reynaud, Amélie; Leroux, Lionel; Réant, Patricia; Cornolle, Claire; Roudaut, Raymond; Dos Santos, Pierre; Lafitte, Stéphane

    2015-01-01

    Objective To investigate transcatheter aortic valve implantation (TAVI) feasibility, effectiveness and safety in radiation-induced aortic valve stenosis cases. Methods 198 consecutive patients referred for TAVI were prospectively enrolled. They were divided into two groups: patients with a history of chest radiation therapy with suspected radiation-induced valvular disease (RXT) and others with suspected degenerative aortic valve stenosis (NRXT). Procedural, early and mid-term clinical outcomes were compared. Results Of the 198 patients enrolled in our study, 9.6% qualified for inclusion in the RXT group. A comparison of baseline characteristics revealed that patients with RXT were younger than patients with NRXT (68.3 vs 82.5?years; p<0.05) and exhibited a lower surgical risk score (Euroscore: 7.1% vs 21.8%; p<0.05) and a higher frequency of hostile thorax and porcelain aorta (52.6% vs 28.5%; p<0.05; 63.2% vs 10.6%; p<0.05, respectively). In both groups, the implantation success rate was high and the 30-day safety end point acceptable (RXT: 94.7% and 83.3%; NRXT: 93.9% and 75.6%, respectively). At 6?months, overall mortality was significantly lower in the RXT group (0% vs 18%; p=0.048). Conclusions In patients suffering from radiation-induced aortic valve stenosis and contraindicated for surgery, TAVI is a promising approach, with high feasibility, acceptable risk, low mortality and high clinical effectiveness at mid-term follow-up. PMID:26339494

  13. Pre - Transcatheter Aortic Valve Implantation Workup in the Cardiac Catheterisation Laboratory.

    PubMed

    Zaman, Sarah; Gooley, Robert; McCormick, Liam; Harper, Richard; Meredith, Ian T

    2015-12-01

    Transcatheter aortic valve implantation (TAVI) is a rapidly evolving field with exponential growth worldwide in TAVI numbers. One of the principle methods in improving outcomes with a new technique such as TAVI is to ensure that patients undergo efficient pre-procedural evaluation. Standard TAVI workup includes clinical assessment, surgical and frailty risk scoring, blood investigations, echocardiography, pulmonary function tests, computed tomography (CT) angiography and cardiac catheterisation. Patients sent to the cardiac catheterisation laboratory (CCL) for TAVI workup require a systematic and thorough approach. This can include iliofemoral angiography, aortography, aortic valve crossing, haemodynamic evaluation, coronary angiography and right heart catheterisation. In addition, several key steps are required to evaluate suitability for the percutaneous transfemoral TAVI approach. This is the first review to systematically describe steps to evaluate pre-TAVI patients in the CCL. Due to the rapidly rising TAVI numbers, this workup will likely be performed not only by TAVI operators but also by the general interventional cardiologist. PMID:26361818

  14. Recent Advances in Transcatheter Aortic Valve Implantation: Novel Devices and Potential Shortcomings

    PubMed Central

    Blumenstein, J.; Liebetrau, C.; Linden, A. Van; Moellmann, H.; Walther, T.; Kempfert, J.

    2013-01-01

    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

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

    NASA Astrophysics Data System (ADS)

    Nigam, Vishal

    2011-11-01

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

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

    PubMed

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

    2015-02-01

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

  17. Transcatheter aortic valve implantation in a patient with bicuspid aortic stenosis and a borderline-sized annulus.

    PubMed

    Colkesen, Yucel; Baykan, Oytun; Dagdelen, Sinan; Cayli, Murat

    2015-11-01

    Bicuspid aortic valve (BAV) is currently considered an exclusion criterion for transcatheter aortic valve implantation (TAVI). The risk of adverse aortic events such as incomplete sealing, severe paravalvular regurgitation or dislocation due to elliptic shape and asymmetric calcifications in annulus are higher in TAVI. In this case report, we detailed a case of successful trans-femoral TAVI in a 51-year old male with BAV and its management without in-hospital and 30-day complications. The challenge in this case was the patient's anatomy with a 27-mm annulus for balloon expandable device. The applied strategy was balloon sizing and overdilating the 29-mm stented valve with additional volume that obviated re-ballooning. Trans-femoral TAVI was performed uneventfully under fluoroscopic and transoesophageal echocardiography guidance. A multidetector computed tomography (MDCT) evaluation at 1 month did not show device dislodgement or any other complications. Evidence for evaluation post-TAVI is not sufficient in BAV. We believe patients with BAV should undergo a comprehensive assessment after TAVI including MDCT evaluation. PMID:26265070

  18. The Early Variation of Left Ventricular Strain after Aortic Valve Replacement by Three-Dimensional Echocardiography

    PubMed Central

    Cheng, Leilei; Fan, Li; Wang, Chunsheng; Shu, Xianhong

    2015-01-01

    Aortic stenosis (AS) and aortic incompetence (AI) are common aortic valve diseases. Both may deteriorate into irreversible myocardial dysfunction and will increase the risk of sudden death. In this study, we aimed to investigate the early variation trend of left ventricular function by three-dimensional speckle tracking echocardiography (3D-STE) in the patients who underwent cardiac surgeries for aortic valve disease. Twenty patients with severe aortic AS and 16 patients with severe AI were enrolled. All of them underwent the aortic valve replacement (AVR) procedures. The patients’ global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 3D-STE before surgery and at 1 week after surgery. In addition, GLS and GCS were followed at 1 month as well as 3 months after AVR. In AS patients, the GCS after AVR altered little both at 1 week (p = 0.562) and at 1 month (p = 0.953) compared with the data before the surgery. And it increased significantly at 3 months of follow-up observation compared to that before AVR (p<0.05). Meanwhile, GLS increased progressively after AVR and improved significantly at 3 months after surgery (p<0.05). For the AI patients, GLS as well as GCS decreased at 1 week after AVR compared to those data at baseline (p<0.05). However, these two parameters recovered at 1 month after AVR. Furthermore, GLS and GCS improved significantly at 3 months after the surgery (p<0.05). Therefore, both GLS and GCS were influenced by AVR and would be improved at 3 months after surgery both in AS patients or AI patients. GLS and GCS can be finely evaluated by 3D-STE, and they are helpful to determine the variation tendency of left ventricular function in patients with AVR. PMID:26473730

  19. Aorto-pulmonary fistula accompanied by root abscess and destruction of native aortic valve caused by brucellosis

    PubMed Central

    Sabzi, Feridoun; Faraji, Reza

    2015-01-01

    Brucellosis endocarditis is a zoonosis infection of cardiovascular system with world-wide distribution, which is endemic in many provinces of the Iran. The present report describes an exceptional case of fistulization between the aorta and pulmonary artery by Brucella melitensis in a 34-year-old patient. He presented with the complaints of fever and weight loss and congestive heart failure. He was strongly positive for Brucellosis by serological reaction and conventional microbiological cultures from blood and valve tissue were positive. Echocardiography revealed aortic root abscess, cavity formation in aortic ring, large vegetation and native aortic valve destruction with aortic regurgitation and fistula from non-coronary sinus to pulmonary artery and pericarditis. The patient underwent open heart surgery with aortic valve replacement and transpulmonary fistula repair. The patient had uneven full postoperative recovery and with good general condition discharged to home in 16th days of hospitalization. PMID:26322294

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

    PubMed

    Dandes, Eric; Kirsch, Jacobo; Novaro, Gian

    2012-03-01

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

  1. Artificial aortic valve dysfunction due to pannus and thrombus – different methods of cardiac surgical management

    PubMed Central

    Marcinkiewicz, Anna; Ko?mider, Anna; Walczak, Andrzej; Zwoli?ski, Rados?aw; Jaszewski, Ryszard

    2015-01-01

    Introduction Approximately 60 000 prosthetic valves are implanted annually in the USA. The risk of prosthesis dysfunction ranges from 0.1% to 4% per year. Prosthesis valve dysfunction is usually caused by a thrombus obstructing the prosthetic discs. However, 10% of prosthetic valves are dysfunctional due to pannus formation, and 12% of prostheses are damaged by both fibrinous and thrombotic components. The authors present two patients with dysfunctional aortic prostheses who were referred for cardiac surgery. Different surgical solutions were used in the treatment of each case. Case study 1 The first patient was a 71-year-old woman whose medical history included arterial hypertension, stable coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and hypercholesterolemia; she had previously undergone left-sided mastectomy and radiotherapy. The patient was admitted to the Cardiac Surgery Department due to aortic prosthesis dysfunction. Transthoracic echocardiography revealed complete obstruction of one disc and a severe reduction in the mobility of the second. The mean transvalvular gradient was very high. During the operation, pannus covering the discs’ surface was found. A biological aortic prosthesis was reimplanted without complications. Case study 2 The second patient was an 87-year-old woman with arterial hypertension, persistent atrial fibrillation, and COPD, whose past medical history included gastric ulcer disease and ischemic stroke. As in the case of the first patient, she was admitted due to valvular prosthesis dysfunction. Preoperative transthoracic echocardiography revealed an obstruction of the posterior prosthetic disc and significant aortic regurgitation. Transesophageal echocardiography and fluoroscopy confirmed the prosthetic dysfunction. During the operation, a thrombus growing around a minor pannus was found. The thrombus and pannus were removed, and normal functionality of the prosthetic valve was restored. Conclusions Precise and modern diagnostic methods facilitated selection of the treatment method. However, the intraoperative view also seems to be crucial in individualizing the surgical approach. PMID:26702274

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

    PubMed Central

    2014-01-01

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

  3. Advanced age and the clinical outcomes of transcatheter aortic valve implantation

    PubMed Central

    Alsara, Osama; Alsarah, Ahmad; Laird-Fick, Heather

    2014-01-01

    Aortic valve stenosis (AS) is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the effect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular injures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality. PMID:25009568

  4. Combined elective percutaneous coronary intervention and transapical transcatheter aortic valve implantation

    PubMed Central

    Pasic, Miralem; Dreysse, Stephan; Unbehaun, Axel; Buz, Semih; Drews, Thorsten; Klein, Christoph; D'Ancona, Giuseppe; Hetzer, Roland

    2012-01-01

    There is no established strategy of how and when to treat coronary artery disease (CAD) in patients referred for transcatheter aortic valve implantation (TAVI). Simultaneous, single-stage treatment of both pathologies is a possible solution. We report our initial results of simultaneously performed transapical TAVI and elective percutaneous coronary interventions (PCI) in high-risk patients with severe aortic valve stenosis. Between April 2008 and July 2011, a total of 419 patients underwent transapical TAVI. Combined elective PCI and TAVI were performed in 46 (11%) patients. Only the most significant coronary lesion or lesions were treated. Technical success of the combined approach was 100%. The mean count of implanted stents per patient was 1.6 ± 1.0 (range, 1–5 stents). The 30-day mortality rates in the PCI and TAVI group was 4.3%. Survival at 12, 24 and 36 months of the PCI and TAVI group 87.1 ± 5.5, 69.7 ± 10.3 and 69.7 ± 10.3%, respectively. The results showed that the single-stage approach with combined elective PCI and TAVI is feasible and safe. It has become our primary choice for treatment of high-risk patients with severe aortic valve stenosis and CAD. PMID:22232234

  5. Left ventricular function in patients with ventricular arrhythmias and aortic valve disease

    SciTech Connect

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

    1983-02-01

    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.

  6. Fast valve

    DOEpatents

    Van Dyke, W.J.

    1992-04-07

    A fast valve is disclosed that can close on the order of 7 milliseconds. It is closed by the force of a compressed air spring with the moving parts of the valve designed to be of very light weight and the valve gate being of wedge shaped with O-ring sealed faces to provide sealing contact without metal to metal contact. The combination of the O-ring seal and an air cushion create a soft final movement of the valve closure to prevent the fast air acting valve from having a harsh closing. 4 figs.

  7. Fast valve

    DOEpatents

    Van Dyke, William J. (Grafton, VA)

    1992-01-01

    A fast valve is disclosed that can close on the order of 7 milliseconds. It is closed by the force of a compressed air spring with the moving parts of the valve designed to be of very light weight and the valve gate being of wedge shaped with O-ring sealed faces to provide sealing contact without metal to metal contact. The combination of the O-ring seal and an air cushion create a soft final movement of the valve closure to prevent the fast air acting valve from having a harsh closing.

  8. Percutaneous Aortic Balloon Valvuloplasty and Intracardiac Adrenaline in Electromechanical Dissociation as Bridge to Transcatheter Aortic Valve Implantation

    PubMed Central

    Chaara, Jawad; Meier, Pascal; Ellenberger, Christophe; Gasche, Yvan; Bendjelid, Karim; Noble, Stephane; Roffi, Marco

    2015-01-01

    Abstract This report describes an emergent balloon aortic valvuloplasty (BAV) procedure performed under cardiopulmonary resuscitation in a 79-year-old man with severe symptomatic aortic stenosis (mean gradient 78?mm Hg, valve area 0.71?cm2, and left ventricular ejection fraction 40%) awaiting surgery and who was admitted for heart failure rapidly evolving to cardiogenic shock and multiorgan failure. Decision was made to perform emergent BAV. After crossing the valve with a 6 French catheter, the patient developed an electromechanical dissociation confirmed at transesophageal echocardiography and cardiac arrest. Manual chest compressions were initiated along with the application of high doses of intravenous adrenaline, and BAV was performed under ongoing resuscitation. Despite BAV, transoesophageal echocardiography demonstrated no cardiac activity. At this point, it was decided to advance a pigtail catheter over the wire already in place in the left ventricle and to inject intracardiac adrenaline (1?mg, followed by 5?mg). Left ventricular contraction progressively resumed and, in the absence of aortic regurgitation, an intraaortic balloon pump was inserted. The patient could be weaned from intraaortic balloon pump and vasopressors on day 1, extubated on day 6, and recovered from multiorgan failure. In the absence of neurologic deficits, he underwent uneventful transcatheter aortic valve implantation on day 12 and was discharged to a cardiac rehabilitation program on day 30. At 3-month follow-up, he reported dyspnea NYHA class II as the only symptom. This case shows that severe aortic stenosis leading to electromechanical dissociation may be treated by emergent BAV and intracardiac administration of high-dose adrenaline. Intracardiac adrenaline may be considered in case of refractory electromechanical dissociation occurring in the cardiac catheterization laboratory. PMID:26131825

  9. Association of Serum Phosphate Levels with Aortic Valve Sclerosis and Annular Calcification: the Cardiovascular Health Study

    PubMed Central

    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

    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

  10. Technical Approach Determines Inflammatory Response after Surgical and Transcatheter Aortic Valve Replacement

    PubMed Central

    Erdoes, Gabor; Lippuner, Christoph; Kocsis, Istvan; Schiff, Marcel; Stucki, Monika; Carrel, Thierry; Windecker, Stephan; Eberle, Balthasar; Stueber, Frank; Book, Malte

    2015-01-01

    Objective To investigate the periprocedural inflammatory response in patients with isolated aortic valve stenosis undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) with different technical approaches. Material and Methods Patients were prospectively allocated to one of the following treatments: SAVR using conventional extracorporeal circulation (CECC, n = 47) or minimized extracorporeal circulation (MECC, n = 15), or TAVI using either transapical (TA, n = 15) or transfemoral (TF, n = 24) access. Exclusion criteria included infection, pre-procedural immunosuppressive or antibiotic drug therapy and emergency indications. We investigated interleukin (IL)-6, IL-8, IL-10, human leukocyte antigen (HLA-DR), white blood cell count, high-sensitivity C-reactive protein (hs-CRP) and soluble L-selectin (sCD62L) levels before the procedure and at 4, 24, and 48 h after aortic valve replacement. Data are presented for group interaction (p-values for inter-group comparison) as determined by the Greenhouse-Geisser correction. Results SAVR on CECC was associated with the highest levels of IL-8 and hs-CRP (p<0.017, and 0.007, respectively). SAVR on MECC showed the highest descent in levels of HLA-DR and sCD62L (both p<0.001) in the perioperative period. TA-TAVI showed increased intraprocedural concentration and the highest peak of IL-6 (p = 0.017). Significantly smaller changes in the inflammatory markers were observed in TF-TAVI. Conclusion Surgical and interventional approaches to aortic valve replacement result in inflammatory modulation which differs according to the invasiveness of the procedure. As expected, extracorporeal circulation is associated with the most marked pro-inflammatory activation, whereas TF-TAVI emerges as the approach with the most attenuated inflammatory response. Factors such as the pre-treatment patient condition and the extent of myocardial injury also significantly affect inflammatory biomarker patterns. Accordingly, TA-TAVI is to be classified not as an interventional but a true surgical procedure, with inflammatory biomarker profiles comparable to those found after SAVR. Our study could not establish an obvious link between the extent of the periprocedural inflammatory response and clinical outcome parameters. PMID:26599610

  11. Implantation of transcatheter aortic valve prosthesis through the ascending aorta concomitant with coronary artery bypass grafting without cardiopulmonary bypass

    PubMed Central

    Leal, João Carlos Ferreira; Avanci, Luis Ernesto; Abelaira Filho, Achilles; Almeida, Thiago Faria; Braile, Domingo Marcolino

    2014-01-01

    Introdution The transcatheter aortic valve implantation in the treatment of high-risk symptomatic aortic stenosis has increased the number of implants every year. The learning curve for transcatheter aortic valve implantation has improved since the last 12 years, allowing access alternatives. Objective The aim of this study is to approach the implantation of transcatheter aortic valve through transaortic via associated with off-pump cardiopulmonary bypass surgery in a 67-year-old man, with chronic obstructive pulmonary disease, arterial hypertension and kidney transplant. Methods Off-pump coronary artery bypass surgery was performed and the valve in the aortic position was released successfully. Results There were no complications in the intraoperative and postoperative period. Gradient reduction, effective orifice increasing of the prosthesis and absence of valvular regurgitation after implantation were observed by transesophageal echocardiography. Conclusion Procedural success demonstrates that implantation of transcatheter aortic valve through the ascending aorta associated with coronary artery bypass surgery without CPB is a new option for these patients. PMID:25714221

  12. Costs and in-hospital outcomes of transcatheter aortic valve implantation versus surgical aortic valve replacement in commercial cases using a propensity score matched model.

    PubMed

    Minutello, Robert M; Wong, S Chiu; Swaminathan, Rajesh V; Feldman, Dmitriy N; Kaple, Ryan K; Horn, Evelyn M; Devereux, Richard B; Salemi, Arash; Sun, Xuming; Singh, Harsimran; Bergman, Geoffrey; Kim, Luke K

    2015-05-15

    The aim of this study was to compare in-hospital cost and outcomes between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). TAVI is an effective treatment option in patients with symptomatic aortic stenosis who are at high risk for traditional SAVR. Several studies using trial data or outside United States registry data have addressed TAVI cost issues, although there is a paucity of cost data involving commercial cases in the United States. Using Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Nationwide Inpatient Sample files, a propensity score-matched analysis of all commercial TAVI and SAVR cases performed in 2011 was conducted. Overall hospital cost and length of stay, as well as procedural complications, were compared between the 2 matched cohorts: 595 TAVI patients were matched to 1,785 SAVR patients in a 1:3 ratio. There was no difference in mean ($181,912 vs $196,298) or median ($152,993 vs $155,974) hospital cost between TAVI and SAVR (p = 0.60). The TAVI group had significantly shorter lengths of hospital stay than the SAVR group (mean 9.76 vs 12.01 days, p <0.001). There was no difference in postprocedural in-hospital death or stroke, but TAVI patients were more likely to have bleeding complications, to have vascular complications, and to require pacemakers. In conclusion, when analyzing in-hospital cost of commercial TAVI and SAVR cases using the Nationwide Inpatient Sample data set, TAVI is an economically satisfactory alternative to SAVR and results in an approximately 2-day shorter length of stay during the index hospitalization. PMID:25784513

  13. The TriGuard embolic deflection device for prevention of stroke and cerebral embolization during transcatheter aortic valve replacement.

    PubMed

    Baumbach, Andreas; Pietras, Cody; Lansky, Alexandra

    2015-11-01

    The incidence of embolic ischemic cerebral events during transcatheter aortic valve implantation remains high. The effects range from clinically silent embolic lesions in the brain to severe disabling stroke. Memory loss and other functional neurocognitive impairment are a direct result of embolic strokes. The TriGuard embolic deflection device is a nitinol frame filter that is placed across all three aortic cerebral vessel ostia to prevent particles from entering the brain circulation during the procedure. The results of clinical studies suggest that this procedure can lead to a reduction of embolic events, and an improvement of neurocognitive function when compared with unprotected transcatheter aortic valve implantation. PMID:26364995

  14. Depressurization valve

    DOEpatents

    Skoda, G.I.

    1989-03-28

    A depressurization valve for use in relieving completely the pressure in a simplified boiling water reactor is disclosed. The normally closed and sealed valve is provided with a valve body defining a conduit from an outlet of a manifold from the reactor through a valve seat. A closing valve disk is configured for fitting to the valve seat to normally close the valve. The seat below the disk is provided with a radially extending annulus extending a short distance into the aperture defined by the seat. The disk is correspondingly provided with a longitudinally extending annulus that extends downwardly through the aperture defined by the seat towards the high pressure side of the valve body. A ring shaped membrane is endlessly welded to the seat annulus and to the disk annulus. The membrane is conformed over the confronted surface of the seat and disk in a C-sectioned configuration to seal the depressurization valve against the possibility of weeping. The disk is held to the closed position by an elongate stem extending away from the high pressure side of the valve body. The stem has a flange configured integrally to the stem for bias by two springs. The first spring acts from a portion of the housing overlying the disk on the stem flange adjacent the disk. This spring urges the stem and attached disk away from the seat and thus will cause the valve to open at any pressure. A second spring-preferably of the Belleville variety-acts on a latch plate surrounding and freely moving relative to the end of the stem. This second spring overcomes the bias of the first spring and any pressure acting upon the disk. This Belleville spring maintains through its spring force the valve in the closed position. At the same time, the latch plate with its freedom of movement relative to the stem allows the stem to thermally expand during valve temperature excursion.

  15. Elevated Cyclic Stretch Induces Aortic Valve Calcification in a Bone Morphogenic Protein-Dependent Manner

    PubMed Central

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

    2010-01-01

    Calcified aortic valve (AV) cusps have increased expression of bone morphogenic proteins (BMPs) and transforming growth factor-?1 (TGF-?1). Elevated stretch loading on the AV is known to increase expression of matrix remodeling enzymes and pro-inflammatory proteins. Little, however, is known about the mechanism by which elevated stretch might induce AV calcification. We investigated the hypothesis that elevated stretch may cause valve calcification via a BMP-dependent mechanism. Porcine AV cusps were cultured in a stretch bioreactor, at 10% (physiological) or 15% (pathological) stretch and 70 beats per minute for 3, 7, and 14 days, in osteogenic media supplemented with or without high phosphate (3.8 mmol/L), TGF-?1 (1 ng/ml), as well as the BMP inhibitor noggin (1, 10, and 100 ng/ml). Fresh cusps served as controls. Alizarin red and von Kossa staining demonstrated that 15% stretch elicited a stronger calcification response compared with 10% stretch in a fully osteogenic medium containing high phosphate and TGF-?1. BMP-2, -4, and Runx2 expression was observed after 3 days on the fibrosa surface of the valve cusp and was stretch magnitude-dependent. Cellular apoptosis was highest at 15% stretch. Tissue calcium content and alkaline phosphatase activity were similarly stretch-dependent and were significantly reduced by noggin in a dose dependent manner. These results underline the potential role of BMPs in valve calcification due to altered stretch. PMID:20489151

  16. Mitral and aortic valve sclerosis/calcification and carotid atherosclerosis: results from 1065 patients.

    PubMed

    Rossi, Andrea; Faggiano, Pompilio; Amado, Alexandra E; Cicoira, Mariantonietta; Bonapace, Stefano; Franceschini, Lorenzo; Dini, Frank L; Ghio, Stefano; Agricola, Eustachio; Temporelli, Pier Luigi; Vassanelli, Corrado

    2014-11-01

    This study assesses whether aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are associated with carotid artery atherosclerosis, independently of traditional cardiovascular risk factors. A total of 1065 patients underwent both echocardiography and carotid artery ultrasound scanning. AVS and MAC were defined as focal areas of increased echogenicity and thickening of the aortic leaflets or mitral valve annulus. Carotid artery atherosclerosis was defined as presence/absence of any atherosclerotic plaque or presence/absence of plaque >50 %. Of 1065 patients (65 ± 9 years; 38 % female) who comprised the study population, 642 (60 %) had at least one atherosclerotic plaque. AVS, but not mitral valve sclerosis; was associated with the presence of carotid atherosclerosis (odds ratio (OR) 1.9, 95 % confidence interval (CI) 1.2-3.9; P = 0.005) and the degree of carotid atherosclerosis (OR 2.1, 95 % CI 1.2-3.9; P = 0.01) in a multivariate model including age, gender, previous ischemic heart disease, hypertension, dyslipidemia, smoking, diabetes, family cardiovascular history, left ventricular size, mass, and ejection fraction, and left atrial size. AVS is a significant predictor of carotid atherosclerosis, independently of other cardiovascular clinical and echocardiographic risk factors. PMID:24196525

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

    PubMed Central

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

    2013-01-01

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

  18. Influence of hypothermia on right atrial cardiomyocyte apoptosis in patients undergoing aortic valve replacement

    PubMed Central

    Castedo, Evaristo; Castejón, Raquel; Monguio, Emilio; Ramis, Sebastian; Montero, Carlos G; Serrano-Fiz, Santiago; Burgos, Raul; Escudero, Cristina; Ugarte, Juan

    2007-01-01

    Background There is increasing evidence that programmed cell death can be triggered during cardiopulmonary bypass (CPB) and may be involved in postoperative complications. The purpose of this study was to investigate whether apoptosis occurs during aortic valve surgery and whether modifying temperature during CPB has any influence on cardiomyocyte apoptotic death rate. Methods 20 patients undergoing elective aortic valve replacement for aortic stenosis were randomly assigned to either moderate hypothermic (ModHT group, n = 10, 28°C) or mild hypothermic (MiHT group, n = 10, 34°C) CPB. Myocardial samples were obtained from the right atrium before and after weaning from CPB. Specimens were examined for apoptosis by flow cytometry analysis of annexin V-propidium iodide (PI) and Fas death receptor staining. Results In the ModHT group, non apoptotic non necrotic cells (annexin negative, PI negative) decreased after CPB, while early apoptotic (annexin positive, PI negative) and late apoptotic or necrotic (PI positive) cells increased. In contrast, no change in the different cell populations was observed over time in the MiHT group. Fas expression rose after reperfusion in the ModHT group but not in MiHT patients, in which there was even a trend for a lower Fas staining after CPB (p = 0.08). In ModHT patients, a prolonged ischemic time tended to induce a higher increase of Fas (p = 0.061). Conclusion Our data suggest that apoptosis signal cascade is activated at early stages during aortic valve replacement under ModHT CPB. This apoptosis induction can effectively be attenuated by a more normothermic procedure. PMID:17241480

  19. Functional Heart Valve Scaffolds Obtained by Complete Decellularization of Porcine Aortic Roots in a Novel Differential Pressure Gradient Perfusion System.

    PubMed

    Sierad, Leslie Neil; Shaw, Eliza Laine; Bina, Alexander; Brazile, Bryn; Rierson, Nicholas; Patnaik, Sourav S; Kennamer, Allison; Odum, Rebekah; Cotoi, Ovidiu; Terezia, Preda; Branzaniuc, Klara; Smallwood, Harrison; Deac, Radu; Egyed, Imre; Pavai, Zoltan; Szanto, Annamaria; Harceaga, Lucian; Suciu, Horatiu; Raicea, Victor; Olah, Peter; Simionescu, Agneta; Liao, Jun; Movileanu, Ionela; Harpa, Marius; Simionescu, Dan Teodor

    2015-12-01

    There is a great need for living valve replacements for patients of all ages. Such constructs could be built by tissue engineering, with perspective of the unique structure and biology of the aortic root. The aortic valve root is composed of several different tissues, and careful structural and functional consideration has to be given to each segment and component. Previous work has shown that immersion techniques are inadequate for whole-root decellularization, with the aortic wall segment being particularly resistant to decellularization. The aim of this study was to develop a differential pressure gradient perfusion system capable of being rigorous enough to decellularize the aortic root wall while gentle enough to preserve the integrity of the cusps. Fresh porcine aortic roots have been subjected to various regimens of perfusion decellularization using detergents and enzymes and results compared to immersion decellularized roots. Success criteria for evaluation of each root segment (cusp, muscle, sinus, wall) for decellularization completeness, tissue integrity, and valve functionality were defined using complementary methods of cell analysis (histology with nuclear and matrix stains and DNA analysis), biomechanics (biaxial and bending tests), and physiologic heart valve bioreactor testing (with advanced image analysis of open-close cycles and geometric orifice area measurement). Fully acellular porcine roots treated with the optimized method exhibited preserved macroscopic structures and microscopic matrix components, which translated into conserved anisotropic mechanical properties, including bending and excellent valve functionality when tested in aortic flow and pressure conditions. This study highlighted the importance of (1) adapting decellularization methods to specific target tissues, (2) combining several methods of cell analysis compared to relying solely on histology, (3) developing relevant valve-specific mechanical tests, and (4) in vitro testing of valve functionality. PMID:26467108

  20. Hypercholesterolemia induces side-specific phenotype changes and PPAR&[gamma] pathway activation in swine aortic valve endothelium

    PubMed Central

    Guerraty, Marie A.; Grant, Gregory R.; Karanian, John W.; Chiesa, Oscar A.; Pritchard, William F.; Davies, Peter F.

    2010-01-01

    Background The endothelium of normal aortic valves expresses different phenotypes on the aortic and ventricular sides. On the aortic side, which is susceptible to aortic valve sclerosis (AVS), there is a balanced co-expression of both pro-pathological and protective pathways. Side-specific global gene expression can address endothelial phenotype balance in early AVS. Methods and Results Adult male swine were fed a hypercholesterolemic (HC) or an isocaloric normal diet for 2-week and 6-month periods. HC induced localized lipid insudation confined to the aortic side of the leaflet. Transcript profiling of valve endothelial populations showed that the susceptible aortic side was more sensitive to 2-weeks hypercholesterolemia than the ventricular side (1325 vs 87 genes differentially expressed). Greater sensitivity, however, was not evidence of dysfunctional phenotype. Instead, pathway analyses identified differential expression of caspase3-, PPAR&[gamma], TNF&[alpha]-, and NF&[kappa]B-related pathways that were consistent with a protective endothelial phenotype; this was confirmed at the protein level at 2 weeks and persisted at 6 months. Conclusions In a large animal model at high spatial resolution, endothelium on the patho-susceptible side of the aortic valve leaflet is responsive to hypercholesterolemia. Transcript profiles indicative of a protective phenotype were induced and persisted on the side prone to AVS. PMID:19926833

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

    PubMed Central

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

    2014-01-01

    Transcatheter aortic valve implantation (TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths (16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques. PMID:25228962

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

    PubMed Central

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

    2015-01-01

    Objective: The objective of this study is to evaluate the first applications and short term outcomes of transcatheter aortic valve implantation (TAVI) in our clinic, which is a new technology for the patients with high risk for surgical aortic valve replacement (SAVR). Materials and Methods: Between January 2010 and December 2012, twenty five patients (16 males, 9 females; mean age 74.04±8.86 years) diagnosed with severe aortic stenosis, who were at high risk for surgery (EuroSCORE II: 5.58±4.20) and underwent TAVI in our clinic, were evaluated. The demographic and clinical characteristics of patients, anaesthetic management, complications during pre- and post-operative periods and the mortality rate in the first 30 days and six months were recorded. Results: Edwards SAPIEN Valve prostheses were implanted by transfemoral approach (percutaneously in 10 patients and surgically in 15 patients) in all patients. The TAVI procedure was performed under general anaesthesia. The success rate of the TAVI procedure was 100%. Three patients had limited dissection of the femoral artery; however, intervention was not needed due to good distal perfusion rate. Permanent pacemaker was implanted to four patients because of long-term atrioventricular blockage. After the procedure, all patients were transferred to the Intensive Care Unit (ICU) and all patients were extubated in the ICU. The mean mechanical ventilation duration (minutes) was 166.20±39.32, the mean critical care unit stay (day) was 5.64±2.99 and the mean hospital stay (day) was 11.92±5.54. Acute renal failure was observed in one patient and stroke was observed in two patients on the first postoperative day. The mortality rate in the first 30 days and 6 months was found to be 4% and 16%, respectively. Conclusion: Transcatheter aortic valve implantation is a great option for patients with severe aortic stenosis who are at high risk for SAVR. In our institute, procedural success and short term outcomes for patients underwent TAVI were found to be similar to the other studies in the national and international literature. PMID:26180492

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

    NASA Technical Reports Server (NTRS)

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

    2002-01-01

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

  4. Improvement in left ventricular function assessed by tissue Doppler imaging after aortic valve replacement for severe aortic stenosis

    PubMed Central

    Nieh, Chih-Chiang; Teo, Alvin Yeng-Hok; Soo, Wern Miin; Lee, Glenn K; Singh, Devinder; Poh, Kian-Keong

    2015-01-01

    INTRODUCTION The effects of reduction of left ventricular (LV) systemic afterload following aortic valve replacement (AVR) for severe aortic valve stenosis (AS) were investigated, using echocardiography and tissue Doppler imaging (TDI). METHODS We compared the preoperative and postoperative echocardiographic assessments of 23 patients with severe AS who had undergone isolated AVR (n = 13) or concomitant AVR with coronary artery bypass grafting (CABG) (n = 10). Conventional echocardiographic evaluations and TDI at the lateral mitral annulus were performed. RESULTS Echocardiography was performed at a median of 120 (interquartile range: 66–141) days after AVR. There was significant reduction in aortic transvalvular mean pressure gradient after AVR. Although LV dimensions, mass and ejection fraction remained unchanged, LV diastolic and systolic functions improved (as observed on TDI). Early diastolic (E’), late diastolic (A’) and systolic (S’) mitral annular velocities increased significantly (p < 0.05). There was significant improvement in TDI-derived parameters among the patients who had isolated AVR, while among the patients who had concomitant AVR with CABG, only S’ had significant improvement (p = 0.028). CONCLUSION TDI was able to detect improvements in LV systolic and diastolic function after AVR for severe AS. There was less improvement in the TDI-derived diastolic parameters among patients who underwent concomitant AVR with CABG than among patients who underwent isolated AVR. PMID:26702162

  5. Interrupted aortic arch with post-interruption aneurysm and bicuspid aortic valve in an adult: a case report and literature review

    PubMed Central

    Patel, Dhruv M.; Maldjian, Pierre D.; Lovoulos, Constantinos

    2015-01-01

    Interrupted aortic arch in adults is rare with a limited number of reported cases. We describe a case of a 53-year-old woman with interrupted aortic arch, bicuspid aortic valve, and post-interruption saccular aneurysm of the aorta. To our knowledge, this is only the second report of an adult patient with all 3 abnormalities. We also review the literature on this unusual condition and discuss its relationship with coarctation of the aorta. PMID:26649108

  6. Impact of Diabetes Mellitus and Hemoglobin A1C on Outcome After Transcatheter Aortic Valve Implantation.

    PubMed

    Chorin, Ehud; Finkelstein, Ariel; Banai, Shmuel; Aviram, Galit; Barkagan, Michael; Barak, Leehee; Keren, Gad; Steinvil, Arie

    2015-12-15

    Surgical aortic valve replacement (SAVR) is associated with an increased mortality risk in elderly or high-risk patients. Transcatheter aortic valve implantation (TAVI) is an alternative to surgery in patients with symptomatic severe aortic stenosis who are inoperable or at high operative risk. The impact of diabetes mellitus (DM) on patients referred to TAVI merits further investigation. The aim of our study was to evaluate the clinical characteristics and the impact of DM status on the updated Valve Academic Research Consortium 2-defined outcomes of TAVI and to stratify patient outcomes according to their initial glycated hemoglobin (HbA1c) levels. We enrolled and stratified patients who underwent TAVI at our institution according to DM status. A total of 586 patients were enrolled: 348 (59%) without DM and 238 (41%) with DM. There were no significant differences in 30-day mortality patients with diabetes compared to patients without diabetes (3.3% vs 2.9%, p = 0.974). Insulin-treated DM was not associated with adverse outcome in comparison to orally treated DM. To delineate the prognostic power of HbA1C in these patients, the cohort was divided into 3 groups according to HbA1C levels (<5.7%, 5.7% to 6.49%, and ?6.5%). Patients with HbA1C ?6.5% were at increased risk for mortality during follow-up (hazard ratio 2.571, 95% confidence interval 1.077 to 6.136, p = 0.033) compared to patients with HbA1C <5.7%. In conclusion, unlike SAVR, DM is not associated with an increased mortality risk after TAVI, nor is it associated with increased complications rates. A more poorly controlled disease, as manifested by elevated HbA1c levels, may be associated with increased mortality during long-term follow-up. PMID:26602074

  7. Osteopetrosis: a Case of 'Hostile Chest' Associated with Symptomatic Aortic Valve Stenosis.

    PubMed

    Villa, Emmanuel; Lauria, Giuseppe; Messina, Antonio; Rizzi, Andrea; D'Ambrosio, Angela; Leonzi, Ornella; Sabatini, Tony; Troise, Giovanni

    2015-01-01

    Osteopetrosis is a heterogeneous group of heritable conditions in which there is a defect in bone resorption by osteoclasts. It is associated with an increased skeletal mass due to abnormally dense, but brittle, bones. Osteopetrosis varies greatly in severity, and fracture treatment remains a matter of controversy due to altered responses to fixation and the risk of osteomyelitis. The fate of sternotomy in this condition is unknown, and osteopetrosis could represent a situation of 'hostile chest'. Here, the case is described of a patient with osteopetrosis and concomitant symptomatic aortic valve stenosis and coronary artery disease. PMID:26182630

  8. [Left ventricular rupture of mitral valve prosthesis implantation treated using an intra-aortic balloon pump counterpulsation].

    PubMed

    García-Villarreal, Ovidio Alberto; Ramírez-González, Bertín; Saldaña-Becerra, Martín A

    2015-01-01

    Left ventricular rupture is an infrequent but potentially fatal complication of mitral valve replacement. In spite of the fact that several methods of repair have previously been described, the mortality rate remains nearly 85%. The use of the intra-aortic balloon pump counterpulsation may increase the possibilities of success in the repair of this dreaded complication. We present here three cases of left ventricular rupture associated to mitral valve prosthesis implantation successfully treated with the aid of intra-aortic balloon pump counterpulsation. PMID:26581539

  9. Aortic dilatation and calcification in asymptomatic patients with bicuspid aortic valve: analysis in a Korean health screening population.

    PubMed

    Lee, Mirae; Sung, Jidong; Cho, Soo Jin; Choi, Soo Hee; Cho, Sung Won; Oh, Jae K; Park, Sung-Ji; Kim, Duk-Kyung

    2013-03-01

    Entire anatomic area involved in the bicuspid aortic valve (BAV) disease has not been studied well, especially in Asian populations. We investigated prevalence and vascular characteristics of the BAV disease in a Korean population. In a health screening program from 2005 through 2010, 38 BAV patients (BAV group, 0.16 %, 35 males) were isolated among a total of 23,291 persons based on echocardiography. Each BAV patient was matched with three TAV patients (TAV group, n = 114) of the same age, gender, BSA, and hypertension. Using echocardiography and low-dose chest CT scan, diameters of the aortic root to proximal descending aorta (pDA) and pulmonary artery (PA), morphologic types of BAV, and calcification in the aortic root were evaluated in both groups. Diameters of the sinotubular junction and ascending aorta in BAV group were larger than in TAV group (29 ± 7 vs. 27 ± 3 mm, p = 0.046; 42 ± 7 vs. 34 ± 4 mm, p < 0.001, respectively). Diameters of the annulus, sinus of Valsalva, aortic arch, pDA, and PA were not different between two groups. Calcification in the aortic root was approximately seven times more common in BAV group (p < 0.001). Diameters of the aortic root were larger in the R-L type (n = 24) than in the R-N type (n = 11). Prevalence of BAV in a Korean population appears lower than in Western populations. Within the entire anatomic boundaries of BAV, the ascending aorta was predominantly dilated in BAV patients. The R-L type showed more dilatation than the R-N type, not in the ascending aorta but in the aortic root. PMID:22923281

  10. Depressurization valve

    DOEpatents

    Skoda, George I. (Santa Clara, CA)

    1989-01-01

    A depressurization valve for use in relieving completely the pressure in a simplified boiling water reactor is disclosed. The normally closed and sealed valve is provided with a valve body defining a conduit from an outlet of a manifold from the reactor through a valve seat. A closing valve disk is configured for fitting to the valve seat to normally close the valve. The seat below the disk is provided with a radially extending annulus extending a short distance into the aperture defined by the seat. The disk is correspondingly provided with a longitudinally extending annulus that extends downwardly through the aperture defined by the seat towards the high pressure side of the valve body. A ring shaped membrane is endlessly welded to the seat annulus and to the disk annulus. The membrane is conformed over the confronted surface of the seat and disk in a C-sectioned configuration to seal the depressurization valve against the possibility of weeping. The disk is held to the closed position by an elongate stem extending away from the high pressure side of the valve body. The stem has a flange configured integrally to the stem for bias by two springs. The first spring acts from a portion of the housing overlying the disk on the stem flange adjacent the disk. This spring urges the stem and attached disk away from the seat and thus will cause the valve to open at any pressure. A second spring--preferably of the Belleville variety--acts on a latch plate surrounding and freely moving relative to the end of the stem. This second spring overcomes the bias of the first spring and any pressure acting upon the disk. This Belleville spring maintains through its spring force the valve in the closed position. At the same time, the latch plate with its freedom of movement relative to the stem allows the stem to thermally expand during valve temperature excursion. The latch plate in surrounding the stem is limited in its outward movement by a boss attached to the stem at the end of the stem remote from the disk. The latch plate is held normally closed by three radial latches spaced at 120.degree. around the periphery of the plate.

  11. Infective endocarditis of the aortic valve in a Border collie dog with patent ductus arteriosus

    PubMed Central

    AOKI, Takuma; SUNAHARA, Hiroshi; SUGIMOTO, Keisuke; ITO, Tetsuro; KANAI, Eiichi; FUJII, Yoko

    2014-01-01

    Infective endocarditis (IE) in dogs with cardiac shunts has not been reported previously. However, we encountered a dog with concurrent patent ductus arteriosus (PDA) and IE. The dog was a 1-year-old, 13.9-kg female Border collie and presented with anorexia, weight loss, pyrexia (40.4°C) and lameness. A continuous murmur with maximal intensity over the left heart base (Levine 5/6) was detected on auscultation. Echocardiography revealed a PDA and severe aortic stenosis (AS) caused by aortic-valve vegetative lesions. Corynebacterium spp. and Bacillus subtilis were isolated from blood cultures. The dog responded to aggressive antibiotic therapy, and the PDA was subsequently surgically corrected. After a series of treatments, the dog showed long-term improvement in clinical status. PMID:25391395

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

    E-print Network

    the stresses of cyclic loading over billions of heart beats. Replacement valves that consist of animal tissues the in-plane stiffness of the tissue and decreases anisotropy. Tissue replacement valves suffer from poor in these regions and how to mitigate them is important in order to improve the design of replacement heart valves

  13. Association of Aortic Valve Sclerosis with Previous Coronary Artery Disease and Risk Factors

    PubMed Central

    Marmelo, Filipe Carvalho; Mateus, Sónia Matilde Fonseca; Pereira, Alexandre José Marques

    2014-01-01

    Background Aortic valve sclerosis (AVS) is characterized by increased thickness, calcification and stiffness of the aortic leaflets without fusion of the commissures. Several studies show an association between AVS and presence of coronary artery disease. Objective The aim of this study is to investigate the association between presence of AVS with occurrence of previous coronary artery disease and classical risk factors. Methods The sample was composed of 2,493 individuals who underwent transthoracic echocardiography between August 2011 and December 2012. The mean age of the cohort was 67.5 ± 15.9 years, and 50.7% were female. Results The most frequent clinical indication for Doppler echocardiography was the presence of stroke (28.8%), and the most common risk factor was hypertension (60.8%). The most prevalent pathological findings on Doppler echocardiography were mitral valve sclerosis (37.1%) and AVS (36.7%). There was a statistically significant association between AVS with hypertension (p < 0.001), myocardial infarction (p = 0.007), diabetes (p = 0.006) and compromised left ventricular systolic function (p < 0.001). Conclusion: Patients with AVS have higher prevalences of hypertension, stroke, hypercholesterolemia, myocardial infarction, diabetes and compromised left ventricular systolic function when compared with patients without AVS. We conclude that there is an association between presence of AVS with previous coronary artery disease and classical risk factors. PMID:25229357

  14. Biomedical Impact in Implantable Devices-The Transcatheter Aortic Valve as an example

    NASA Astrophysics Data System (ADS)

    Anastasiou, Alexandros; Saatsakis, George

    2015-09-01

    Objective: To update of the scientific community about the biomedical engineering involvement in the implantable devices chain. Moreover the transcatheter Aortic Valve (TAV) replacement, in the field of cardiac surgery, will be analyzed as an example of contemporary implantable technology. Methods: A detailed literature review regarding biomedical engineers participating in the implantable medical product chain, starting from the design of the product till the final implantation technique. Results: The scientific role of biomedical engineers has clearly been established. Certain parts of the product chain are implemented almost exclusively by experienced biomedical engineers such as the transcatheter aortic valve device. The successful professional should have a multidisciplinary knowledge, including medicine, in order to pursue the challenges for such intuitive technology. This clearly indicates that biomedical engineers are among the most appropriate scientists to accomplish such tasks. Conclusions: The biomedical engineering involvement in medical implantable devices has been widely accepted by the scientific community, worldwide. Its important contribution, starting from the design and extended to the development, clinical trials, scientific support, education of other scientists (surgeons, cardiologists, technicians etc.), and even to sales, makes biomedical engineers a valuable player in the scientific arena. Notably, the sector of implantable devices is constantly raising, as emerging technologies continuously set up new targets.

  15. Association Between Transcatheter Aortic Valve Implantation Volume and Outcomes in the United States.

    PubMed

    Kim, Luke K; Minutello, Robert M; Feldman, Dmitriy N; Swaminathan, Rajesh V; Bergman, Geoffrey; Singh, Harsimran; Kaple, Ryan K; Wong, S Chiu

    2015-12-15

    With the rapid advance of transcatheter aortic valve implantation (TAVI), it is important to evaluate the relationship between TAVI volumes and outcomes. The aim of this study was to analyze in-hospital outcomes after TAVI stratified according to hospital volumes. Using the National Inpatient Sample files from 2012, hospitals performing transfemoral (TF)-TAVI and transapical (TA)-TAVI were divided into high-volume and low-volume centers. A total of 7,660 patients underwent TAVI in 256 hospitals in 2012. In the TF-TAVI cohort, multivariate logistic regression analyses demonstrated that low TF-TAVI volume status was an independent predictor of death and bleeding. In the TA-TAVI cohort, low volume status was a predictor of death, myocardial infarction, and need for permanent pacemaker. In addition, hospitals that performed low TA-TAVI volume were associated with significantly higher rate of death after surgical aortic valve replacement in comparison with the hospitals that perform high TA-TAVI volume (3.6% vs 2.3%, p <0.001). In conclusion, centers with lower volume of TAVI had more frequent adverse events compared with higher volume centers. PMID:26508710

  16. Defective recovery of QT dispersion following transcatheter aortic valve implantation: frequency, predictors and prognosis

    PubMed Central

    Nuis, Rutger-Jan; Turgut, Gokhan; van der Boon, Robert M; van Mieghem, Nicolas M; Nauta, Sjoerd T; Serruys, Patrick W; van Domburg, Ron T; Zuchelli, Giulio; Jordaens, Luc; de Jaegere, Peter P

    2015-01-01

    Background Corrected QT dispersion (cQTD) has been correlated with non-uniform ventricular repolarisation and increased mortality. In patients with aortic stenosis, cQTD has been shown improved after surgical valve replacement, but the effects of transcatheter aortic valve implantation (TAVI) are unknown. Therefore, we sought to explore the frequency, predictors and prognostic effects of defective cQTD recovery at 6 months after TAVI. Methods A total of 222 patients underwent TAVI with the Medtronic-CoreValve System between November 2005 and January 2012. Patients who were on class I or III antiarrhythmics or on chronic haemodialysis or who developed atrial fibrillation, a new bundle branch block or became pacemaker dependent after TAVI were excluded. As a result, pre-, post- and follow-up ECG (median: 6 months) analysis was available in 45 eligible patients. Defective cQTD recovery was defined as any progression beyond the baseline cQTD at 6 months. Results In the 45 patients, the mean cQTD was 47 ± 23 ms at baseline, 45 ± 17 ms immediately after TAVI and 40 ± 16 ms at 6 months (15% reduction, P = 0.049). Compared to baseline, cQTD at 6 months was improved in 60% of the patients whereas defective cQTD recovery was present in 40%. cQTD increase immediately after TAVI was an independent predictor of defective cQTD recovery at 6 months (per 10 ms increase; OR: 1.89, 95% CI: 1.15–3.12). By univariable analysis, defective cQTD recovery was associated with late mortality (HR: 1.52, 95% CI: 1.05–2.17). Conclusions Despite a gradual reduction of cQTD after TAVI, 40% of the patients had defective recovery at 6 months which was associated with late mortality. More detailed ECG analysis after TAVI may help to avoid late death. PMID:26512238

  17. Regenerative Potential of Low-Concentration SDS-Decellularized Porcine Aortic Valved Conduits In Vivo

    PubMed Central

    Paniagua Gutierrez, José Rodolfo; Berry, Helen; Korossis, Sotirios; Mirsadraee, Saeed; Lopes, Sergio Veiga; da Costa, Francisco; Kearney, John; Watterson, Kevin; Fisher, John

    2015-01-01

    The aims of this study were to determine the functional biocompatibility of low-concentration SDS-decellularized porcine aortic roots in vivo. A previously developed process was modified for 9- and 15-mm-diameter aortic roots to facilitate implantation into the porcine abdominal aorta (n=3) and juvenile sheep right ventricular outflow tract (n=7), respectively. Native allogeneic aortic roots were used as controls. Acellular porcine roots explanted from pigs at weeks were largely repopulated with stromal cells of appropriate phenotype, and there was evidence that macrophages were involved in the regenerative process. Native allogeneic roots were subject to a classic allograft rejection response. Acellular porcine roots explanted from sheep at 6 months showed evidence of appropriate cellular repopulation, again with evidence of a role for macrophages in the regenerative process. There was some degree of calcification of two of the explanted acellular roots, likely due to incomplete removal of DNA before implantation. Native allogeneic ovine roots were subject to a classic allograft rejection response involving T cells, which resulted in overtly calcified and damaged tissues. The study highlighted (1) the importance of removal of DNA from acellular porcine valved roots to avoid calcification and (2) a role for macrophages in the regeneration of low-concentration SDS-decellularized aortic roots, as has been reported for other acellular biological extracellular matrix scaffolds. PMID:25156153

  18. Longitudinal strain predicts left ventricular mass regression after aortic valve replacement for severe aortic stenosis and preserved left ventricular function.

    PubMed

    Gelsomino, Sandro; Lucà, Fabiana; Parise, Orlando; Lorusso, Roberto; Rao, Carmelo Massimiliano; Vizzardi, Enrico; Gensini, Gian Franco; Maessen, Jos G

    2013-11-01

    We explored the influence of global longitudinal strain (GLS) measured with two-dimensional speckle-tracking echocardiography on left ventricular mass regression (LVMR) in patients with pure aortic stenosis (AS) and normal left ventricular function undergoing aortic valve replacement (AVR). The study population included 83 patients with severe AS (aortic valve area <1 cm(2)) treated with AVR. Bioprostheses were implanted in 58 patients (69.8 %), and the 25 remaining patients (30.2 %) received mechanical prostheses. Peak systolic longitudinal strain was measured in four-chamber (PLS4ch), two-chamber (PLS2ch), and three-chamber (PLS3ch) views, and global longitudinal strain was obtained by averaging the peak systolic values of the 18 segments. Median follow-up was 66.6 months (interquartile range 49.7-86.3 months). At follow-up, values of PLS4ch, PLS2ch, PLS3ch, and GLS were significantly lower (less negative) in patients who did not show left ventricular (LV) mass regression (all P < 0.001). Baseline global strain was the strongest predictor of lack of LVMR (odds ratio 3.5 (95 % confidence interval 3.0-4.9), P < 0.001), and GLS value ?-9.9 % predicted lack of LVMR with 95 % sensitivity and 87 % specificity (P < 0.001). Other multivariable predictors were the preoperative LV mass value (cutoff value ?147 g/m(2), P < 0.001), baseline effective orifice area index (cutoff ?0.35 cm(2)/m(2), P = 0.01), and baseline mean gradient (cutoff ?58 mmHg, P = 0.01). Finally, we failed to find interactions between GLS and other significant parameters (all P < 0.05). Global longitudinal strain accurately predicts LV mass regression in patients with pure AS undergoing AVR. Our findings must be confirmed by further larger studies. PMID:23180240

  19. Measurement of Opening and Closing Angles of Aortic Valve Prostheses In Vivo Using Dual-Source Computed Tomography: Comparison with Those of Manufacturers' in 10 Different Types

    PubMed Central

    Suh, Young Joo; Hong, Yoo Jin; Lee, Hye-Jeong; Hur, Jin; Im, Dong Jin; Kim, Yun Jung; Choi, Byoung Wook

    2015-01-01

    Objective The aims of this study were to compare opening and closing angles of normally functioning mechanical aortic valves measured on dual-source computed tomography (CT) with the manufacturers' values and to compare CT-measured opening angles according to valve function. Materials and Methods A total of 140 patients with 10 different types of mechanical aortic valves, who underwent dual-source cardiac CT, were included. Opening and closing angles were measured on CT images. Agreement between angles in normally functioning valves and the manufacturer values was assessed using the interclass coefficient and the Bland-Altman method. CT-measured opening angles were compared between normal functioning valves and suspected dysfunctioning valves. Results The CT-measured opening angles of normally functioning valves and manufacturers' values showed excellent agreement for seven valve types (intraclass coefficient [ICC], 0.977; 95% confidence interval [CI], 0.962-0.987). The mean differences in opening angles between the CT measurements and the manufacturers' values were 1.2° in seven types of valves, 11.0° in On-X valves, and 15.5° in ATS valves. The manufacturers' closing angles and those measured by CT showed excellent agreement for all valve types (ICC, 0.953; 95% CI, 0.920-0.972). Among valves with suspected dysfunction, those with limitation of motion (LOM) and an increased pressure gradient (PG) had smaller opening angles than those with LOM only (p < 0.05). Conclusion Dual-source cardiac CT accurately measures opening and closing angles in most types of mechanical aortic valves, compared with the manufacturers' values. Opening angles on CT differ according to the type of valve dysfunction and a decreased opening angle may suggest an elevated PG. PMID:26356549

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

    PubMed

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

    2015-02-01

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

  1. Mineral metabolism disturbances are associated with the presence and severity of calcific aortic valve disease*

    PubMed Central

    Yang, Zhen-kun; Ying, Chen; Zhao, Hong-yan; Fang, Yue-hua; Chen, Ying; Shen, Wei-feng

    2015-01-01

    Objective: We investigated whether disturbance of calcium and phosphate metabolism is associated with the presence and severity of calcific aortic valve disease (CAVD) in patients with normal or mildly impaired renal function. Methods: We measured serum levels of calcium, phosphate, alkaline phosphatase (AKP), intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25-OHD), and biomarkers of bone turnover in 260 consecutive patients with normal or mildly impaired renal function and aortic valve sclerosis (AVSc) (n=164) or stenosis (AVS) (n=96) and in 164 age- and gender-matched controls. Logistic regression models were used to determine the association of mineral metabolism parameters with the presence and severity of CAVD. Results: Stepwise increases were observed in serum levels of calcium, phosphate, AKP, and iPTH from the control group to patients with AVS, and with reverse changes for 25-OHD levels (all P<0.001). Similarly, osteocalcin, procollagen I N-terminal peptide, and ?-isomerized type I collagen C-telopeptide breakdown products were significantly increased stepwise from the control group to patients with AVS (all P<0.001). In patients with AVS, serum levels of iPTH were positively, in contrast 25-OHD levels were negatively, related to trans-aortic peak flow velocity and mean pressure gradient. After adjusting for relevant confounding variables, increased serum levels of calcium, phosphate, AKP, and iPTH and reduced serum levels of 25-OHD were independently associated with the presence and severity of CAVD. Conclusions: This study suggests an association between mineral metabolism disturbance and the presence and severity of CAVD in patients with normal or mildly impaired renal function. Abnormal bone turnover may be a potential mechanism. PMID:25990053

  2. Hemodynamic impact and outcome of permanent pacemaker implantation following transcatheter aortic valve implantation.

    PubMed

    Biner, Simon; Michowitz, Yoav; Leshem-Rubinow, Eran; Topilsky, Yan; Ben-Assa, Eyal; Shimiaie, Jason; Banai, Shmuel; Keren, Gad; Steinvil, Arie; Finkelstein, Ariel

    2014-01-01

    Transcatheter aortic valve implantation (TAVI) frequently requires postprocedural permanent pacemaker (PPM) implantation. We evaluated clinical and hemodynamic impact of PPM after TAVI. Clinical and echocardiographic data were retrospectively analyzed in 230 consecutive patients who underwent TAVI and echocardiography at baseline and after 6 months. Echocardiographic parameters included left ventricular ejection fraction (LVEF), left ventricular (LV) stroke volume, early mitral velocity/annulus velocity ratio (E/e'), right ventricular index of myocardial performance, systolic pulmonary artery pressure (SPAP), and aortic, mitral, and tricuspid regurgitation grades. Clinical outcomes included 2-year survival and cardiovascular and PPM-related event-free survival. The Medtronic CoreValve and Edwards Sapien prosthesis were used in 201 and 29 patients, respectively. PPM was required in 58 patients (25.4%). Two-year and event-free survival rates were similar between patients with and without PPM. At 6 months, patients with PPM demonstrated attenuated improvement in LVEF (-0.9 ± 8.7% vs 2.3 ± 10.8%, respectively, p = 0.03) and LV stroke volume (-2 ± 16 vs 4 ± 10 ml/m(2), respectively, p = 0.015), a trend toward smaller reduction in systolic pulmonary artery pressure (-1 ± 12 vs -6 ± 10 mm Hg, respectively, p = 0.09), and deterioration of right ventricular index of myocardial performance (-3 ± 17% vs 5 ± 26%, respectively, p = 0.05). The differences in post-TAVI aortic, mitral, and tricuspid regurgitation grades were insignificant. In conclusion, PPM implantation after TAVI is associated with reduced LVEF and impaired LV unloading. However, this unfavorable hemodynamic response does not affect the 2-year clinical outcome. The maintenance of clinical benefit appears to be driven by TAVI-related recovery of LV and right ventricular performance that mitigates unfavorable impact of PPM. PMID:24210334

  3. Echocardiographic assessment of prosthetic valves.

    PubMed

    Tanabe, Kazuaki

    2015-12-01

    Echocardiographic evaluation of prosthetic valves is similar in many respects to evaluation of native valve disease. However, there are some important differences. First, there are several types of prosthetic valves with different fluid dynamics for each basic design and differing flow velocities for each valve size. Second, the mechanisms of valve dysfunction are somewhat different from those for native valve disease. Third, the technical aspects of imaging artificial devices, specifically the problem of acoustic shadowing, significantly affect the diagnostic approach when prosthetic valve dysfunction is suspected. Fourth, transcatheter aortic valve implantation (TAVI) has rapidly expanded in recent years. Echocardiography plays an essential role in identifying patients suitable for TAVI and providing intra-procedural monitoring, and is the modality for post-procedure follow-up. Both an understanding of the basic approach to echocardiographic evaluation and detailed knowledge of the specific flow dynamics for the size and type of prosthesis in an individual patient are needed for appropriate patient management. PMID:26286254

  4. Health Status after Transcatheter Aortic Valve Replacement in Patients at Extreme Surgical Risk: Results from the CoreValve U.S. Trial

    PubMed Central

    Osnabrugge, Ruben L.; Arnold, Suzanne V.; Reynolds, Matthew R.; Magnuson, Elizabeth A.; Wang, Kaijun; Gaudiani, Vincent A.; Stoler, Robert C.; Burdon, Thomas A.; Kleiman, Neal; Reardon, Michael J.; Adams, David H.; Popma, Jeffrey J.; Cohen, David J.

    2015-01-01

    Objectives To characterize health status outcomes after transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis among patients at extreme surgical risk and to identify pre-procedural patient characteristics associated with a poor outcome. Background For many patients considering TAVR, improvement in quality of life may be of even greater importance than prolonged survival. Methods Patients with severe, symptomatic aortic stenosis who were considered to be at prohibitive risk for surgical aortic valve replacement were enrolled in the single-arm CoreValve U.S. Extreme Risk Study. Health status was assessed at baseline and at 1, 6, and 12 months after TAVR using the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Short-Form-12 (SF-12), and the EuroQol-5D. The overall summary scale of the KCCQ (range 0-100; higher scores = better health) was the primary health status outcome. A poor outcome after TAVR was defined as either death, a KCCQ-overall summary score (KCCQ-OS) <45 or a decline in KCCQ-OS of 10 points at 6-month follow-up. Results A total of 471 patients underwent TAVR via the transfemoral approach, of whom 436 (93%) completed the baseline health status survey. All health status measures demonstrated considerable impairment at baseline. After TAVR, there was substantial improvement in both disease-specific and generic health status measures, with an increase in the KCCQ-OS of 23.9 points (95% confidence interval [CI] 20.3-27.5) at 1 month, 27.4 points (95% CI 24.2-30.6) at 6 months, 27.4 points (95% CI 24.1-30.8) at 12 months, along with substantial increases in SF-12 scores and EQ-5D utilities as well (all p<0.003 compared with baseline). Nonetheless, 39% of patients had a poor outcome after TAVR. Baseline factors independently associated with poor outcome included wheelchair dependency, lower mean aortic valve gradient, prior CABG, oxygen dependency, very high predicted mortality with surgical AVR, and low serum albumin. Conclusions Among patients with severe aortic stenosis, TAVR with a self-expanding bioprosthesis resulted in substantial improvements in both disease-specific and generic health-related quality of life, but there remained a large minority of patients who died or had very poor quality of life despite TAVR. Predictive models based on a combination of clinical factors as well as disability and frailty may provide insight into the optimal patient population for which TAVR is beneficial. PMID:25700755

  5. Predictors of Poor Outcomes After Transcatheter Aortic Valve Replacement: Results from the PARTNER Trial

    PubMed Central

    Arnold, Suzanne V.; Reynolds, Matthew R.; Lei, Yang; Magnuson, Elizabeth A.; Kirtane, Ajay J.; Kodali, Susheel K.; Zajarias, Alan; Thourani, Vinod H.; Green, Philip; Rodés-Cabau, Josep; Beohar, Nirat; Mack, Michael J.; Leon, Martin B.; Cohen, David J.

    2014-01-01

    Background Transcatheter Aortic Valve Replacement (TAVR) has emerged as a less invasive option for valve replacement for high-risk patients with severe aortic stenosis. However, not all patients derive a mortality or quality of life (QoL) benefit from TAVR. As such, we sought to build and validate a prediction model to identify patients at high risk for a poor outcome after TAVR, using a novel definition of outcome that integrates QoL with mortality. Methods and Results We examined QoL and mortality outcomes among 2137 patients who underwent TAVR in the PARTNER randomized trial or the associated continued access registry. QoL was assessed using the Overall Summary Scale of the Kansas City Cardiomyopathy Questionnaire (KCCQ-OS, range 0-100; higher=better) at baseline and at 1, 6, and 12 months. A poor 6-month outcome—defined as death, KCCQ-OS <45, or a decrease in KCCQ-OS by ?10 points compared with baseline—occurred in 704 patients (33%). A multivariable model was constructed using a split-sample design to identify a parsimonious set of covariates to identify patients at high-risk for poor outcome. The resulting model demonstrated adequate discrimination (c-index=0.66) and good calibration with the observed data and performed similarly in the separate validation cohort. Based on pre-procedure characteristics alone, the model identified 211 patients (10% of the population) with a ?50% likelihood of a poor outcome after TAVR. These individuals were more likely to have low body weights, low mean aortic valve gradients, oxygen-dependent lung disease, and poor baseline functional and cognitive status. A second model that explored predictors of poor outcome at 1 year identified similar predictors as the original model and was able to identify 1102 patients (52%) with ?50% likelihood and 178 (8%) with ?70% likelihood of a poor 1-year outcome after TAVR Conclusions Using a large, multicenter cohort of patients undergoing TAVR, we have developed and validated predictive models that can identify patients at high-risk for a poor outcome after TAVR. These models may help guide treatment choices and offer patients realistic expectations of outcomes based on their presenting characteristics. PMID:24958751

  6. Pump Speed Waveform Analysis to Detect Aortic Valve Opening in Patients on Ventricular Assist Device Support.

    PubMed

    Hayward, Christopher; Lim, Choon Pin; Schima, Heinrich; Macdonald, Peter; Moscato, Francesco; Muthiah, Kavitha; Granegger, Marcus

    2015-08-01

    As the aortic valve (AV) opens, the pump pressure head remains constant, which is reflected as a "notch/plateau" in pump pressure and flow signals. However, instantaneous flow estimation may be influenced by friction and is particularly difficult in axial pumps. Therefore, a new method to determine the duration of AV opening based on the area under the curve (AUC) of the power spectral density analysis of pump speed signal was developed. Data from patients implanted with HeartWare HVAD left ventricular assist device were studied at different pump speeds, with simultaneous transthoracic echocardiography in two cohorts. In the first group, pump data of 15 patients were used to investigate the ability to discriminate between an open and closed AV. In the second cohort of a further 13 patients, the duration of AV opening was measured from digitized M-mode images, and the relationship between the AV opening time and the new method assessed. In 14 of the initial 15 patients, AV status could be discriminated using only one threshold for all patients. In the second cohort, gradual speed reduction resulted in aortic valve opening in 12 of the 13 patients. The correlation between AV opening duration and AUC was 0.96?±?0.03. Regression analysis indicated a linear relationship in each of the patients with a small error between the fit and the measured opening time (root mean square error?=?11.0?±?7.6?ms). However, the slopes (69.0?±?52.8) and intercepts (-31.4?±?78.0) varied widely between patients. The sensitivity and specificity for the new method using AUC threshold of 0.95 for aortic valve closure was 95% and 91%, respectively. The newly developed method to detect AV opening not only provides information on the AV status during LVAD support (open/closed) but also gives insight into the duration of AV opening. Because the slope of the relationship varies from patient to patient, initial training and adaptation of the method to each patient seems to be required. PMID:26234450

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

    SciTech Connect

    Nagy, Edit; Department of Cardiology, Karolinska University Hospital, Stockholm ; Caidahl, Kenneth; Department of Clinical Physiology, Karolinska University Hospital, Stockholm ; Franco-Cereceda, Anders; Department of Throracic Surgery, Karolinska University Hospital, Stockholm ; Baeck, Magnus; Department of Cardiology, Karolinska University Hospital, Stockholm

    2012-04-13

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

  8. En bloc aortic and mitral valve replacement and left ventricular outflow tract enlargement using a combined transaortic and trans-septal atrial approach.

    PubMed

    Hassan, Mohammed; Windsor, Jimmy; Ricci, Marco

    2015-12-01

    Aortic and mitral valve replacement with division and reconstruction of the inter-valvular fibrous body has been described in clinical situations involving infective endocarditis, extensive annular calcifications and diminutive valve annuli. Herein, we describe a combined transaortic and trans-septal approach with division of the inter-valvular fibrosa for combined aortic and mitral valve replacement. The reconstruction of the inter-valvular fibrous body, atrial walls and aortic root was carried out using a 'three-patch' technique with bovine pericardium. PMID:26409564

  9. Thoracic Aorta 3D Hemodynamics in Pediatric and Young Adult Patients With Bicuspid Aortic Valve

    PubMed Central

    Allen, Bradley D.; van Ooij, Pim; Barker, Alex J.; Carr, Maria; Gabbour, Maya; Schnell, Susanne; Jarvis, Kelly B.; Carr, James C.; Markl, Michael; Rigsby, Cynthia; Robinson, Joshua D.

    2015-01-01

    Background To evaluate the 3D hemodynamics in the thoracic aorta of pediatric and young adult bicuspid aortic valve (BAV) patients. Methods 4D flow MRI was performed in 30 pediatric and young adult BAV patients (age: 13.9 ± 4.4 (range: [3.4, 20.7]) years old, M:F = 17:13) as part of this Institutional Review Board-approved study. Nomogram-based aortic root Z-scores were calculated to assess aortic dilatation and degree of aortic stenosis (AS) severity was assessed on MRI. Data analysis included calculation of time-averaged systolic 3D wall shear stress (WSSsys) along the entire aorta wall, and regional quantification of maximum and mean WSSsys and peak systolic velocity (velsys) in the ascending aorta (AAo), arch, and descending aorta (DAo). The 4D flow MRI AAo velsys was also compared with echocardiography peak velocity measurements. Results There was a positive correlation with both mean and max AAo WSSsys and peak AAo velsys (mean: r = 0.84, P < 0.001, max: r = 0.94, P < 0.001) and AS (mean: rS = 0.43, P = 0.02, max: rS = 0.70, P < 0.001). AAo peak velocity was significantly higher when measured with echo compared with 4D flow MRI (2.1 ± 0.98 m/s versus 1.27 ± 0.49 m/s, P < 0.001). Conclusion In pediatric and young adult patients with BAV, AS and peak ascending aorta velocity are associated with increased AAo WSS, while aortic dilation, age, and body surface area do not significantly impact AAo hemodynamics. Prospective studies are required to establish the role of WSS as a risk-stratification tool in these patients. PMID:25644073

  10. [Technologies for cardiac valve prostheses].

    PubMed

    Nakano, Kiyoharu

    2009-07-01

    To show the technological development of cardiac valve prostheses, a historical review of both mechanical and biological valve prostheses and a current overview of modern cardiac valve devices are provided. Scince the 1st implantation of Starr-Edwards ball valve in 1960, both mechanical and biological valve prostheses have advanced. The valve design, the material of the leaflet and the hausing of mechanical prostheses have improved. Currently, the majority of the mechanical prostheses are bileaflet tilting disc valves made of pyrolytic carbon, which is antithromboembolic. However, anticoagulation therapy with warfarin is still required. As for the bioprostheses, although the fixation and anti-mineralization methods of the tissues improved, the durability of these valves is still limited. For the material of the current biological valves, the porcine aortic valve or bovine pericardium are used. The tissues are fixed by non-pressure or low-pressure method in glutaraldehyde solution. A stented and non-stented valves are available. Epoch-making events in this field are the implantation of new bioprosthetic valves using tissue engineering methods and the development of the transcatheter valve replacement therapies. PMID:20715694

  11. [Infective endocarditis of pulmonary valve. Considerations apropos of a case associated with interventricular communication and aortic insufficiency ].

    PubMed

    Branco, L M; Agapito, A F; Oliveira, J A; Gonçalves, J M; Quininha, J; Velho, H V; Pereira, A J; Ferreira, M L; Antunes, A M; Bento, R

    1990-03-01

    We report the case of a 23 year old patient in whom heart disease was detected in childhood. He began to have suddenly fever and symptoms of right side heart failure. There were signs of aortic regurgitation, a systodiastolic murmur in the left parasternal region and a diastolic murmur in the left 4th intercostal space. The bidimensional and Doppler Echocardiogram showed a saccular dilatation in the right ventricular outflow tract. He was submitted to catheterisation which confirmed aortic regurgitation and detected ventricular septal defect and pulmonary hypertension. During surgery, a subaortic ventricular septal defect was seen as well as a dilatation of the right coronary aortic cusp which prolapsed through the defect to the right ventricular outflow tract. Vegetations were seen in the pulmonary valve. The aortic valve and a pulmonary cusp were excised and a Björk Shiley aortic prosthetic valve was inserted. The septal defect was closed. The patient is still alive, symptomless, with 40 months of follow up. We discuss some problems related to this case, particularly the surgical indication and the rarity of the morphology discovered. PMID:2390283

  12. Morphological and Chemical Study of Pathological Deposits in Human Aortic and Mitral Valve Stenosis: A Biomineralogical Contribution

    PubMed Central

    Cottignoli, Valentina; Salvador, Loris; Valfré, Carlo

    2015-01-01

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

  13. Impact of secondary hyperparathyroidism on ventricular mass regression after aortic valve replacement for aortic stenosis in hemodialysis-dependent patients.

    PubMed

    Takami, Yoshiyuki; Tajima, Kazuyoshi

    2015-07-01

    In hemodialysis (HD)-dependent patients, secondary hyperparathyroidism induces cardiac hypertrophy. This study investigated whether parathyroid hormone (PTH) levels affect the degree of left ventricular (LV) mass regression in HD patients after aortic valve replacement (AVR) for aortic stenosis (AS). We retrospectively obtained preoperative and 2-year postoperative echocardiography and intact PTH measurements in 88 HD patients who underwent AVR, with bioprostheses (n = 35, 40%) and mechanical valves (n = 53, 60%) of effective orifice area >0.80 cm2/m2, between January 1997 and December 2010. The LV mass decreased significantly from 308 ± 88 to 217 ± 68 g at follow-up of 28 ± 4 months after AVR (p < 0.001). The LV mass regression at follow-up was inversely related to preoperative PTH values (R = 0.44, p = 0.001). The LV mass regression at follow-up was significantly smaller in the patients (n = 47) with PTH ?100 pg/mL than in those (n = 41) with PTH <100 pg/mL throughout the study period (61 ± 75 versus 108 ± 49 g, p < 0.0001). After adjusting for female sex, hypertension, and baseline LV mass, high PTH values were found to be independent predictor of less LV mass regression at 2-year follow-up (? = 0.23, r2 = 0.24, p = 0.02). In conclusion, the HD patients with high levels of PTH presented with less LV mass regression after AVR for AS without patient-prosthesis mismatch. Secondary hyperparathyroidism may impair regression of cardiac hypertrophy after AVR in HD patients with AS. PMID:24760625

  14. Biological Niches within Human Calcified Aortic Valves: Towards Understanding of the Pathological Biomineralization Process

    PubMed Central

    Cottignoli, Valentina; Relucenti, Michela; Agrosì, Giovanna; Cavarretta, Elena; Familiari, Giuseppe; Salvador, Loris; Maras, Adriana

    2015-01-01

    Despite recent advances, mineralization site, its microarchitecture, and composition in calcific heart valve remain poorly understood. A multiscale investigation, using scanning electron microscopy (SEM), transmission electron microscopy (TEM), and energy dispersive X-ray spectrometry (EDS), from micrometre up to nanometre, was conducted on human severely calcified aortic and mitral valves, to provide new insights into calcification process. Our aim was to evaluate the spatial relationship existing between bioapatite crystals, their local growing microenvironment, and the presence of a hierarchical architecture. Here we detected the presence of bioapatite crystals in two different mineralization sites that suggest the action of two different growth processes: a pathological crystallization process that occurs in biological niches and is ascribed to a purely physicochemical process and a matrix-mediated mineralized process in which the extracellular matrix acts as the template for a site-directed nanocrystals nucleation. Different shapes of bioapatite crystallization were observed at micrometer scale in each microenvironment but at the nanoscale level crystals appear to be made up by the same subunits. PMID:26509159

  15. Biological Niches within Human Calcified Aortic Valves: Towards Understanding of the Pathological Biomineralization Process.

    PubMed

    Cottignoli, Valentina; Relucenti, Michela; Agrosì, Giovanna; Cavarretta, Elena; Familiari, Giuseppe; Salvador, Loris; Maras, Adriana

    2015-01-01

    Despite recent advances, mineralization site, its microarchitecture, and composition in calcific heart valve remain poorly understood. A multiscale investigation, using scanning electron microscopy (SEM), transmission electron microscopy (TEM), and energy dispersive X-ray spectrometry (EDS), from micrometre up to nanometre, was conducted on human severely calcified aortic and mitral valves, to provide new insights into calcification process. Our aim was to evaluate the spatial relationship existing between bioapatite crystals, their local growing microenvironment, and the presence of a hierarchical architecture. Here we detected the presence of bioapatite crystals in two different mineralization sites that suggest the action of two different growth processes: a pathological crystallization process that occurs in biological niches and is ascribed to a purely physicochemical process and a matrix-mediated mineralized process in which the extracellular matrix acts as the template for a site-directed nanocrystals nucleation. Different shapes of bioapatite crystallization were observed at micrometer scale in each microenvironment but at the nanoscale level crystals appear to be made up by the same subunits. PMID:26509159

  16. Aortic regurgitation and mitral valve prolapse with Down's syndrome: a case-control study.

    PubMed

    Goldhaber, S Z; Brown, W D; Robertson, N; Rubin, I L; Sutton, M G

    1988-08-01

    This case-control study was designed to determine whether aortic regurgitation (AR) and mitral valve prolapse (MVP) are specifically associated with Down's syndrome, or occur in a comparably retarded population without Down's syndrome. The 92 control subjects resided at the same institution as the 131 cases, and had mental retardation attributable to low birth weight or perinatal asphyxia. Mean (+/- SD) ages of the cases and the control group were 41 +/- 11 years compared with 40 +/- 13 years, respectively. The relative risk of AR among the cases (those with Down's syndrome) was 2.9 (95% confidence interval, 0.65-13.2; P = 0.16) and that of MVP was 3.5 (95% confidence interval, 1.2-10.2; P = 0.02). The results showed that these two valvular abnormalities are specifically associated with Down's syndrome in adults. PMID:2975337

  17. The silent and apparent neurological injury in transcatheter aortic valve implantation study (SANITY): concept, design and rationale

    PubMed Central

    2014-01-01

    Background The incidence of clinically apparent stroke in transcatheter aortic valve implantation (TAVI) exceeds that of any other procedure performed by interventional cardiologists and, in the index admission, occurs more than twice as frequently with TAVI than with surgical aortic valve replacement (SAVR). However, this represents only a small component of the vast burden of neurological injury that occurs during TAVI, with recent evidence suggesting that many strokes are clinically silent or only subtly apparent. Additionally, insult may manifest as slight neurocognitive dysfunction rather than overt neurological deficits. Characterisation of the incidence and underlying aetiology of these neurological events may lead to identification of currently unrecognised neuroprotective strategies. Methods The Silent and Apparent Neurological Injury in TAVI (SANITY) Study is a prospective, multicentre, observational study comparing the incidence of neurological injury after TAVI versus SAVR. It introduces an intensive, standardised, formal neurologic and neurocognitive disease assessment for all aortic valve recipients, regardless of intervention (SAVR, TAVI), valve-type (bioprosthetic, Edwards SAPIEN-XT) or access route (sternotomy, transfemoral, transapical or transaortic). Comprehensive monitoring of neurological insult will also be recorded to more fully define and compare the neurological burden of the procedures and identify targets for harm minimisation strategies. Discussion The SANITY study undertakes the most rigorous assessment of neurological injury reported in the literature to date. It attempts to accurately characterise the insult and sustained injury associated with both TAVI and SAVR in an attempt to advance understanding of this complication and associations thus allowing for improved patient selection and procedural modification. PMID:24708720

  18. Intracardiac echocardiography for guidance of transcatheter aortic valve implantation under monitored sedation: a solution to a dilemma?

    PubMed

    Bartel, Thomas; Edris, Ahmad; Velik-Salchner, Corinna; Müller, Silvana

    2016-01-01

    Transcatheter aortic valve implantation (TAVI) has been established as a valuable alternative to surgical aortic valve replacement in patients deemed to have high or prohibitive perioperative risk. However, there are several technical constraints and procedural risks inherent to TAVI. These risks include annulus rupture, ventricular perforation, aortic dissection, coronary occlusion, and dislodgement or migration of the valve prosthesis to the aorta or the left ventricle (LV). Other complications may be related to inappropriate valve deployment and subsequent paravalvular leak. Most complications cannot be detected at an early stage without echocardiographic guidance. Although not addressed by current guidelines, some European centres have advocated a 'minimalist' approach with exclusively fluoroscopic and angiographic guidance. Transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging, has been established as a standard approach for peri-interventional guidance of TAVI. However, TEE monitoring almost always necessitates general anaesthesia and endotracheal intubation. A potential alternative to TEE is intracardiac echocardiography (ICE) that may provide a solution to a common dilemma: the most important advantage of ICE being the compatibility with monitored anaesthesia care without endotracheal intubation. Other advantages of ICE include uninterrupted monitoring, no fluoroscopic interference, and precise Doppler-based assessment of pulmonary artery pressures. Limitations of ICE include the need for additional venous access, the learning curve associated with a new device, and potentially increased cost. PMID:26497737

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

    PubMed

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

    2009-12-01

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

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

    SciTech Connect

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

    2009-04-15

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

  1. Local versus general anesthesia for transcatheter aortic valve implantation (TAVR) – systematic review and meta-analysis

    PubMed Central

    2014-01-01

    Background The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR). TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported. Methods This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals. Results Seven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P?=?0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P <0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P?=?0.460), also cardiac- and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P?=?0.830). Conclusion These data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR. PMID:24612945

  2. Causes of Death Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

    PubMed Central

    Xiong, Tian-Yuan; Liao, Yan-Biao; Zhao, Zhen-Gang; Xu, Yuan-Ning; Wei, Xin; Zuo, Zhi-Liang; Li, Yi-Jian; Cao, Jia-Yu; Tang, Hong; Jilaihawi, Hasan; Feng, Yuan; Chen, Mao

    2015-01-01

    Background Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death. Methods and Results The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005). Conclusions Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR. PMID:26391132

  3. Meta-analysis of the impact of mitral regurgitation on outcomes after transcatheter aortic valve implantation.

    PubMed

    Chakravarty, Tarun; Van Belle, Eric; Jilaihawi, Hasan; Noheria, Amit; Testa, Luca; Bedogni, Francesco; Rück, Andreas; Barbanti, Marco; Toggweiler, Stefan; Thomas, Martyn; Khawaja, Muhammed Zeeshan; Hutter, Andrea; Abramowitz, Yigal; Siegel, Robert J; Cheng, Wen; Webb, John; Leon, Martin B; Makkar, Raj R

    2015-04-01

    Significant mitral regurgitation (MR) constitutes an important co-existing valvular heart disease burden in the setting of aortic valve stenosis. There are conflicting reports on the impact of significant MR on outcomes after transcatheter aortic valve implantation (TAVI). We evaluated the impact of MR on outcomes after TAVI by performing a meta-analysis of 8 studies involving 8,927 patients reporting TAVI outcomes based on the presence or absence of moderate-severe MR. Risk ratios (RRs) were calculated using the inverse variance random-effects model. None-mild MR was present in 77.8% and moderate-severe MR in 22.2% of the patients. The presence of moderate-severe MR at baseline was associated with increased mortality at 30 days (RR 1.35, 95% confidence interval [CI] 1.14 to 1.59, p = 0.003) and 1 year (RR 1.24, 95% CI 1.13 to 1.37, p <0.0001). The increased mortality associated with moderate-severe MR was not influenced by the cause of MR (functional or degenerative MR; RR 0.90, 95% CI 0.62 to 1.30, p = 0.56). The severity of MR improved in 61 ± 6.0% of patients after TAVI. Moderate-severe residual MR, compared with none-mild residual MR after TAVI, was associated with significantly increased 1-year mortality (RR 1.48, 95% CI 1.31 to 1.68, p <0.00001). In conclusion, baseline moderate-severe MR and significant residual MR after TAVI are associated with an increase in mortality after TAVI and represent an important group to target with medical or transcatheter therapies in the future. PMID:25779617

  4. Computational Fluid Dynamic Analysis to Prevent Aortic Root and Valve Clots during Left Ventricular Assist Device Support

    PubMed Central

    Poullis, Michael

    2012-01-01

    Abstract: Aortic root and valve clots are rare but well described in patients on maximal left ventricular assist device (LVAD) support. We performed a theoretical analysis using computational fluid dynamic analyses in two dimensions to try and ascertain if inflow cannula design/orientation/placement affect aortic root flow dynamics. Two-dimensional computational fluid dynamics using easy CFD-G was performed. The effect of a curved inflow cannula, a straight cannula, and one with a hole in the outer curve was analyzed. In addition, the effect of inflow conduit angulation on the ascending aorta was studied. Computational fluid dynamic (CFD) analysis predicts that stagnant blood exists in the aortic root when little or no cardiac ejection is taking place. Coronary flow is too small to affect the root flow streamlines. A hole on the root side of a curved inflow aortic cannula increases the flow in the aortic root and may decrease the incidence of root and valve thrombosis. The angle of the inflow conduit attachment to the ascending aorta was also found to be crucial with regard to aortic root blood stasis. In addition, a baffle at the tip of the inflow cannula may prove to be beneficial. Theoretical analysis using the technique of CFD predicts that inflow cannula position and design may affect the incidence of aortic root thrombosis during LVAD support when minimal cardiac ejection is occurring. PMID:23441562

  5. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...false Valve locks, valves, and valve magnets. 236.383 Section 236.383 Transportation...383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off...every three months, and valves and valve magnets shall be tested at least once every...

  6. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...false Valve locks, valves, and valve magnets. 236.383 Section 236.383 Transportation...383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off...every three months, and valves and valve magnets shall be tested at least once every...

  7. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...false Valve locks, valves, and valve magnets. 236.383 Section 236.383 Transportation...383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off...every three months, and valves and valve magnets shall be tested at least once every...

  8. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...false Valve locks, valves, and valve magnets. 236.383 Section 236.383 Transportation...383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off...every three months, and valves and valve magnets shall be tested at least once every...

  9. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...false Valve locks, valves, and valve magnets. 236.383 Section 236.383 Transportation...383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off...every three months, and valves and valve magnets shall be tested at least once every...

  10. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Valve locks, valves, and valve magnets. 236.383... Inspection and Tests § 236.383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off type shall be tested at least once every three months, and valves and valve magnets shall...

  11. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Valve locks, valves, and valve magnets. 236.383... Inspection and Tests § 236.383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off type shall be tested at least once every three months, and valves and valve magnets shall...

  12. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Valve locks, valves, and valve magnets. 236.383... Inspection and Tests § 236.383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off type shall be tested at least once every three months, and valves and valve magnets shall...

  13. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Valve locks, valves, and valve magnets. 236.383... Inspection and Tests § 236.383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off type shall be tested at least once every three months, and valves and valve magnets shall...

  14. 49 CFR 236.383 - Valve locks, valves, and valve magnets.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Valve locks, valves, and valve magnets. 236.383... Inspection and Tests § 236.383 Valve locks, valves, and valve magnets. Valve locks on valves of the non-cut-off type shall be tested at least once every three months, and valves and valve magnets shall...

  15. Piezoelectric valve

    DOEpatents

    Petrenko, Serhiy Fedorovich

    2013-01-15

    A motorized valve has a housing having an inlet and an outlet to be connected to a pipeline, a saddle connected with the housing, a turn plug having a rod, the turn plug cooperating with the saddle, and a drive for turning the valve body and formed as a piezoelectric drive, the piezoelectric drive including a piezoelectric generator of radially directed standing acoustic waves, which is connected with the housing and is connectable with a pulse current source, and a rotor operatively connected with the piezoelectric generator and kinematically connected with the rod of the turn plug so as to turn the turn plug when the rotor is actuated by the piezoelectric generator.

  16. Matched Comparison of Two Different Biological Prostheses for Complete Supra-annular Aortic Valve Replacement.

    PubMed

    Fiegl, Kathrin; Deutsch, Marcus-Andre; Rondak, Ina-Christine; Lange, Ruediger; Guenzinger, Ralf

    2015-09-01

    Objective?The aim of this retrospective study was to evaluate the hemodynamic performance of the St. Jude Medical Trifecta (SJM Trifecta; St. Jude Medical, St Paul, Minnesota, United States) and the Carpentier-Edwards Perimount Magna Ease (CEPM Ease; Edwards Lifesciences, Irvine, California, United States) bioprostheses early postoperative and at 1 year. Methods?From October 2007 to October 2008, a total of 61 consecutive patients underwent aortic valve replacement (AVR) with the CEPM Ease prosthesis. From a prospective cohort of 201 patients (March 2011 to January 2012) who received AVR with the SJM Trifecta valve, a matched group of 51 patients was selected. Matching was conducted 1:1 by ejection fraction, gender, age, and body surface area. A Hegar dilator was used to define the aortic tissue annulus diameter. Data were grouped on the basis of the patient's tissue annulus diameter (?22?mm; 23-24?mm; ?25 mm). Results?Early postoperative and at 1?year mean pressure gradients (MPGs) in the various groups ranged from 7.2?±?4.6 to 7.1?±?2.4?mm Hg and from 10.0?±?4.3 to 8.0?±?2.8?mm Hg in the SJM Trifecta group and from 18.0?±?5.0 to 12.1?±?3.6?mm Hg and from 17.7?±?4.5 to 11.8?±?3.2?mm Hg in the CEPM Ease group, respectively. Likewise, effective orifice areas (EOAs) ranged from 1.7?±?0.5 to 2.0?±?0.5 cm(2) and from 1.5?±?0.3 to 1.7?±?0.4 cm(2) in the SJM Trifecta group and from 1.3?±?0.5 to 1.9?±?0.5 cm(2) and from 1.2?±?0.3 to 1.8?±?0.3 cm(2) in the CEPM Ease group, respectively. A marked left ventricular mass (LVM) regression across all annulus sizes was noted in both groups. Severe patient-prosthesis mismatch (PPM) was infrequent overall. Conclusion?The SJM Trifecta valve showed lower MPGs early postoperative and at 1?year as well as higher EOA and effective orifice area index early postoperative. No significant differences were detected with regard to LVM regression and PPM. PMID:25893918

  17. High implantation technique during CoreValve replacement in a high-risk aortic stenosis patient with a sigmoid left ventricular hypertrophy and a large aortic annulus.

    PubMed

    K?l?ç, Teoman; Ural, Ertan; Yavuz, ?adan; Ho?ten, Tülay; ?nce, Hüseyin

    2015-04-01

    The appropriate size, accurate alignment and correct positioning of transcatheter aortic valves (TAVIs) at the point of deployment are emphasized as key factors in placement and fixation of the devices. Presence of a sigmoid left ventricular septum in the patient is one of the important limitations of TAVIs, especially with the Edwards-Sapien Valve (ESV), due to the risk of aortic embolization of the prosthesis. In cases of a pronounced sigmoid septum, transapical implantation of the ESV or the usage of a Medtronic CoreValve (MCV) is generally recommended. However, severe left ventricular hypertrophy and sigmoid septum are also risk factors for the development of conduction disturbances with the usage of MCV. The depth of implantation of MCV within the left ventricular outflow tract and larger or significantly oversized prostheses have also been reported as important predictors of permanent pacemaker (PPM) requirement after MCV implantation. Thus, recent reports indicate that there may be less need for a PPM if a high implantation technique is used to place the MCV at a short implantation depth. In this report, we present the high implantation technique under rapid pacing during transcatheter aortic MCV implantation in a surgically high-risk aortic stenosis patient with sigmoid left ventricular hypertrophy and a large aortic annulus. PMID:25906000

  18. Opening of Aortic Valve During Exercise Is Key to Preventing Development of Aortic Insufficiency During Ventricular Assist Device Treatment.

    PubMed

    Imamura, Teruhiko; Kinugawa, Koichiro; Nitta, Daisuke; Hatano, Masaru; Ono, Minoru

    2015-01-01

    Although we previously demonstrated that opening of the native aortic valve (AV) at rest prevents development of aortic insufficiency (AI) during continuous-flow (CF) left ventricular assist device (LVAD) support, the clinical impact of native AV opening during exercise remained unknown. We enrolled 37 patients with a closed native AV at rest 3 months after CF LVAD implantation and followed them from 2006 to 2014. Seven patients (19%) who achieved opening of the native AV during cardiopulmonary exercise testing at 3 months (opening AV group) had higher exercise tolerability and improved left ventricular contractility during exercise compared with those with a closed native AV (closed AV group) (p < 0.05 for all). The opening group experienced no AI at 6 months and had a higher readmission-free rate because of cardiovascular events compared with the closed group during the 2 years study period (100% vs. 56%, p = 0.005). Among those with a closed AV, use of the centrifugal pump was a significant predictor of AI-free status (p < 0.05; odds ratio, 5.400). In conclusion, opening of the native AV during exercise and centrifugal pump use were key to preventing the development of AI. Aggressive cardiac rehabilitation may have a prophylactic impact on development of AI during CF LVAD treatment. PMID:25955152

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

    PubMed Central

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

    2005-01-01

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

  20. CT-Angiography–Based Evaluation of the Aortic Annulus for Prosthesis Sizing in Transcatheter Aortic Valve Implantation (TAVI)–Predictive Value and Optimal Thresholds for Major Anatomic Parameters

    PubMed Central

    Schwarz, Florian; Lange, Philipp; Zinsser, Dominik; Greif, Martin; Boekstegers, Peter; Schmitz, Christoph; Reiser, Maximilian F.; Kupatt, Christian; Becker, Hans C.

    2014-01-01

    Background/Objectives To evaluate the predictive value of CT-derived measurements of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI) and to calculate optimal cutoff values for the selection of various prosthesis sizes. Methods The local IRB waived approval for this single-center retrospective analysis. Of 441 consecutive TAVI-patients, 90 were excluded (death within 30 days: 13; more than mild aortic regurgitation: 10; other reasons: 67). In the remaining 351 patients, the CoreValve (Medtronic) and the Edwards Sapien XT valve (Edwards Lifesciences) were implanted in 235 and 116 patients. Optimal prosthesis size was determined during TAVI by inflation of a balloon catheter at the aortic annulus. All patients had undergone CT-angiography of the heart or body trunk prior to TAVI. Using these datasets, the diameter of the long and short axis as well as the circumference and the area of the aortic annulus were measured. Multi-Class Receiver-Operator-Curve analyses were used to determine the predictive value of all variables and to define optimal cutoff-values. Results Differences between patients who underwent implantation of the small, medium or large prosthesis were significant for all except the large vs. medium CoreValve (all p’s<0.05). Furthermore, mean diameter, annulus area and circumference had equally high predictive value for prosthesis size for both manufacturers (multi-class AUC’s: 0.80, 0.88, 0.91, 0.88, 0.88, 0.89). Using the calculated optimal cutoff-values, prosthesis size is predicted correctly in 85% of cases. Conclusion CT-based aortic root measurements permit excellent prediction of the prosthesis size considered optimal during TAVI. PMID:25084451

  1. Plasma valve

    DOEpatents

    Hershcovitch, Ady (Mount Sinai, NY); Sharma, Sushil (Hinsdale, IL); Noonan, John (Naperville, IL); Rotela, Elbio (Clarendon Hills, IL); Khounsary, Ali (Hinsdale, IL)

    2003-01-01

    A plasma valve includes a confinement channel and primary anode and cathode disposed therein. An ignition cathode is disposed adjacent the primary cathode. Power supplies are joined to the cathodes and anode for rapidly igniting and maintaining a plasma in the channel for preventing leakage of atmospheric pressure through the channel.

  2. Kytococcus schroeteri prosthetic valve endocarditis

    PubMed Central

    Yousri, Taher; Hawari, Mohammad; Saad, Rasheed; Langley, Steve

    2010-01-01

    We report the case of a 64-year-old male patient with a prosthetic aortic valve who presented with clinical features of endocarditis confirmed by transoesophageal echocardiography. His blood cultures were positive for a very rare and newly described organism—Kytococcus schroeteri. The patient underwent aortic valve replacement and a 6-week course of intravenous antibiotics. This is the fifth reported case of endocarditis associated with this organism. PMID:22778375

  3. Association Between Shear Stress and Platelet-derived TGF-?1 Release and Activation in Animal Models of Aortic Valve Stenosis

    PubMed Central

    Wang, Wei; Vootukuri, Spandana; Meyer, Alexander; Ahamed, Jasimuddin; Coller, Barry S.

    2014-01-01

    Objective Aortic valve stenosis (AS) is characterized by fibrosis and calcification of valves leading to aortic valve (AV) narrowing, resulting in high wall shear stress (WSS) across the valves. We previously demonstrated that high shear stress can activate platelet-derived transforming growth factor-?1 (TGF-?1), a cytokine implicated inducing fibrosis and calcification. The aim of this study was to invest the role of shear-induced platelet release of TGF-?1 and its activation in AS. Approach and Results We studied hypercholesterolemic Ldlr?/?Apob100/100/Mttpfl/fl/Mx1Cre+/+ (Reversa) mice that develop AS on western diet (WD) and a surgical ascending aortic constriction (AAC) mouse model that acutely simulates the hemodynamics of AS to study shear-induced platelet TGF-?1 release and activation. Reversa mice on WD for 6 months had thickening of the AVs, increased WSS and increased plasma TGF-?1 levels. There were weak and moderate correlations between WSS and TGF-?1 levels in the progression and reversed Reversa groups, and a stronger correlation in the AAC model in WT mice, but not in mice with a targeted deletion of megakaryocyte and platelet TGF-?1 (Tgfb1flox). Plasma total TGF-?1 levels correlated with collagen deposition in the stenotic valves in Reversa mice. Although active TGF-?1 levels were too low to be measured directly, we found: 1. canonical TGF-?1 (p-Smad2/3) signaling in the leukocytes and canonical and non-canonical (p-Erk1/2) TGF-?1 signaling in AVs of Reversa mice on a WD, and 2. TGF-?1 signaling of both pathways in the AAC stenotic area in WT, but not Tgfb1flox mice. Conclusions Shear-induced, platelet-derived TGF-?1 activation may contribute to AS. PMID:24903096

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

    PubMed Central

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

    2015-01-01

    Understanding the role of mechanical forces on cell behavior is critical for tissue engineering, regenerative medicine, and disease initiation studies. Current hemodynamic bioreactors are largely limited to 2D substrates or the application of general flow conditions at a tissue level, which eliminates the investigation of some essential physiological and pathological responses. One example is the mesenchymal transformation of endothelial cells in response to shear stress. Endothelial to mesenchymal transformation (EndMT) is a valve morphogenic mechanism associated with aortic valve disease initiation. The aortic valve experiences oscillatory shear on the disease-susceptible fibrosa, and the role of hemodynamics on adult EndMT is unknown. The goal of this work was to develop and characterize a microfluidic bioreactor that applies physiologically relevant laminar or oscillatory shear stresses to endothelial cells and permits the quantitative analysis of 3D cell-extracellular matrix (ECM) interactions. In this study, porcine aortic valve endothelial cells were seeded onto 3D collagen I gels and exposed to different magnitudes of steady or oscillatory shear stress for 48 hours. Cells elongated and aligned perpendicular to laminar, but not oscillatory shear. Low steady shear stress (2 dyne/cm2) and oscillatory shear stress upregulated EndMT- (ACTA2, Snail, TGFB1) and inflammation- (ICAM1, NFKB1) related gene expression, EndMT-related (?SMA) protein expression, and matrix invasion when compared with static controls or cells exposed to high steady shear (10 and 20 dyne/cm2). Our system enables direct testing of the role of shear stress on endothelial cell mesenchymal transformation in a dynamic, 3D environment and shows that hemodynamics regulate EndMT in adult valve endothelial cells. PMID:24898772

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

    PubMed

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-06-01

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

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

    PubMed Central

    Kolakalapudi, Pavani; Chaudhry, Sadaf; Omar, Bassam

    2015-01-01

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

  7. Outcomes of Patients at Estimated Low, Intermediate, and High Risk Undergoing Transcatheter Aortic Valve Implantation for Aortic Stenosis.

    PubMed

    Barbash, Israel Moshe; Finkelstein, Ariel; Barsheshet, Alon; Segev, Amit; Steinvil, Arie; Assali, Abid; Ben Gal, Yanai; Vaknin Assa, Hana; Fefer, Paul; Sagie, Alex; Guetta, Victor; Kornowski, Ran

    2015-12-15

    Intermediate- or low-risk patients with severe aortic stenosis were excluded from earlier transcatheter aortic valve implantation (TAVI) clinical trials; however, they are already being treated by TAVI despite a lack of data regarding the safety and efficacy in these patients. We aimed to assess the safety and efficacy of TAVI in patients at intermediate or low risk. Patients undergoing TAVI during 2008 to 2014 were included into a shared database (n = 1,327). Procedural outcomes were adjudicated according to Valve Academic Research Consortium 2 definitions. Patients were stratified according to their Society of Thoracic Surgeons (STS) score into 3 groups: high (STS ?8, n = 223, 17%), intermediate (STS 4 to 8; n = 496, 38%), or low risk (STS <4; n = 576, 45%). Low-risk patients were significantly younger and more likely to be men compared to intermediate- and high-risk patients. Baseline characteristics differed significantly between the groups with a gradual increase in the rates of previous bypass surgery, stroke, peripheral vascular disease, renal failure, lung disease, and frailty scores, from low to high risk groups. Compared with intermediate- and high-risk patients, low-risk patients were more likely to undergo TAVI through the transfemoral route (81% vs 88% vs 95%, p <0.001) and under conscious sedation (69% vs 72% vs 81%, <0.001). There were no significant differences in the rates of procedural complications apart from acute kidney injury (19% vs 17% vs 13%, p = 0.03) and stroke rates (4.5% vs 2% vs 2.3%, p = 0.1). Short- and long-term mortality rates were significantly higher for intermediate- (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.2 to 2.9) and high-risk patients (HR 4.1, 95% CI 2.7 to 6.4) than low-risk patients also after multivariate adjustment (HR 1.6, 95% CI 1 to 2.6 and HR 2.7, 95% CI 1.7 to 4.5, respectively; all p <0.05). In conclusion, TAVI for intermediate- and low-risk patients is safe and associated with improved outcome compared with high-risk patients. PMID:26602076

  8. Vascular Complications and Bleeding After Transfemoral Transcatheter Aortic Valve Implantation Performed Through Open Surgical Access.

    PubMed

    Leclercq, Florence; Akodad, Mariama; Macia, Jean-Christophe; Gandet, Thomas; Lattuca, Benoit; Schmutz, Laurent; Gervasoni, Richard; Nogue, Erika; Nagot, Nicolas; Levy, Gilles; Maupas, Eric; Robert, Gabriel; Targosz, Frederic; Vernhet, Hélène; Cayla, Guillaume; Albat, Bernard

    2015-11-01

    Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p <0.001). Mortality at 1-month and 1-year follow-up (n = 26, 6.6%; and n = 67, 17.2%, respectively) was not related to major or minor VC (p = 0.6). In multivariable analysis, only diabetes (odds ratio 2.5, 95% confidence interval 1.1 to 6.1, p = 0.034) and chronic kidney failure (odds ratio 3.0, 95% confidence interval 1.0 to 9.0, p = 0.046) were predictive of VC, whereas body mass index, gender, Euroscore, and lower limb arteriopathy were not. In conclusion, minimal rate of VC and bleeding can be obtained after transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients. PMID:26414600

  9. Fibroblast growth factor 23 and parathyroid hormone predict extent of aortic valve calcifications in patients with mild to moderate chronic kidney disease

    PubMed Central

    Di Lullo, Luca; Gorini, Antonio; Bellasi, Antonio; Morrone, Luigi F.; Rivera, Rodolfo; Russo, Luigi; Santoboni, Alberto; Russo, Domenico

    2015-01-01

    Background Cardiac valve calcifications are present in dialysis patients and regarded as dependent on a deranged mineral metabolism. Few data are available for patients with chronic kidney disease (CKD) not on dialysis. This study evaluates the potential association between the extent of cardiac valve calcification and levels of intact parathyroid hormone (i-PTH), phosphorus, calcium, 25-OH vitamin D, fibroblast growth factor 23 (FGF-23), Klotho and C-reactive protein (CRP) simultaneously measured in patients with mild to moderate CKD. Methods Consecutive non-hospitalized patients referring to five nephrology units were evaluated. Inclusion criteria were age >18 years, CKD Stages 3–4, and the presence of aortic and/or mitral valve calcification assessed by echocardiography as routinely clinical evaluation. Patients underwent clinical examination and routine biochemistry. Baseline i-PTH, phosphorus, calcium, 25-OH vitamin D, FGF-23, Klotho and CRP were simultaneously ascertained. Results Extent of aortic valve calcification (n = 100 patients) was moderate in 68 patients and mild in the remaining patients. Mitral valve calcification (n = 96 patients) score was 1, 2 and 3 in 61, 34 and 1 patients, respectively. In univariate analysis, no association was found between extent of mitral valve calcification and markers of mineral metabolism and CRP; aortic valve extent of calcification was positively associated with i-PTH (r2 = 0.212; P = 0.03) and FGF-23 (r2 = 0.272; P = 0.01), and negatively with Klotho (r2 = ?0.208; P = 0.04). In multivariable analysis, extent of aortic valve calcification was associated with FGF-23 (P = 0.01) and PTH (P = 0.01) levels. Conclusions Extent of aortic valve calcification is associated to FGF-23 and PTH in naïve CKD patients with mild to moderate CKD. Further studies should examine whether FGF-23 assay should be included in routine clinical evaluation of CKD as part of cardiovascular risk stratification. PMID:26613033

  10. Impact of atrial fibrillation on outcomes in patients who underwent transcatheter aortic valve replacement.

    PubMed

    Maan, Abhishek; Heist, E Kevin; Passeri, Jonathan; Inglessis, Ignacio; Baker, Joshua; Ptaszek, Leon; Vlahakes, Gus; Ruskin, Jeremy N; Palacios, Igor; Sundt, Thoralf; Mansour, Moussa

    2015-01-15

    Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgical high-risk patients with severe aortic stenosis. The aim of this study was to determine the impact of atrial fibrillation (AF) on procedural outcomes. Data from 137 patients who underwent TAVR using Edwards SAPIEN valve were reviewed. The predictors of new-onset atrial fibrillation (NOAF) after the procedure were analyzed. In addition, the post-TAVR clinical outcomes and adverse events were compared according to the presence and absence of preprocedural and postprocedural AF. Previous AF was present in 49% of the patients who underwent TAVR. After the procedure, NOAF was detected in 21% of patients, and the cumulative incidence of post-TAVR AF was 60%. After TAVR, 50% of all the episodes of NOAF occurred in the initial 24 hours after the procedure. Transapical approach was observed to an important predictor of NOAF (adjusted odds ratio [OR] 5.05, 95% confidence interval [CI] 1.40 to 18.20, p = 0.013). The composite outcome of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after TAVR was significantly higher in patients with previous AF (33 of 67 vs 19 of 70, adjusted OR 2.60, 95% CI 1.22 to 5.54, p = 0.013) compared with patients who did not have previous AF. The presence of post-TAVR AF led to a prolongation in the duration of intensive care unit stay by an average of 70 hours (95% CI 25 to 114.7 hours, p = 0.002). Similarly, post-TAVR AF also led to the prolongation in the hospital stay by an average of 6.7 days (95% CI 4.69 to 8.73 days, p <0.0005). In conclusion, our study demonstrates that the presence of AF before TAVR is an important predictor of the composite end point of all-cause mortality, stroke, vascular complications, and repeat hospitalization in 1 month after the procedure. AF after TAVR is more likely to be encountered with the transapical approach and is associated with a prolongation of intensive care unit and hospital stay. PMID:25465936

  11. Impact of preprocedural mitral regurgitation upon mortality after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis

    PubMed Central

    Khawaja, M Z; Williams, R; Hung, J; Arri, S; Asrress, K N; Bolter, K; Wilson, K; Young, C P; Bapat, V; Hancock, J; Thomas, M; Redwood, S

    2014-01-01

    Objective To identify the effects of preprocedural significant mitral regurgitation (MR) and change in MR severity upon mortality after transcatheter aortic valve implantation (TAVI) using the Edwards SAPIEN system. Methods A retrospective analysis of 316 consecutive patients undergoing TAVI for aortic stenosis at a single centre in the UK between March 2008 and January 2013. Patients were stratified into two groups according to severity of MR: ?grade 3 were classed as significant and ?grade 2 were non-significant. Change in MR severity was assessed by comparison of baseline and 30-day echocardiograms. Results 60 patients had significant MR prior to TAVI (19.0%). These patients were of higher perioperative risk (logistic EuroScore 28.7±16.6% vs 20.3±10.7%, p=0.004) and were more dyspnoeic (New York Heart Association class IV 20.0% vs 7.4%, p=0.014). Patients with significant preprocedural MR displayed greater 12-month and cumulative mortality (28.3% vs 20.2%, log-rank p=0.024). Significant MR was independently associated with mortality (HR 4.94 (95% CI 2.07 to 11.8), p<0.001). Of the 60 patients with significant MR only 47.1% had grade 3–4 MR at 30?days (p<0.001). Patients in whom MR improved had lower mortality than those in whom it deteriorated (log-rank p=0.05). Conclusions Significant MR is frequently seen in patients undergoing TAVI and is independently associated with increased all-cause mortality. Yet almost half also exhibit significant improvements in MR severity. Those who improve have better outcomes, and future work could focus upon identifying factors independently associated with such an improvement. PMID:25155800

  12. Comparative Survival After Transapical, Direct Aortic, and Subclavian Transcatheter Aortic Valve Implantation (Data from the UK TAVI Registry).

    PubMed

    Fröhlich, Georg M; Baxter, Paul D; Malkin, Christopher J; Scott, D Julian A; Moat, Neil E; Hildick-Smith, David; Cunningham, David; MacCarthy, Philip A; Trivedi, Uday; de Belder, Mark A; Ludman, Peter F; Blackman, Daniel J

    2015-11-15

    Many patients have iliofemoral vessel anatomy unsuitable for conventional transfemoral (TF) transcatheter aortic valve implantation (TAVI). Safe and practical alternatives to the TF approach are, therefore, needed. This study compared outcomes of alternative nonfemoral routes, transapical (TA), direct aortic (DA), and subclavian (SC), with standard femoral access. In this retrospective study, data from 3,962 patients in the UK TAVI registry were analyzed. All patients who received TAVI through a femoral, subclavian, TA, or DA approach were eligible for inclusion. The primary outcome measure was survival up to 2 years. Median Logistic EuroSCORE was similar for SC, DA, and TA but significantly lower in the TF cohort (22.1% vs 20.3% vs 21.2% vs 17.0%, respectively, p <0.0001). Estimated 1-year survival rate was similar for TF (84.6 ± 0.7%) and SC (80.5 ± 3%, p = 0.27) but significantly worse for TA (74.7 ± 1.6%, p <0.001) and DA (75.2 ± 3.3%, p <0.001). A Cox proportional hazard model was used to analyze survival up to 2 years. Survival in the SC group was not significantly different from the TF group (hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.88 to 1.70, p = 0.24). In contrast, survival in the TA (HR 1.74, 95% CI 1.43 to 2.11; p <0.001) and DA (HR 1.55, 95% CI 1.13 to 2.14; p <0.01) cohorts was significantly reduced compared with TF. In conclusion, TA and DA TAVI were associated with similar survival, both significantly worse than with the TF route. In contrast, subclavian access was not significantly different from TF and may represent the safest nonfemoral access route for TAVI. PMID:26409640

  13. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement

    PubMed Central

    Schuetz, Philipp; Huber, Andreas; Müller, Beat; Maisano, Francesco; Taramasso, Maurizio; Moarof, Igal; Obeid, Slayman; Stähli, Barbara E.; Cahenzly, Martin; Binder, Ronald K.; Liebetrau, Christoph; Möllmann, Helge; Kim, Won-Keun; Hamm, Christian; Lüscher, Thomas F.

    2015-01-01

    Background Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR). Elevated levels of midregional proadrenomedullin (MR-proADM) levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population. Objectives We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population. Methods We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality. Results During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%). Patients with MR-proADM levels above the 75th percentile (? 1.3 nmol/l) had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0–26.0, P < 0.01), whereas patients with EuroSCORE II scores above the 75th percentile (> 6.8) only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8–5.6, P = 0.13). The Harrell’s C-statistic was 0.58 (95% CI 0.45–0.82) for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71–0.92, P = 0.01). In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ?1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1–31.3), P <0.01) and improved the model’s net reclassification index (0.89, 95% CI (0.28–1.59). These results were confirmed in the independent validation cohort. Conclusions Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis. PMID:26630012

  14. Interleukin-1 Beta Induces an Inflammatory Phenotype in Human Aortic Valve Interstitial Cells Through Nuclear Factor Kappa Beta

    PubMed Central

    Nadlonek, Nicole; Lee, Joon H.; Reece, T. Brett; Weyant, Michael J.; Cleveland, Joseph C.; Meng, Xianzhong; Fullerton, David A.

    2013-01-01

    Background Mechanisms of inflammation have been implicated in the pathogenesis of aortic stenosis. When stimulated, human aortic valve interstitial cells (AVICs) have been shown to become inflammatory cells. Increased levels of interleukin (IL)-1? have been found in the leaflets of stenotic aortic valves. The purpose of this study was to determine the effects of IL-1? on isolated human AVICs and to determine the intracellular signaling pathway by which the effects are mediated. The results of this study demonstrated that IL-1? induces an inflammatory phenotype in human AVICs. Methods Human AVICs were isolated from normal aortic valves from explanted hearts of patients undergoing cardiac transplantation (n = 4) and grown in culture. When grown to confluence, the cells were treated with IL-1? (10 ng/mL). Cell culture media was analyzed for IL-6, IL-8, and monocyte chemoattractant protein-1 (enzyme-linked immunosorbent assay). Cell lysates were analyzed for intercellular adhesion molecule-1 (immunoblot). Inhibition of nuclear factor-?? was by Bay 11-7085 (5 ?M). Inhibition of extracellular signal regulated kinase-1/2 was by PD098059 (20 nM). Statistics were by analysis of variance, with p less than 0.05 significant. Results Interluekin-1? induced an inflammatory phenotype in human AVICs. The IL-1? stimulation resulted in significantly increased production of the inflammatory cytokines, IL-6 and IL-8, the chemokine monocyte chemoattractant protein-1, and intercellular adhesion molecule-1. Inhibition of nuclear factor-?? prevented these changes, whereas inhibition of extracellular signal regulated kinase-1/2 had no effect. Conclusions Interleukin-1? induced an inflammatory phenotype in human AVICs, which was prevented by inhibition of nuclear factor-??. These data implicate IL-1? in the pathogenesis of aortic stenosis. PMID:23735716

  15. Comparison of Mesenchymal Stem Cell Source Differentiation Toward Human Pediatric Aortic Valve Interstitial Cells within 3D Engineered Matrices.

    PubMed

    Duan, Bin; Hockaday, Laura A; Das, Shoshana; Xu, Charlie; Butcher, Jonathan T

    2015-08-01

    Living tissue-engineered heart valves (TEHV) would be a major benefit for children who require a replacement with the capacity for growth and biological integration. A persistent challenge for TEHV is accessible human cell source(s) that can mimic native valve cell phenotypes and matrix remodeling characteristics that are essential for long-term function. Mesenchymal stem cells derived from bone marrow (BMMSC) or adipose tissue (ADMSC) are intriguing cell sources for TEHV, but they have not been compared with pediatric human aortic valve interstitial cells (pHAVIC) in relevant 3D environments. In this study, we compared the spontaneous and induced multipotency of ADMSC and BMMSC with that of pHAVIC using different induction media within three-dimensional (3D) bioactive hybrid hydrogels with material modulus comparable to that of aortic heart valve leaflets. pHAVIC possessed some multi-lineage differentiation capacity in response to induction media, but limited to the earliest stages and much less potent than either ADMSC or BMMSC. ADMSC expressed cell phenotype markers more similar to pHAVIC when conditioned in basic fibroblast growth factor (bFGF) containing HAVIC growth medium, while BMMSC generally expressed similar extracellular matrix remodeling characteristics to pHAVIC. Finally, we covalently attached bFGF to PEG monoacrylate linkers and further covalently immobilized in the 3D hybrid hydrogels. Immobilized bFGF upregulated vimentin expression and promoted the fibroblastic differentiation of pHAVIC, ADMSC, and BMMSC. These findings suggest that stem cells retain a heightened capacity for osteogenic differentiation in 3D culture, but can be shifted toward fibroblast differentiation through matrix tethering of bFGF. Such a strategy is likely important for utilizing stem cell sources in heart valve tissue engineering applications. PMID:25594437

  16. Subject-specific finite-element modeling of normal aortic valve biomechanics from 3D+t TEE images.

    PubMed

    Labrosse, Michel R; Beller, Carsten J; Boodhwani, Munir; Hudson, Christopher; Sohmer, Benjamin

    2015-02-01

    In the past decades, developments in transesophageal echocardiography (TEE) have opened new horizons in reconstructive surgery of the aortic valve (AV), whereby corrections are made to normalize the geometry and function of the valve, and effectively treat leaks. To the best of our knowledge, we propose the first integrated framework to process subject-specific 3D+t TEE AV data, determine age-matched material properties for the aortic and leaflet tissues, build a finite element model of the unpressurized AV, and simulate the AV function throughout a cardiac cycle. For geometric reconstruction purposes, dedicated software was created to acquire the 3-D coordinates of 21 anatomical landmarks of the AV apparatus in a systematic fashion. Measurements from ten 3D+t TEE datasets of normal AVs were assessed for inter- and intra-observer variability. These tests demonstrated mean measurement errors well within the acceptable range. Simulation of a complete cardiac cycle was successful for all ten valves and validated the novel schemes introduced to evaluate age-matched material properties and iteratively scale the unpressurized dimensions of the valves such that, given the determined material properties, the dimensions measured in vivo closely matched those simulated in late diastole. The leaflet coaptation area, describing the quality of the sealing of the valve, was measured directly from the medical images and was also obtained from the simulations; both approaches correlated well. The mechanical stress values obtained from the simulations may be interpreted in a comparative sense whereby higher values are indicative of higher risk of tearing and/or development of calcification. PMID:25476416

  17. Transcatheter aortic valve implantation in very elderly patients: immediate results and medium term follow-up

    PubMed Central

    Pascual, Isaac; Muñoz-García, Antonio J; López-Otero, Diego; Avanzas, Pablo; Jimenez-Navarro, Manuel F; Cid-Alvarez, Belén; del Valle, Raquel; Alonso-Briales, Juan H; Ocaranza-Sanchez, Raimundo; Hernández, José M; Trillo-Nouche, Ramiro; Morís, César

    2015-01-01

    Objective To evaluate immediate transcatheter aortic valve implantation (TAVI) results and medium-term follow-up in very elderly patients with severe and symptomatic aortic stenosis (AS). Methods This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly (> 85 years) patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rates from any cause at two years. Results The study included 160 consecutive patients with a mean age of 87 ± 2.1 years (range from 85 to 94 years) and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 (35.6%) patients scoring ? 20%. Procedural success rate was 97.5%, with 25 (15.6%) patients experiencing acute complications with major bleeding (the most frequent). Global mortality rate during hospitalization was 8.8% (n = 14) and 30-day mortality rate was 10% (n = 16). Median follow up period was 252.24 ± 232.17 days. During the follow-up period, 28 (17.5%) patients died (17 of them due to cardiac causes). The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ? 20 was the unique variable associated with overall mortality. Conclusions TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients. PMID:26345138

  18. Association of the C-Reactive Protein Gene (CRP) rs1205 C>T Polymorphism with Aortic Valve Calcification in Patients with Aortic Stenosis

    PubMed Central

    Wypasek, Ewa; Potaczek, Daniel P.; Undas, Anetta

    2015-01-01

    Elevation in C-reactive protein (CRP) levels have been shown in patients with aortic valve stenosis (AS). Minor allele of the CRP gene (CRP) rs1205 C>T polymorphism has been associated with lower plasma CRP concentrations in cohorts of healthy and atherosclerotic patients. Considering the existing similarities between atherosclerosis and AS, we examined the effect of CRP rs1205 C>T polymorphism on the AS severity. Three hundred consecutive Caucasian patients diagnosed with AS were genotyped for the rs1205 C>T polymorphism using the TaqMan assay. Severity of the AS was assessed using transthoracic echocardiography. The degree of calcification was analyzed semi-quantitatively. Carriers of the rs1205 T allele were characterized by elevated serum CRP levels (2.53 (1.51–3.96) vs. 1.68 (0.98–2.90) mg/L, p < 0.001) and a higher proportion of the severe aortic valve calcification (70.4% vs. 55.1%, p = 0.01) compared with major homozygotes. The effect of CRP rs1205 polymorphism on CRP levels is opposite in AS-affected than in unaffected subjects, suggesting existence of a disease-specific molecular regulatory mechanism. Furthermore, rs1205 variant allele predisposes to larger aortic valve calcification, potentially being a novel genetic risk marker of disease progression. PMID:26473826

  19. Automatic shutoff valve

    NASA Technical Reports Server (NTRS)

    Hawkins, S. F.; Overbey, C. W.

    1980-01-01

    Cellulose-sponge disk absorbs incoming water and expands with enough force to shut valve. When water recedes, valve opens by squeezing sponge dry to its original size. This direct mechanical action is considered more reliable than solenoid valve.

  20. From the ground up: building a minimally invasive aortic valve surgery program.

    PubMed

    Nguyen, Tom C; Lamelas, Joseph

    2015-03-01

    Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a "virtual lobby" for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority. PMID:25870815

  1. The natural history of guidelines: the case of aortopathy related to bicuspid aortic valves.

    PubMed

    Hardikar, Ashutosh A; Marwick, Thomas H

    2015-11-15

    Clinical guidelines represent statements that seek to synthesize the best evidence to guide a course of action to improve health outcomes and more cost-effective use of resources. However, even when the evidence is not definitive, comprehensive documents are still needed to guide clinical decision-making. In these circumstances, guidelines are inevitably affected by perceptions of the problem and their possible solutions. From 1998 to 2014, 10 different international guidelines have focused on the aortopathy related to bicuspid aortic valves. Recommended thresholds for intervention started at a cutoff level of 5.5cm in 1998, reached a nadir of 4 to 4.5cm in 2010, and returned to a 5.5cm cutoff level in 2014. During this time, no conclusive objective proof was published to support either an aggressive or conservative strategy. The consequence was that an undefined number of patients underwent surgery (and potential complications thereof) at an earlier disease stage than might have been necessary. This experience might provide a clue as to how guidelines evolve, and provide insight as to how to avoid a similar process in the future. PMID:26197400

  2. From the ground up: building a minimally invasive aortic valve surgery program

    PubMed Central

    Lamelas, Joseph

    2015-01-01

    Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a “virtual lobby” for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority. PMID:25870815

  3. [Vascular Calcification - Pathological Mechanism and Clinical Application - . Extracellular matrix tenascin-X in calcific aortic valves].

    PubMed

    Matsumoto, Ken-ichi

    2015-05-01

    We previously disclosed a novel extracellular matrix tenascin-X (TNX) , the largest member of the tenascin family. So far, we have made efforts to elucidate the roles of TNX. TNX is involved in collagen deposition, collagen fibrillogenesis, and modulation of collagen stiffness. Homozygous mutations in TNXB, the gene encoding TNX, cause a classic-type Ehlers-Danlos syndrome (EDS) , a heritable connective tissue disorder, whereas haploinsufficiency of TNXB and heterozygous mutations in TNXB are associated with hypermobility-type EDS. Recently, we performed proteomic analyses of calcific aortic valves (CAVs) compared with relatively adjacent normal tissues to understand the underlying molecular mechanisms of dystrophic valvular calcification. Interestingly, we found that TNX was the protein with the greatest decrease in expression among the differentially expressed proteins and that expression levels of proteins modulating collagen structure and function, such as type I collagen and decorin, were also decreased in CAVs. In this review, I will discuss about the decreased level of collagen due to the reduction of expression levels of proteins that play regulatory roles in collagen functions such as fibril organization and fibrillogenesis in CAVs. PMID:25926574

  4. Magnetically operated check valve

    NASA Technical Reports Server (NTRS)

    Morris, Brian G. (inventor); Bozeman, Richard J., Jr. (inventor)

    1994-01-01

    A magnetically operated check valve is disclosed. The valve is comprised of a valve body and a movable poppet disposed therein. A magnet attracts the poppet to hold the valve shut until the force of fluid flow through the valve overcomes the magnetic attraction and moves the poppet to an unseated, open position. The poppet and magnet are configured and disposed to trap a magnetically attracted particulate and prevent it from flowing to a valve seating region.

  5. Pulmonary valve stenosis

    MedlinePLUS

    ... valve pulmonary stenosis; Pulmonary stenosis; Stenosis - pulmonary valve; Balloon valvuloplasty - pulmonary ... water pills) Treat abnormal heartbeats and rhythms Percutaneous balloon pulmonary dilation (valvuloplasty) may be performed when no ...

  6. Fluid-structure interaction of an aortic heart valve prosthesis driven by an animated anatomic left ventricle

    NASA Astrophysics Data System (ADS)

    Le, Trung Bao; Sotiropoulos, Fotis

    2013-07-01

    We develop a novel large-scale kinematic model for animating the left ventricle (LV) wall and use this model to drive the fluid-structure interaction (FSI) between the ensuing blood flow and a mechanical heart valve prosthesis implanted in the aortic position of an anatomic LV/aorta configuration. The kinematic model is of lumped type and employs a cell-based, FitzHugh-Nagumo framework to simulate the motion of the LV wall in response to an excitation wavefront propagating along the heart wall. The emerging large-scale LV wall motion exhibits complex contractile mechanisms that include contraction (twist) and expansion (untwist). The kinematic model is shown to yield global LV motion parameters that are well within the physiologic range throughout the cardiac cycle. The FSI between the leaflets of the mechanical heart valve and the blood flow driven by the dynamic LV wall motion and mitral inflow is simulated using the curvilinear immersed boundary (CURVIB) method (Ge and Sotiropoulos, 2007; Borazjani et al., 2008) [1,2] implemented in conjunction with a domain decomposition approach. The computed results show that the simulated flow patterns are in good qualitative agreement with in vivo observations. The simulations also reveal complex kinematics of the valve leaflets, thus, underscoring the need for patient-specific simulations of heart valve prosthesis and other cardiac devices.

  7. In-body tissue-engineered aortic valve (Biovalve type VII) architecture based on 3D printer molding.

    PubMed

    Nakayama, Yasuhide; Takewa, Yoshiaki; Sumikura, Hirohito; Yamanami, Masashi; Matsui, Yuichi; Oie, Tomonori; Kishimoto, Yuichiro; Arakawa, Mamoru; Ohmuma, Kentaro; Tajikawa, Tsutomu; Kanda, Keiichi; Tatsumi, Eisuke

    2015-01-01

    In-body tissue architecture--a novel and practical regeneration medicine technology--can be used to prepare a completely autologous heart valve, based on the shape of a mold. In this study, a three-dimensional (3D) printer was used to produce the molds. A 3D printer can easily reproduce the 3D-shape and size of native heart valves within several processing hours. For a tri-leaflet, valved conduit with a sinus of Valsalva (Biovalve type VII), the mold was assembled using two conduit parts and three sinus parts produced by the 3D printer. Biovalves were generated from completely autologous connective tissue, containing collagen and fibroblasts, within 2 months following the subcutaneous embedding of the molds (success rate, 27/30). In vitro evaluation, using a pulsatile circulation circuit, showed excellent valvular function with a durability of at least 10 days. Interposed between two expanded polytetrafluoroethylene grafts, the Biovalves (N?=?3) were implanted in goats through an apico-aortic bypass procedure. Postoperative echocardiography showed smooth movement of the leaflets with minimal regurgitation under systemic circulation. After 1 month of implantation, smooth white leaflets were observed with minimal thrombus formation. Functional, autologous, 3D-shaped heart valves with clinical application potential were formed following in-body embedding of specially designed molds that were created within several hours by 3D printer. PMID:24764308

  8. A Complicated Case of Triple Valve Infective Endocarditis in an IV Drug User with a Bicuspid Aortic Valve Requiring Three Separate Salvage Operations: A Case Report and Literature Review

    PubMed Central

    Khan, Shahzad; Smyrlis, Athanasios; Yaranov, Dmitry; Oelberg, David; Jimenez, Eric

    2015-01-01

    Infective endocarditis (IE) is an infection of the endocardium that involves valves and adjacent mural endocardium or a septal defect. Local complications include severe valvular insufficiency, which may lead to intractable congestive heart failure and myocardial abscesses. If left untreated, IE is generally fatal. Diagnosing IE can be straightforward in patients with the typical oslerian manifestations such as bacteremia, evidence of active valvulitis, peripheral emboli, and immunologic vascular phenomena. In the acute course, however, the classic peripheral stigmata may be few or absent, particularly among intravenous drug abuse (IVDA) patients in whom IE is often due to a S. aureus infection of right-sided heart valves. We present a complicated case of a very aggressive native aortic valve MSSA (methicillin sensitive Staphylococcus aureus) IE in a young adult male with a past medical history of bicuspid aortic valve and IV drug abuse. His clinical course was complicated by aortic valve destruction and development of third-degree AV block, as well as an aorto-left atrial fistula requiring emergent operation for AV replacement and patch repair. The patient required two reoperations for recurrent endocarditis and its complications. PMID:26146571

  9. Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

    PubMed Central

    Silva, Leonardo Sinnott; Caramori, Paulo Ricardo Avancini; Nunes Filho, Antonio Carlos Bacelar; Katz, Marcelo; Guaragna, João Carlos Vieira da Costa; Lemos, Pedro; Lima, Valter; Abizaid, Alexandre; Tarasoutchi, Flavio; de Brito Jr, Fabio S.

    2015-01-01

    Background Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge. Objectives To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI. Methods The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)]. Results The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05). Conclusions In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required. PMID:26247244

  10. Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review.

    PubMed

    Glavis-Bloom, Justin; Vasher, Scott; Marmor, Meghan; Fine, Antonella B; Chan, Philip A; Tashima, Karen T; Lonks, John R; Kojic, Erna M

    2015-11-01

    Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis. PMID:26403965

  11. Beyond Adding Years to Life: Health-related Quality-of-life and Functional Outcomes in Patients with Severe Aortic Valve Stenosis at High Surgical Risk Undergoing Transcatheter Aortic Valve Replacement

    PubMed Central

    Deutsch, Marcus-André; Bleiziffer, Sabine; Elhmidi, Yacine; Piazza, Nicolo; Voss, Bernhard; Lange, Ruediger; Krane, Markus

    2013-01-01

    Aortic valve stenosis (AVS) is the most frequent acquired valvular heart disease in western industrialized countries and its prevalence considerably increases with age. Once becoming symptomatic severe AVS has a very poor prognosis. Progressive and rapid symptom deterioration leads to an impairment of functional status and compromised healthrelated quality-of-life (HrQoL) simultaneously. Until recently, surgical aortic valve replacement (SAVR) has been the only effective treatment option for improving symptoms and prolonging survival. Transcatheter aortic valve replacement (TAVR) emerged as an alternative treatment modality for those patients with severe symptomatic AVS in whom the risk for SAVR is considered prohibitive or too high. TAVR has gained clinical acceptance with almost startling rapidity and has even quickly become the standard of care for the treatment of appropriately selected individuals with inoperable AVS during recent years. Typically, patients currently referred for and treated by TAVR are elderly with a concomitant variable spectrum of multiple comorbidities, disabilities and limited life expectancy. Beyond mortality and morbidity, the assessment of HrQoL is of paramount importance not only to guide patient-centered clinical decision-making but also to judge this new treatment modality. As per current evidence, TAVR significantly improves HrQoL in high-surgical risk patients with severe AVS with sustained effects up to two years when compared with optimal medical care and demonstrates comparable benefits relative to SAVR. Along with a provision of a detailed overview of the current literature regarding functional and HrQoL outcomes in patients undergoing TAVR, this review article addresses specific considerations of the HrQoL aspect in the elderly patient and finally outlines the implications of HrQoL outcomes for medico-economic deliberations. PMID:24313648

  12. Rest and exercise hemodynamics of 20 to 23 mm allograft, Medtronic Intact (porcine), and St. Jude Medical valves in the aortic position.

    PubMed

    Jaffe, W M; Coverdale, H A; Roche, A H; Whitlock, R M; Neutze, J M; Barratt-Boyes, B G

    1990-08-01

    Doppler echocardiography was used to measure gradients and valve areas at rest and after supine bicycle exercise in 35 patients with valve replacements 20 to 23 mm in size. Thirteen patients with a St. Jude Medical valve (St. Jude Medical, Inc., St. Paul, Minn.) were matched to 13 patients with an allograft valve, and seven patients with a Medtronic Intact (porcine) valve (Medtronic, Inc., Minneapolis, Minn.) to seven patients with an allograft valve. Patients were matched for age, sex, valve size, body surface area, and left ventricular systolic function. There was no statistically significant difference between the matched groups for body surface areas, resting cardiac output, exercise heart rate, or workload achieved. Mean pressure gradient was higher for St. Jude Medical than for allograft groups, both at rest (11.8 +/- 6.67 mm Hg for St. Jude Medical versus 6.67 +/- 2.98 mm Hg for allografts) and after exercise (16.4 +/- 8.47 mm Hg versus 9.7 +/- 3.94 mm Hg), but the differences were of borderline significance (p = 0.016 and 0.027, respectively). Valve area at rest was similar for both devices (1.4 +/- 0.45 cm2 for St. Jude Medical versus 1.8 +/- 0.56 cm2 for allograft; p greater than 0.1). There were highly significant differences between patients with Intact and those with allograft valves for resting mean pressure gradient (19.3 +/- 4.23 mm Hg for Intact versus 5.9 +/- 3.68 mm Hg for allograft; p less than 0.001) and for exercise mean pressure gradient (27.8 +/- 8.63 mm Hg versus 8.1 +/- 8.43 mm Hg; p less than 0.001). The differences between the valve areas at rest also were significant (1.1 +/- 0.12 cm2 versus 2.2 +/- 0.62 cm2; p less than 0.01). It is concluded that when a tissue valve is indicated in patients with a small aortic root, the freehand allograft aortic valve is an ideal device from the hemodynamic perspective and is superior to the Intact valve. It is also probably superior in this respect to the St. Jude Medical valve, although the analysis may be biased slightly in favor of the allograft valve. PMID:2385114

  13. Incidence and Progression of Aortic Valve Calcium in the Multi-Ethnic Study of Atherosclerosis (MESA)

    PubMed Central

    Owens, David S.; Katz, Ronit; Takasu, Junichiro; Kronmal, Richard; Budoff, Matthew J.; O’Brien, Kevin D.

    2010-01-01

    Aortic valve calcium (AVC) is common among older adults and shares epidemiologic and histopathologic similarities to atherosclerosis. However, prospective studies have failed to identify meaningful risk-associations with incident (“new”) AVC or its progression. In this study, AVC was quantified from serial computed tomography (CT) images in 5,880 participants (aged 45–84 years) of the Multi-Ethnic Study of Atherosclerosis, using Agatston methodology. Multivariate backwards selection modeling was used to identify risk factors for incident AVC and AVC progression. During a mean follow up of 2.4±0.9 years, 210 subjects (4.0%) developed incident AVC. The incidence rate (mean 1.7 %/year) increased significantly with age (p<0.001). Risk factors for incident AVC included age, male gender, BMI, current smoking, and the use of lipid lowering and antihypertensive medications. Among those with AVC at baseline, the median rate of AVC progression was 2 Agatston units/year [IQR ?21, 37]. Baseline Agatston score was a strong, independent predictor of progression, especially among those with high calcium scores at baseline. In conclusion, in this ethnically diverse, pre-clinical cohort, the rate of incident AVC a significantly with age. Incident AVC risk was associated with several traditional cardiovascular risk factors, specifically age, male gender, BMI, current smoking, and the use of both antihypertensive and lipid lowering medications. AVC progression risk was associated with male gender and the baseline Agatston score. Additional research is needed to determine if age- and stage-specific mechanisms underlie risk for AVC progression. PMID:20185020

  14. Trend in Hospitalizations among Medicare Survivors of Aortic Valve Replacement in United States, 1999–2010

    PubMed Central

    Murugiah, Karthik; Wang, Yun; Dodson, John A; Nuti, Sudhakar V; Dharmarajan, Kumar; Ranasinghe, Isuru; Cooper, Zack; Krumholz, Harlan M.

    2015-01-01

    Background Mortality rates after aortic valve replacement (AVR) have declined, but little is known about the risk of hospitalization among survivors, and how that has changed over time. Methods Among Medicare patients who underwent AVR from 1999–2010 and survived to one year, we assessed trends in 1-year hospitalization rates, mean cumulative length of stay (LOS) (average number of hospitalization days per patient in the entire year), and adjusted annual Medicare payments per patient toward hospitalizations. We characterized hospitalizations by principal diagnosis and mean LOS. Results Among 1-year survivors of AVR, 43% of patients were hospitalized within that year, of whom 44.5% were hospitalized within 30 days (19.2% for overall cohort). Hospitalization rates were higher for older (50.3% for >85 years), female (45.1%) and black (48.9%) patients. One-year hospitalization rate decreased from 44.2% (43.5–44.8) in 1999 to 40.9% (40.3–41.4) in 2010. Mean cumulative LOS decreased from 4.8 days to 4.0 days (p <0.05 for trend); annual Medicare payments per patient were unchanged ($5709 to $5737, p=0.32 for trend). The three most common principal diagnoses in hospitalizations were heart failure (12.7%), arrhythmia (7.9%), and postoperative complications (4.4%). Mean LOS declined from 6.0 days to 5.3 days (p <0.05 for trend). Conclusions Among Medicare beneficiaries who survived one year after AVR, 3 in 5 remained free of hospitalization; however, certain subgroups had higher rates of hospitalization. After the 30-day period, the hospitalization rate was similar to the general Medicare population. Hospitalization rates and cumulative days spent in hospital decreased over time. PMID:25527425

  15. Microfluidic sieve valves

    DOEpatents

    Quake, Stephen R; Marcus, Joshua S; Hansen, Carl L

    2015-01-13

    Sieve valves for use in microfluidic device are provided. The valves are useful for impeding the flow of particles, such as chromatography beads or cells, in a microfluidic channel while allowing liquid solution to pass through the valve. The valves find particular use in making microfluidic chromatography modules.

  16. Rotary pneumatic valve

    DOEpatents

    Hardee, Harry C. (Albuquerque, NM)

    1991-01-01

    A rotary pneumatic valve which is thrust balanced and the pneumatic pressure developed produces only radial loads on the valve cylinder producing negligible resistance and thus minimal torque on the bearings of the valve. The valve is multiplexed such that at least two complete switching cycles occur for each revolution of the cylinder spindle.

  17. Liquid rocket valve components

    NASA Technical Reports Server (NTRS)

    1973-01-01

    A monograph on valves for use with liquid rocket propellant engines is presented. The configurations of the various types of valves are described and illustrated. Design criteria and recommended practices for the various valves are explained. Tables of data are included to show the chief features of valve components in use on operational vehicles.

  18. Remote actuated valve implant

    DOEpatents

    McKnight, Timothy E; Johnson, Anthony; Moise, Jr., Kenneth J; Ericson, Milton Nance; Baba, Justin S; Wilgen, John B; Evans, III, Boyd McCutchen

    2014-02-25

    Valve implant systems positionable within a flow passage, the systems having an inlet, an outlet, and a remotely activatable valve between the inlet and outlet, with the valves being operable to provide intermittent occlusion of the flow path. A remote field is applied to provide thermal or magnetic activation of the valves.

  19. Functional Status and Quality of Life After Transcatheter Aortic Valve Replacement: A Systematic Review

    PubMed Central

    Kim, Caroline A.; Rasania, Suraj P.; Afilalo, Jonathan; Popma, Jeffrey J.; Lipsitz, Lewis A.; Kim, Dae Hyun

    2014-01-01

    Background Transcatheter aortic valve replacement (TAVR) prolongs survival in high-risk patients with severe aortic stenosis. However, its functional and quality-of-life benefits have not been established. Purpose To evaluate the changes in functional status and quality of life after TAVR. Data Sources MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from January 1, 2002, to September 30, 2013. Study Selection Studies of TAVR that reported the New York Heart Association (NYHA) class, Short-Form (SF)-12/36 physical and mental component summary (points), or other measures of functional status. Data Extraction Two reviewers independently extracted the mean change (follow-up – baseline) in primary outcomes. Due to substantial heterogeneity, data were not pooled; the range (minimum, maximum) of mean change was summarized. Data Synthesis We identified 60 observational studies (56 pre-post comparison and 4 head-to-head comparative studies) and 2 randomized controlled trials (11,205 patients). Most studies showed a clinically important decrease in NYHA class at 6–11 months (range: ?0.8, ?2.1), 12–23 months (?0.8, ?2.1), 24–35 months (?1.2, ?2.6), and ?36 months (?1.2, ?1.6). The improvement in SF-12/36 physical component score was clinically important over 12 months (4.9, 26.9), while the change in mental component score was smaller (1.0, 8.9). Clinically important improvements were observed in other disease-specific measures and 6-minute walk test, but less consistently seen in general health measures. Limitations Comparative evidence is limited by few head-to-head studies of functional outcomes. Survivor bias may have overestimated the benefits. Conclusions TAVR provides clinically important benefits in physical function and disease-specific measures of quality of life, but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision-making. PMID:24727842

  20. Meta-analysis of predictors of all-cause mortality after transcatheter aortic valve implantation.

    PubMed

    Giordana, Francesca; D'Ascenzo, Fabrizio; Nijhoff, Freek; Moretti, Claudio; D'Amico, Maurizio; Biondi Zoccai, Giuseppe; Sinning, Jan Malte; Nickenig, George; Van Mieghem, Nicolas M; Chieffo, Adelaide; Dumonteil, Nicolas; Tchetche, Didier; Barbash, Israel M; Waksman, Ron; D'Onofrio, Augusto; Lefevre, Thierry; Pilgrim, Thomas; Amabile, Nicolas; Codner, Pablo; Kornowski, Ran; Yong, Ze Yie; Baan, Jan; Colombo, Antonio; Latib, Azeem; Salizzoni, Stefano; Omedè, Pierluigi; Conrotto, Federico; La Torre, Michele; Marra, Sebastiano; Rinaldi, Mauro; Gaita, Fiorenzo

    2014-11-01

    The aim of this study was to identify predictors of 30-day and midterm mortality after transcatheter aortic valve implantation (TAVI) by means of a systemic review. TAVI was demonstrated to be safe and efficacious in patients with severe aortic stenosis. An accurate estimation of procedural risk of these patients represents an actual challenge. The PubMed and Cochrane Collaboration databases were systematically searched for studies reporting on the incidence and independent predictors of 30-day and midterm mortality. Adverse events were pooled with random effect, whereas independent predictors are reported as odds ratios (ORs) with 95% confidence intervals (CIs). A total of 25 studies with 8,874 patients were included (median age 82.5 ± 1.5 years, 54.6% women). At 30 days, 7.5% of patients (n = 663) died. At midterm follow-up (median 365 days, interquartile range 267 to 365 days), the cumulative mortality rate was 21.6% (n = 1,917). Acute kidney injury (AKI) stage ?2 (OR 18.0, 95% CI 6.3 to 52), preprocedural hospitalization for heart failure (OR 9.4, 95% CI 2.6 to 35), periprocedural acute myocardial infarction (OR 8.5, 95% CI 2.6 to 33.5), and increased pro-brain natriuretic peptide (pro-BNP) levels (OR 5.4, 95% CI 1.7 to 16.5) were the most important independent predictors of 30-day mortality. Increased pro-BNP levels (OR 11, 95% CI 1.5 to 81), AKI stage 3 (OR 6.8, 95% CI 2.6 to 15.7), left ventricular ejection fraction <30% (OR 6.7, 95% CI 3.5 to 12.7), and periprocedural acute myocardial infarction (OR 6.5, 95% CI 2.3 to 18.1) represented the predictors of midterm mortality. In conclusion, in this large meta-analysis of patients undergoing TAVI, we found that high pro-BNP levels and postprocedural AKI were the strongest independent predictors of both 30-day and 1-year mortality. These findings may contribute to a better understanding of the risk assessment process of patients undergoing TAVI. PMID:25217456

  1. Carotenoids Co-Localize with Hydroxyapatite, Cholesterol, and Other Lipids in Calcified Stenotic Aortic Valves. Ex Vivo Raman Maps Compared to Histological Patterns

    PubMed Central

    Bonetti, A.; Bonifacio, A.; Mora, A. Della; Livi, U.; Marchini, M.; Ortolani, F.

    2015-01-01

    Unlike its application for atherosclerotic plaque analysis, Raman microspectroscopy was sporadically used to check the sole nature of bioapatite deposits in stenotic aortic valves, neglecting the involvement of accumulated lipids/lipoproteins in the calcific process. Here, Raman microspectroscopy was employed for examination of stenotic aortic valve leaflets to add information on nature and distribution of accumulated lipids and their correlation with mineralization in the light of its potential precocious diagnostic use. Cryosections from surgically explanted stenotic aortic valves (n=4) were studied matching Raman maps against specific histological patterns. Raman maps revealed the presence of phospholipids/triglycerides and cholesterol, which showed spatial overlapping with one another and Raman-identified hydroxyapatite. Moreover, the Raman patterns correlated with those displayed by both von-Kossa-calcium- and Nile-blue-stained serial cryosections. Raman analysis also provided the first identification of carotenoids, which co-localized with the identified lipid moieties. Additional fit concerned the distribution of collagen and elastin. The good correlation of Raman maps with high-affinity staining patterns proved that Raman microspectroscopy is a reliable tool in evaluating calcification degree, alteration/displacement of extracellular matrix components, and accumulation rate of different lipid forms in calcified heart valves. In addition, the novel identification of carotenoids supports the concept that valve stenosis is an atherosclerosis-like valve lesion, consistently with their previous Raman microspectroscopical identification inside atherosclerotic plaques. PMID:26150160

  2. Vacuum breaker valve assembly

    DOEpatents

    Thompson, J.L.; Upton, H.A.

    1999-04-27

    Breaker valve assemblies for a simplified boiling water nuclear reactor are described. The breaker valve assembly, in one form, includes a valve body and a breaker valve. The valve body includes an interior chamber, and an inlet passage extends from the chamber and through an inlet opening to facilitate transporting particles from outside of the valve body to the interior chamber. The breaker valve is positioned in the chamber and is configured to substantially seal the inlet opening. Particularly, the breaker valve includes a disk which is sized to cover the inlet opening. The disk is movably coupled to the valve body and is configured to move substantially concentrically with respect to the valve opening between a first position, where the disk completely covers the inlet opening, and a second position, where the disk does not completely cover the inlet opening. 1 fig.

  3. Scissor thrust valve actuator

    DOEpatents

    DeWall, Kevin G.; Watkins, John C; Nitzel, Michael E.

    2006-08-29

    Apparatus for actuating a valve includes a support frame and at least one valve driving linkage arm, one end of which is rotatably connected to a valve stem of the valve and the other end of which is rotatably connected to a screw block. A motor connected to the frame is operatively connected to a motor driven shaft which is in threaded screw driving relationship with the screw block. The motor rotates the motor driven shaft which drives translational movement of the screw block which drives rotatable movement of the valve driving linkage arm which drives translational movement of the valve stem. The valve actuator may further include a sensory control element disposed in operative relationship with the valve stem, the sensory control element being adapted to provide control over the position of the valve stem by at least sensing the travel and/or position of the valve stem.

  4. Heart valve replacement during pregnancy.

    PubMed

    Cunha, Claúdio Ribeiro da; Santos, Paulo Cesar; Castineira, Caroline Pastorin; Pereira, Flávia Souza Fernandes

    2007-01-01

    We describe a woman with gestational age of 20 weeks, who was submitted to a complex procedure. She underwent replacement of the biological mitral and aortic valve, both by biological prosthesis, valvuloplasty of the tricuspid valve, as well as thrombectomy of the left atrium. Extracorporeal circulation (ECC) was used during 105 minutes. The patient was discharged from hospital in good health conditions and the newborn remained in the Neonatal Intensive Care Unit (NICU) in a stable state. This is a complex procedure with a high maternal and fetal mortality. Therefore, this is an important case regarding valve abnormalities treatment during pregnancy. PMID:18488120

  5. Acute obstruction of a mechanical aortic valve in a young woman: case report and review of the literature

    PubMed Central

    Karapanagiotidis, Georgios T; Sarsam, Mazin A I; Fletcher, Simon N

    2014-01-01

    Summary Acute aortic valve obstruction is a medical and surgical emergency necessitating intensive care unit admission. The differential diagnosis includes thrombosis, pannus formation or vegetations. The diagnosis should be obtained as soon as possible, with possible orientation towards the cause. Different diagnostic modalities exist nowadays. Notably, the transesophageal echocardiography (TEE) offers a diagnosis and a guide for management. Surgical treatment remains of choice despite growing evidence about a benefit of combined thrombolytic and anticoagulation line of management. Learning points Acute management and resuscitation of acute valvular obstruction.Differential diagnosis and role of echo in the diagnosis.Management options.

  6. Valve for fluid control

    DOEpatents

    Oborny, Michael C. (Albuquerque, NM); Paul, Phillip H. (Livermore, CA); Hencken, Kenneth R. (Pleasanton, CA); Frye-Mason, Gregory C. (Cedar Crest, NM); Manginell, Ronald P. (Albuquerque, NM)

    2001-01-01

    A valve for controlling fluid flows. This valve, which includes both an actuation device and a valve body provides: the ability to incorporate both the actuation device and valve into a unitary structure that can be placed onto a microchip, the ability to generate higher actuation pressures and thus control higher fluid pressures than conventional microvalves, and a device that draws only microwatts of power. An electrokinetic pump that converts electric potential to hydraulic force is used to operate, or actuate, the valve.

  7. Sickle cell disease and aortic valve replacement: use of cardiopulmonary bypass, partial exchange transfusion, platelet sequestration, and continuous hemofiltration.

    PubMed Central

    Sutton, S W; Hunley, E K; Duncan, M A; Rodriguez, R; Meyers, T P

    1999-01-01

    Sickle cell disease in patients undergoing open heart procedures presents a multitude of challenges to the medical staff. With improved techniques of cardiopulmonary bypass, surgery, and anesthesia for treating patients with sickle cell disease, perfusionists will likely encounter patients with this genetic disorder on a more frequent basis. A 40-year-old black woman was admitted to our institution with recurrent Staphylococcus epidermidis and sepsis. She underwent transesophageal echocardiography and cardiac catheterization and was subsequently diagnosed with severe aortic insufficiency. The aortic valve was replaced. Herein, we report our experience in the preoperative, perioperative, and postoperative management of this patient. We present a concise update on the current literature and techniques used by others in similar cases, and we provide a brief section on future considerations to assist fellow practitioners in recognizing this disease and meeting the accompanying challenges. PMID:10653257

  8. Mitral Valve Prolapse in Persons with Down Syndrome.

    ERIC Educational Resources Information Center

    Pueschel, Siegfried M.; Werner, John Christian

    1994-01-01

    Examination of 36 home-reared young adults with Down's syndrome found that 20 had abnormal echocardiographic findings. Thirteen had mitral valve prolapse, three had mitral valve prolapse and aortic insufficiency, two had only aortic insufficiency, and two had other mitral valve disorders. Theories of pathogenesis and relationship to exercise and…

  9. Extended contrast detection on fluoroscopy and angiography for image-guided trans-catheter aortic valve implantations (TAVI)

    NASA Astrophysics Data System (ADS)

    Liu, Yinxiao; Liao, Rui; Lv, Xudong

    2012-02-01

    Navigation and deployment of the prosthetic valve during trans-catheter aortic valve implantation (TAVI) can be greatly facilitated with 3-D models showing detailed anatomical structures. Fast and robust automatic contrast detection at the aortic root on X-ray images is indispensable for automatically triggering a 2-D/3-D registration to align the 3-D model. Previously, we have proposed an automatic method for contrast detection at the aortic root on fluoroscopic and angiographic sequences [4]. In this paper, we extend that algorithm in several ways, making it more robust to handle more general and difficult cases. Specifically, the histogram likelihood ratio test is multiplied with the histogram portion computation to handle faint contrast cases. Histogram mapping corrects sudden changes in the global brightness, thus avoiding potential false positives. Respiration and heart beating check further reduces the false positive rate. In addition, a probe mask is introduced to enhance the contrast feature curve when the dark ultrasound probe partially occludes the aortic root. Lastly, a semi-global registration method for aligning the aorta shape model is implemented to improve the robustness of the algorithm with respect to the selection of region of interest (ROI) containing the aorta. The extended algorithm was evaluated on 100 sequences, and improved the detection accuracy from 94% to 100%, compared to the original method. Also, the robustness of the extended algorithm was tested with 20 different shifts of the ROI, and the error rate was as low as 0.2%, in comparison to 6.6% for the original method.

  10. MATR3 disruption in human and mouse associated with bicuspid aortic valve, aortic coarctation and patent ductus arteriosus

    PubMed Central

    Quintero-Rivera, Fabiola; Xi, Qiongchao J.; Keppler-Noreuil, Kim M.; Lee, Ji Hyun; Higgins, Anne W.; Anchan, Raymond M.; Roberts, Amy E.; Seong, Ihn Sik; Fan, Xueping; Lage, Kasper; Lu, Lily Y.; Tao, Joanna; Hu, Xuchen; Berezney, Ronald; Gelb, Bruce D.; Kamp, Anna; Moskowitz, Ivan P.; Lacro, Ronald V.; Lu, Weining; Morton, Cynthia C.; Gusella, James F.; Maas, Richard L.

    2015-01-01

    Cardiac left ventricular outflow tract (LVOT) defects represent a common but heterogeneous subset of congenital heart disease for which gene identification has been difficult. We describe a 46,XY,t(1;5)(p36.11;q31.2)dn translocation carrier with pervasive developmental delay who also exhibited LVOT defects, including bicuspid aortic valve (BAV), coarctation of the aorta (CoA) and patent ductus arteriosus (PDA). The 1p breakpoint disrupts the 5? UTR of AHDC1, which encodes AT-hook DNA-binding motif containing-1 protein, and AHDC1-truncating mutations have recently been described in a syndrome that includes developmental delay, but not congenital heart disease [Xia, F., Bainbridge, M.N., Tan, T.Y., Wangler, M.F., Scheuerle, A.E., Zackai, E.H., Harr, M.H., Sutton, V.R., Nalam, R.L., Zhu, W. et al. (2014) De Novo truncating mutations in AHDC1 in individuals with syndromic expressive language delay, hypotonia, and sleep apnea. Am. J. Hum. Genet., 94, 784–789]. On the other hand, the 5q translocation breakpoint disrupts the 3? UTR of MATR3, which encodes the nuclear matrix protein Matrin 3, and mouse Matr3 is strongly expressed in neural crest, developing heart and great vessels, whereas Ahdc1 is not. To further establish MATR3 3? UTR disruption as the cause of the proband's LVOT defects, we prepared a mouse Matr3Gt-ex13 gene trap allele that disrupted the 3? portion of the gene. Matr3Gt-ex13 homozygotes are early embryo lethal, but Matr3Gt-ex13 heterozygotes exhibit incompletely penetrant BAV, CoA and PDA phenotypes similar to those in the human proband, as well as ventricular septal defect (VSD) and double-outlet right ventricle (DORV). Both the human MATR3 translocation breakpoint and the mouse Matr3Gt-ex13 gene trap insertion disturb the polyadenylation of MATR3 transcripts and alter Matrin 3 protein expression, quantitatively or qualitatively. Thus, subtle perturbations in Matrin 3 expression appear to cause similar LVOT defects in human and mouse. PMID:25574029

  11. [Knack and pitfall in valve replacement].

    PubMed

    Takano, T; Amano, J

    2010-07-01

    We choose prosthetic or bioprosthetic valves according to AHA/ACC guidelines in valve replacement. It is important to remove only the calcification and avoid over-resection to preserve the valve annulus during aortic valve replacement. We leave posterior leaflet as well as basal chordae in mitral valve replacement in case of large mitral annulus. Sutures should be tied-down after those on both adjacent sides are pulled up and the sawing cuff and annulus are firmly attached. Intra-operative transesophageal echocardiography is useful for detecting a stack valve, perivalvular leakage and remnant air in the cardiac chambers. We performed 53 cases of valve replacement in 2009. One patient (1.9%) died because of ventricular arrhythmia during hospital stay. Re-operation was required in 2 cases (3.8%) of infective endocarditis due to prosthetic valve endocarditis. No other major complication was observed. PMID:20715438

  12. Comparison of minimally invasive closed circuit versus standard extracorporeal circulation for aortic valve replacement: a randomized study.

    PubMed

    Castiglioni, Alessandro; Verzini, Alessandro; Colangelo, Nicola; Nascimbene, Simona; Laino, Giovanni; Alfieri, Ottavio

    2009-07-01

    To evaluate the clinical results of aortic valve replacement performed with a miniaturized closed circuit extracorporeal circulation (MECC) system and to compare it to standard cardiopulmonary bypass (CPB). One hundred and twenty consecutive patients undergoing isolated aortic valve replacement were randomly assigned to either a miniaturized closed circuit CPB with the maquet-cardiopulmonary MECC System (study group, n=60) or to a standard CPB (control group, n=60). Demographic characteristic and operative data were similar in the two groups. No hospital death occurred in either group and no difference in intensive care unit (ICU) stay and in-hospital stay was observed. Patients in the study group showed lower chest tube drainage (212+/-62 ml vs. 420+/-219 ml, P<0.05) and lower need for blood products (6.1% vs. 40.4%, P<0.05) than patients in the control group. Platelet count at ICU arrival was significantly higher in the study group (139+/-40 x 10(9)/l vs. 164+/-75 x 10(9)/l, P=0.05). Peak postoperative troponin I release was significantly lower in the MECC group (3.81+/-2.7 ng/dl vs. 6.6+/-6.8 ng/dl, P<0.05). In this randomized study the MECC system has demonstrated best postoperative clinical results in terms of need for transfusion, platelets consumption and myocardial damage as compared to standard CPB. PMID:19342389

  13. Biologic determinants of dystrophic calcification and osteocalcin deposition in glutaraldehyde-preserved porcine aortic valve leaflets implanted subcutaneously in rats.

    PubMed Central

    Levy, R. J.; Schoen, F. J.; Levy, J. T.; Nelson, A. C.; Howard, S. L.; Oshry, L. J.

    1983-01-01

    Bioprosthetic cardiac valve calcification is a frequent complication after long-term valve replacement. In this study the authors sought to examine the biologic determinants of this type of dystrophic calcification using subcutaneous implants of glutaraldehyde-preserved porcine aortic valve leaflets (GPVs) in rats. GPVs and clinical valvular bioprostheses were prepared identically. Retrieved implants were examined for calcification and the deposition of osteocalcin (OC), a vitamin K-dependent, bone-derived protein, that is found in other dystrophic and ectopic calcifications. GPVs implanted in 3-week-old rats calcified progressively (GPV Ca2+, 122.9 +/- 6.0 micrograms/mg) after 21 days, with mineral deposition occurring in a morphologic pattern comparable to that noted in clinical retrievals. Calcified GPVs accumulated osteocalcin (OC, 183.4 +/- 19.4 ng/mg); Nonpreserved porcine aortic leaflet implants did not calcify (Ca2+ + 5.6 +/- 1.0 micrograms/mg). Millipore diffusion chamber (0.45-mu pore size enclosed GPV implants accumulated calcium and adsorbed osteocalcin despite the absence of attached host cells. GPVs implanted for 21 days in 8-month-old rats calcified less (GPV Ca2+, 22.4 +/- 5.0 micrograms/mg) than did GPVs implanted in 3-week-old rats (see above). High-dose warfarin therapy (80 mg/kg) did not alter GPV calcification (GPV Ca2+, 39.6 +/- 2.9 micrograms/mg) in 72-hour subcutaneous implants in 3-week-old male rats, compared with control rats (GPV Ca2+, 40.8 +/- 4.8 micrograms/mg). Images Figure 3 Figure 1 Figure 2 Figure 4 Figure 6 Figure 7 PMID:6605687

  14. Engineering tissue constructs to mimic native aortic and pulmonary valve leaflets' structures and mechanics

    NASA Astrophysics Data System (ADS)

    Masoumi, Nafiseh

    There are several disadvantages correlated with current heart valve replacement, including anticoagulation therapy for patients with mechanical valves and the low durability of bioprosthetic valves. The non-viable nature of such devices is a critical drawback especially for pediatric cases due to the inability of the graft to grow in vivo with the patients. A tissue engineered heart valve (TEHV) with remodeling and growth ability, is conceptually appealing to use in the surgical repair and could serve as a permanent replacements when operating for pediatric valvular lesions. It is critical that scaffolds for functional heart valve tissue engineering, be capable of mimicking the native leaflet's structure and mechanical properties at the time of implantation. Meanwhile, the scaffolds should be able to support cellular proliferation and native-like tissue formation as the TEHV remodels toward a scaffold-free state. Our overall hypothesis is that an "ideal" engineered construct, designed based on native leaflet's structure and mechanics, will complement a native heart valve leaflet in providing benchmarks for use in the design of clinically-applicable TEHV. This hypothesis was addressed through several experiments conducted in the present study. To establish a functional biomimetic TEHV, we developed scaffolds capable of matching the anisotropic stiffness of native leaflet while promoting native-like cell and collagen content and supporting the ECM generation. Scaffolds with various polymer contents (e.g., poly (glycerol sebacate) (PGS) and poly (epsilon-caprolactone) (PCL)) and structural designs (e.g., microfabricated and microfibrous scaffolds), were fabricated based on native leaflet's structure and mechanics. It was found that the tri-layered scaffold, designed with assembly of microfabricated PGS and microfibrous PGS/PCL was a functional leaflet capable of promoting tissue formation. Furthermore, to investigate the effect of cyclic stress and flexure individually on the TEHV development, we designed a simple and novel stretch-flexure bioreactor in which samples were subjected to well-defined stimulations with a controlled strain-rate. The stretch and flexure was found to accelerate and increase tissue formation on the microfabricated PGS scaffolds cultivated in the bioreactors.

  15. Pregnancy-induced remodeling of heart valves.

    PubMed

    Pierlot, Caitlin M; Moeller, Andrew D; Lee, J Michael; Wells, Sarah M

    2015-11-01

    Recent studies have demonstrated remodeling of aortic and mitral valves leaflets under the volume loading and cardiac expansion of pregnancy. Those valves' leaflets enlarge with altered collagen fiber architecture, content, and cross-linking and biphasic changes (decreases, then increases) in extensibility during gestation. This study extends our analyses to right-sided valves, with additional compositional measurements for all valves. Valve leaflets were harvested from nonpregnant heifers and pregnant cows. Leaflet structure was characterized by leaflet dimensions, and ECM composition was determined using standard biochemical assays. Histological studies assessed changes in cellular and ECM components. Leaflet mechanical properties were assessed using equibiaxial mechanical testing. Collagen thermal stability and cross-linking were assessed using denaturation and hydrothermal isometric tension tests. Pulmonary and tricuspid leaflet areas increased during pregnancy by 35 and 55%, respectively. Leaflet thickness increased by 20% only in the pulmonary valve and largely in the fibrosa (30% thickening). Collagen crimp length was reduced in both the tricuspid (61%) and pulmonary (42%) valves, with loss of crimped area in the pulmonary valve. Thermomechanics showed decreased collagen thermal stability with surprisingly maintained cross-link maturity. The pulmonary leaflet exhibited the biphasic change in extensibility seen in left side valves, whereas the tricuspid leaflet mechanics remained largely unchanged throughout pregnancy. The tricuspid valve exhibits a remodeling response during pregnancy that is significantly diminished from the other three valves. All valves of the heart remodel in pregnancy in a manner distinct from cardiac pathology, with much similarity valve to valve, but with interesting valve-specific responses in the aortic and tricuspid valves. PMID:26371175

  16. Promoting endothelialization on decellularized porcine aortic valve by immobilizing branched polyethylene glycolmodified with cyclic-RGD peptide: an in vitro study.

    PubMed

    Zhou, Jianliang; Nie, Bin'en; Zhu, Zhigang; Ding, Jingli; Yang, Wei; Shi, Jiawei; Dong, Xiao; Xu, Jianjun; Dong, Nianguo

    2015-01-01

    We functionally modify a decellularized porcine aortic valve using a novel complex biologically active cyclic- (c)-RGD modified with branched polyethylene glycol (PEG), namely, c-RDG-PEG. Human umbilical vein endothelial cell (HUVEC) adhesion and proliferation were detected for up to 8 d after seeding on the scaffold. (1)H nuclear magnetic resonance (D2O) showed signal peaks at 7.27 and 7.38 ppm associated with protons of the phenyl group in c-RGD-PEG. Attenuated total reflectance Fourier transform infrared spectroscopy showed characteristic peaks for PEG at 1100 and 1342?cm(-1). These represented vibration peaks of C-O and -CH2 bonds, suggesting successful grafting of c-RGD-PEG to a decellularized porcine aortic valve (DPAV). The tensile strengths were significantly increased in the c-RGD-PEG-DPAV group compared to the native valve and DPAV groups (P??valve and DPAV groups (P??valve surface. The modified DPAV resulted in good adhesion and proliferation of endothelial cells and is an appropriate approach to modify tissue engineered heart valves for promoting endothelialization. PMID:26584634

  17. [Aortic root replacement with free-style stentless valve for aorto-left and right ventricular communication due to infective endocarditis; report of a case].

    PubMed

    Kamikubo, Y; Murashita, T; Kunishige, H; Shiiya, N; Matsui, Y; Yasuda, K

    2004-04-01

    Aortic root abscess remains a major determinant of both early and late results of surgical treatment of endocarditis. This complication rarely progresses to intracardiac shunt followed by cardiac failure. We report a surgical case of a 40-year-old man, who had been diagnosed as prosthetic valve endocarditis with aortic root abscess ruptured into left and right ventricle creating aorto-left and right ventricular communication. Because of complete debridment of infective and/or dead tissue, aortic root replacement was required. We used free-style stentless valve, xenograft, since homograft was not available at the time of operation. We believe that this prosthesis has easier handling and is more resistant to infection, therefore, it might be an option for infective endocarditis with aortic root abscess. PMID:15071869

  18. Quickly Removable Valve

    NASA Technical Reports Server (NTRS)

    Robbins, John S.

    1988-01-01

    Unit removed with minimal disturbance. Valve inlet and outlet ports adjacent to each other on same side of valve body. Ports inserted into special manifold on fluid line. Valve body attached to manifold by four bolts or, alternatively, by toggle clamps. Electromechanical actuator moves in direction parallel to fluid line to open and close valve. When necessary to clean valve, removed simply by opening bolts or toggle clamps. No need to move or separate ports of fluid line. Valve useful where disturbance of fluid line detrimental or where fast maintenance essential - in oil and chemical industries, automotive vehicles, aircraft, and powerplants.

  19. Ball valve extractor

    DOEpatents

    Herndon, Charles (Walterboro, SC); Brown, Roger A. (North Augusta, SC)

    2002-01-01

    An apparatus and process for removing a ball valve is provided. The ball valve removal tool provides a handle sliding along the length of a shaft. One end of the shaft is secured within an interior cavity of a ball valve while the opposite end of the shaft defines a stop member. By providing a manual sliding force to the handle, the handle impacts the stop member and transmits the force to the ball valve. The direction of the force is along the shaft of the removal tool and disengages the ball valve from the ball valve housing.

  20. Timing of Dynamic NT-proBNP and hs-cTnT Response to Exercise Challenge in Asymptomatic Children with Moderate Aortic Valve Regurgitation or Moderate Aortic Valve Stenosis.

    PubMed

    Mawad, Wadi; Abadir, Sylvia; Fournier, Anne; Bigras, Jean-Luc; Curnier, Daniel; Kadem, Lyes; Dahdah, Nagib

    2015-12-01

    Patients with congenital aortic valve stenosis (AVS) can remain asymptomatic but may develop progressive and often underestimated exercise intolerance. The risk of increased left ventricular (LV) wall stress, irreversible myocardial fibrosis and sudden death in untreated patients warrants earlier intervention. The timing for curative therapy for severe AVS is clear, but optimal timing for moderate stenosis (modAS) is unknown. AVS often coexists with aortic regurgitation, which adds a volume overload to an already pressure-overloaded LV, adding an additional challenge to the estimation of disease severity. We investigated the possible value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) upon treadmill exercise challenge in children with asymptomatic modAS versus moderate regurgitation (modAR). The aim was to determine optimal timing of peak biochemical response. Blood samples were obtained at rest, and then at 20, 40 and 60 min after peak exercise comparing modAS and modAR to healthy controls. Exercise performance was equivalent in all groups, with no difference for biomarker levels at rest. The increase in NT-proBNP was significant in modAR at 40 min (99.2 ± 48.6 ng/L; p = 0.04) and 60 min into recovery (100.0 ± 53.7 ng/L; p = 0.01), but not in modAS. The increase in hs-cTnT was significant only at 60 min into recovery for modAS and modAR. NT-proBNP and hs-cTnT following exercise challenge are possible discriminant biomarkers of modAR from modAS and controls at 60 min into recovery despite comparable exercise performance. This offers a promising avenue for future stratification of aortic valve disease and optimal timing of intervention. PMID:26123813

  1. Influence of the aortic valve leaflets on the fluid-dynamics in aorta in presence of a normally functioning bicuspid valve.

    PubMed

    Bonomi, D; Vergara, C; Faggiano, E; Stevanella, M; Conti, C; Redaelli, A; Puppini, G; Faggian, G; Formaggia, L; Luciani, G B

    2015-11-01

    In this work, we consider the blood fluid-dynamics in the ascending aorta in presence of a normally functioning bicuspid aortic valve (BAV). In particular, we perform an unsteady finite element study in real geometries with physiological velocity boundary conditions at the inlet to assess the effect of the inclusion of the leaflets on the fluid-dynamic abnormalities characterizing BAV cases. To this aim, we perform a comparison in two geometries (a dilated and a non-dilated ones) among three scenarios which are built up for each geometry: BAV without leaflets, BAV with leaflets, and tricuspid case with leaflets. For each case, we compute four indices quantifying flow asymmetry, reversal flows, helical patterns, and wall shear stresses. Our results show that the inclusion of the leaflets increases the fluid-dynamics abnormalities, especially for the non-dilated configuration, which presents a greater increment of the indices. In particular, we observe that the values of the time-averaged wall shear stress and of the systolic jet asymmetry increase by approximatively 100 and 40 %, respectively, when considering the leaflets. PMID:25943772

  2. Magnetically guided recellularization of decellularized stented porcine pericardium-derived aortic valve for TAVI.

    PubMed

    Ghodsizad, Ali; Bordel, Viktor; Wiedensohler, Herrman; Elbanayosy, Ali; Koerner, Michael Martin; Gonzalez Berjon, Jose M; Barrios, Roberto; Farag, Mina; Zeriouh, Mohamad; Loebe, Matthias; Noon, George Peter; Koegler, Gesine; Karck, Matthias; Ruhparwar, Arjang

    2014-01-01

    Application of somatic stem cells for growth, proliferation, and differentiation in a three-dimensional pattern is an important aspect in tissue engineering. Here, we report on our bioreactor, which we applied for magnetically guided recellularization of nitinol-stented valve. Human-derived unrestricted somatic stem cells were cultured in medium in our pulsatile dynamic bioreactor for 4-6 days. Stented valves were prepared by decellularization of porcine pericardium and construction of stented tissue-engineered valves (n = 8). A magnetic field was created around the bioreactor to prevent the loss of cells. In the control group, no magnetic device was used (n = 4). Morphological characterization was assessed by immunohistochemical staining of paraffin sections and electron microscopy. The bioreactor enabled the preservation of physiologic culture conditions with aerobic cell metabolism and physiological pH values. Histological analysis showed homogeneous seeding of the pericardium with progenitor cells in the recellularized samples, whereas no cell seeding could be observed in the nonmagnetic group. Our magnetically guided multifunctional bioreactor allows for an efficient three-dimensional culturing of somatic stem cells on decellularized organ-specific matrix. PMID:25000385

  3. Traumatic disruption of the fibrous skeleton of the heart, with injury of the tricuspid and mitral valves, aortic annulus, and ventricular septum

    PubMed Central

    Kratz, John M.; Sade, Robert M.; Usher, Bruce W.; Gaddy, Joe E.

    1980-01-01

    In an automobile accident, a young man sustained blunt trauma to the chest that caused injury to the fibrous skeleton of the heart. The mitral and tricuspid valves and their annuli were lacerated, the aortic annulus was separated from the ventricular septum, and the ventricular septum was disrupted; however, with surgical management, the patient survived. PMID:15216256

  4. Quadricuspid aortic valve and anomalous origin of the left circumflex coronary artery in a young man with Down syndrome

    PubMed Central

    Bassareo, Pier Paolo; Hasan, Tammam; Bonvicini, Marco; Mercuro, Giuseppe

    2015-01-01

    Key Clinical Message The Authors present the case of an asymptomatic 36-year-old man, affected by Down syndrome, with an unexpected quadricuspid aortic valve coupled with the anomalous origin of the left circumflex coronary artery from the proximal right coronary artery. This is the first report of the concomitant presence of these three conditions. PMID:25914823

  5. Pump isolation valve

    DOEpatents

    Kinney, Calvin L. (Penn Hills, PA); Wetherill, Todd M. (Lower Burrell, PA)

    1983-08-02

    The pump isolation valve provides a means by which the pump may be selectively isolated from the remainder of the coolant system while being compatible with the internal hydraulic arrangement of the pump during normal operation of the pump. The valve comprises a valve cylinder disposed around the pump and adjacent to the last pump diffuser with a turning vane attached to the lower end of the valve cylinder in a manner so as to hydraulically match with the discharge diffuser. The valve cylinder is connected to a drive means for sliding the valve cylinder relative to the diffuser support cylinder so as to block flow in either direction through the discharge diffuser when the valve is in the closed position and to aid in the flow of the coolant from the discharge diffuser by means of the turning vane when the valve is in the open position.

  6. Mitral Valve Prolapse

    MedlinePLUS

    ... is due to small, usually harmless, tumor-like growths of collagen on the valve leaflets (called myxomatous changes). Mitral valve prolapse occurs in 2 percent to 3 percent of the population. A person can be born with the genetic ...

  7. Mitral Valve Prolapse

    MedlinePLUS

    ... may not close tightly. These flaps normally help seal or open the valve. Much of the time, ... and tricuspid valves close. They form a tight seal that prevents blood from flowing back into the ...

  8. Valve Health Monitor (VHM)

    NASA Technical Reports Server (NTRS)

    Perotti, Jose M.; Delgado, H. (Technical Monitor)

    2002-01-01

    This presentation reports on progress being made on developing a Valve Health Monitor (VHM) Smart Current Signature Sensor. Topics cover include: design needs, target valves, current signatures, VHM design approach and VHM status/conclusions.

  9. Mitral valve surgery - open

    MedlinePLUS

    ... the rest of your life. Biological, made of human or animal tissue. These valves last 10 to 12 years. ... occur, but this is rare. Valves made from human or animal tissue fail over time, but have a lower ...

  10. Overflow control valve

    DOEpatents

    Hundal, Rolv (Hempfield, PA); Kessinger, Boyd A. (Murrysville, PA); Parlak, Edward A. (North Huntingdon, PA)

    1984-07-24

    An overflow control valve for use in a liquid sodium coolant pump tank which valve can be extended to create a seal with the pump tank wall or retracted to break the seal thereby accommodating valve removal. An actuating shaft which controls valve disc position also has cams which bear on roller surfaces to force retraction of a sliding cylinder against spring tension to retract the cylinder from sealing contact with the pump tank.

  11. Stemless Ball Valve

    NASA Technical Reports Server (NTRS)

    Burgess, Robert K.; Yakos, David; Walthall, Bryan

    2012-01-01

    This invention utilizes a new method of opening and closing a ball valve. Instead of rotating the ball with a perpendicular stem (as is the case with standard ball valves), the ball is rotated around a fixed axis by two guide pins. This innovation eliminates the leak point that is present in all standard ball valves due to the penetration of an actuation stem through the valve body. The VOST (Venturi Off-Set-Technology) valve has been developed for commercial applications. The standard version of the valve consists of an off-set venturi flow path through the valve. This path is split at the narrowest portion of the venturi, allowing the section upstream from the venturi to be rotated. As this rotation takes place, the venturi becomes restricted as one face rotates with respect to the other, eventually closing off the flow path. A spring-loaded seal made of resilient material is embedded in the upstream face of the valve, making a leak-proof seal between the faces; thus a valve is formed. The spring-loaded lip seal is the only seal that can provide a class six, or bubble-tight, seal against the opposite face of the valve. Tearing action of the seal by high-velocity gas on this early design required relocation of the seal to the downstream face of the valve. In the stemless embodiment of this valve, inner and outer magnetic cartridges are employed to transfer mechanical torque from the outside of the valve to the inside without the use of a stem. This eliminates the leak path caused by the valve stems in standard valves because the stems penetrate through the bodies of these valves.

  12. Aerodynamic Shutoff Valve

    NASA Technical Reports Server (NTRS)

    Horstman, Raymond H.

    1992-01-01

    Aerodynamic flow achieved by adding fixed fairings to butterfly valve. When valve fully open, fairings align with butterfly and reduce wake. Butterfly free to turn, so valve can be closed, while fairings remain fixed. Design reduces turbulence in flow of air in internal suction system. Valve aids in development of improved porous-surface boundary-layer control system to reduce aerodynamic drag. Applications primarily aerospace. System adapted to boundary-layer control on high-speed land vehicles.

  13. Artificial Heart Valve Design

    E-print Network

    Provancher, William

    of the heart valve tissue · Years of high blood pressure and/or years of heavy alcohol drinking can cause direction flow of blood through the heart · Heart valves allow blood to flow through in a forward direction, but does not let any blood through in the opposite direction #12;Why does a heart valve start leaking

  14. Heart Valve Diseases

    MedlinePLUS

    Your heart has four valves. Normally, these valves open to let blood flow through or out of your heart, and then shut to keep it from flowing ... close tightly. It's one of the most common heart valve conditions. Sometimes it causes regurgitation. Stenosis - when ...

  15. Liquid rocket valve assemblies

    NASA Technical Reports Server (NTRS)

    1973-01-01

    The design and operating characteristics of valve assemblies used in liquid propellant rocket engines are discussed. The subjects considered are as follows: (1) valve selection parameters, (2) major design aspects, (3) design integration of valve subassemblies, and (4) assembly of components and functional tests. Information is provided on engine, stage, and spacecraft checkout procedures.

  16. Microblower assisted barometric valve

    DOEpatents

    Rossabi, Joseph; Hyde, Warren K.; Riha, Brian D.; Jackson, Dennis G.; Sappington, Frank

    2005-12-06

    A gas exchange apparatus is provided which provides for both passive fluid flow and blower associated fluid flow through a barometric valve. A battery powered blower is provided which allows for operation of the barometric valve during times when the barometric valve would otherwise be closed, and provides for enhanced volume of gas exchange.

  17. Dump valve assembly

    DOEpatents

    Owen, T.J.

    1984-01-01

    A dump valve assembly comprising a body having a bore defined by a tapered wall and a truncated spherical valve member adapted to seat along a spherical surface portion thereof against said tapered wall. Means are provided for pivoting said valve member between a closed position engagable with said tapered wall and an open position disengaged therefrom.

  18. Lock For Valve Stem

    NASA Technical Reports Server (NTRS)

    Burley, Richard K.; Guirguis, Kamal S.

    1991-01-01

    Simple, cheap device locks valve stem so its setting cannot be changed by unauthorized people. Device covers valve stem; cover locked in place with standard padlock. Valve lock made of PVC pipe and packing band. Shears, drill or punch, and forming rod only tools needed.

  19. Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices

    PubMed Central

    2010-01-01

    Background Cardiovascular magnetic resonance (CMR) is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI) featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve®) including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve® prosthesis as an initial step towards real-time CMR-guided TAVI. Methods The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T1-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding. Results CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences. Conclusions The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement in vivo after suggested design modifications of the delivery system. PMID:20942968

  20. Effect of coarctation of the aorta and bicuspid aortic valve on flow dynamics and turbulence in the aorta using particle image velocimetry

    NASA Astrophysics Data System (ADS)

    Keshavarz-Motamed, Zahra; Garcia, Julio; Gaillard, Emmanuel; Maftoon, Nima; Di Labbio, Giuseppe; Cloutier, Guy; Kadem, Lyes

    2014-03-01

    Blood flow in the aorta has been of particular interest from both fluid dynamics and physiology perspectives. Coarctation of the aorta (COA) is a congenital heart disease corresponding to a severe narrowing in the aortic arch. Up to 85 % of patients with COA have a pathological aortic valve, leading to a narrowing at the valve level. The aim of the present work was to advance the state of understanding of flow through a COA to investigate how narrowing in the aorta (COA) affects the characteristics of the velocity field and, in particular, turbulence development. For this purpose, particle image velocimetry measurements were conducted at physiological flow and pressure conditions, with three different aorta configurations: (1) normal case: normal aorta + normal aortic valve; (2) isolated COA: COA (with 75 % reduction in aortic cross-sectional area) + normal aortic valve and (3) complex COA: COA (with 75 % reduction in aortic cross-sectional area) + pathological aortic valve. Viscous shear stress (VSS), representing the physical shear stress, Reynolds shear stress (RSS), representing the turbulent shear stress, and turbulent kinetic energy (TKE), representing the intensity of fluctuations in the fluid flow environment, were calculated for all cases. Results show that, compared with a healthy aorta, the instantaneous velocity streamlines and vortices were deeply changed in the presence of the COA. The normal aorta did not display any regions of elevated VSS, RSS and TKE at any moment of the cardiac cycle. The magnitudes of these parameters were elevated for both isolated COA and complex COA, with their maximum values mainly being located inside the eccentric jet downstream of the COA. However, the presence of a pathologic aortic valve, in complex COA, amplifies VSS (e.g., average absolute peak value in the entire aorta for a total flow of 5 L/min: complex COA: = 36 N/m2; isolated COA = 19 N/m2), RSS (e.g., average peak value in the entire aorta for a total flow of 5 L/min: complex COA: = 84.6 N/m2; isolated COA = 44 N/m2) and TKE (e.g., average peak value in the entire aorta for a total flow of 5 L/min: complex COA: = 215 N/m2; isolated COA = 100 N/m2). This demonstrates that the pathological aortic valve strongly interacts with the COA. Findings of this study indicate that the presence of both a COA and a pathological aortic valve significantly alters hemodynamics in the aorta and thus might contribute to the progression of the disease in this region. This study can partially explain the complications associated in patients with COA, in the presence of a pathological aortic valve and the consequent adverse outcome post-surgery.

  1. [Surgical Treatment of Prosthetic Valve Endocarditis].

    PubMed

    Kaminishi, Yuichiro; Akutsu, Hirohiko; Sugaya, Akira; Kurumisawa, Soki; Takazawa, Ippei; Sato, Hirotaka; Muraoka, Arata; Aizawa, Kei; Ohki, Shinichi; Saito, Tsutomu; Kawahito, Koji; Misawa, Yoshio

    2015-10-01

    Between 2003 and 2014, at Jichi Medical University Hospital, 11 patients with prosthetic valve endocarditis(PVE) underwent re-operation. There was 1 in-hospital death and 2 late deaths. The cause of death was cirrhosis, heart failure and sepsis, respectively. Emergency surgery, previous double valve replacement (DVR) and Staphylococcus infection were common risk factors for all 3 cases. Two cases of patients that survived who underwent mitral valve replacement( MVR) and DVR for PVE after DVR were treated with multiple antibiotic courses for bacteremia associated with hemodialysis and colon cancer. One patient who underwent DVR after mitral valve plasty which was complicated with cerebral hemorrhage, had survived and was discharged. Of the aortic PVE patients, 2 cases of aortic valve replacement(AVR) using a mechanical valve, 1 case of aortic root replacement (ARR) using a mechanical valve, and 1 ARR using the homograft, were considered cured and never relapsed. A patient with aortic PVE, who underwent AVR after cesarean section for heart failure in birth period, has received ARR twice with the mechanical valve for recurrent pseudo-aneurysm of the left ventricular outflow tract. Since hemodialysis and colon cancer is a risk factor for recurrent PVE, it is necessary to consider the long-term administration of antibiotics after surgery. PMID:26469256

  2. Early and late improvement of global and regional left ventricular function after transcatheter aortic valve implantation in patients with severe aortic stenosis: an echocardiographic study

    PubMed Central

    Giannini, Cristina; Petronio, Anna Sonia; Talini, Enrica; De Carlo, Marco; Guarracino, Fabio; Grazia, Maria; Donne, Delle; Nardi, Carmela; Conte, Lorenzo; Barletta, Valentina; Marzilli, Mario; Di Bello, Vitantonio

    2011-01-01

    The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm2/m2; p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings. PMID:22254204

  3. Leakage test during mitral valve repair.

    PubMed

    Watanabe, Taiju; Arai, Hirokuni

    2014-11-01

    Mitral valve repair is the preferred surgical treatment for mitral regurgitation. Cardiac surgeons must increasingly pursue high-quality mitral valve repair, which ensures excellent long-term outcomes. Intraoperative assessment of a competency of the repaired mitral valve before closure of the atrium is an important step in accomplishing successful mitral valve repair. Saline test is the most simple and popular method to evaluate the repaired valve. In addition, an "Ink test" can provide confirmation of the surface of coaptation, which is often insufficient in the assessment of saline test. There are sometimes differences between the findings of the leakage test in an arrested heart and the echocardiographic findings after surgery. Assessment of the mitral valve in an arrested heart may not accurately reflect its function in a contractile heart. Assessment of the valve on the beating heart induced by antegrade or retrograde coronary artery perfusion can provide a more physiological assessment of the repaired valve. Perfusion techniques during beating heart surgery mainly include antegrade coronary artery perfusion without aortic cross-clamping, and retrograde coronary artery perfusion via the coronary sinus with aortic cross-clamping. It is the most important point for the former approach to avoid air embolism with such precaution as CO2 insufflation, left ventricular venting, and transesophageal echocardiography, and for the latter approach to maintain high perfusion flow rate of coronary sinus and adequate venting. Leakage test during mitral valve repair increasingly takes an important role in successful mitral valve reconstruction. PMID:25156036

  4. Isolated Pulmonary Valve Endocarditis.

    PubMed

    Chowdhury, Mohammed Andaleeb; Moukarbel, George V

    2016-01-01

    Endocarditis of only the pulmonary valve is a very rare finding and is often missed during echocardiographic evaluation due to limited views of the pulmonary valve and a low index of suspicion. We report 2 cases of pulmonary valve endocarditis (PVE), highlighting the importance of echocardiography in the assessment of the infected pulmonary valve. In addition, we review the published case reports of isolated PVE from 1979 to 2013 in order to study the role of echocardiography in the diagnosis of pulmonary valve masses. PMID:26501696

  5. Extracellular matrix remodeling and cell phenotypic changes in dysplastic and hemodynamically altered semilunar human cardiac valves

    PubMed Central

    Stephens, Elizabeth H.; Shangkuan, Jennifer; Kuo, Joyce J.; Carroll, Joshua L.; Kearney, Debra L.; Carberry, Kathleen E.; Fraser, Charles D.; Grande-Allen, K. Jane

    2015-01-01

    Introduction Congenital cardiac valve disease is common, affecting ~1% of the population, with substantial morbidity and mortality, but suboptimal treatment options. Characterization of the specific matrix and valve cell phenotypic abnormalities in these valves could lend insight into disease pathogenesis and potentially pave the way for novel therapies. Methods Thirty-five human aortic and pulmonic valves were categorized based on gross and microscopic assessment into control valves (n=21); dysplastic valves, all except one also displaying hemodynamic changes (HEMO/DYSP, n=6); and hemodynamically altered valves (HEMO, n=8). Immunohistochemistry was performed on valve sections and flow cytometry on valvular interstitial cells. Results While both hemodynamically altered aortic and pulmonic valves demonstrated increased collagen turnover and cell activation, prolyl 4-hydroxylase and hyaluronan increased in hemodynamically altered aortic valves but decreased in hemodynamically altered pulmonic valves relative to control valves (P<.001). HEMO/DYSP aortic valves demonstrated decreased collagen and elastic fiber synthesis and turnover compared to both hemodynamically altered aortic valves and control aortic valves (each P<.006). Valvular interstitial cells from both hemodynamically altered and HEMO/DYSP pulmonic valves showed altered cell phenotype compared to control valves (each P<.032), especially increased non-muscle myosin. Furthermore, valvular interstitial cells from hemodynamically altered pulmonic valves and HEMO/DYSP aortic and pulmonic valves each demonstrated greater size and complexity compared to control valves (each P<.05). Conclusions Dysplastic semilunar valves displayed alterations in collagen and elastic fiber turnover that were distinct from valves similarly exposed to altered hemodynamics as well as to control valves. These results demonstrate that dysplastic valves are not simply valves with gross changes or loss of leaflet layers, but contain complex matrix and cell phenotype changes that, with future study, could potentially be targets for novel nonsurgical treatments. PMID:20817569

  6. Main Oxidizer Valve Design

    NASA Technical Reports Server (NTRS)

    Addona, Brad; Eddleman, David

    2015-01-01

    A developmental Main Oxidizer Valve (MOV) was designed by NASA-MSFC using additive manufacturing processes. The MOV is a pneumatically actuated poppet valve to control the flow of liquid oxygen to an engine's injector. A compression spring is used to return the valve to the closed state when pneumatic pressure is removed from the valve. The valve internal parts are cylindrical in shape, which lends itself to traditional lathe and milling operations. However, the valve body represents a complicated shape and contains the majority of the mass of the valve. Additive manufacturing techniques were used to produce a part that optimized mass and allowed for design features not practical with traditional machining processes.

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

    SciTech Connect

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

    2008-09-15

    In order to improve the safety and efficacy of percutaneous aortic valve replacement procedures, a closed bore hybrid x-ray/MRI (CBXMR) system is proposed in which an x-ray C-arm will be positioned with its isocenter {approx_equal}1 m from the entrance of a clinical MRI scanner. This system will harness the complementary strengths of both modalities to improve clinical outcome. A key component of the CBXMR system will be a rotating anode x-ray tube to produce high-quality x-ray images. There are challenges in positioning an x-ray tube in the magnetic fringe field of the MRI magnet. Here, the effects of an external magnetic field on x-ray tube induction motors of radiography x-ray tubes and the corresponding reduction of x-ray tube heat loadability are investigated. Anode rotation frequency f{sub anode} was unaffected when the external magnetic field B{sub b} was parallel to the axis of rotation of the anode but decreased when B{sub b} was perpendicular to the axis of rotation. The experimental f{sub anode} values agreed with predicted values to within {+-}3% over a B{sub b} range of 0-30 mT. The MRI fringe field at the proposed location of the x-ray tube mounted on the C-arm ({approx_equal}4 mT) reduced f{sub anode} by only 1%, so x-ray tube heat loadability will not be compromised when using CBXMR systems for percutaneous aortic valve replacement procedures. Eddy current heating power in the rotor due to an MRI fringe field was found to be two orders of magnitude weaker than the heating power produced on the anode due to a fluoroscopic exposure, so eddy current heating had no effect on x-ray tube heat loadability.

  8. Closed bore XMR (CBXMR) systems for aortic valve replacement: Active magnetic shielding of x-ray tubes

    SciTech Connect

    Bracken, John A.; DeCrescenzo, Giovanni; Komljenovic, Philip; Lillaney, Prasheel V.; Fahrig, Rebecca; Rowlands, J. A.

    2009-05-15

    Hybrid closed bore x-ray/MRI systems are being developed to improve the safety and efficacy of percutaneous aortic valve replacement procedures by harnessing the complementary strengths of the x-ray and MRI modalities in a single interventional suite without requiring patient transfer between two rooms. These systems are composed of an x-ray C-arm in close proximity ({approx_equal}1 m) to an MRI scanner. The MRI magnetic fringe field can cause the electron beam in the x-ray tube to deflect. The deflection causes the x-ray field of view to shift position on the detector receptacle. This could result in unnecessary radiation exposure to the patient and the staff in the cardiac catheterization laboratory. Therefore, the electron beam deflection must be corrected. The authors developed an active magnetic shielding system that can correct for electron beam deflection to within an accuracy of 5% without truncating the field of view or increasing exposure to the patient. This system was able to automatically adjust to different field strengths as the external magnetic field acting on the x-ray tube was changed. Although a small torque was observed on the shielding coils of the active shielding system when they were placed in a magnetic field, this torque will not impact their performance if they are securely mounted on the x-ray tube and the C-arm. The heating of the coils of the shielding system for use in the clinic caused by electric current was found to be slow enough not to require a dedicated cooling system for one percutaneous aortic valve replacement procedure. However, a cooling system will be required if multiple procedures are performed in one session.

  9. Early Regression of Severe Left Ventricular Hypertrophy after Transcatheter Aortic Valve Replacement is Associated with Decreased Hospitalizations

    PubMed Central

    Lindman, Brian R.; Stewart, William J.; Pibarot, Philippe; Hahn, Rebecca T.; Otto, Catherine M.; Xu, Ke; Devereux, Richard B.; Weissman, Neil J.; Enriquez-Sarano, Maurice; Szeto, Wilson Y.; Makkar, Raj; Miller, D. Craig; Lerakis, Stamatios; Kapadia, Samir; Bowers, Bruce; Greason, Kevin L.; McAndrew, Thomas C.; Lei, Yang; Leon, Martin B.; Douglas, Pamela S.

    2014-01-01

    Objective Examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). Background LVM regression after valve replacement for aortic stenosis (AS) is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. Methods Of 2115 patients with symptomatic AS at high surgical risk receiving TAVR in the PARTNER randomized trial or continued access registry, 690 had both severe LVH (LVM index [LVMi] ³149 g/m2 men, ³122 g/m2 women) at baseline and an LVMi measurement 30 days post-TAVR. Clinical outcomes were compared for patients with greater than vs. lesser than median percent change in LVMi between baseline and 30 days using Cox proportional hazard models to evaluate event rates from 30 to 365 days. Results Compared to patients with lesser regression, patients with greater LVMi regression had a similar rate of all-cause mortality (14.1% vs. 14.3%, p=0.99), but a lower rate of rehospitalization (9.5% vs. 18.5%, HR 0.50; 95% CI, 0.32–0.78; p=0.002) and a lower rate of rehospitalizations specifically for heart failure (7.3% vs. 13.6%, p=0.01). The association with a lower rate of hospitalizations was consistent across sub-groups and remained significant after multivariable adjustment (HR 0.53; 95% CI, 0.34–0.84; p=0.007). Patients with greater LVMi regression had lower BNP (p=0.002) and a trend toward better quality of life (p=0.06) at 1 year compared to those with lesser regression. Conclusions In high-risk patients with severe AS and severe LVH undergoing TAVR, those with greater early LV mass regression had half the rate of rehospitalization over the subsequent year. PMID:24947722

  10. Impact of Preprocedural B-Type Natriuretic Peptide Levels on the Outcomes After Transcatheter Aortic Valve Implantation.

    PubMed

    Abramowitz, Yigal; Chakravarty, Tarun; Jilaihawi, Hasan; Lee, Chin; Cox, Justin; Sharma, Rahul P; Mangat, Geeteshwar; Cheng, Wen; Makkar, Raj R

    2015-12-15

    There are limited data on the effect of baseline B-type natriuretic peptide (BNP) on the outcome after transcatheter aortic valve implantation (TAVI). We investigated the influence of baseline BNP levels on the short-term and midterm clinical outcomes after TAVI. During a 3-year period, 780 patients with severe aortic stenosis underwent TAVI at our institute and had baseline BNP levels. We compared the high, mid, and low tertiles of BNP levels. TAVI end points, device success, and adverse events were considered according to the Valve Academic Research Consortium 2 definitions. Device success was significantly lower for patients with high BNP (98.1% vs 96.2% vs 91.9% for the low, mid, and high BNP tertiles, respectively; p = 0.003). All-cause mortality up to 30 days was 1.2% (3 of 260) versus 2.3% (6 of 260) versus 5% (13 of 260), respectively (p = 0.03). Six-month mortality rate was 4.1% (10 of 241) for the low BNP tertile, 5% (12 of 239) for the mid BNP tertile, and 17.1% (40 of 234) for the high BNP tertile (p <0.001). In the multivariate model, high tertile of baseline BNP was found to be significantly associated with all-cause mortality (hazard ratio 3.3, 95% confidence interval 1.64 to 6.48; p = 0.001). In conclusion, elevated BNP levels are associated with increased short-term and midterm mortality after TAVI. We recommend measurement of baseline BNP as part of risk stratification models for TAVI. PMID:26602075

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

    PubMed Central

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

    2008-01-01

    In order to improve the safety and efficacy of percutaneous aortic valve replacement procedures, a closed bore hybrid x-ray?MRI (CBXMR) system is proposed in which an x-ray C-arm will be positioned with its isocenter ?1 m from the entrance of a clinical MRI scanner. This system will harness the complementary strengths of both modalities to improve clinical outcome. A key component of the CBXMR system will be a rotating anode x-ray tube to produce high-quality x-ray images. There are challenges in positioning an x-ray tube in the magnetic fringe field of the MRI magnet. Here, the effects of an external magnetic field on x-ray tube induction motors of radiography x-ray tubes and the corresponding reduction of x-ray tube heat loadability are investigated. Anode rotation frequency fanode was unaffected when the external magnetic field Bb was parallel to the axis of rotation of the anode but decreased when Bb was perpendicular to the axis of rotation. The experimental fanode values agreed with predicted values to within ±3% over a Bb range of 0–30 mT. The MRI fringe field at the proposed location of the x-ray tube mounted on the C-arm (?4 mT) reduced fanode by only 1%, so x-ray tube heat loadability will not be compromised when using CBXMR systems for percutaneous aortic valve replacement procedures. Eddy current heating power in the rotor due to an MRI fringe field was found to be two orders of magnitude weaker than the heating power produced on the anode due to a fluoroscopic exposure, so eddy current heating had no effect on x-ray tube heat loadability. PMID:18841857

  12. Apelin attenuates the osteoblastic differentiation of aortic valve interstitial cells via the ERK and PI3-K/Akt pathways.

    PubMed

    Yuan, Zhao-Shun; Zhou, Yang-Zhao; Liao, Xiao-Bo; Luo, Jia-Wen; Shen, Kang-Jun; Hu, Ye-Rong; Gu, Lu; Li, Jian-Ming; Tan, Chang-Ming; Chen, He-Ming; Zhou, Xin-Min

    2015-12-01

    Aortic valve calcification (AVC), which used to be recognized as a passive and irreversible process, is now widely accepted as an active and regulated process characterized by osteoblastic differentiation of aortic valve interstitial cells (AVICs). Apelin, the endogenous ligand for G-protein-coupled receptor APJ, was found to have protective cardiovascular effects in several studies. However, the effects and mechanisms of apelin on osteoblastic differentiation of AVICs have not been elucidated. Using a pro-calcific medium, we devised a method to produce calcific human AVICs. These cells were used to study the relationship between apelin and the osteoblastic calcification of AVICs and the involved signaling pathways. Alkaline phosphatase (ALP) activity/expression and runt-related transcription factor 2 (Runx2) expression were examined as hallmark proteins in this research. The involved signaling pathways were studied using the extracellular signal-regulated kinase (ERK) inhibitor, PD98059, and the phosphatidylinositol 3-kinase (PI3-K) inhibitor, LY294002. The results indicate that apelin attenuates the expression and activity of ALP, the expression of Runx2, and the formation of mineralized nodules. This protective effect was dependent on the dose of apelin, reaching the maximum at 100 pM, and was connected to activity of ERK and Akt (a downstream effector of PI3-K). The activation of ERK and PI3-K initiated the effects of apelin on ALP activity/expression and Runx2, but PD98059 and LY294002 abolished the effect. These results demonstrate that apelin attenuates the osteoblastic differentiation of AVICs via the ERK and PI3-K/Akt pathway. PMID:26142632

  13. Brachial artery diameter has a predictive value in the improvement of flow-mediated dilation after aortic valve replacement for aortic stenosis.

    PubMed

    Takata, Munenori; Amiya, Eisuke; Watanabe, Masafumi; Ozeki, Atsuko; Watanabe, Aya; Kawarasaki, Shuichi; Nakao, Tomoko; Hosoya, Yumiko; Uno, Kansei; Saito, Aya; Murasawa, Takahide; Ono, Minoru; Nagai, Ryozo; Komuro, Issei

    2015-03-01

    Aortic stenosis (AS) is the most common valvular disease and aortic valve replacement (AVR) is one of its most effective interventions. AS affects not only the left ventricle, but also vascular function beyond the stenotic valve, which can lead to various types of vascular dysfunction. However, research evaluating the effect of AS on aortic vascular function is limited. In this study, we investigated clinical meaning to evaluate endothelial function in subjects with AS. From April 2011 to April 2012, 20 consecutive adult patients with degenerative AS (mean age, 74.7 ± 7.4 years; range 50-83 years) who underwent AVR at our institution were included in the study. We measured flow-mediated dilation (FMD) to evaluate the effect of AS on endothelial function. The difference between brachial artery diameter (BAD) before (4.0 ± 0.7 mm) and after AVR (3.9 ± 0.6 mm) was not significant (p = 0.043), but FMD significantly improved after AVR (from 3.1 ± 1.8 to 6.0 ± 2.7 %, p < 0.0001). We also analyzed FMD × BAD index, endogenous vasodilatory capability independent of BAD, resulting that it also significantly increased after AVR (12.3 ± 7.0-22.5 ± 9.3, p < 0.0001). We divided patients into two groups by pre- to post-AVR change in FMD (?FMD); large-?FMD group [?FMD >3.0 % (median value)] and small-?FMD group (?FMD <3.0 %). There were no significant changes in age, blood pressure, heart rate, B-type natriuretic peptide, or echocardiographic parameters in either group. In contrast, BAD was significantly larger in the small ?FMD group (4.3 ± 0.7 mm) than in the large ?FMD group (3.7 ± 0.7 mm) (p = 0.030). In addition, cardio-thoracic ratio was significantly greater in the small ?FMD group (58.4 ± 7.1 %) than in the large ?FMD group (53.7 ± 4.6 %) (p = 0.048). Receiver operating characteristic curve analysis of BAD to differentiate large and small ?FMD demonstrated an area under the curve of 0.750 (p = 0.059) and that optimal cutoff for BAD was 4.28 mm (70 % sensitivity, 80 % specificity). AVR in subjects with AS is associated with a significant improvement in FMD in the brachial artery. Measurement of the BAD may be helpful in distinguishing whether the impairment of FMD in AS derives from a stenotic valve or vascular remodeling. PMID:24497127

  14. CAM operated fuel valve

    SciTech Connect

    Kelly, S.T.; Katchka, J.R.

    1991-09-03

    This patent describes improvement in a fuel control valve construction comprising a housing means having an inlet means adapted to be interconnected to a fuel source and a main outlet means adapted to be interconnected to a main burner means, the housing means having a main valve seat for interconnecting the inlet means with the main outlet means, the housing means having a movable main valve member for opening and closing the main valve seat, the housing means having a movable lever operatively associated with the main valve member and having a manually operable actuator means for controlling the operating positions of the lever, the lever having an intermediate cam follower portion and opposed ends disposed on each side of the cam follower portion with one end of the opposed ends being pivotally mounted to the housing means and with the other end of the opposed ends for operating the main valve member, the housing means having biasing means operatively interconnected to the lever to tend to pivot the lever in one direction that opens the main valve member away from its the main valve seat. The improvement comprises; the housing means has a thermostatically controlled means that is operatively associated with the lever and is adapted to engage and hold the lever in a position wherein the main valve member is in a closed condition against its the main valve seat when the thermostatically controlled means is in one operating condition thereof and the actuator means is in the on condition thereof.

  15. Exercise Training in Athletes with Bicuspid Aortic Valve Does Not Result in Increased Dimensions and Impaired Performance of the Left Ventricle

    PubMed Central

    Stefani, Laura; Galanti, Giorgio; Innocenti, Gabriele; Mercuri, Roberto; Maffulli, Nicola

    2014-01-01

    Background. Bicuspid aortic valve (BAV) is one of the most common congenital heart disease (0.9%–2%) and is frequently found in the athletes and in the general population. BAV can lead to aortic valve dysfunction and to a progressive aortic dilatation. Trained BAV athletes exhibit a progressive enlargement of the left ventricle (LV) compared to athletes with normal aortic valve morphology. The present study investigates the possible relationship between different aortic valve morphology and LV dimensions. Methods. In the period from 2000 to 2011, we investigated a total of 292 BAV subjects, divided into three different groups (210 athletes, 59 sedentaries, and 23 ex-athletes). A 2D echocardiogram exam to classify BAV morphology and measure the standard LV systo-diastolic parameters was performed. The study was conducted as a 5-year follow-up echocardiographic longitudinal and as cross-sectional study. Results. Typical BAV was more frequent in all three groups (68% athletes, 67% sedentaries, and 63% ex-athletes) than atypical. In BAV athletes, the typical form was found in 51% (107/210) of soccer players, 10% (21/210) of basketball players, 10% track and field athletics (20/210), 8% (17/210) of cyclists, 6% (13/210) swimmers, and 15% (32/210) of rugby players and others sport. Despite a progressive enlargement of the LV (P < 0.001) observed during the follow-up study, no statistical differences of the LV morphology and function were evident among the diverse BAV patterns either in sedentary subjects or in athletes. Conclusion. In a large population of trained BAV athletes, with different prevalence of typical and atypical BAV type, there is a progressive nonstatistically significant enlargement of the LV. In any case, the dimensions of the LV remained within normal range. The metabolic requirements of the diverse sport examined in the present investigations do not seem to produce any negative impact in BAV athletes PMID:24600528

  16. Use of aortic valvo-pumps placed in valve annulus for long-term left ventricular assist.

    PubMed

    Qian, Kun-Xi; Wang, Dongfang; Topaz, Stephen R; Ru, Wei-Min; Zeng, Pei; Yuan, Hai-Yu; Wang, Hao; Wang, Fang-Qung; Feng, Zi-Gang; Zwischenberger, Joseph B

    2005-01-01

    To provide better anatomical fit and physiologic adaptation, three aortic valvo-pumps with different dimensions were developed. Each pump has a rotor with an impeller and drive magnets and a stator consisting of a motor coil with iron core and an outflow guide vane. The devices had outer diameters of 21 mm, 23 mm, and 25 mm, respectively, and weighted 27 g, 31 g, and 40 g, respectively. Laboratory testing demonstrated that the rotating speed for maintaining a diastolic pressure of 80 mm Hg at zero flow rate should be 17500 rpm, 15000 rpm, and 12500 rpm, respectively; the largest flow at these same speeds will be 5 l/min, 7 l/min, and 10 l/min, respectively, with approximately 50 mm Hg pressure head increase. Therefore, these three pumps may meet the hemodynamic requirements of patients with body weights of 40-60 kg, 60-80 kg, and 80-100 kg. The first in vivo trial exhibited that the 25 mm valvo-pump can be sewn onto the aortic valve annulus of a 80 kg body weight pig without harm to adjacent organ functions. The devices occupy no additional anatomic space and deliver the blood directly from ventricle to the aorta, thus producing less physiologic disturbance to the natural circulation. Neither connecting conduits nor bypass circuits are necessary, thus eliminating the most dangerous sites of thrombosis in traditional left ventricular assist devices. PMID:16340359

  17. Cognitive function after transapical aortic valve implantation: a single-centre study with 3-month follow-up

    PubMed Central

    Knipp, Stephan C.; Kahlert, Philipp; Jokisch, Daniel; Schlamann, Marc; Wendt, Daniel; Weimar, Christian; Jakob, Heinz; Thielmann, Matthias

    2013-01-01

    OBJECTIVES Reports on adverse neurological events following transcatheter aortic valve implantation (TAVI) have focused on strokes, while more subtle postoperative cognitive decline has not yet been systematically investigated. In this study, we prospectively examined neurological and cognitive outcomes in patients undergoing transapical (TA) and surgical aortic valve replacement (AVR). METHODS A total of 64 patients with severe symptomatic aortic stenosis were investigated between January 2008 and July 2009. Clinical neurological examination and comprehensive neuropsychological testing were performed before and after the procedure, at discharge and at 3-month follow-up. Diffusion-weighted magnetic resonance imaging (DW-MRI) was applied to detect morphological brain injury. RESULTS TA-TAVI patients (n = 27) were older and at higher surgical risk compared with surgical AVR patients (n = 37; mean age 82.2 ± 4.7 vs 67.5 ± 8.9 years; log EuroSCORE 36.4 ± 13.2 vs 2.6 ± 8.5%, both P <0.001). There was one stroke in each group (3.7 vs 2.7%, P = 0.49), both classified as embolic based on imaging characteristics. After TA-TAVI, cognitive tests showed no decline during follow-up, while, after AVR, 7 of 11 tests showed a decline early after surgery. Similarly, with-in patient analysis showed that the rate of individuals with clinically relevant cognitive decline was increased early after AVR (TA-TAVI vs AVR: 18 vs 46% at discharge [P = 0.03]; 28 vs 6% at 3 months [P = 0.04]). New focal ischaemic cerebral lesions were detected on DW-MRI in 58% (7 of 12) of patients after TA-TAVI vs 34% (12 of 35) after AVR (P = 0.13). The number of brain lesions per patient and cumulative embolic load per patient were similar between groups. An association between postoperative cerebral ischaemia and cognitive dysfunction was not found (odds ratio 2.37, 95% confidence interval 0.05–113.75, P = 0.66). CONCLUSIONS Cognitive function was only mildly impaired after TA-TAVI when compared with a marked, albeit transient, decline after surgical AVR. Focal embolic brain injury tended to occur more frequently after TA-TAVI, but this was not related to cognitive decline during the 3-month follow-up. PMID:23148084

  18. Comparison of Outcome of Transcatheter Aortic Valve Implantation With Versus Without Previous Coronary Artery Bypass Grafting (from the FRANCE 2 Registry).

    PubMed

    Castellant, Philippe; Didier, Romain; Bezon, Eric; Couturaud, Francis; Eltchaninoff, Hélène; Iung, Bernard; Donzeau-Gouge, Patrick; Chevreul, Karine; Fajadet, Jean; Leprince, Pascal; Leguerrier, Alain; Lievre, Michel; Prat, Alain; Teiger, Emmanuel; Laskar, Marc; Boschat, Jacques; Gilard, Martine

    2015-08-01

    Previous coronary artery bypass grafting (CABG) increases operative risk in conventional valve replacement. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high-risk patient subgroups. The present study compared outcome and overall survival in patients who underwent TAVI with and without history of CABG. From January 2010 to December 2011, 683 of the 3,761 patients selected for TAVI in 34 French centers (18%) had a history of CABG. Outcomes (mortality and complications) were collected prospectively according to the Valve Academic Research Consortium (VARC) criteria. Patients with previous CABG were younger, with higher rates of diabetes and vascular disease and higher logistic European System for Cardiac Operative Risk Evaluation (29.8 ± 16.4 vs 20.1 ± 13.0, p <0.001) but lower rates of pulmonary disease. Two types of valve (Edwards SAPIEN and Medtronic CoreValve) were implanted in equal proportions in the 2 groups. The 30-day and 1-year mortality rates from all causes on Kaplan-Meier analysis (9.2% vs 9.7%, p = 0.71; and 19.0% vs 20.2%, p = 0.49, respectively) did not differ according to the history of CABG. There were no significant differences in the Valve Academic Research Consortium complications (myocardial infarction, stroke or vascular, and bleeding complications). On multivariate analysis, CABG was not associated with greater 1-year post-TAVI mortality. In conclusion, previous CABG did not adversely affect outcome in patients who underwent TAVI, which may be an alternative to surgery in high-risk patients with severe aortic stenosis and history of CABG. PMID:26071993

  19. Automatic rotary valve actuator

    SciTech Connect

    Cook, W.E.

    1985-03-28

    This report describes the design, construction, and operation of a microcomputer-controlled valve actuator for operating test valves requiring rotary motion of the valve stem. An AIM 65 microcomputer, using a FORTH language program, controls an air motor and air clutch mounted within an oven to accomplish testing at elevated temperatures. The valve actuator closes the test valve until a preset torque is reached and then opens the valve to its initial starting point. The number of cycles and extremes of rotation are tallied and printed as the test progresses. Provisions are made to accept remote signals to stop the test and to indicate to a remote device when the test has been stopped.

  20. Intelligent Flow Control Valve

    NASA Technical Reports Server (NTRS)

    Kelley, Anthony R (Inventor)

    2015-01-01

    The present invention is an intelligent flow control valve which may be inserted into the flow coming out of a pipe and activated to provide a method to stop, measure, and meter flow coming from the open or possibly broken pipe. The intelligent flow control valve may be used to stop the flow while repairs are made. Once repairs have been made, the valve may be removed or used as a control valve to meter the amount of flow from inside the pipe. With the addition of instrumentation, the valve may also be used as a variable area flow meter and flow controller programmed based upon flowing conditions. With robotic additions, the valve may be configured to crawl into a desired pipe location, anchor itself, and activate flow control or metering remotely.

  1. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis.

    PubMed

    Durand, Eric; Eltchaninoff, Hélène; Canville, Alexandre; Bouhzam, Najime; Godin, Matthieu; Tron, Christophe; Rodriguez, Carlos; Litzler, Pierre-Yves; Bauer, Fabrice; Cribier, Alain

    2015-04-15

    There is currently no consensus on the duration of hospitalization required after transfemoral transcatheter aortic valve implantation (TAVI). We report the feasibility and safety of early discharge after TAVI with the Edwards SAPIEN-XT prosthesis. From 2009 to 2013, 337 patients underwent transfemoral TAVI with the Edwards SAPIEN-XT prosthesis using local anesthesia and were discharged home either early (?3 days, Early Discharge group, n = 121) or after 3 days (Late Discharge group, n = 216). The primary end point of the study combined death and rehospitalization from discharge to 30-day follow-up. Patients in the Early Discharge group were less symptomatic (New York Heart Association class ?III: 64.5% vs 75.5%, p = 0.01) and had less renal failure (creatinine: 102.1 ± 41.0 vs 113.3 ± 58.9 ?mol/L, p = 0.04), atrial fibrillation (33.1% vs 46.3%, p = 0.02), and previous balloon aortic valvuloplasty (11.6% vs 23.1%, p = 0.01) and were more likely to have a pacemaker before TAVI (16.5% vs 8.3%, p = 0.02). Pre-existing pacemaker (p = 0.05) and the absence of acute kidney injury (p = 0.02) were independent predictors of an early discharge, whereas previous balloon aortic valvuloplasty (p = 0.03) and post-TAVI blood transfusions (p = 0.002) were independent predictors of late discharge. The primary end point occurred in 4 patients (3.3%) in the Early Discharge group and in 11 patients (5.1%) in the Late Discharge group (p = 0.58). In conclusion, the results of our study suggest that early discharge after transfemoral TAVI using the Edwards SAPIEN-XT prosthesis is feasible and safe in selected patients. PMID:25726383

  2. Large Patent Ductus Arteriosus in a 44-Year-Old Woman Leading to Calcium Deposition in the Left Atrium and Mitral and Aortic Valves

    PubMed Central

    Roberts, Carey Camille

    2015-01-01

    This report describes unusual autopsy findings in a 44-year-old woman who had a large, calcified patent ductus arteriosus that produced substantial left-to-right shunting. The patient died in 1962, 7 days after patch closure of the aortic orifice of the ductus. Numerous calcific deposits were present in the mural left atrial endocardium, the mitral valve leaflets and annulus, and the aortic valve cusps. The cause of the left-sided calcific deposits was perhaps related to the patient's several-decades-old giant aortopulmonary shunt, causing a major increase in the volume of blood passing through the left-sided cardiac chambers in comparison with the volume in the right side. To our knowledge, such findings in a patient with patent ductus arteriosus have not been reported previously. PMID:26175644

  3. Lethal Aorto-Right Ventricular Defect After Transcatheter Aortic Valve Implantation in a Patient With Radiation-Induced Porcelain Aorta: Notes of Caution.

    PubMed

    Leroux, Lionel; Dijos, Marina; Peltan, Julien; Casassus, Frederic; Seguy, Benjamin; Natsumeda, Makoto; Lafitte, Stephane; Labrousse, Louis; Dos Santos, Pierre

    2016-01-01

    A 47-year-old man with severe radiation-induced aortic stenosis was rejected for cardiac surgery because of porcelain aorta. We successfully implanted an Edwards SAPIEN valve (Edwards Lifesciences, Irvine, CA), but the patient was readmitted 3 weeks later for heart failure with a continuous murmur on auscultation. Echocardiography showed a small defect between the aorta and the infundibulum of the right ventricle, which was also confirmed with aortography and computed tomography. Medical therapy was optimized; however, he died unexpectedly a few weeks later. We concluded that irradiated tissues are particularly fragile and require specific attention during transcatheter aortic valve implantation. Furthermore, this case suggests that a more aggressive closure should have been applied. PMID:26342846

  4. Tubing drain valve

    SciTech Connect

    Soderberg, P.B.

    1987-02-24

    A method is described for operating a valve means. The valve means comprises a tubular piston movable within a tubular member suitable for use in a borehole pipe string to open and close a port through the wall of the tubular member. The method comprises: biassing the valve means in its closed position; pressurizing the interior of the piston to a predetermined pressure to overcome the biassing closed force and to actuate the valve means to its open position; biassing the valve means to its open position; and actuating the valve means to its closed position by engaging a first arm of a dog pivotally mounted on the piston with an engaging means insertable through the interior of the tubular piston; moving the piston relative to the tubular member; rotating the dog about its pivot to bring a second arm of the dog into contact with a detent in the tubular member; and applying sufficient force to the first arm to continue rotating the dog about the pivot, while engaging the detent with the second arm of the dog, in order to overcome the biassing open force to actuate the valve means to its closed position. A tubing drain valve suitable for use in a borehole pipe string, comprising: a sub suitable for incorporating within a borehole pipe string; and a port between the interior and the exterior of the sub; and valve means for opening and closing the port.

  5. Heart valve surgery - series (image)

    MedlinePLUS

    ... Replacement heart valves are either natural (biologic) or artificial (mechanical). Natural valves are from human donors (cadavers), ... pigs) which are placed in synthetic rings, and artificial valves are made of metal or plastic. Natural ...

  6. Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation.

    PubMed

    De Backer, Ole; Arnous, Samer; Sandholt, Benjamin; Brooks, Matthew; Biasco, Luigi; Franzen, Olaf; Lönn, Lars; Bech, Bo; Søndergaard, Lars

    2015-04-15

    Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI-induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients. PMID:25728645

  7. Preservation of native aortic valve flow and full hemodynamic support with the TORVAD using a computational model of the cardiovascular system.

    PubMed

    Gohean, Jeffrey R; George, Mitchell J; Chang, Kay-Won; Larson, Erik R; Pate, Thomas D; Kurusz, Mark; Longoria, Raul G; Smalling, Richard W

    2015-01-01

    This article describes the stroke volume selection and operational design for the toroidal ventricular assist device (TORVAD), a synchronous, positive-displacement ventricular assist device (VAD). A lumped parameter model was used to simulate hemodynamics with the TORVAD compared with those under continuous-flow VAD support. Results from the simulation demonstrated that a TORVAD with a 30 ml stroke volume ejecting with an early diastolic counterpulse provides comparable systemic support to the HeartMate II (HMII) (cardiac output 5.7 L/min up from 3.1 L/min in simulated heart failure). By taking the advantage of synchronous pulsatility, the TORVAD delivers full hemodynamic support with nearly half the VAD flow rate (2.7 L/min compared with 5.3 L/min for the HMII) by allowing the left ventricle to eject during systole and thus preserving native aortic valve flow (3.0 L/min compared with 0.4 L/min for the HMII, down from 3.1 L/min at baseline). The TORVAD also preserves pulse pressure (26.7 mm Hg compared with 12.8 mm Hg for the HMII, down from 29.1 mm Hg at baseline). Preservation of aortic valve flow with synchronous pulsatile support could reduce the high incidence of aortic insufficiency and valve cusp fusion reported in patients supported with continuous-flow VADs. PMID:25485562

  8. LV mechanics in mitral and aortic valve diseases: value of functional assessment beyond ejection fraction.

    PubMed

    Galli, Elena; Lancellotti, Patrizio; Sengupta, Partho P; Donal, Erwan

    2014-11-01

    The assessment of myocardial function in the context of valvular heart disease remains highly challenging. The myocardium deforms simultaneously in 3 dimensions, and global left ventricular (LV) function parameters such as volume and ejection fraction may remain compensated despite the changes in myocardial deformation properties. Current guidelines recommend valve replacement/repair in the presence of symptoms or reduced LV ejection fraction, but the resolution of symptoms or recovery of LV function post-surgery may not be reliably predicted. A wealth of evidence currently suggests that LV dysfunction is frequently subclinical despite normal ejection fraction. It may precede the onset of symptoms and portend a poor outcome due to progressive myocardial remodeling and dysfunction during the post-operative period. The advent of novel tissue-tracking echocardiography techniques has unleashed new opportunities for the clinical identification of early abnormalities in LV function. This review gathers and summarizes current evidence regarding the use of these techniques to assess myocardial deformation in patients with valvular heart disease. PMID:25459597

  9. Clinical Outcome and Cost Analysis of Sutureless Versus Transcatheter Aortic Valve Implantation With Propensity Score Matching Analysis.

    PubMed

    Santarpino, Giuseppe; Pfeiffer, Steffen; Jessl, Jürgen; Dell'Aquila, Angelo; Vogt, Ferdinand; von Wardenburg, Che; Schwab, Johannes; Sirch, Joachim; Pauschinger, Matthias; Fischlein, Theodor

    2015-12-01

    Surgical sutureless and interventional transcatheter aortic valve prostheses are nowadays extensively adopted in high-risk elderly patients. An explorative analysis was carried out to compare the clinical outcome and costs associated to these approaches. Since 2010, a total of 626 patients were distributed between transcatheter aortic valve implantation (TAVI; n = 364) and sutureless (n = 262) groups. Patients of both groups were not comparable for clinical and surgical characteristics, but many patients were in a "gray zone"; therefore, a retrospective propensity score analysis was possible and performed. For the matched pair samples, postoperative, follow-up clinical data, and costs data were obtained. In-hospital death occurred in 5 patients in sutureless group and 3 patients in TAVI group (p = 0.36). Blood transfusions were higher in sutureless group (2.1 ± 2.3 vs 0.4 ± 1.0 U). TAVI group had a shorter intensive care unit and hospital stay (2.2 ± 2.7 vs 3.2 ± 3.5 days, p = 0.037; 12 ± 6 vs 14 ± 6 days, p = 0.017). No differences in postoperative neurologic (p = 0.361), renal (p = 0.106), or respiratory (p = 0.391) complications were observed between groups. At follow-up (24.5 ± 13.8 months), 1 patient in sutureless group and 7 patients in TAVI group died (p = 0.032). Paravalvular leakage occurred more frequently in patients in TAVI group (35 [34%] vs 7 [6.9%]; p <0.001) with an impact on follow-up survival rate. The costs associated to the 2 procedures are similar when the cost of the device was excluded (p = 0.217). When included, the sutureless approach resulted a cost saving (€22,451 vs €33,877, p <0.001). In conclusion, the patients in the "gray zone" record a satisfying clinical outcome after sutureless surgery and TAVI. Patients in the sutureless group endure more hospital complications, but TAVI entails a higher follow-up mortality. On the costs aspects, TAVI technologies are more expensive, and it reflects on higher overall hospital costs. PMID:26433277

  10. Power Plant Valves

    NASA Technical Reports Server (NTRS)

    1981-01-01

    Rockwell International employed NASTRAN to identify high stress areas in valve products and the mechanical configurations necessary to accommodate them. Also used in seismic and vibration analysis of valves to establish design adequacy under severe conditions, such as those that might occur in an earthquake. Program offers significant savings in analysis effort compared with other analytical approaches.

  11. Valve for abrasive material

    DOEpatents

    Gardner, Harold S. (Turtle Creek, PA)

    1982-01-01

    A ball valve assembly for controlling the flow of abrasive particulates including an enlarged section at the bore inlet and an enlarged section at the bore outlet. A refractory ceramic annular deflector is positioned in each of the enlarged sections, substantially extending the useful life of the valve.

  12. Heimlich valve and pneumothorax.

    PubMed

    Gogakos, Apostolos; Barbetakis, Nikolaos; Lazaridis, George; Papaiwannou, Antonis; Karavergou, Anastasia; Lampaki, Sofia; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Rapti, Aggeliki; Trakada, Georgia; Zissimopoulos, Athanasios; Tsirgogianni, Katerina; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-03-01

    The Heimlich valve is a small one-way valve used for chest drainage that empties into a flexible collection device and prevents return of gases or fluids into the pleural space. The Heimlich valve is less than 13 cm (5 inches) long and facilitates patient ambulation. Currently there are several systems in the market. It can be used in many patients instead of a traditional water seal drainage system. The Heimlich chest drainage valve was developed so that the process of draining the pleural cavity could be accomplished in a safe, relatively simple, and efficient manner. This valve system has replaced the cumbersome underwater drainage bottle system. Moreover; the Heimlich valve system connects to chest tubing and allows fluid and air to pass in one direction only. This system functions in any position, and it does not ever need to be clamped, a regulated suction can be attached to it if necessary. The valve drains into a plastic bag that can be held at any level, allowing the patient undergoing chest drainage to be ambulatory simply by carrying the bag. In the current mini review we will present the Heimlich valve system and method of insertion. PMID:25861609

  13. Space Vehicle Valve System

    NASA Technical Reports Server (NTRS)

    Kelley, Anthony R. (Inventor); Lindner, Jeffrey L. (Inventor)

    2014-01-01

    The present invention is a space vehicle valve system which controls the internal pressure of a space vehicle and the flow rate of purged gases at a given internal pressure and aperture site. A plurality of quasi-unique variable dimension peaked valve structures cover the purge apertures on a space vehicle. Interchangeable sheet guards configured to cover valve apertures on the peaked valve structure contain a pressure-activated surface on the inner surface. Sheet guards move outwardly from the peaked valve structure when in structural contact with a purge gas stream flowing through the apertures on the space vehicle. Changing the properties of the sheet guards changes the response of the sheet guards at a given internal pressure, providing control of the flow rate at a given aperture site.

  14. Insights into new-onset rhythm conduction disorders detected by multi-detector row computed tomography after transcatheter aortic valve implantation.

    PubMed

    Katsanos, Spyridon; van Rosendael, Philippe; Kamperidis, Vasileios; van der Kley, Frank; Joyce, Emer; Debonnaire, Philippe; Karalis, Ioannis; Bax, Jeroen J; Marsan, Nina Ajmone; Delgado, Victoria

    2014-11-15

    New-onset rhythm conduction disorders are frequent after transcatheter aortic valve implantation (TAVI). Multidetector row computed tomography may shed light on the pathophysiology of rhythm conduction disorders in patients who undergo TAVI with the Edwards SAPIEN valve. A total of 94 patients (mean age 81 ± 7 years, 48% men) treated with TAVI with the Edwards SAPIEN valve who underwent pre- and post-TAVI multidetector row computed tomography were included. Patients with preexisting right bundle branch block or left bundle branch block (LBBB) and permanent pacemakers were excluded. Pacemaker implantation or new-onset LBBB at 1-month follow-up was the combined end point. Overall, 1 pacemaker was implanted, and 14 cases of new-onset LBBB were recorded. Among several clinical and multi-detector row computed tomographic variables, overexpansion of the transcatheter valve >15% of native annular area (odds ratio 5.277, 95% confidence interval 1.398 to 19.919, p = 0.014) and depth of frame into the left ventricular outflow tract (odds ratio 1.401, 95% confidence interval 1.066 to 1.770, p = 0.010) were independently related to the need for a pacemaker or new-onset LBBB. In conclusion, overexpansion of the transcatheter prosthesis by >15% of native aortic annular area and implantation depth of the frame into the left ventricular outflow tract were independently associated with the need for a pacemaker or new-onset LBBB in patients who underwent TAVI with the Edwards SAPIEN valve. PMID:25245414

  15. A prospective, non-randomized comparison of SAPIEN XT and CoreValve implantation in two sequential cohorts of patients with severe aortic stenosis

    PubMed Central

    Kasel, Albert Markus; Cassese, Salvatore; Ischinger, Thomas; Leber, Alexander; Antoni, Diethmar; Riess, Gotthard; Vogel, Jayshree; Kastrati, Adnan; Eichinger, Walter; Hoffmann, Ellen

    2014-01-01

    Objectives: Few data is available comparing Edwards SAPIEN XT - SXT (Edwards Lifesciences, Irvine, California) with Medtronic CoreValve - CoV (Medtronic Inc., Minneapolis, Minnesota) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). Methods: We selected consecutive patients undergoing transfemoral TAVR with SXT or CoV at our Institution. Main outcomes were Valve Academic Research Consortium (VARC)-combined safety endpoints. Results: A total of 100 patients (SXT, n=50 versus CoV, n=50) were analyzed. Both SXT and CoV showed good device success rates (98% versus 90%, p=0.20). SXT versus CoV reduced the occurrence of paravalvular regurgitation after TAVR (26% versus 90%, p<0.0001) though not affecting the rate of moderate/severe regurgitation (p=0.20). SXT versus CoV required less frequently a permanent pacemaker after TAVR (8% versus 38%, p<0.0001). In-hospital major vascular complications (8% versus 4%, p>0.99), life-threatening bleedings (2% versus 4%, p>0.99), stroke (4% versus 6%, p>0.99) and death (6% versus 2%, p>0.99) did not differ between SXT and CoV. However, safety endpoints favored SXT (17% versus 34.6%, p=0.01), due to a numerically higher incidence of ischemic stroke and Acute Kidney Injury Stage 3 after CoV. At multivariate analysis, TAVR with SXT (odds ratio=0.21, 95% confidence intervals [0.05-0.84], p=0.03) was predictive of fewer adverse events. Conclusions: Transcatheter valve implantation with Edwards SAPIEN XT was associated with lower VARC-combined safety endpoints as compared with Medtronic CoreValve. More extensive cohorts are needed to confirm these results. PMID:25006536

  16. Comparison of Outcomes of Transfemoral Transcatheter Aortic Valve Implantation Using a Minimally Invasive Versus Conventional Strategy.

    PubMed

    Attizzani, Guilherme F; Alkhalil, Ahmad; Padaliya, Bimal; Tam, Chor-Cheung; Lopes, Joao Pedro; Fares, Anas; Bezerra, Hiram G; Medallion, Benjamin; Park, Soon; Deo, Salil; Sareyyupoglu, Basar; Parikh, Sahil; Zidar, David; Elgudin, Yakov; Popovich, Kehllee; Davis, Angela; Staunton, Elizabeth; Tomic, Ana; Mazzurco, Stacey; Avery, Edward; Markowitz, Alan; Simon, Daniel I; Costa, Marco A

    2015-12-01

    Some centers, mostly in Europe, have demonstrated the feasibility of a minimally invasive strategy (MIS; i.e., local anesthesia and conscious sedation, performed in the cath laboratory without transesophageal echocardiography guidance). Nonetheless, the experience of MIS for TAVI using both commercially available valves is lacking in the United States. We, therefore, retrospectively studied all transfemoral TAVI cases performed at our institution between March 2011 and November 2014 to assess the safety and efficacy of MIS. Patients were dichotomized according to the strategy (MIS vs conventional strategy [CS]) used for the procedure. One hundred sixteen patients were included in the MIS group and 91 patients were included in the CS group. Baseline characteristics were similar, and procedural success was comparable (99.1% in MIS and 98.9% in CS, p = 1). One intraprocedural death occurred in each group, whereas conversion rates to general anesthesia were low (3.4%). Comparable device success was obtained. Rates of complications and >mild paravalvular leak before discharge were low and comparable. Length of hospital stay was significantly reduced in the MIS (median, 3.0 [2.0 to 5.0] days) compared with than that in CS group (median 6.0 days [3.5, 8.0]). At a median follow-up of 230 days, no significant difference in survival rate was detected (89% vs 88%, p = 0.9). On average, MIS was associated with remarkable cost saving compared with CS ($16,000/case). In conclusion, TAVI through MIS was associated with a shorter postprocedural hospital stay, lower costs, and similar safety profile while keeping procedural efficacy compared with CS. PMID:26433275

  17. Mixed partial anomalous pulmonary venous drainage coexistent with an aortic valve abnormality – analysis of ultrasound diagnostics in a 10-year-old girl with Turner syndrome

    PubMed Central

    Karolczak, Maciej A.; Komarnicka, Justyna; Mirecka, Ma?gorzata

    2014-01-01

    The authors present a case of echocardiographic diagnosis of a rare congenital cardiovascular anomaly in the form of mixed partial anomalous pulmonary veins connection in a 10-year-old girl with Turner syndrome and congenital mild stenosis of insufficient bicuspid aortic valve, made while diagnosing the causes of intestinal tract bleeding. The article presents various diagnostic difficulties leading to the delayed determination of a correct diagnosis, resulting from the absence of symptoms of circulatory failure in the early stage of the disease and the occurrence of severe and dominant auscultatory phenomena typical for congenital aortic valve defect which effectively masked the syndromes of increased pulmonary flow. The authors discuss the role of the impact of phenotypic characteristics of the Turner syndrome, in particular a short webbed neck restricting the suprasternal echocardiographic access and the presence of psychological factors associated with a long-term illness. The importance of indirect echocardiographic symptoms suggesting partial anomalous pulmonary veins connection in the presence of bicuspid aortic valve, e.g. enlargement of the right atrium and right ventricle, and paradoxical interventricular septum motion were emphasized in patients lacking ASD, pulmonary hypertension or tricupid and pulmonary valve abnormalities. The methodology of echocardiographic examination enabling direct visualization of the abnormal vascular structures was presented. Special attention was paid to the significance of highly sensitive echocardiographic projections: high right and left parasternal views in sagittal and transverse planes with patient lying on the side, with the use of two-dimensional imaging and color Doppler. Finally, the limitations of echocardiography resulting from the visualization and tracking of abnormal vascular structures hidden behind ultrasound non-conductive tissues were indicated, as was the role of other diagnostic modalities, such as angio-CT and/or nuclear magnetic resonance. PMID:26672491

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

    PubMed Central

    Sun, Ling; Rajamannan, Nalini M.; Sucosky, Philippe

    2014-01-01

    Hemodynamic stresses are presumed to play an important role in the development of calcific aortic valve disease (CAVD). The elucidation of the shear stress mechanisms involved in the pathogenesis of CAVD has been hampered by the complexity of the native unsteady and side-specific valvular flow environment. To address this gap, this article describes the design and validation of a novel device to expose leaflet samples to time-dependent side-specific shear stress. The device built on a double cone-and-plate geometry was dimensioned based on our previous single-sided shear stress device that minimizes secondary flow effects inherent to this geometry. A fluid–structure interaction (FSI) model was designed to predict the actual shear stress produced on a tissue sample mounted in the new device. Staining was performed on porcine leaflets conditioned in the new bioreactor to assess endothelial integrity and cellular apoptosis. The FSI results demonstrated good agreement between the target (native) and the actual side-specific shear stress produced on a tissue sample. No significant difference in endothelial integrity and cellular apoptosis was detected between samples conditioned for 96 h and fresh controls. This new device will enable the investigation of valvular response to normal and pathologic hemodynamics and the potential mechano-etiology of CAVD. PMID:21455792

  19. Dual hydraulic safety valve

    SciTech Connect

    Leismer, D.D.; Blizzard, W.A. Jr.

    1989-06-13

    This patent describes a subsurface well safety valve for controlling the fluid flow through a well conduit and including a housing having a bore and a valve closure member moving between open and closed positions for controlling the fluid flow through the bore, a tubular member telescopically moving in the housing for controlling the movement of the valve closure member. The improvement in fluid actuating means for actuating the valve closure member comprising, a first piston and cylinder assembly in the housing adapted to be connected to a hydraulic control line, the first assembly connected to the tubular member, a second piston and cylinder assembly in the housing adapted to be connected to a hydraulic control line, the second assembly disconnected from the tubular member, and means for disconnecting the first assembly from the tubular member and connecting the second assembly to the tubular member. The method of operating a subsurface well safety valve for controlling the fluid flow through a well conduit in which the valve includes a housing having a bore and a valve closure member moving between open and closed positions for controlling the fluid flow through the bore.

  20. Face-Sealing Butterfly Valve

    NASA Technical Reports Server (NTRS)

    Tervo, John N.

    1992-01-01

    Valve plate made to translate as well as rotate. Valve opened and closed by turning shaft and lever. Interactions among lever, spring, valve plate, and face seal cause plate to undergo combination of translation and rotation so valve plate clears seal during parts of opening and closing motions.

  1. Left ventricular pseudoaneurysm after valve replacement.

    PubMed

    Lee, Jun Ho; Jeon, Seok Chol; Jang, Hyo-Jun; Chung, Won-Sang; Kim, Young Hak; Kim, Hyuck

    2015-02-01

    We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy. PMID:25705601

  2. Sutureless Aortic Valve Replacement International Registry (SU-AVR-IR): design and rationale from the International Valvular Surgery Study Group (IVSSG)

    PubMed Central

    Phan, Kevin; Bouchard, Denis; Carrel, Thierry P.; Dapunt, Otto E.; Di Bartolomeo, Roberto; Eichstaedt, Harald C.; Fischlein, Theodor; Folliguet, Thierry; Gersak, Borut; Glauber, Mattia; Haverich, Axel; Misfeld, Martin; Oberwalder, Peter J.; Santarpino, Giuseppe; Shrestha, Malakh Lal; Solinas, Marco; Vola, Marco; Alamanni, Francesco; Albertini, Alberto; Bhatnagar, Gopal; Carrier, Michel; Clark, Stephen; Collart, Federic; Kappert, Utz; Kocher, Alfred; Meuris, Bart; Mignosa, Carmelo; Ouda, Ahmed; Pelletier, Marc; Rahmanian, Parwis Baradaran; Reineke, David; Teoh, Kevin; Troise, Giovanni; Villa, Emmanuel; Wahlers, Thorsten; Yan, Tristan D.

    2015-01-01

    Background Sutureless aortic valve replacement (SU-AVR) is an innovative approach which shortens cardiopulmonary bypass and cross-clamp durations and may facilitate minimally invasive approach. Evidence outlining its safety, efficacy, hemodynamic profile and potential complications is replete with small-volume observational studies and few comparative publications. Methods Minimally invasive aortic valve surgery and high-volume SU-AVR replacement centers were contacted for recruitment into a global collaborative coalition dedicated to sutureless valve research. A Research Steering Committee was formulated to direct research and support the mission of providing registry evidence warranted for SU-AVR. Results The International Valvular Surgery Study Group (IVSSG) was formed under the auspices of the Research Steering Committee, comprised of 36 expert valvular surgeons from 27 major centers across the globe. IVSSG Sutureless Projects currently proceeding include the Retrospective and Prospective Phases of the SU-AVR International Registry (SU-AVR-IR). Conclusions The global pooling of data by the IVSSG Sutureless Projects will provide required robust clinical evidence on the safety, efficacy and hemodynamic outcomes of SU-AVR. PMID:25870808

  3. Long life valve design concepts

    NASA Technical Reports Server (NTRS)

    Jones, J. R.; Hall, A. H., Jr.

    1975-01-01

    Valve concept evaluation, final candidate selection, design, manufacture, and demonstration testing of a pneumatically actuated 10-inch hybrid poppet butterfly shutoff valve are presented. Conclusions and recommendations regarding those valve characteristics and features which would serve to guide in the formulation of future valve procurements are discussed. The pertinent design goals were temperature range of plus 200 to minus 423 F, valve inlet pressure 35 psia, actuation pressure 750 psia, main seal leakage 3 x 0.00001 sccs at 35 psia valve inlet pressure, and a storage and operating life of 10 years. The valve was designed to be compatible with RP-1, propane, LH2, LO2, He, and N2.

  4. Percutaneous Pulmonary Valve Placement

    PubMed Central

    Prieto, Lourdes R.

    2015-01-01

    Patients with congenital heart disease and pulmonary valve disease need multiple procedures over their lifetimes to replace their pulmonary valves. Chronic pulmonary stenosis, regurgitation, or both have untoward effects on ventricular function and on the clinical status of these patients. To date, all right ventricle–pulmonary artery conduits have had relatively short lifespans. Percutaneous pulmonary valve implantation, although relatively new, will probably reduce the number of operative procedures that these patients will have to undergo over a lifetime. Refinement and further development of this procedure holds promise for the extension of this technology to other patient populations. PMID:26175629

  5. Quartz ball valve

    NASA Technical Reports Server (NTRS)

    Goetz, C.; Ingle, W. M. (inventors)

    1980-01-01

    A ball valve particularly suited for use in the handling of highly corrosive fluids is described. It is characterized by a valve housing formed of communicating segments of quartz tubing, a pair of communicating sockets disposed in coaxial alignment with selected segments of tubing for establishing a pair of inlet ports communicating with a common outlet port, a ball formed of quartz material supported for displacement between the sockets and configured to be received alternately thereby, and a valve actuator including a rod attached to the ball for selectively displacing the ball relative to each of the sockets for controlling fluid flow through the inlet ports.

  6. Mesofluidic two stage digital valve

    DOEpatents

    Jansen, John F; Love, Lonnie J; Lind, Randall F; Richardson, Bradley S

    2013-12-31

    A mesofluidic scale digital valve system includes a first mesofluidic scale valve having a valve body including a bore, wherein the valve body is configured to cooperate with a solenoid disposed substantially adjacent to the valve body to translate a poppet carried within the bore. The mesofluidic scale digital valve system also includes a second mesofluidic scale valve disposed substantially perpendicular to the first mesofluidic scale valve. The mesofluidic scale digital valve system further includes a control element in communication with the solenoid, wherein the control element is configured to maintain the solenoid in an energized state for a fixed period of time to provide a desired flow rate through an orifice of the second mesofluidic valve.

  7. Transcatheter versus Surgical Aortic Valve Replacement in Patients with Diabetes and Severe Aortic Stenosis at High Risk for Surgery: An Analysis of the PARTNER Trial

    PubMed Central

    Lindman, Brian R.; Pibarot, Philippe; Arnold, Suzanne V.; Suri, Rakesh; McAndrew, Thomas C.; Maniar, Hersh S.; Zajarias, Alan; Kodali, Susheel; Kirtane, Ajay J.; Thourani, Vinod H.; Tuzcu, E. Murat; Svensson, Lars G.; Waksman, Ron; Smith, Craig R.; Leon, Martin B.

    2013-01-01

    Objectives To determine whether a less invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS). Background Diabetes is associated with increased morbidity and mortality after surgical AVR for AS. Methods Among treated patients with severe symptomatic AS at high-risk for surgery in the PARTNER trial, we examined outcomes stratified by diabetes status of patients randomly assigned to transcatheter or surgical AVR. The primary outcome was all-cause mortality at 1 year. Results Among 657 patients enrolled in PARTNER who underwent treatment, there were 275 patients with diabetes (145 transcatheter, 130 surgical). There was a significant interaction between diabetes and treatment group for 1-year all-cause mortality (p=0.048). Among diabetic patients, all-cause mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the surgical group (HR 0.60; 95% CI, 0.36–0.99; p=0.04). Results were consistent among patients treated via transfemoral or transapical routes. In contrast, among non-diabetic patients, there was no significant difference in all-cause mortality at 1 year (p=0.48). Among diabetic patients, the 1-year rates of stroke were similar between treatment groups (3.5% transcatheter vs. 3.5% surgery, p=0.88), but the rates of renal failure requiring dialysis >30 days were lower in the transcatheter group (0% vs. 6.1%, p=0.003). Conclusions Among patients with diabetes and severe symptomatic AS at high-risk for surgery, this post-hoc stratified analysis of the PARTNER trial suggests there is a survival benefit, no increase in stroke, and less renal failure from treatment with transcatheter compared to surgical AVR. PMID:24291272

  8. Vascularization of bioprosthetic valve material

    NASA Astrophysics Data System (ADS)

    Boughner, Derek R.; Dunmore-Buyze, Joy; Heenatigala, Dino; Lohmann, Tara; Ellis, Chris G.

    1999-04-01

    Cell membrane remnants represent a probable nucleation site for calcium deposition in bioprosthetic heart valves. Calcification is a primary failure mode of both bovine pericardial and porcine aortic heterograft bioprosthesis but the nonuniform pattern of calcium distribution within the tissue remains unexplained. Searching for a likely cellular source, we considered the possibility of a previously overlooked small blood vessel network. Using a videomicroscopy technique, we examined 5 matched pairs of porcine aortic and pulmonary valves and 14 samples from 6 bovine pericardia. Tissue was placed on a Leitz Metallux microscope and transilluminated with a 75 watt mercury lamp. Video images were obtained using a silicon intensified target camera equipped with a 431 nm interference filter to maximize contrast of red cells trapped in a capillary microvasculature. Video images were recorded for analysis on a Silicon Graphics Image Analysis work station equipped with a video frame grabber. For porcine valves, the technique demonstrated a vascular bed in the central spongiosa at cusp bases with vessel sizes from 6-80 micrometers . Bovine pericardium differed with a more uniform distribution of 7-100 micrometers vessels residing centrally. Thus, small blood vessel endothelial cells provide a potential explanation patterns of bioprosthetic calcification.

  9. 3D Printed Trileaflet Valve Conduits Using Biological Hydrogels and Human Valve Interstitial Cells

    PubMed Central

    Duan, Bin; Kapetanovic, Edi; Hockaday, Laura A.; Butcher, Jonathan T.

    2014-01-01

    Tissue engineering has great potential to provide a functional de novo living valve replacement capable of integration with host tissue and growth. Among various valve conduit fabrication techniques, 3D bioprinting enables deposition of cells and hydrogels into 3D constructs with anatomical geometry and heterogeneous mechanical properties. Successful translation of this approach is however constrained by the dearth of printable and biocompatible hydrogel materials. Furthermore, it is not known how human valve cells respond to these printed environments. In this study, we develop 3D printable formulations of hybrid hydrogels based on methacrylated hyaluronic acid (Me-HA) and methacrylated gelatin (Me-Gel), and utilize them to bioprint heart valve conduits containing encapsulated human aortic valvular interstitial cells (HAVIC). Increasing Me-Gel concentration resulted in lower stiffness and higher viscosity, facilitated cell spreading, and better maintained HAVIC fibroblastic phenotype. Bioprinting accuracy was dependent upon the relative concentrations of Me-Gel and Me-HA, but when optimized enabled the fabrication of a trileaflet valve shape accurate to the original design. HAVIC encapsulated within bioprinted heart valves maintained high viability, and remodeled the initial matrix by depositing collagen and glyosaminoglycans. These findings represent the first rational design of bioprinted trileaflet valve hydrogels that regulate encapsulated human VIC behavior. The use of anatomically accurate living valve scaffolds through bioprinting may accelerate our understanding of physiological valve cell interactions and our progress towards de novo living valve replacements. PMID:24334142

  10. Mitral Valve Prolapse

    MedlinePLUS

    ... back through the valve also may have a heart murmur . A heart murmur is the sound caused by the leaking blood. ... For Parents MORE ON THIS TOPIC The Heart Heart Murmurs Atrial Septal Defect Quiz: Heart & Circulatory System Getting ...

  11. Flow metering valve

    DOEpatents

    Blaedel, K.L.

    1983-11-03

    An apparatus for metering fluids at high pressures of about 20,000 to 60,000 psi is disclosed. The apparatus includes first and second plates which are positioned adjacent each other to form a valve chamber. The plates are made of materials which have substantially equal elastic properties. One plate has a planar surface area, and the other a recessed surface area defined by periphery and central lips. When the two plates are positioned in adjacent contacting relationship, a valve chamber is formed between the planar surface area and the recessed surface area. Fluid is introduced into the chamber and exits therefrom when a deformation occurs at positions where they no longer form a valve seat. This permits the metering of fluids at high pressures and at slow variable rates. Fluid then exits from the chamber until an applied external force becomes large enough to bring the valve seats back into contact.

  12. Mitral Valve Repair Surgery

    MedlinePLUS Videos and Cool Tools

    ... end, where the valve doesn’t leak, the stress is taken off the chordal structure. But as ... on and as patients are put under increased stress and strain. Another question: “I will have mitral ...

  13. Mitral Valve Prolapse.

    ERIC Educational Resources Information Center

    Bergy, Gordon G.

    1980-01-01

    Mitral valve prolapse is the most common heart disease seen in college and university health services. It underlies most arrhythmia and many chest complaints. Activity and exercise restrictions are usually unnecessary. (Author/CJ)

  14. Valve Repair or Replacement

    MedlinePLUS

    ... valve surgery can be done using a robot. Robotic surgery does not require a large incision in ... The Texas Heart Institute has a robot. With robotic surgery, the surgeon has a control console, a ...

  15. Relation of Left Ventricular Mass to Prognosis in Initially Asymptomatic Mild to Moderate Aortic Valve Stenosis

    PubMed Central

    Rossebø, Anne B.; Pedersen, Terje R.; Cioffi, Giovanni; Lønnebakken, Mai Tone; Cramariuc, Dana; Rogge, Barbara P.; Devereux, Richard B.

    2015-01-01

    Background— The prognostic importance of left ventricular (LV) mass in nonsevere asymptomatic aortic stenosis has not been documented in a large prospective study. Methods and Results— Cox regression analysis was used to assess the impact of echocardiographic LV mass on rate of major cardiovascular events in 1656 patients (mean age, 67 years; 39.6% women) with mild-to-moderate asymptomatic aortic stenosis participating in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study. Patients were followed during 4.3 years of randomized treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily or placebo. At baseline, LV mass index was 45.9+14.9 g/m2.7, and peak aortic jet velocity was 3.09+0.54 m/s. During follow-up, 558 major cardiovascular events occurred. In Cox regression analyses, 1 SD (15 g/m2.7) higher baseline LV mass index predicted increases in hazards of 12% for major cardiovascular events, 28% for ischemic cardiovascular events, 34% for cardiovascular mortality, and 23% for combined total mortality and hospitalization for heart failure (all P<0.01), independent of confounders. In time-varying models, taking the progressive increase in LV mass index during follow-up into account, 1 SD higher in-study LV mass index was consistently associated with 13% to 61% higher hazard for cardiovascular events (all P<0.01), independent of age, sex, body mass index, valvuloarterial impedance, LV ejection fraction and concentricity, and the presence of concomitant hypertension. Conclusions— Higher LV mass index is independently associated with increased cardiovascular morbidity and mortality during progression of aortic stenosis. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677. PMID:26489804

  16. Liquid blocking check valve

    DOEpatents

    Merrill, John T. (Pleasant Hill, CA)

    1984-01-01

    A liquid blocking check valve useful particularly in a pneumatic system utilizing a pressurized liquid fill chamber. The valve includes a floatable ball disposed within a housing defining a chamber. The housing is provided with an inlet aperture disposed in the top of said chamber, and an outlet aperture disposed in the bottom of said chamber in an offset relation to said inlet aperture and in communication with a cutaway side wall section of said housing.

  17. Mud saver valve

    SciTech Connect

    Baugh, B.F.

    1990-02-13

    This patent describes a mud saver valve for retaining drilling fluid in the kelly of a rotary drilling rig. It comprises: a kelly sub defining an open-ended elongated body having threaded ends for forming a connection between the kelly and a drill pipe string; an enlarged bore formed in said elongated body; a tubular body received within said enlarged bore of said elongated body, said tubular body including an enlarged portion defining a shoulder for engagement with a shoulder formed in said elongated body; hollow piston means axially disposed within said tubular body. The piston means being axially movable relative to said tubular body and defining a fluid passage therethrough; valve means removably mounted within said tubular body. The valve means cooperating with said piston means to normally close the fluid passage through said piston means, wherein said valve means is movable between a first and second position; a stop member removably connected to said tubular body. The stop member including a first internal circumferential tapered shoulder for limiting downward movement of said valve means; and means for urging said piston means into engagement with said valve means.

  18. Advanced 3-D analysis, client-server systems, and cloud computing-Integration of cardiovascular imaging data into clinical workflows of transcatheter aortic valve replacement.

    PubMed

    Schoenhagen, Paul; Zimmermann, Mathis; Falkner, Juergen

    2013-06-01

    Degenerative aortic stenosis is highly prevalent in the aging populations of industrialized countries and is associated with poor prognosis. Surgical valve replacement has been the only established treatment with documented improvement of long-term outcome. However, many of the older patients with aortic stenosis (AS) are high-risk or ineligible for surgery. For these patients, transcatheter aortic valve replacement (TAVR) has emerged as a treatment alternative. The TAVR procedure is characterized by a lack of visualization of the operative field. Therefore, pre- and intra-procedural imaging is critical for patient selection, pre-procedural planning, and intra-operative decision-making. Incremental to conventional angiography and 2-D echocardiography, multidetector computed tomography (CT) has assumed an important role before TAVR. The analysis of 3-D CT data requires extensive post-processing during direct interaction with the dataset, using advance analysis software. Organization and storage of the data according to complex clinical workflows and sharing of image information have become a critical part of these novel treatment approaches. Optimally, the data are integrated into a comprehensive image data file accessible to multiple groups of practitioners across the hospital. This creates new challenges for data management requiring a complex IT infrastructure, spanning across multiple locations, but is increasingly achieved with client-server solutions and private cloud technology. This article describes the challenges and opportunities created by the increased amount of patient-specific imaging data in the context of TAVR. PMID:24282750

  19. Advanced 3-D analysis, client-server systems, and cloud computing—Integration of cardiovascular imaging data into clinical workflows of transcatheter aortic valve replacement

    PubMed Central

    Zimmermann, Mathis; Falkner, Juergen

    2013-01-01

    Degenerative aortic stenosis is highly prevalent in the aging populations of industrialized countries and is associated with poor prognosis. Surgical valve replacement has been the only established treatment with documented improvement of long-term outcome. However, many of the older patients with aortic stenosis (AS) are high-risk or ineligible for surgery. For these patients, transcatheter aortic valve replacement (TAVR) has emerged as a treatment alternative. The TAVR procedure is characterized by a lack of visualization of the operative field. Therefore, pre- and intra-procedural imaging is critical for patient selection, pre-procedural planning, and intra-operative decision-making. Incremental to conventional angiography and 2-D echocardiography, multidetector computed tomography (CT) has assumed an important role before TAVR. The analysis of 3-D CT data requires extensive post-processing during direct interaction with the dataset, using advance analysis software. Organization and storage of the data according to complex clinical workflows and sharing of image information have become a critical part of these novel treatment approaches. Optimally, the data are integrated into a comprehensive image data file accessible to multiple groups of practitioners across the hospital. This creates new challenges for data management requiring a complex IT infrastructure, spanning across multiple locations, but is increasingly achieved with client-server solutions and private cloud technology. This article describes the challenges and opportunities created by the increased amount of patient-specific imaging data in the context of TAVR. PMID:24282750

  20. Association of Aortic Valve Calcification to the Presence, Extent, and Composition of Coronary Artery Plaque Burden: ROMICAT Study

    PubMed Central

    Mahabadi, Amir A.; Bamberg, Fabian; Toepker, Michael; Schlett, Christopher L.; Rogers, Ian S.; Nagurney, John T.; Brady, Thomas J.; Hoffmann, Udo; Truong, Quynh A.

    2009-01-01

    Background Aortic valve calcification (AVC) is associated with cardiovascular risk factors and coronary artery calcification. We sought to determine whether AVC is associated with the presence and extent of overall plaque burden, as well as to plaque composition (calcified, mixed, and non-calcified). Methods We examined 357 subjects (mean age: 53 ± 12 years, 61% male) who underwent contrast-enhanced ECG-gated 64-slice multi-detector computed tomography from the ROMICAT trial for the assessment of presence and extent of coronary plaque burden according to the 17-coronary segment model and presence of AVC. Results Patients with AVC (n=37, 10%) were more likely than those without AVC (n=320, 90%) to have coexisting presence of any coronary plaque (89% vs. 46%, p<0.001) and had a greater extent of coronary plaque burden (6.4 segments vs. 1.8 segments, p<0.001). Those with AVC had over 3-fold increase odds of having any plaque (adjusted odds ratio [OR] 3.6, p=0.047) and an increase of 2.5 segments of plaque (p<0.001) as compared to those without AVC. When stratified by plaque composition, AVC was associated most with calcified plaque (OR 5.2, p=0.004), then mixed plaque (OR 3.2, p=0.02), but not with non-calcified plaque (p=0.96). Conclusion AVC is associated with the presence and greater extent of coronary artery plaque burden and may be part of the later stages of the atherosclerosis process, as its relation is strongest with calcified plaque, less with mixed plaque, and nonsignificant with non-calcified plaque. If AVC is present, consideration for aggressive medical therapy may be warranted. PMID:19781415

  1. Improvement of left ventricular longitudinal systolic function after transcatheter aortic valve implantation: a speckle-tracking prospective study.

    PubMed

    D'Ascenzi, Flavio; Cameli, Matteo; Iadanza, Alessandro; Lisi, Matteo; Zacà, Valerio; Reccia, Rosanna; Curci, Valeria; Torrisi, Andrea; Sinicropi, Giuseppe; Pierli, Carlo; Mondillo, Sergio

    2013-06-01

    Transcatheter aortic valve implantation (TAVI) is able to determine a significant improvement of left ventricular ejection fraction (LVEF). The variations of LV global longitudinal strain (GLS) have not been yet investigated in TAVI patients with reduced LVEF. The aim of this study was to determine the effects of TAVI on LV function by 2D speckle-tracking echocardiography (STE) in patients with reduced LVEF. Eighteen consecutive patients undergoing TAVI in our centre were prospectively enrolled. Echocardiography was performed pre-procedurally the day of TAVI and at 40-day and 3-month follow-up (FU). The mean age of TAVI patients was 79.75 ± 7.68 years. The mean EuroSCORE was 26.59 ± 14.62%. A significant decrease of mean trans-aortic gradient was observed 40 days after TAVI (51.69 ± 18.82 vs. 9.62 ± 3.28 mmHg, p < 0.0001). LV mass index significantly decreased at 40-day FU (165.72 ± 37.75 vs. 145.52 ± 31.32 g/m(2), p < 0.001) with a further reduction at 3-month FU (136.91 ± 26.91 g/m(2), p < 0.05 in comparison with 40-day FU). The mean pre-procedural LVEF was 45.87 ± 7.95%. LVEF significantly increased at 40-day FU (55.20 ± 5.91%, p < 0.05) and remained stable at 3-month FU (55.58 ± 6.14%). Interestingly, an early improvement of LV GLS was observed at 40-day FU (-11.09 ± 3.40 vs. -14.40 ± 3.68%, p < 0.001) with a slight further increase at 3-month FU (-14.71 ± 3.56%). Our results indicate that significant improvements of LVEF and LV GLS can be observed in patients undergoing TAVI with impaired LVEF. Two-dimensional STE was able to detect the reverse remodeling of LV function, adding further insights into the assessment of LV mid-term recovery after TAVI. PMID:23271458

  2. Influence of Municipality-Level Mean Income on Access to Aortic Valve Surgery: A Cross-Sectional Observational Study under Japan's Universal Health-Care Coverage

    PubMed Central

    Lee, Seitetsu L.; Hashimoto, Hideki; Kohro, Takahide; Horiguchi, Hiromasa; Koide, Daisuke; Komuro, Issei; Fushimi, Kiyohide; Yamazaki, Tsutomu; Yasunaga, Hideo

    2014-01-01

    Background Universal health-care coverage has attracted the interest of policy makers as a way of achieving health equity. However, previous reports have shown that despite universal coverage, socioeconomic disparity persists in access to high-tech invasive care, such as cardiac treatment. In this study, we aimed to investigate the association between socioeconomic status and care of aortic stenosis in the context of Japan's health-care system, which is mainly publicly funded. Methods We chose aortic stenosis in older people as a target because such patients are likely to be affected by socioeconomic disparity. Using a large Japanese claim-based inpatient database, we identified 12,893 isolated aortic stenosis patients aged over 65 years who were hospitalized between July 2010 and March 2012. Municipality socioeconomic status was represented by the mean household income of the patients' residential municipality, categorized into quartiles. The likelihood of undergoing aortic valve surgery and in-hospital mortality was regressed against socioeconomic status level with adjustments for hospital volume, regional number of cardiac surgeons per 1 million population, and patients' clinical status. Results We found no significant differences between the highest and lowest quartile groups in surgical indication (odds ratio, 0.84; 95% confidence interval, 0.69–1.03) or in-hospital mortality (1.00; 0.68–1.48). Hospital volume was significantly associated with lower postoperative mortality (odds ratio of the highest volume tertile to the lowest, 0.49; 0.34–0.71). Conclusions Under Japan's current universal health-care coverage, municipality socioeconomic status did not appear to have a systematic relationship with either treatment decision for surgical intervention or postoperative survival following aortic valve surgery among older patients. Our results imply that universal health-care coverage with high publicly funded coverage offers equal access to high-tech cardiovascular care. PMID:25360759

  3. Aneurysm of Sinus of Valsalva Dissecting Into the Interventricular Septum After Aortic Valve Replacement: Diagnosis by Echocardiography and Magnetic Resonance Imaging and Treatment With Surgical Sealant

    PubMed Central

    Park, Kyu-Hwan; Son, Chang-Woo; Son, Jang-Won; Jo, Hyun-Su; Yoon, Joon-Cheol; Lee, Won-Jae; Lee, Sang-Hee; Hong, Geu-Ru; Park, Jong-Seon; Kim, Young-Jo; Choi, Jung-Hyun; Lee, Dong-Hyup

    2011-01-01

    Aneurysm of the sinus of Valsalva that causes dissection of the interventricular septum is an extremely rare entity. In this report we describe a case of aneurysm of the sinus of Valsalva dissecting into the interventricular septum, from the base to mid septum, after aortic valve replacement. After the diagnosis was made by transthoracic echocardiography and magnetic resonance imaging, the patient was successfully treated with surgical sealant-mediated occlusion of the aneurysmal sac and cardiac resynchronization therapy used for the first time. PMID:21949531

  4. Pressure valve for needle gate valve control. June 13, 1913. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Pressure valve for needle gate valve control. June 13, 1913. Photocopy of original drawing. Drawing on file at the Salt River Project Archives. Phoenix, Arizona - Cross Cut Hydro Plant, North Side of Salt River, Tempe, Maricopa County, AZ

  5. 9. BUTTERFLY VALVE CONTROL DIABLO POWERHOUSE. BUTTERFLY VALVES WERE MANUFACTURED ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    9. BUTTERFLY VALVE CONTROL DIABLO POWERHOUSE. BUTTERFLY VALVES WERE MANUFACTURED BY THE PELTON WATER WHEEL COMPANY IN 1931, 1989. - Skagit Power Development, Diablo Powerhouse, On Skagit River, 6.1 miles upstream from Newhalem, Newhalem, Whatcom County, WA

  6. Check valves aging assessment

    SciTech Connect

    Haynes, H.D.

    1991-01-01

    In support of the NRC Nuclear Plant Aging Research (NPAR) program, the Oak Ridge National Laboratory (ORNL) has carried out an assessment of several check value diagnostic monitoring methods, in particular, those based on measurements of acoustic emission, ultrasonics, and magnetic flux. The evaluations have focussed on the capabilities of each method to provide information useful in determining check valve aging and service wear effects, check valve failures, and undesirable operating modes. This paper describes the benefits and limitations associated with each method and includes recent laboratory and field test data, including data obtained from the vendors who recently participated in a comprehensive series of tests directed by a nuclear industry users group. In addition, as part of the ORNL Advanced Diagnostic Engineering Research and Development Center (ADEC), two novel nonintrusive monitoring methods were developed that provide several unique capabilities. These methods, based on external ac- an dc-magnetic monitoring are also described. None of the examined methods could, by themselves, monitor both the instantaneous position and motion of check valve internals and valve leakage; however, the combination of acoustic emission monitoring with one of the other methods provides the means to determine vital check valve operational information.

  7. Fast closing valve

    DOEpatents

    Hanson, Clark L. (Livermore, CA)

    1984-01-10

    A valve is provided for protecting the high vacuum of a particle accelera in the event of air leakage, wherein the valve provides an axially symmetrical passage to avoid disturbance of the partical beam during normal operation, and yet enables very rapid and tight closure of the beam-carrying pipe in the event of air leakage. The valve includes a ball member (30) which can rotate between a first position wherein a bore (32) in the member is aligned with the beam pipe, and a second position out of line with the pipe. A seal member (38) is flexibly sealed to the pipe, and has a seal end which can move tightly against the ball member after the bore has rotated out of line with the pipe, to thereby assure that the seal member does not retard rapid rotation of the ball valve member. The ball valve member can be rapidly rotated by a conductive arm (40) fixed to it and which is rotated by the discharge of a capacitor bank through coils (44, 45) located adjacent to the arm.

  8. Percutaneous valve replacement: weird or wonderful?

    PubMed

    Thiem, A; Cremer, J; Lutter, G

    2006-02-01

    Percutaneous treatment of valve diseases has proven to be an effective alternative to open surgery since the early 1980's. For most patients with rheumatic mitral stenosis, use of percutaneous catheter-based techniques as balloon valvuloplasty for the treatment of both congenital pulmonary stenosis as well as trans-septal commissurotomy has become a good therapeutic option. Furthermore in the mid 1990's in vitro studies demonstrated the feasibility of percutaneous catheter-based valve implantation first in pulmonary and subsequently in aortic position. Afterwards initial in vivo implantations were successfully undertaken. Limitations of this new branch of transcatheter-based techniques are: risk of embolization due to pre-dilatation; difficult deployment; migration of valved stent; paravalvular leakage and limited durability of the implanted valve. Hence, many advances and improvements are necessary prior to pronouncing a new real alternative and safe therapeutic option. Up to now the gold standard for the treatment of heart valve disease is still open surgical valve repair and replacement. Percutaneous valve replacement procedures offer substantial advantages both to patients and medical care providers. From a medical point of view, they may help reduce surgical risks, offer a less invasive procedure, lower complication rates and shorten rehabilitation times in future. From an economic standpoint, shorter hospital stays result in overall cost reduction. PMID:16467739

  9. Locking apparatus for gate valves

    DOEpatents

    Fabyan, Joseph (Livermore, CA); Williams, Carl W. (Manteca, CA)

    1988-01-01

    A locking apparatus for fluid operated valves having a piston connected to the valve actuator which moves in response to applied pressure within a cylinder housing having a cylinder head, a catch block is secured to the piston, and the cylinder head incorporates a catch pin. Pressure applied to the cylinder to open the valve moves the piston adjacent to the cylinder head where the catch pin automatically engages the catch block preventing futher movement of the piston or premature closure of the valve. Application of pressure to the cylinder to close the valve, retracts the catch pin, allowing the valve to close. Included are one or more selector valves, for selecting pressure application to other apparatus depending on the gate valve position, open or closed, protecting such apparatus from damage due to premature closing caused by pressure loss or operational error.

  10. Magnetostrictive valve assembly

    NASA Technical Reports Server (NTRS)

    Richard, James A. (Inventor)

    2008-01-01

    A magnetostrictive valve assembly includes a housing that defines a passage with a seat being formed therein. A magnetically-biased and axially-compressed magnetostrictive assembly slidingly fitted in the passage is configured as a hollow and open-ended conduit adapted to support a flow of a fluid therethrough. Current-carrying coil(s) disposed about the passage in the region of the magnetostrictive assembly generate a magnetic field in the passage when current flows through the coil(s). A hollow valve body with side ports is coupled on one end thereof to an axial end of the magnetostrictive assembly. The other end of the valve body is designed to seal with the seat formed in the housing's passage when brought into contact therewith.

  11. Variable Valve Actuation

    SciTech Connect

    Jeffrey Gutterman; A. J. Lasley

    2008-08-31

    Many approaches exist to enable advanced mode, low temperature combustion systems for diesel engines - such as premixed charge compression ignition (PCCI), Homogeneous Charge Compression Ignition (HCCI) or other HCCI-like combustion modes. The fuel properties and the quantity, distribution and temperature profile of air, fuel and residual fraction in the cylinder can have a marked effect on the heat release rate and combustion phasing. Figure 1 shows that a systems approach is required for HCCI-like combustion. While the exact requirements remain unclear (and will vary depending on fuel, engine size and application), some form of substantially variable valve actuation is a likely element in such a system. Variable valve actuation, for both intake and exhaust valve events, is a potent tool for controlling the parameters that are critical to HCCI-like combustion and expanding its operational range. Additionally, VVA can be used to optimize the combustion process as well as exhaust temperatures and impact the after treatment system requirements and its associated cost. Delphi Corporation has major manufacturing and product development and applied R&D expertise in the valve train area. Historical R&D experience includes the development of fully variable electro-hydraulic valve train on research engines as well as several generations of mechanical VVA for gasoline systems. This experience has enabled us to evaluate various implementations and determine the strengths and weaknesses of each. While a fully variable electro-hydraulic valve train system might be the 'ideal' solution technically for maximum flexibility in the timing and control of the valve events, its complexity, associated costs, and high power consumption make its implementation on low cost high volume applications unlikely. Conversely, a simple mechanical system might be a low cost solution but not deliver the flexibility required for HCCI operation. After modeling more than 200 variations of the mechanism it was determined that the single cam design did not have enough flexibility to satisfy three critical OEM requirements simultaneously, (maximum valve lift variation, intake valve opening timing and valve closing duration), and a new approach would be necessary. After numerous internal design reviews including several with the OEM a dual cam design was developed that had the flexibility to meet all motion requirements. The second cam added complexity to the mechanism however the cost was offset by the deletion of the electric motor required in the previous design. New patent applications including detailed drawings and potential valve motion profiles were generated and alternate two cam designs were proposed and evaluated for function, cost, reliability and durability. Hardware was designed and built and testing of sample hardware was successfully completed on an engine test stand. The mechanism developed during the course of this investigation can be applied by Original Equipment Manufacturers, (OEM), to their advanced diesel engines with the ultimate goal of reducing emissions and improving fuel economy. The objectives are: (1) Develop an optimal, cost effective, variable valve actuation (VVA) system for advanced low temperature diesel combustion processes. (2) Design and model alternative mechanical approaches and down-select for optimum design. (3) Build and demonstrate a mechanism capable of application on running engines.

  12. Valve-spring Surge

    NASA Technical Reports Server (NTRS)

    Marti, Willy

    1937-01-01

    Test equipment is described that includes a system of three quartz indicators whereby three different pressures could be synchronized and simultaneously recorded on a single oscillogram. This equipment was used to test the reliction of waves at ends of valve spring, the dynamical stress of the valve spring for a single lift of the valve, and measurement of the curve of the cam tested. Other tests included simultaneous recording of the stress at both ends of the spring, spring oscillation during a single lift as a function of speed, computation of amplitude of oscillation for a single lift by harmonic analysis, effect of cam profile, the setting up of resonance, and forced spring oscillation with damping.

  13. Hydrogen gas relief valve

    DOEpatents

    Whittlesey, Curtis C. (Birmingham, MI)

    1985-01-01

    An improved battery stack design for an electrochemical system having at least one cell from which a gas is generated and an electrolyte in communication with the cell is described. The improved battery stack design features means for defining a substantially closed compartment for containing the battery cells and at least a portion of the electrolyte for the system, and means in association with the compartment means for selectively venting gas from the interior of the compartment means in response to the level of the electrolyte within the compartment means. The venting means includes a relief valve having a float member which is actuated in response to the level of the electrolyte within the compartment means. This float member is adapted to close the relief valve when the level of the electrolyte is above a predetermined level and open the relief valve when the level of electrolyte is below this predetermined level.

  14. Josephson magnetic rotary valve

    SciTech Connect

    Soloviev, I. I.; Klenov, N. V.; Bakurskiy, S. V.; Bol'ginov, V. V.; Ryazanov, V. V.; Kupriyanov, M. Yu.; Golubov, A. A.

    2014-12-15

    We propose a control element for a Josephson spin valve. It is a complex Josephson device containing ferromagnetic (F) layer in the weak-link area consisting of two regions, representing 0 and ? Josephson junctions, respectively. The valve's state is defined by mutual orientations of the F-layer magnetization vector and boundary line between 0 and ? sections of the device. We consider possible implementation of the control element by introduction of a thin normal metal layer in a part of the device area. By means of theoretical simulations, we study properties of the valve's structure as well as its operation, revealing such advantages as simplicity of control, high characteristic frequency, and good legibility of the basic states.

  15. Self-regulating valve

    DOEpatents

    Humphreys, D.A.

    1982-07-20

    A variable, self-regulating valve having a hydraulic loss coefficient proportional to a positive exponential power of the flow rate. The device includes two objects in a flow channel and structure which assures that the distance between the two objects is an increasing function of the flow rate. The range of spacing between the objects is such that the hydraulic resistance of the valve is an increasing function of the distance between the two objects so that the desired hydraulic loss coefficient as a function of flow rate is obtained without variation in the flow area.

  16. Impact of the use of transradial versus transfemoral approach as secondary access in transcatheter aortic valve implantation procedures.

    PubMed

    Allende, Ricardo; Urena, Marina; Cordoba, Juan G; Ribeiro, Henrique Barbosa; Amat-Santos, Ignacio; DeLarochellière, Robert; Paradis, Jean-Michel; Doyle, Daniel; Mohammadi, Siamak; Côté, Mélanie; Abdul-Jawad, Omar; Del Trigo, Maria; Ortas, María Rosario; Laflamme, Louis; Laflamme, Jerôme; DeLarochellière, Hugo; Dumont, Eric; Rodés-Cabau, Josep

    2014-12-01

    No data exist on the impact of vascular complications related to the secondary access site in transcatheter aortic valve implantation (TAVI). The objectives of this nonrandomized study were to determine the rate of vascular complications related to the secondary access site in TAVI procedures and to evaluate the clinical impact of using the radial versus femoral approach as a secondary access in such procedures. A total of 462 consecutive patients (mean age 79 ± 9 years, 50% men) who underwent TAVI were included. The femoral approach (FA) was used as the secondary access (for the insertion of a 5F pigtail catheter) in 335 patients and the radial approach (RA) in 127 patients. Thirty-day events were prospectively collected. There were no baseline differences between groups, except for a higher prevalence of women and peripheral disease in the FA group (p <0.05 for both). A total of 74 vascular access site complications occurred in 70 patients (15%), and 23% of them (29% in the FA group) were related to the secondary access. The use of FA as secondary access was associated with a higher rate of vascular complications (5.0% vs 0% in the RA group, p = 0.005, adjusted p = 0.014). All major vascular complications related to the secondary access occurred in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049), and this translated into a higher rate of major and/or life-threatening bleeding events related to the secondary access in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049). In conclusion, about 1/4 of vascular access site complications in TAVI are related to the secondary access. The use of the RA as a secondary access was associated with a major reduction in vascular complications. These results highlight the impact of secondary access vascular complications in TAVI procedures and support the use of the RA as the preferred secondary access. PMID:25439451

  17. Use of a targeted, combinatorial next-generation sequencing approach for the study of bicuspid aortic valve

    PubMed Central

    2014-01-01

    Background Bicuspid aortic valve (BAV) is the most common type of congenital heart disease with a population prevalence of 1-2%. While BAV is known to be highly heritable, mutations in single genes (such as GATA5 and NOTCH1) have been reported in few human BAV cases. Traditional gene sequencing methods are time and labor intensive, while next-generation high throughput sequencing remains costly for large patient cohorts and requires extensive bioinformatics processing. Here we describe an approach to targeted multi-gene sequencing with combinatorial pooling of samples from BAV patients. Methods We studied a previously described cohort of 78 unrelated subjects with echocardiogram-identified BAV. Subjects were identified as having isolated BAV or BAV associated with coarctation of aorta (BAV-CoA). BAV cusp fusion morphology was defined as right-left cusp fusion, right non-coronary cusp fusion, or left non-coronary cusp fusion. Samples were combined into 19 pools using a uniquely overlapping combinatorial design; a given mutation could be attributed to a single individual on the basis of which pools contained the mutation. A custom gene capture of 97 candidate genes was sequenced on the Illumina HiSeq 2000. Multistep bioinformatics processing was performed for base calling, variant identification, and in-silico analysis of putative disease-causing variants. Results Targeted capture identified 42 rare, non-synonymous, exonic variants involving 35 of the 97 candidate genes. Among these variants, in-silico analysis classified 33 of these variants as putative disease-causing changes. Sanger sequencing confirmed thirty-one of these variants, found among 16 individuals. There were no significant differences in variant burden among BAV fusion phenotypes or isolated BAV versus BAV-CoA. Pathway analysis suggests a role for the WNT signaling pathway in human BAV. Conclusion We successfully developed a pooling and targeted capture strategy that enabled rapid and cost effective next generation sequencing of target genes in a large patient cohort. This approach identified a large number of putative disease-causing variants in a cohort of patients with BAV, including variants in 26 genes not previously associated with human BAV. The data suggest that BAV heritability is complex and polygenic. Our pooling approach saved over $39,350 compared to an unpooled, targeted capture sequencing strategy. PMID:25260786

  18. Analysis of flow within a left ventricle model fully assisted with continuous flow through the aortic valve.

    PubMed

    Yano, Tetsuya; Funayama, Masanori; Sudo, Seiichi; Mitamura, Yoshinori

    2012-08-01

    Blood compatibility of a ventricular assist device (VAD) depends on the dynamics of blood flow. The focus in most previous studies was on blood flow in the VAD. However, the tip shape and position of the VAD inflow cannula influence the dynamics of intraventricular blood flow and thus thrombus formation in the ventricle. In this study, blood flow in the left ventricle (LV) under support with a catheter-type continuous flow blood pump was investigated. The flow field was analyzed both numerically and experimentally to investigate the effects of catheter tip shape and its insertion depth on intraventricular flow patterns. A computational model of the LV cavity with a simplified shape was constructed using computer-aided design software. Models of catheters with three different tip shapes were constructed and each was integrated to the LV model. In addition, three variations of insertion depth were prepared for all models. The fully supported intraventricular flow field was calculated by computational fluid dynamics (CFD). A transparent LV model made of silicone was also fabricated to analyze the intraventricular flow field by the particle image velocimetry technique. A mock circulation loop was constructed and water containing tracer particles was circulated in the loop. The motion of particles in the LV model was recorded with a digital high-speed video camera and analyzed to reveal the flow field. The results of numerical and experimental analyses indicated the formation of two large vortices in the bisector plane of the mitral and aortic valve planes. The shape and positioning of the catheter tip affected the flow distribution in the LV, and some of these combinations elongated the upper vortex toward the ventricular apex. Assessment based on average wall shear stress on the LV wall indicated that the flow distribution improved the washout effect. The flow patterns obtained from flow visualization coincided with those calculated by CFD analysis. Through these comparisons, the numerical analysis was validated. In conclusion, results of these numerical and experimental analyses of flow field in the LV cavity provide useful information when designing catheter-type VADs. PMID:22882441

  19. Lipomatous hamartoma of mitral valve.

    PubMed

    Bhat, Seetharama Ps; Gowda Sl, Girish; Chikkatur, Raghavendra; Nanjappa, Manjunath C

    2016-01-01

    Primary cardiac tumors are very rare, and tumors arising from cardiac valves are extremely rare. We present a case of lipomatous hamartoma of the mitral valve in a young female. This is the 6th case of lipomatous hamartoma of the mitral valve to be reported. We discuss the operative and histopathological findings. PMID:24821963

  20. Valve stem and packing assembly

    DOEpatents

    Wordin, John J. (Bingham County, ID)

    1991-01-01

    A valve stem and packing assembly is provided in which a rotatable valve stem includes a first tractrix surface for sliding contact with a stem packing and also includes a second tractrix surface for sliding contact with a bonnet. Force is applied by means of a spring, gland flange, and gland on the stem packing so the stem packing seals to the valve stem and bonnet. This configuration serves to create and maintain a reliable seal between the stem packing and the valve stem. The bonnet includes a second complementary tractrix surface for contacting the second sliding tractrix surface, the combination serving as a journal bearing for the entire valve stem and packing assembly. The journal bearing so configured is known as a Schiele's pivot. The Schiele's pivot also serves to maintain proper alignment of the valve stem with respect to the bonnet. Vertical wear between the surfaces of the Schiele's pivot is uniform at all points of contact between the second sliding tractrix surface and the second complementary tractrix surface of a bonnet. The valve stem is connected to a valve plug by means of a slip joint. The valve is opened and closed by rotating the valve stem. The slip joint compensates for wear on the Schiele's pivot and on the valve plug. A ledge is provided on the valve bonnet for the retaining nut to bear against. The ledge prevents overtightening of the retaining nut and the resulting excessive friction between stem and stem packing.

  1. Valve stem and packing assembly

    DOEpatents

    Wordin, J.J.

    1991-09-03

    A valve stem and packing assembly is provided in which a rotatable valve stem includes a first tractrix surface for sliding contact with a stem packing and also includes a second tractrix surface for sliding contact with a bonnet. Force is applied by means of a spring, gland flange, and gland on the stem packing so the stem packing seals to the valve stem and bonnet. This configuration serves to create and maintain a reliable seal between the stem packing and the valve stem. The bonnet includes a second complementary tractrix surface for contacting the second sliding tractrix surface, the combination serving as a journal bearing for the entire valve stem and packing assembly. The journal bearing so configured is known as a Schiele's pivot. The Schiele's pivot also serves to maintain proper alignment of the valve stem with respect to the bonnet. Vertical wear between the surfaces of the Schiele's pivot is uniform at all points of contact between the second sliding tractrix surface and the second complementary tractrix surface of a bonnet. The valve stem is connected to a valve plug by means of a slip joint. The valve is opened and closed by rotating the valve stem. The slip joint compensates for wear on the Schiele's pivot and on the valve plug. A ledge is provided on the valve bonnet for the retaining nut to bear against. The ledge prevents over tightening of the retaining nut and the resulting excessive friction between stem and stem packing. 2 figures.

  2. Lightweight Valve Closes Duct Quickly

    NASA Technical Reports Server (NTRS)

    Fournier, Walter L.; Burgy, N. Frank

    1991-01-01

    Expanding balloon serves as lightweight emergency valve to close wide duct. Uninflated balloon stored in housing of duct. Pad resting on burst diaphragm protects balloon from hot gases in duct. Once control system triggers valve, balloon inflates rapidly to block duct. Weighs much less than does conventional butterfly, hot-gas, or poppet valve capable of closing duct of equal diameter.

  3. Mitral valve-in-valve with the lotus mechanically expanding platform.

    PubMed

    Feldman, Ted; Reardon, Michael J

    2015-12-01

    Disadvantages of existing balloon expandable or self-expanding transcatheter platforms for mitral valve-in-valve include the potential for malposition during deployment and for LV outflow tract obstruction Controlled mechanical valve expansion, the option to reposition, and stable hemodynamics throughout the procedure make the LOTUS valve an attractive option for mitral valve-in-valve Correct sizing remains a critical aspect of all trancatheter valve implant procedures, including valve-in-valve implants. PMID:26582326

  4. Unusual mechanism of myocardial infarction in prosthetic valve endocarditis

    PubMed Central

    Atik, Fernando A; Campos, Vanessa G; da Cunha, Claudio R; de Oliveira, Felipe Bezerra Martins; Otto, Maria Estefânia Bosco; Monte, Guilherme U

    2015-01-01

    A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to aortic valve replacement with a stented bioprosthesis. He developed Staphylococcus epidermidis prosthetic valve endocarditis a month later, presenting in the emergency room with acute myocardial infarction. The mechanism of myocardial ischemia was a large aortic root abscess causing left main extrinsic compression. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic to right atrium fistula and coronary artery bypass grafting of the left anterior descending. After a difficult postoperative period with multiple problems, he was eventually discharged home. At 36-month follow-up, he is asymptomatic with no recurrent infection, and the left main coronary artery is widely patent on control chest computed tomography. PMID:26045678

  5. Coronary artery compression three months after transcatheter pulmonary valve implantation.

    PubMed

    Dehghani, Payam; Kraushaar, Greg; Taylor, Dylan A

    2015-03-01

    We report a case of a 29-year-old man who developed exercised-induced myocardial infarction 3 months post Melody valve implantation. We introduce the concept of ruling out dynamic coronary artery compression by simulating transcatheter pulmonary valve implant while increasing cardiac output and thus aortic dimensions in the catheterization laboratory. © 2014 Wiley Periodicals, Inc. PMID:25115934

  6. Ball fuel valve with reserve position

    SciTech Connect

    Tupper, W.E.

    1992-05-26

    This patent describes a fuel valve adapted for use with the fuel tank of a motor vehicle. It comprises a valve body defining an internal valve chamber; substantially cylindrical nylon main inlet tube having one end attached to the valve body in communication with the main fuel inlet; substantially cylindrical nylon reserve inlet tube having one end attached to the valve body in communication with the reserve fuel inlet; a valve assembly operatively engaging the valve body; a plurality of valve gaskets operatively disposed within the internal valve chamber to seal the ball element within the internal valve chamber.

  7. Valve for gas centrifuges

    DOEpatents

    Hahs, C.A.; Rurbage, C.H.

    1982-03-17

    The invention is pneumatically operated valve assembly for simulatenously (1) closing gas-transfer lines connected to a gas centrifuge or the like and (2) establishing a recycle path between two on the lines so closed. The value assembly is especially designed to be compact, fast-acting, reliable, and comparatively inexpensive. It provides large reductions in capital costs for gas-centrifuge cascades.

  8. Thermostatic Radiator Valve Evaluation

    SciTech Connect

    Dentz, Jordan; Ansanelli, Eric

    2015-01-01

    A large stock of multifamily buildings in the Northeast and Midwest are heated by steam distribution systems. Losses from these systems are typically high and a significant number of apartments are overheated much of the time. Thermostatically controlled radiator valves (TRVs) are one potential strategy to combat this problem, but have not been widely accepted by the residential retrofit market.

  9. Improved Merge Valve

    NASA Technical Reports Server (NTRS)

    George-Falvy, Dez

    1992-01-01

    Circumferential design combines compactness and efficiency. In remotely controlled valve, flow in tributary duct along circumference of primary duct merged with flow in primary duct. Flow in tributary duct regulated by variable throat nuzzle driven by worm gear. Design leak-proof, and most components easily fabricated on lathe.

  10. Multi-port valve assembly

    DOEpatents

    Guggenheim, S. Frederic (Teaneck, NJ)

    1986-01-01

    A multi-port fluid valve apparatus is used to control the flow of fluids through a plurality of valves and includes a web, which preferably is a stainless steel endless belt. The belt has an aperture therethrough and is progressed, under motor drive and control, so that its aperture is moved from one valve mechanism to another. Each of the valve mechanisms comprises a pair of valve blocks which are held in fluid-tight relationship against the belt. Each valve block consists of a block having a bore through which the fluid flows, a first seal surrounding the bore and a second seal surrounding the first seal, with the distance between the first and second seals being greater than the size of the belt aperture. In order to open a valve, the motor progresses the belt aperture to where it is aligned with the two bores of a pair of valve blocks, such alignment permitting a flow of the fluid through the valve. The valve is closed by movement of the belt aperture and its replacement, within the pair of valve blocks, by a solid portion of the belt.

  11. The SAPIEN 3 valve: lights and shadows.

    PubMed

    Facchin, M; Mojoli, M; Covolo, E; Tarantini, G

    2014-12-01

    Transcatheter aortic valve implantation (TAVI) has become an accepted alternative treatment option for high-risk or inoperable patients with symptomatic severe aortic stenosis. The future challenge for TAVI devices is to ensure results in terms of safety and efficacy that may justify an eligibility extension for this procedure to patients at intermediate and low risk for surgery. The ideal aortic valve prosthesis should be durable, with optimal hemodynamic performance and able to reduce the current major complications of TAVI procedure, in particular vascular complications (not infrequent with the transfemoral access route), paravalvular leaks, stroke and atrioventricular block requiring a permanent pacemaker. The SAPIEN 3™ (S3) (Edwards Lifesciences, Irvine, CA, USA) is the last Edwards family's transcatheter heart valves and incorporates a number of new and enhance