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Sample records for aortic stenosis study

  1. Aortic stenosis

    Science.gov (United States)

    ... stenosis; Valvular aortic stenosis; Congenital heart - aortic stenosis; Rheumatic fever - aortic stenosis Images Aortic stenosis Heart valves References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  2. Regional aortic distensibility and its relationship with age and aortic stenosis: a computed tomography study.

    Science.gov (United States)

    Wong, Dennis T L; Narayan, Om; Leong, Darryl P; Bertaso, Angela G; Maia, Murilo G; Ko, Brian S H; Baillie, Timothy; Seneviratne, Sujith K; Worthley, Matthew I; Meredith, Ian T; Cameron, James D

    2015-06-01

    Aortic distensibility (AD) decreases with age and increased aortic stiffness is independently associated with adverse cardiovascular outcomes. The association of severe aortic stenosis (AS) with AD in different aortic regions has not been evaluated. Elderly subjects with severe AS and a cohort of patients without AS of similar age were studied. Proximal aortic cross-sectional-area changes during the cardiac cycle were determined using retrospective-ECG-gating on 128-detector row computed-tomography. Using oscillometric-brachial-blood-pressure measurements, the AD at the ascending-aorta (AA), proximal-descending-aorta (PDA) and distal-descending-aorta (DDA) was determined. Linear mixed effects modelling was used to determine the association of age and aortic stenosis on regional AD. 102 patients were evaluated: 36 AS patients (70-85 years), 24 AS patients (>85 years) and 42 patients without AS (9 patients DDA (1.1 ± 1.2 vs. 1.2 ± 0.8, P = 0.97). In patients without AS, AD decreased with age in all aortic regions (P < 0.001). The AA in patients <50 years were the most distensible compared to other aortic regions. There is regional variation in aortic distensibility with aging. Patients with aortic stenosis demonstrated regional differences in aortic distensibility with lower distensibility demonstrated in the proximal ascending aorta compared to an age-matched cohort. PMID:25855464

  3. Calcific Aortic Stenosis: Lessons Learned from Experimental and Clinical Studies

    OpenAIRE

    Rajamannan, Nalini M

    2008-01-01

    Calcific aortic stenosis is the most common indication for surgical valve replacement in the United States. For years this disease has been described as a passive degenerative process during which serum calcium attaches to the valve surface and binds to the leaflet to form nodules. Therefore, surgical treatment of this disease has been the approach towards relieving outflow obstruction in these patients. Recent studies demonstrate an association between atherosclerosis and its risk factors fo...

  4. Stroke in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Greve, Anders Møller; Dalsgaard, Morten; Bang, Casper N;

    2014-01-01

    BACKGROUND AND PURPOSE: There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass graftin...... associated with mortality. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677....

  5. Valvular Aortic Stenosis: A Proteomic Insight

    Directory of Open Access Journals (Sweden)

    Fernando Vivanco

    2010-02-01

    Full Text Available Calcified aortic valve disease is a slowly progressive disorder that ranges from mild valve thickening with no obstruction of blood flow, known as aortic sclerosis, to severe calcification with impaired leaflet motion or aortic stenosis. In the present work we describe a rapid, reproducible and effective method to carry out proteomic analysis of stenotic human valves by conventional 2-DE and 2D-DIGE, minimizing the interference due to high calcium concentrations. Furthermore, the protocol permits the aortic stenosis proteome to be analysed, advancing our knowledge in this area. Summary: Until recently, aortic stenosis (AS was considered a passive process secondary to calcium deposition in the aortic valves. However, it has recently been highlighted that the risk factors associated with the development of calcified AS in the elderly are similar to those of coronary artery disease. Furthermore, degenerative AS shares histological characteristics with atherosclerotic plaques, leading to the suggestion that calcified aortic valve disease is a chronic inflammatory process similar to atherosclerosis. Nevertheless, certain data does not fit with this theory making it necessary to further study this pathology. The aim of this study is to develop an effective protein extraction protocol for aortic stenosis valves such that proteomic analyses can be performed on these structures. In the present work we have defined a rapid, reproducible and effective method to extract proteins and that is compatible with 2-DE, 2D-DIGE and MS techniques. Defining the protein profile of this tissue is an important and challenging task that will help to understand the mechanisms of physiological/pathological processes in aortic stenosis valves.

  6. Bilateral ostial coronary stenosis and rheumatic aortic valve stenosis.

    Science.gov (United States)

    Sorokin, Alexeyi; Weich, Hellmuth; Doubell, Anton; Moolman, Johannes A

    2006-01-01

    A 49-year-old patient presented with angina pectoris and clinical findings of aortic valve stenosis and regurgitation. Rheumatic aortic valve stenosis and regurgitation was diagnosed on echocardiography. Coronary angiography findings showed severe calcification in the aorta root with right coronary ostial occlusion, and were suggestive of left main ostial stenosis and proximal main stem stenosis, which was confirmed on CT angiography. Curvilinear calcification of the aorta was present on CT angiography. The findings suggested syphilitic aortitis. Syphilis serology was positive (RPR titre 1/16). The angina was caused by severe coronary ostial disease likely due to syphilitic aortitis and exacerbated by the rheumatic aortic valve stenosis and regurgitation. PMID:16885079

  7. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis

    DEFF Research Database (Denmark)

    Rossebo, A.B.; Pedersen, T.R.; Boman, K.; Brudi, P.; Chambers, J.B.; Egstrup, K.; Gerdts, E.; Gohlke-Barwolf, C.; Holme, I.; Kesaniemi, Y.A.; Malbecq, W.; Nienaber, C.A.; Ray, S.; Skjaerpe, T.; Wachtell, K.; Willenheimer, R.

    2008-01-01

    BACKGROUND: Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, but lipid-lowering studies have had conflicting results. METHODS: We conducted a randomized, double-blind trial involving 1873 patients with mild-to-moderate, asymptomatic aortic stenosis. The patients...

  8. Reducing the Inconsistency between Doppler and Invasive Measurements of the Severity of Aortic Stenosis Using Aortic Valve Coefficient: A Retrospective Study on Humans

    OpenAIRE

    Anup K. Paul; Banerjee, Rupak K; Arumugam Narayanan; Effat, Mohamed A; Jason J. Paquin

    2014-01-01

    Background. It is not uncommon to observe inconsistencies in the diagnostic parameters derived from Doppler and catheterization measurements for assessing the severity of aortic stenosis (AS) which can result in suboptimal clinical decisions. In this pilot study, we investigate the possibility of improving the concordance between Doppler and catheter assessment of AS severity using the functional diagnostic parameter called aortic valve coefficient (AVC), defined as the ratio of the transvalv...

  9. Predictors of exercise capacity and symptoms in severe aortic stenosis

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Kjaergaard, Jesper; Pecini, Redi;

    2010-01-01

    This study investigated the association between invasive and non-invasive estimates of left ventricular (LV) filling pressure and exercise capacity, in order to find new potential candidates for risk markers in severe aortic valve stenosis (AS).......This study investigated the association between invasive and non-invasive estimates of left ventricular (LV) filling pressure and exercise capacity, in order to find new potential candidates for risk markers in severe aortic valve stenosis (AS)....

  10. Temporal trends in the incidence and prognosis of aortic stenosis

    DEFF Research Database (Denmark)

    Martinsson, Andreas; Li, Xinjun; Andersson, Charlotte;

    2015-01-01

    BACKGROUND: The aging of Western populations is expected to result in increasing occurrence of aortic stenosis (AS), but data are limited. Recent studies have reported declining incidence and mortality for other major heart diseases. We aimed to study temporal trends in the incidence and prognosis...... could suggest that improved risk factor control and cardiovascular therapy, combined with increased use of aortic valve replacement in the elderly and reduced perioperative mortality in aortic valve replacement, have translated into favorable effects for AS....

  11. DEGENERATIVE AORTIC STENOSIS: PATHOGENESIS AND NEW PRINCIPLES OF TREATMENT

    OpenAIRE

    O. V. Andropova; V. N. Anokhin

    2016-01-01

    Aim. To reveal of markers of inflammation and progression of calcification in patients with degenerative aortic stenosis (DAS). Material and methods. A single-stage study was done in 85 patients with degenerative calcification of aortic valve (42 patients with DAS and 43 patients without DAS). The techniques for assessing the severity of aortic valve calcification included ultrasonic diagnostics and multislice spiral computed tomography. Markers of inflammation and lipid profile were investig...

  12. Supravalvular aortic stenosis with sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Pradeep Vaideeswar

    2015-01-01

    Full Text Available Sudden cardiac death (SCD most commonly results from previously undiagnosed congenital, acquired, or hereditary cardiac diseases. Congenital aortic valvular, subvalvular, and supravalvular disease with left ventricular outflow tract obstruction is an important preventable cause of sudden death. This report documents sudden death presumably due to acute myocardial ischemia in a young male with an undiagnosed supravalvular aortic stenosis (SVAS due to a rare association of isolation of coronary sinuses of Valsalva. Congenital supravalvular pulmonary stenosis and mitral valvular dysplasia were also present.

  13. Usefulness of the Electrocardiogram in Predicting Cardiovascular Mortality in Asymptomatic Adults With Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis Study)

    DEFF Research Database (Denmark)

    Greve, Anders M; Dalsgaard, Morten; Bang, Casper N; Egstrup, Kenneth; Rossebø, Anne B; Boman, Kurt; Cramariuc, Dana; Nienaber, Christoph A; Ray, Simon; Gohlke-Baerwolf, Christa; Okin, Peter M; Devereux, Richard B; Køber, Lars; Wachtell, Kristian

    2014-01-01

    Hypertension and coronary heart disease are common in aortic stenosis (AS) and may impair prognosis for similar AS severity. Different changes in the electrocardiogram may be reflective of the separate impacts of AS, hypertension, and coronary heart disease, which could lead to enhanced risk...... cardiovascular death. In 1,473 patients followed for a mean of 4.3 years (6,362 patient-years of follow-up), 70 cardiovascular deaths (5%) occurred. In multivariate analysis, heart rate (hazard ratio [HR] 1.5 per 11.2 minute(-1) [1 SD], 95% confidence interval [CI] 1.2 to 1.8), sum of Q-wave amplitude (HR 1.......3 per 2.0 mm [1 SD], 95% CI 1.1 to 1.6), and Cornell voltage-duration product (HR 1.4 per 763 mm × ms [1 SD], 95% CI 1.2 to 1.7) remained independently associated with cardiovascular death. Combining the prognostic information contained in each of the 3 ECG variables improved integrated discrimination...

  14. Coronary Ostial Stenosis after Aortic Valve Replacement

    Science.gov (United States)

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

    2010-01-01

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

  15. Global Strain in Severe Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbæk, Lars; Poulsen, Mikael K;

    2012-01-01

    Score, history with ischemic heart disease and ejection fraction. CONCLUSIONS: -In patients with symptomatic severe aortic stenosis undergoing AVR reduced GLS provides important prognostic information beyond standard risk factors. Clinical Trial Registration-URL: http://www.clinicaltrial.gov. Unique identifier...

  16. Molecular mechanisms of inflammation and calcification in aortic valve stenosis

    OpenAIRE

    Nagy, Edit

    2012-01-01

    Aortic valve stenosis is a slowly progressive disorder with a spectrum of disease ranging from aortic sclerosis to severe destroyed valvular architecture leading to critical outflow obstruction. The diseased valve is characterized by inflammation, as an initiating event, pathological remodeling of extracellular matrix and pronounced calcification, which all eventually cause restricted leaflet mobility. Compelling evidence obtained from both experimental animal models and human studies provide...

  17. Indexing aortic valve area by body surface area increases the prevalence of severe aortic stenosis

    DEFF Research Database (Denmark)

    Jander, Nikolaus; Gohlke-Bärwolf, Christa; Bahlmann, Edda;

    2014-01-01

    To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). Cut-off values for severe stenosis are...

  18. Spatial quantitative vectorcardiography in aortic stenosis: correlation with hemodynamic findings.

    Science.gov (United States)

    Talwar, K K; Mohan, J C; Narula, J; Kaul, U; Bhatia, M L

    1988-02-01

    Thirty-four patients with hemodynamically documented valvar aortic stenosis without congestive heart failure were studied by the corrected Frank lead system vectorcardiography, with special emphasis on the angular characteristics of spatial R max to define the severity of the lesion. Spatial QRS-T angle demonstrated a highly significant correlation with the peak left ventricular systolic pressure (r = 0.72, P less than 0.001) and a significant correlation with peak transvalvar aortic gradient (r = 0.49, P less than 0.01). Furthermore, all patients with a QRS-T angle of more than 90 degrees had significant aortic stenosis (TVG greater than or equal to 50 mm Hg). The peak left ventricular systolic pressure and transvalvar aortic gradient also demonstrated a significant negative correlation with azimuth angle (r = -0.36 and -0.34, respectively; P less than 0.05) and a positive correlation with spatial R max magnitude (r = 0.38 and 0.41, respectively; P less than 0.05). There was no correlation between elevation angle of spatial R max and left ventricle systolic pressure or transvalvar aortic gradient. Our study indicates that spatial quantitative vectorcardiographic angular characteristics, particularly spatial QRS-T angle, may be a useful adjunct to other noninvasive techniques to assess the severity of valvar aortic stenosis. PMID:3343071

  19. Association of ischemic heart disease to global and regional longitudinal strain in asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Carstensen, Helle Gervig; Larsen, Linnea Hornbech; Hassager, Christian;

    2015-01-01

    . Thus the purpose of this study was to evaluate the association between subclinical ischemic heart disease and global and regional longitudinal strain in asymptomatic patients with significant aortic stenosis. Prevalent patients with a diagnosis of aortic stenosis at six hospitals in the Greater...... independent of aortic valve area, stroke volume index, pro-BNP, valvulo-arterial impedance, body mass index and heart rate. In linear regression models with both aortic valve area and significant coronary stenosis, apical (p < 0.001) and mid (p < 0.01) longitudinal strain were associated to significant...

  20. Influence of obesity on left ventricular adaptation, grading and outcome in aortic valve stenosis

    OpenAIRE

    Rogge, Barbara

    2014-01-01

    Background/Aim: Obesity is associated with hemodynamic changes characterized by volume overload adding to the progressive pressure overload induced by aortic valve stenosis (AS). This thesis investigated whether concomitant obesity in patients with AS independently impacts left ventricular (LV) adaptation, grading and outcome during progression of the valve stenosis.Methods: The project was a planned substudy of the Simvastin Ezetimibe in Aortic Stenosis study (SEAS), a prospec...

  1. DEGENERATIVE AORTIC STENOSIS: PATHOGENESIS AND NEW PRINCIPLES OF TREATMENT

    Directory of Open Access Journals (Sweden)

    O. V. Andropova

    2006-01-01

    Full Text Available Aim. To reveal of markers of inflammation and progression of calcification in patients with degenerative aortic stenosis (DAS. Material and methods. A single-stage study was done in 85 patients with degenerative calcification of aortic valve (42 patients with DAS and 43 patients without DAS. The techniques for assessing the severity of aortic valve calcification included ultrasonic diagnostics and multislice spiral computed tomography. Markers of inflammation and lipid profile were investigated.    Results. Higher blood levels of total holesterol and holesterol of low density lipoprotein were revealed in patients with DAS in comparison with patients without DAS. They also had higher levels of inflammation markers: C-reactive protein and interleukin-6. There were significant correlations between DAS severity, lipid metabolism disturbances and inflammation markers. Conclusion. Atherogenesis and inflammation may have pathogenic influence on progression of aortic valve calcification and DAS development by lipid infiltration and endothelium cells damage.

  2. Effect of Randomized Lipid Lowering With Simvastatin and Ezetimibe on Cataract Development (from the Simvastatin and Ezetimibe in Aortic Stenosis Study)

    DEFF Research Database (Denmark)

    Bang, Casper N; Greve, Anders M; la Cour, Morten; Boman, Kurt; Gohlke-Bärwolf, Christa; Ray, Simon; Pedersen, Terje; Rossebø, Anne; Okin, Peter M; Devereux, Richard B; Wachtell, Kristian

    2015-01-01

    indicate a possible effect of statin therapy on reducing risk of lens opacities. However, the results are conflicting. The Simvastatin and Ezetimibe in Aortic Stenosis study (NCT00092677) enrolled 1,873 patients with asymptomatic aortic stenosis and no history of diabetes, coronary heart disease, or other...... multivariate analysis adjusted for age, gender, prednisolone treatment, smoking, baseline LDL cholesterol and high sensitivity C-reactive protein; simvastatin plus ezetimibe versus placebo was associated with 44% lower risk of cataract development (hazard ratio 0.56, 95% confidence interval 0.33 to 0.96, p = 0......Recent American College of Cardiology/American Heart Association guidelines on statin initiation on the basis of total atherosclerotic cardiovascular disease risk argue that the preventive effect of statins on cardiovascular events outweigh the side effects, although this is controversial. Studies...

  3. Calcium Scoring of Aortic Valve Calcification in Aortic Valve Stenosis with a Multislice Computed Tomography Scanner: Non-enhanced versus Contrast-enhanced Studies

    International Nuclear Information System (INIS)

    Purpose: Previous studies have shown a positive correlation between amount of aortic valve calcification (AVC) and degree of aortic valve stenosis (AVS). We have investigated whether calcium scoring of AVC from contrast-enhanced images is reliable. Material and Methods: Nineteen patients with suspected AVS underwent retrospectively ECG-gated multislice computed tomography (MSCT). Standardized scan protocols were applied prior to (120 KV, 133 mAseff) and after (120 KV, 500 mAseff) the administration of non-ionic contrast material. Image reconstruction was performed at 60% of the RR interval (slice thickness 3 mm, reconstruction increment 2 mm). AVC was quantified using Agatston score and calcium mass. The number of lesions was calculated. All non-enhanced images were scored using thresholds of 130 HU and 350 HU. Contrast-enhanced images were assessed with a threshold of 350 HU exclusively. Results: Fifteen patients with AVCs were included in the statistical analysis. The mean Agatston score (calcium mass) in non-enhanced images was 2888.4±2844.4 (694.2 mg±869.3 mg). Altering the threshold from 130 HU to 350 HU led to a 58.2% (30.5%) decrease in the AVC score ( P values <0.001). Contrast-enhanced images showed an increased Agatston score (calcium mass) of 56.2% (33.5%) compared to non-enhanced images ( P values <0.05) with the same threshold of 350 HU. Conclusion: Quantification of AVC from contrast-enhanced images is not reliable, as contrast material simulates calcification

  4. Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: a meta analysis

    Institute of Scientific and Technical Information of China (English)

    WU Yi-cheng; ZHANG Jian-feng; SHEN Wei-feng; ZHAO Qiang

    2013-01-01

    Background Transcatheter aortic valve implantation (TAVI) has emerged as the treatment choice for non-operable patients with severe symptomatic aortic stenosis (AS) and may be a good alternative to surgery for those at very high or prohibitive surgical risk.We performed a meta-analysis to evaluate the comparative benefits of TAVI versus surgical aortic valve replacement (SAVR) in patients with severe AS.Methods A comprehensive literature search of PubMed,Embase,ScienceDirect and Cochrane Central Register of Controlled trials was performed,and randomized trials as well as cohort studies with propensity score analysis were included.Results One randomized trial (n=699) and six retrospective cohort studies (n=781) were selected for meta-analysis.Mortality at 30-day and 1-year follow-up was comparable between TAVI and SAVR.Despite similar incidences of stroke,myocardial infarction,re-operation for bleeding,and renal failure requiring dialysis,TAVI was associated with a lower occurrence rate of new-onset atrial fibrillation (OR 0.51,95% CI 0.33-0.78) and shorter procedural time (mean difference -67.50 minutes,95% CI-87.20 to-47.81 minutes).Post-operative aortic regurgitation and permanent pacemaker implantation were more common in patients after TAVI than in those with SAVR (OR 5.53,95% CI 3.41-8.97; OR 1.71,95% Cl 1.02-2.84,respectively).Conclusion In patients with severe symptomatic AS,TAVI and SAVR did not differ with respect to short-and mid-term survival,but the incidence of permanent pacemaker implantation and post-procedural aortic regurgitation remain relatively high after TAVI.

  5. Inside human aortic stenosis: a proteomic analysis of plasma.

    Science.gov (United States)

    Gil-Dones, Félix; Darde, Verónica M; Alonso-Orgaz, Sergio; Lopez-Almodovar, Luis F; Mourino-Alvarez, Laura; Padial, Luis R; Vivanco, Fernando; Barderas, Maria G

    2012-02-16

    Valvular aortic stenosis (AS) produces a slowly progressive obstruction in left ventricular outflow track. For this reason, aortic valve replacement is warranted when the valvular stenosis is hemodinamically significant, becoming the most common worldwide cause of aortic valve surgery. Recent epidemiologic studies have revealed an association between degenerative AS and cardiovascular risk factors for atherosclerosis, althought reducing the exposure to such factors and statin therapies both fail to delay or reverse the pathology. Hence, a deeper understanding of the pathophysiology of this disease is required to identify appropriate preventive measures. A proteomic analysis of plasma will permit to know and identify the changes in protein expression induced by AS in this tissue. Using two-dimensional difference gel electrophoresis (2D-DIGE) followed by mass spectrometry (MS), we compared the crude (not pre-fractioned) and pre-fractioned plasma from AS patients and control subjects. We sought to identify plasma proteins whose expression is modified in AS. In addition we investigated if crude plasma presented some alterations in the more abundant proteins since to date, has never been studied before. We also further investigated the link between this disease and atherosclerosis with a view to identifying new potential markers and therapeutic targets. PMID:22178735

  6. Impact of QRS duration and morphology on the risk of sudden cardiac death in asymptomatic patients with aortic stenosis

    DEFF Research Database (Denmark)

    Greve, Anders M; Gerdts, Eva; Boman, Kurt;

    2012-01-01

    The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS).......The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS)....

  7. Carotid plaque, intima-media thickness, and incident aortic stenosis

    DEFF Research Database (Denmark)

    Martinsson, Andreas; Östling, Gerd; Persson, Margaretha;

    2014-01-01

    OBJECTIVE: Aortic stenosis (AS) shares risk factors with atherosclerotic vascular disease. Carotid intima-media thickness (IMT) and plaque may reflect the cumulative damage from exposure to different atherosclerotic risk factors. We examined the relationship of carotid IMT and plaque with incident...... risk factors for incident AS were studied in age- and sex-adjusted and expanded multivariable-adjusted Cox regression models. A total of 69 (1.4%) participants developed AS during up to 20 years of follow-up. Significant risk factors for AS in age- and sex-adjusted analyses were (P<0.05) body mass...

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

    OpenAIRE

    Bozkurt, Engin; KELEŞ, TELAT; Durmaz, Tahir; Akçay, Murat; Sari, Cenk; Ayhan, Hüseyin; Bayram, Nihal Akar; Aslan, Abdullah Nabi; Baştuğ, Serdal; Bilen, Emine

    2014-01-01

    Introduction Transcatheter aortic valve implantation is a promising alternative to high risk surgical aortic valve replacement. The procedure is mainly indicated in patients with severe symptomatic aortic stenosis who cannot undergo surgery or who are at very high surgical risk. Aim Description early results of our single-center experience with balloon expandable aortic valve implantation. Material and methods Between July 2011 and August 2012, we screened in total 75 consecutive patients wit...

  9. [Unicuspid Aortic Valve Stenosis Combined with Aortic Coarctation;Report of a Case].

    Science.gov (United States)

    Kubota, Takehiro; Wakasa, Satoru; Shingu, Yasushige; Matsui, Yoshiro

    2016-06-01

    Unicuspid aortic valve in an adult is extremely rare. In addition, 90% of the patients with aortic coarctation are reported to die before the age 50. A 60-year-old woman was admitted to our hospital for further examination of exertional dyspnea which had begun one year before. She had been under medical treatment for hypertension since early thirties, and had been also diagnosed with moderate aortic stenosis at 50 years of age. She was at 1st diagnosed with aortic coarctation combined with bicuspid aortic valve stenosis. The aortic valve was then found unicuspid and was replaced under cardiopulmonary bypass with perfusion to both the ascending aorta and the femoral artery. Repair of aortic coarctation was performed 3 months later through left thoracotomy without extracorporeal circulation due to the rich collateral circulation. She had no postoperative complications, and hypertension as well as ankle-brachial index improved to the normal levels. PMID:27246132

  10. Asymmetric septal hypertrophy - a marker of hypertension in aortic stenosis (a SEAS substudy)

    DEFF Research Database (Denmark)

    Tuseth, Nora; Cramariuc, Dana; Rieck, Ashild E;

    2010-01-01

    Some patients with aortic stenosis develop asymmetric septal hypertrophy (ASH) that may influence the surgical approach and is associated with higher perioperative morbidity. The aim of this analysis was to characterize further this subtype of aortic stenosis patients.......Some patients with aortic stenosis develop asymmetric septal hypertrophy (ASH) that may influence the surgical approach and is associated with higher perioperative morbidity. The aim of this analysis was to characterize further this subtype of aortic stenosis patients....

  11. LV reverse remodeling imparted by aortic valve replacement for severe aortic stenosis; is it durable? A cardiovascular MRI study sponsored by the American Heart Association

    Directory of Open Access Journals (Sweden)

    Caruppannan Ketheswaram

    2011-04-01

    Full Text Available Abstract Background In patients with severe aortic stenosis (AS, long-term data tracking surgically induced effects of afterload reduction on reverse LV remodeling are not available. Echocardiographic data is available short term, but in limited fashion beyond one year. Cardiovascular MRI (CMR offers the ability to serially track changes in LV metrics with small numbers due to its inherent high spatial resolution and low variability. Hypothesis We hypothesize that changes in LV structure and function following aortic valve replacement (AVR are detectable by CMR and once triggered by AVR, continue for an extended period. Methods Tweny-four patients of which ten (67 ± 12 years, 6 female with severe, but compensated AS underwent CMR pre-AVR, 6 months, 1 year and up to 4 years post-AVR. 3D LV mass index, volumetrics, LV geometry, and EF were measured. Results All patients survived AVR and underwent CMR 4 serial CMR's. LVMI markedly decreased by 6 months (157 ± 42 to 134 ± 32 g/m2, p 2. Similarly, EF increased pre to post-AVR (55 ± 22 to 65 ± 11%,(p 2. LV stroke volume increased rapidly from pre to post-AVR (40 ± 11 to 44 ± 7 ml, p Conclusion After initial beneficial effects imparted by AVR in severe AS patients, there are, as expected, marked improvements in LV reverse remodeling. Via CMR, surgically induced benefits to LV structure and function are durable and, unexpectedly express continued, albeit markedly incomplete improvement through 4 years post-AVR concordant with sustained improved clinical status. This supports down-regulation of both mRNA and MMP activity acutely with robust suppression long term.

  12. Turner's syndrome associated with bicuspid aortic stenosis and dissecting aortic aneurysm

    OpenAIRE

    Slater, D N; Grundman, M. J.; Mitchell, L

    1982-01-01

    A case of Turner's syndrome is described associated with bicuspid aortic stenosis and fatal rupture of a thoracic dissecting aortic aneurysm. Histology of the aneurysm showed severe cystic medial necrosis. This association has not been previously described in the absence of coarctation.

  13. Diagnosis and management of patients with asymptomatic severe aortic stenosis

    Science.gov (United States)

    Katayama, Minako; Chaliki, Hari P

    2016-01-01

    Aortic stenosis (AS) is a disease that progresses slowly for years without symptoms, so patients need to be carefully managed with appropriate follow up and referred for aortic valve replacement in a timely manner. Development of symptoms is a clear indication for aortic valve intervention in patients with severe AS. The decision for early surgery in patients with asymptomatic severe AS is more complex. In this review, we discuss how to identify high-risk patients with asymptomatic severe AS who may benefit from early surgery. PMID:26981214

  14. Circulating CD14+ monocytes in patients with aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    Sara Shimoni; Valery Meledin; Iris Bar; Jacob Fabricant; Gera Gandelman; Jacob George

    2016-01-01

    BackgroundCalcific aortic stenosis (AS) is an active process sharing similarities with atherosclerosis and chronic inflammation. The pathophysiology of AS is notable for three cardinal components: inflammation, fibrosis and calcification. Monocytes play a role in each of these processes. The role of circulating monocytes in AS is not clear. The aim of the present study was to study an association between cir-culating apoptotic and non apoptotic CD14+ monocytes and AS features.MethodsWe assessed the number of CD14+ monocytes and apoptotic monocytes in 54 patients with significant AS (aortic valve area 0.74 ± 0.27 cm2) and compared them to 33 patients with similar risk factors and no valvular disease. The level of CD14+ monocytes and apoptotic monocytes was assessed by flow cytometry.ResultsThere was no difference in the risk factor profile and known coronary or peripheral vascular diseases between patients with AS and controls.Pa-tients with AS exhibited increased numbers of CD14+ monocytes as compared to controls (9.9% ± 4.9%vs. 7.7% ± 3.9%,P= 0.03). CD14+ monocyte number was related to age and the presence and severity of AS. In patients with AS, both CD14+ monocytes and apoptotic mono-cytes were inversely related to aortic valve area.ConclusionsPatients with significant AS have increased number of circulating CD14+ monocytes and there is an inverse correlation between monocyte count and aortic valve area. These findings may suggest that inflammation is operative not only in early valve injury phase, but also at later developed stages such as calcification when AS is severe.

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

    Science.gov (United States)

    Karataş, Zehra; Karataş, Ahmet; Özlü, Tülay; Goksugur, Sevil B; Varan, Birgül

    2014-01-01

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

  16. Increased risk of aortic valve stenosis in patients with psoriasis

    DEFF Research Database (Denmark)

    Khalid, Usman; Ahlehoff, Ole; Gislason, Gunnar Hilmar;

    2015-01-01

    AIM: Psoriasis is a chronic inflammatory disease associated with increased risk of cardiovascular disease including atherosclerosis. The pathogenesis of aortic valve stenosis (AS) also includes an inflammatory component. We therefore investigated the risk of AS in patients with psoriasis compared...... eligible for analysis. During the study period, we identified 58 747 patients with mild psoriasis and 11 918 patients with severe psoriasis. The overall incidence rates for AS were 8.09, 16.07, and 20.08 per 10 000 person-years for the reference population (48 539 cases [mean follow-up 12.3 years]), mild...... psoriasis (509 cases [mean follow-up 6.2 years]), and severe psoriasis (99 cases [mean follow-up 5.4 years]), respectively. Correspondingly, the fully adjusted IRRs for AS were markedly increased in patients with psoriasis with IRR 1.22 (95% confidence interval [CI] 1.12-1.33) and IRR 1.61 (CI 1...

  17. A hybrid approach for quantifying aortic valve stenosis using impedance cardiography and echocardiography

    OpenAIRE

    Daralammouri, Yunis; Ayoub, Khubaib; Badrieh, Najwan; Lauer, Bernward

    2016-01-01

    Background Impedance cardiography (IC) is a noninvasive modality that utilizes changes in impedance across the thorax to assess hemodynamic parameters, including stroke volume (SV). This study compared aortic valve area (AVA) as assessed by a hybrid approach of transthoracic echocardiography (TTE) and impedance cardiography (IC) to AVA determined at cardiac catheterization using the Gorlin equation. Methods A total of 30 patients with moderate to severe aortic stenosis underwent AVA measureme...

  18. Asymptomatic severe aortic stenosis: challenges in diagnosis and management.

    Science.gov (United States)

    Izumi, Chisato

    2016-08-01

    Optimal management for asymptomatic severe aortic stenosis (AS) remains controversial. Considering the increase in elderly patients, improved surgical outcomes and the introduction of transcatheter aortic valve implantation, we must reconsider the optimal management of asymptomatic severe AS. In this article, previous studies regarding the natural history of asymptomatic severe AS were reviewed to obtain a clinical perspective of AS in the growing elderly patient population. The incidence of sudden death in asymptomatic severe AS varies among studies from 0.25% to 1.7% per year, with differences related to study design and patient background. Except for very severe AS, sudden death or AS-related cardiac death without preceding symptoms is uncommon if 'watchful' waiting strategy is possible. Therefore, early operation is reasonable in very severe AS, but it is not recommended for all patients with severe AS. Using exercise tests, plasma levels of natriuretic peptides and other parameters, risk stratification of asymptomatic severe AS is needed to select patients who may have greater benefit following early operation. On the other hand, 'watchful' waiting is not always possible in real world of our practice. Patient education and periodic echocardiography are essential in 'watchful' waiting, which is not simply waiting strategy without careful monitoring. Individualised discussion regarding the indication for early operation is necessary, considering age, clinical background, predicted natural history and operative risk in each patient. PMID:27091844

  19. Left ventricular diastolic function in valvular aortic stenosis after aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Ristić-Anđelkov Anđelka

    2002-01-01

    Full Text Available In adults with significant sympthomatic aortic valve stenosis, aortic valve replacement is therapy of choice. Replacement of the diseased aortic valve with a prosthetic valve yields relief of left ventricular outflow obstruction. Myocardial remodeling with regression of mass transpires as the heart adapts to the new level of after load. In patients with moderate left ventricular hypertrophy improvement in diastolic function during the first year after aortic valve replacement is visible, while in patients with extreme myocardial hypertrophic changes it was slower.

  20. Catheterization-Doppler discrepancies in nonsimultaneous evaluations of aortic stenosis.

    Science.gov (United States)

    Aghassi, Payam; Aurigemma, Gerard P; Folland, Edward D; Tighe, Dennis A

    2005-05-01

    Prior validation studies have established that simultaneously measured catheter (cath) and Doppler mean pressure gradients (MPG) correlate closely in evaluation of aortic stenosis (AS). In clinical practice, however, cath and Doppler are rarely performed simultaneously; which may lead to discrepant results. Accordingly, our aim was to ascertain agreement between these methods and investigate factors associated with discrepant results. We reviewed findings in 100 consecutive evaluations for AS performed in 97 patients (mean age 72 +/- 10 yr) in which cath and Doppler were performed within 6 weeks. We recorded MPG, aortic valve area (AVA), cardiac output, and ejection fraction (EF) by both methods. Aortic root diameter, left ventricular end-diastolic dimension (LVIDd) and posterior wall thickness (PWT) were measured by echocardiography and gender, heart rate, and heart rhythm were also recorded. An MPG discrepancy was defined as an intrapatient difference > 10 mmHg. Mean pressure gradients by cath and Doppler were 36 +/- 22 mmHg and 37 +/- 20 mmHg, respectively (P = 0.73). Linear regression showed good correlation (r = 0.82) between the techniques. An MPG discrepancy was found in 36 (36%) of 100 evaluations; in 19 (53%) of 36 evaluations MPG by Doppler was higher than cath, and in 17 (47%) of 36, it was lower. In 33 evaluations, EF differed by >10% between techniques. Linear regression analyses revealed that EF difference between studies was a significant predictor of MPG discrepancy (P = 0.004). Women had significantly higher MPG than men by both cath and Doppler (43 +/- 25 mmHg versus 29 +/- 15 mmHg [P = 0.001]; 42 +/- 23 mmHg versus 32 +/- 15 mmHg [P = 0.014], respectively). Women exhibited discrepant results in 23 (47%) of 49 evaluations versus 13 (25%) of 51 evaluations in men (P = 0.037). After adjustment for women's higher MPG, there was no statistically significant difference in MPG discrepancy between genders (P = 0.22). No significant interactions between

  1. Relation of Aortic Valve Morphologic Characteristics to Aortic Valve Insufficiency and Residual Stenosis in Children With Congenital Aortic Stenosis Undergoing Balloon Valvuloplasty.

    Science.gov (United States)

    Petit, Christopher J; Gao, Kevin; Goldstein, Bryan H; Lang, Sean M; Gillespie, Scott E; Kim, Sung-In H; Sachdeva, Ritu

    2016-03-15

    Aortic valve morphology has been invoked as intrinsic to outcomes of balloon aortic valvuloplasty (BAV) for congenital aortic valve stenosis. We sought to use aortic valve morphologic features to discriminate between valves that respond favorably or unfavorably to BAV, using aortic insufficiency (AI) as the primary outcome. All patients who underwent BAV at 2 large-volume pediatric centers from 2007 to 2014 were reviewed. Morphologic features assessed on pre-BAV echo included valve pattern (unicuspid, functional bicuspid, and true bicuspid), leaflet fusion length, leaflet excursion angle, and aortic valve opening area and on post-BAV echo included leaflet versus commissural tear. Primary end point was increase in AI (AI+) of ≥2°. Eighty-nine patients (median age 0.2 years) were included in the study (39 unicuspid, 41 functional bicuspid, and 9 true bicuspid valves). Unicuspid valves had a lower opening area (p valves. Valve gradient pre-BAV and post-BAV were not different among valve patterns. Of the 16 patients (18%) with AI+, 14 had leaflet tears (odds ratio 13.9, 3.8 to 50). True bicuspid valves had the highest rate (33%) of AI+. On multivariate analysis, leaflet tears were associated with AI+, with larger opening area pre-BAV and lower fusion length pre-BAV. AI+ was associated with larger pre-BAV opening area. Gradient relief was associated with reduced angle of excursion. Valve morphology influences outcomes after BAV. Valves with lesser fusion and larger valve openings have higher rates of leaflet tears which in turn are associated with AI. PMID:26805657

  2. Involvement of Immune Cell Network in Aortic Valve Stenosis: Communication between Valvular Interstitial Cells and Immune Cells.

    Science.gov (United States)

    Lee, Seung Hyun; Choi, Jae-Hoon

    2016-02-01

    Aortic valve stenosis is a heart disease prevalent in the elderly characterized by valvular calcification, fibrosis, and inflammation, but its exact pathogenesis remains unclear. Previously, aortic valve stenosis was thought to be caused by chronic passive and degenerative changes associated with aging. However, recent studies have demonstrated that atherosclerotic processes and inflammation can induce valvular calcification and bone deposition, leading to valvular stenosis. In particular, the most abundant cell type in cardiac valves, valvular interstitial cells, can differentiate into myofibroblasts and osteoblast-like cells, leading to valvular calcification and stenosis. Differentiation of valvular interstitial cells can be trigged by inflammatory stimuli from several immune cell types, including macrophages, dendritic cells, T cells, B cells, and mast cells. This review indicates that crosstalk between immune cells and valvular interstitial cells plays an important role in the development of aortic valve stenosis. PMID:26937229

  3. Evaluation of aortic valve stenosis by cardiac multislice computed tomography compared with echocardiography: a systematic review and meta-analysis

    DEFF Research Database (Denmark)

    Abdulla, Jawdat; Sivertsen, Jacob Christian; Kofoed, Klaus Fuglsang;

    2009-01-01

    BACKGROUND AND AIM OF THE STUDY: It has not yet been established whether multi-slice computed tomography (MSCT) is reliable for the quantification of aortic valve area (AVA) in patients with aortic valve stenosis (AVS) and simultaneously for assessment of the coronary anatomy. The study aim, via ...

  4. Robotic-assisted aortic valve bypass (apicoaortic conduit) for aortic stenosis.

    Science.gov (United States)

    Gammie, James S; Lehr, Eric J; Griffith, Bartley P; Dawood, Murtaza Y; Bonatti, Johannes

    2011-08-01

    Aortic valve bypass (AVB [apicoaortic conduit]) surgery consists of the construction of a valved conduit between the left ventricular apex and the descending thoracic aorta. In our institution, AVB is routinely performed without cardiopulmonary bypass or manipulation of the ascending aorta or native aortic valve. We report the case of an 83-year-old man with severe symptomatic bioprosthetic aortic stenosis, chronic thrombocytopenia, and a patent bypass graft who underwent robotically assisted beating-heart AVB through an anterior minithoracotomy. The distal anastomosis was constructed entirely using robotic telemanipulation. Robotic assistance enables the performance of beating-heart AVB through a small incision. PMID:21801931

  5. Balloon aortic valvuloplasty in pregnancy with severe aortic stenosis and infective endocarditis

    Directory of Open Access Journals (Sweden)

    Vinotha

    2012-12-01

    Full Text Available Twenty seven year old lady, previously diagnosed to have aortic stenosis, presented to the obstetric outpatient department at 19 weeks of gestation with fever and breathlessness, NYHA class 4, for one week. Two D Echo revealed left ventricular hypertrophy, a severely stenosed, calcified bicuspid aortic valve, with vegetations on aortic and mitral valves and severe mitral regurgitation. Blood cultures grew nutrionally variant streptococci and she was treated with crystalline penicillin and gentamicin. She stabilised clinically by 21 weeks, by which time, the risk of termination of pregnancy was comparable to continuing the pregnancy. She underwent balloon aortic valvuloplasty. Post balloon aortic valvuloplasty, she was stable. At 34+2 weeks, she underwent emergency LSCS, the indication being intrauterine growth restriction with fetal compromise and breech presentation. She delivered a baby girl, 1.6 kg, Apgar 9 & 10. Our case report highlights the fact that a timely, balloon aortic valvuloplasty can be life saving for patients with pregnancy complicated by severe aortic stenosis and infective endocarditis. [Int J Reprod Contracept Obstet Gynecol 2012; 1(1.000: 69-71

  6. FTO Is Associated with Aortic Valve Stenosis in a Gender Specific Manner of Heterozygote Advantage: A Population-Based Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Cindy Thron

    Full Text Available Single nucleotide polymorphisms (SNPs within the Fat mass and obesity associated (FTO gene have been linked with increased body weight. However, the data on an association of FTO with cardiovascular diseases remains conflicting. Therefore, we ascertained whether FTO is associated with aortic valve stenosis (AVS, one of the most frequent cardiovascular diseases in the Western world.In this population-based case-control study the FTO SNP rs9939609 was analyzed in 300 German patients with AVS and 429 German controls of the KORA survey S4, representing a random population. Blood samples were collected prior to aortic valve replacement in AVS cases and FTO rs9939609 was genotyped via ARMS-PCR. Genotype frequencies differed significantly between AVS cases and KORA controls (p = 0.004. Separate gender-analyses uncovered an association of FTO with AVS exclusively in males; homozygote carriers for the risk-allele (A had a higher risk to develop AVS (p = 0.017, odds ratio (OR 1.727; 95% confidence interval (CI 1.087-2.747, recessive model, whereas heterozygote carriers for the risk-allele showed a lower risk (p = 0.002, OR 0.565, 95% CI 0.384-0.828, overdominant model. After adjustment for multiple co-variables, the odds ratios of heterozygotes remained significant for an association with AVS (p = 0.008, OR 0.565, 95% CI 0.369-0.861.This study revealed an association of FTO rs9939609 with AVS. Furthermore, this association was restricted to men, with heterozygotes having a significantly lower chance to develop AVS. Lastly, the association between FTO and AVS was independent of BMI and other variables such as diabetes mellitus.

  7. Acute Right Coronary Ostial Stenosis during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Sarwar Umran

    2012-01-01

    Full Text Available We report a rare case of acute right coronary artery stenosis developing in a patient undergoing aortic valve replacement. We present a case report with a brief overview of the literature relating to coronary artery occlusion associated with cardiac valve surgery - the theories and treatments are discussed. A 85 year-old female was admitted under the care of the cardiothoracic team with signs and symptoms of heart failure. Investigations, including cardiac echocardiography and coronary angiography, indicated a critical aortic valve stenosis. Intraoperative right ventricular failure ensued post aortic valve replacement. Subsequent investigations revealed an acute occlusion of the proximal right coronary artery with resultant absence of distal flow supplying the right ventricle. An immediate right coronary artery bypass procedure was performed with resolution of the right ventricular failure. Subsequent weaning off cardiopulmonary bypass was uneventful and the patient continued to make excellent recovery in the postoperative phase. To our knowledge this is one of the few documented cases of intraoperative acute coronary artery occlusion developing during valve surgery. However, surgeons should be aware of the potential for acute occlusion so that early recognition and rapid intervention can be instituted.

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

    Science.gov (United States)

    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

  9. Proteomic profile of human aortic stenosis: insights into the degenerative process.

    Science.gov (United States)

    Martín-Rojas, Tatiana; Gil-Dones, Felix; Lopez-Almodovar, Luis F; Padial, Luis R; Vivanco, Fernando; Barderas, Maria G

    2012-03-01

    Degenerative aortic stenosis is the most common worldwide cause of valve replacement. While it shares certain risk factors with coronary artery disease, it is not delayed or reversed by reducing exposure to risk factors (e.g., therapies that lower lipids). Therefore, it is necessary to better understand its pathophysiology for preventive measures to be taken. In this work, aortic valve samples were collected from 20 patients that underwent aortic valve replacement (55% males, mean age of 74 years) and 20 normal control valves were obtained from necropsies (40% males, mean age of 69 years). The proteome of the samples was analyzed by quantitative differential electrophoresis (2D-DIGE) and mass spectrometry, and 35 protein species were clearly increased in aortic valves, including apolipoprotein AI, alpha-1-antitrypsin, serum albumin, lumican, alfa-1-glycoprotein, vimentin, superoxide dismutase Cu-Zn, serum amyloid P-component, glutathione S-transferase-P, fatty acid-binding protein, transthyretin, and fibrinogen gamma. By contrast, 8 protein species were decreased (transgelin, haptoglobin, glutathione peroxidase 3, HSP27, and calreticulin). All of the proteins identified play a significant role in cardiovascular processes, such as fibrosis, homeostasis, and coagulation. The significant changes observed in the abundance of key cardiovascular proteins strongly suggest that they can be involved in the pathogenesis of degenerative aortic stenosis. Further studies are warranted to better understand this process before we can attempt to modulate it. PMID:22276806

  10. Clinical predictors of prosthesis-patient mismatch after aortic valve replacement for aortic stenosis

    OpenAIRE

    Luis M Astudillo; Orlando Santana; Urbandt, Pablo A.; Benjo, Alexandre M.; Lior U Elkayam; Nascimento, Francisco O.; Lamas, Gervasio A.; Joseph Lamelas

    2012-01-01

    OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of >0.85 cm2/m, 0.85-0.6...

  11. Basal longitudinal strain predicts future aortic valve replacement in asymptomatic patients with aortic stenosis

    DEFF Research Database (Denmark)

    Carstensen, Helle Gervig; Larsen, Linnea Hornbech; Hassager, Christian;

    2016-01-01

    AIMS: To evaluate the prognostic value of global longitudinal strain (GLS) and basal longitudinal strain (BLS) with the knowledge of coexisting coronary pathology evaluated by multi-detector computed tomography (MDCT) coronary angiography. BACKGROUND: GLS and BLS are both sensitive markers of...... contrast to GLS, reduced BLS is a significant predictor of future AVR in asymptomatic patients with aortic stenosis, independently of clinical characteristics, conventional echocardiographic measures, and coronary pathology....

  12. MicroRNA Expression Signature in Degenerative Aortic Stenosis

    Science.gov (United States)

    2016-01-01

    Degenerative aortic stenosis, characterized by narrowing of the exit of the left ventricle of the heart, has become the most common valvular heart disease in the elderly. The aim of this study was to investigate the microRNA (miRNA) signature in degenerative AS. Through microarray analysis, we identified the miRNA expression signature in the tissue samples from healthy individuals (n = 4) and patients with degenerative AS (n = 4). Six miRNAs (hsa-miR-193a-3p, hsa-miR-29b-1-5p, hsa-miR-505-5p, hsa-miR-194-5p, hsa-miR-99b-3p, and hsa-miR-200b-3p) were overexpressed and 14 (hsa-miR-3663-3p, hsa-miR-513a-5p, hsa-miR-146b-5p, hsa-miR-1972, hsa-miR-718, hsa-miR-3138, hsa-miR-21-5p, hsa-miR-630, hsa-miR-575, hsa-miR-301a-3p, hsa-miR-636, hsa-miR-34a-3p, hsa-miR-21-3p, and hsa-miR-516a-5p) were downregulated in aortic tissue from AS patients. GeneSpring 13.1 was used to identify potential human miRNA target genes by comparing a 3-way comparison of predictions from TargetScan, PITA, and microRNAorg databases. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis were performed to identify potential pathways and functional annotations associated with AS. Twenty miRNAs were significantly differentially expressed between patients with AS samples and normal controls and identified potential miRNA targets and molecular pathways associated with this morbidity. This study describes the miRNA expression signature in degenerative AS and provides an improved understanding of the molecular pathobiology of this disease.

  13. Recovery from anemia in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation--prevalence, predictors and clinical outcome

    DEFF Research Database (Denmark)

    De Backer, Ole; Arnous, Samer; Lønborg, Jacob;

    2014-01-01

    INTRODUCTION: Preoperative anemia is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and has been linked to a poorer outcome--including a higher 1-year mortality. The aim of this study was to investigate the impact of successful TAVI...... on baseline anemia. METHODS: A total of 253 patients who survived at least 1 year following TAVI were included in this study. The prevalence, predictors and clinical outcome of hemoglobin (Hb)-recovery were assessed. RESULTS: The prevalence of baseline anemia was 49% (n = 124)--recovery from anemia occurred......-recovery, while blood transfusion (OR 0.31, P = 0.038) and chronic kidney disease (CKD, OR 0.33, P = 0.043) were identified as negative predictors at, respectively, one and two years after TAVI. When compared to patients without baseline anemia, those anemic patients with Hb-recovery had a similar functional...

  14. Sirt1 inhibits resistin expression in aortic stenosis.

    Directory of Open Access Journals (Sweden)

    Sophie Carter

    Full Text Available The development of human calcified aortic stenosis (AS includes age-dependent processes that have been involved in atherosclerosis, such as infiltration of macrophages in aortic valves, which then promote production of many pro-inflammatory cytokines, including resistin. However, the molecular mechanisms contributing to these processes are not established. Since Sirt1 has been shown to modulate macrophage biology and inflammation, we examined its levels in human AS and tested its impact on resistin expression. Sirt1 mRNA (p = 0.01 and protein (p<0.05 levels were reduced in explanted valves from AS patients (n = 51 compared to those from control (n = 11 patients. Sirt1 mRNA levels were negatively associated with resistin mRNA levels quantified in AS valves (p = 0.02. Stimulation of Sirt1 by resveratrol or virus-driven overexpression robustly diminished resistin mRNA and protein expression in macrophages, whereas down-regulation of Sirt1 triggered a large increase in resistin expression. These effects were direct, as chromatin immunoprecipitation assays showed that Sirt1 physically interacted with the resistin promoter region at an AP-1 response element. Moreover, Sirt1 blocked c-jun-induced resistin transactivation in gene reporter assays. These findings demonstrate that, in calcified AS, levels of Sirt1 are reduced whereas those of resistin are increased within aortic valve leaflets. Our results also suggest that this loss of Sirt1 expression alleviates its inhibition of resistin transcription in macrophages. Although the overall contribution of this process to the underlying mechanisms for AS disease development remains unresolved, these observations suggest that modification of Sirt1 expression and/or activity could represent a novel approach against inflammation in AS.

  15. Severe Congenital Obstruction of the Left Main Coronary Artery Coexisting With Supravalvular Aortic Stenosis in Williams Syndrome: A Dangerous Association.

    Science.gov (United States)

    Szaflik, Katarzyna; Kaźmierczak, Piotr; Moll, Jacek Jan; Moll, Jadwiga Anna

    2016-03-01

    Congenital obstruction of the left main coronary artery is a complicating feature of supravalvular aortic stenosis. We describe an eight-month-old female patient with Williams syndrome, supravalvular aortic stenosis, and branch pulmonary artery stenosis, with concomitant anomaly of severe obstruction of the left coronary artery orifice. PMID:26582765

  16. Non-invasive estimation of the mean pressure difference in aortic stenosis by Doppler ultrasound.

    OpenAIRE

    Teien, D; Karp, K; Eriksson, P.

    1986-01-01

    The mean pressure difference across the valve in aortic stenosis is an indicator of the severity of the obstruction to flow. Non-invasive determination of the mean pressure gradient by Doppler ultrasonography is, however, complicated by the squared relation between instantaneous velocities and pressure differences. The validity of a new simple formula for calculation of the mean pressure difference from the peak pressure difference was evaluated in 26 patients with aortic stenosis. The formul...

  17. Effect of lipid lowering on new-onset atrial fibrillation in patients with asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Bang, Casper N; Greve, Anders; Boman, Kurt;

    2012-01-01

    Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent atrial fibrillation (AF). This effect has not been investigated on new-onset AF in asymptomatic patients with aortic stenosis (AS).......Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent atrial fibrillation (AF). This effect has not been investigated on new-onset AF in asymptomatic patients with aortic stenosis (AS)....

  18. Velocity ratio predicts outcomes in patients with low gradient severe aortic stenosis and preserved EF

    DEFF Research Database (Denmark)

    Jander, Nikolaus; Hochholzer, Willibald; Kaufmann, Beat A;

    2014-01-01

    OBJECTIVE: To evaluate the usefulness of velocity ratio (VR) in patients with low gradient severe aortic stenosis (LGSAS) and preserved EF. BACKGROUND: LGSAS despite preserved EF represents a clinically challenging entity. Reliance on mean pressure gradient (MPG) may underestimate stenosis severi...

  19. Coronary artery disease and symptomatic severe aortic valve stenosis: clinical outcomes after transcatheter aortic valve implantation.

    Directory of Open Access Journals (Sweden)

    Jennifer eMancio

    2015-04-01

    Full Text Available Background: The impact of coronary artery disease (CAD on outcomes after transcatheter aortic valve implantation (TAVI has not been clarified. Furthermore, less is known about the indication and strategy of revascularization in these high risk patients. Aims: This study sought to determine the prevalence and prognostic impact of CAD in patients undergoing TAVI, and to assess the safety and feasibility of percutaneous coronary intervention (PCI before TAVI.Methods: Patients with severe aortic stenosis (AS undergoing TAVI were included into a prospective single centre registry from 2007 to 2012. Clinical outcomes were compared between patients with and without CAD. In some patients with CAD it was decided to perform elective PCI before TAVI after decision by the Heart Team. The primary endpoints were 30-day and 2-year all-cause mortality.Results: A total of 91 consecutive patients with mean age of 79±9 years (52% men underwent TAVI with a median follow-up duration of 16 months (interquartile range of 27.6 months. CAD was present on 46 patients (51%. At 30-day, the incidences of death were similar between CAD and non-CAD patients (9% and 5%, p=0.44, but at 2 years were 50% in CAD patients and 24% in non-CAD patients (crude hazard ratio with CAD, 2.2; 95% confidence interval [CI], 1.1 to 4.6; p=0.04. Adjusting for age, gender, left ventricular ejection fraction and glomerular filtration rate the hazard of death was 2.6-fold higher in patients with CAD (95% CI, 1.1 to 6.0; p=0.03. Elective PCI before TAVI was performed in 13 patients (28% of CAD patients. There were no more adverse events in patients who underwent TAVI+PCI when compared with those who underwent isolated TAVI. Conclusions: In severe symptomatic AS who underwent TAVI, CAD is frequent and adversely impacts long-term outcomes, but not procedure outcomes. In selected patients, PCI before TAVI appears to be feasible and safe.

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

    OpenAIRE

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

    2001-01-01

    OBJECTIVE—To test the hypothesis that vitamin D receptor polymorphism is associated with calcific aortic valve stenosis.
DESIGN—The distribution of one polymorphism of the vitamin D receptor (BsmI B/b) was examined in 100 consecutive patients with calcific valvar aortic stenosis and compared with a control group of 100 patients (paired match for age, sex, and the presence of coronary artery disease from a total of 630 patients without calcified aortic valves). Polymerase chain reaction and re...

  1. Prognostic importance of atrial fibrillation in asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Greve, Anders; Gerdts, Eva; Boman, Kurt;

    2013-01-01

    BACKGROUND: The frequency and prognostic importance of atrial fibrillation (AF) in asymptomatic mild-to-moderate aortic stenosis (AS) has not been well described. METHODS: Clinical examination, electrocardiography and echocardiography were obtained in asymptomatic patients with mild-to-moderate AS...... in 55 (3.5%) and no AF in 1,421 (90.9%). Incidence of new-onset AF was 1.2%/year; highest in those with impaired LV function. In multivariable analysis, longstanding AF was compared to no AF at baseline, associated with a 4.1-fold higher risk of heart failure (CI 1.2 to 13.8, p=0.02) and a 4.8-fold...... higher risk of non-hemorrhagic stroke (CI 1.7 to 13.6, p=0.003). CONCLUSION: Rate of AF is moderate in asymptomatic AS. Longstanding but not episodic AF was, independently predictive of increased risk of heart failure and non-hemorrhagic stroke. New-onset AF was associated with cardiac decompensation....

  2. Early Manifestation of Supravalvular Aortic and Pulmonary Artery Stenosis in a Patient with Williams Syndrome.

    Science.gov (United States)

    Lee, Jong Uk; Jang, Woo Sung; Lee, Young Ok; Cho, Joon Yong

    2016-04-01

    Williams syndrome (WS) is a developmental disorder characterized by vascular abnormalities such as thickening of the vascular media layer in medium- and large-sized arteries. Supravalvular aortic stenosis (SVAS) and peripheral pulmonary artery stenosis (PPAS) are common vascular abnormalities in WS. The natural course of SVAS and PPAS is variable, and the timing of surgery or intervention is determined according to the progression of vascular stenosis. In our patient, SVAS and PPAS showed rapid concurrent progression within two weeks after birth. We report the early manifestation of SVAS and PPAS in the neonatal period and describe the surgical treatment for stenosis relief. PMID:27066434

  3. Extracellular Matrix Biomarker, Fibulin-1, Is Closely Related to NT-proBNP and Soluble Urokinase Plasminogen Activator Receptor in Patients with Aortic Valve Stenosis (The SEAS Study)

    DEFF Research Database (Denmark)

    Kruger, Ruan; Rasmussen, Lars M; Argraves, William S;

    2014-01-01

    BACKGROUND: Fibulin-1, a circulating extracellular matrix glycoprotein, has been associated with arterial disease and elevated N-terminal prohormone B-type natriuretic peptide (NT-proBNP) in diabetes. Soluble urokinase plasminogen activator receptor (suPAR), a marker of inflammation, has been...... associated with subclinical atherosclerosis. Therefore, we aimed to explore the interplay between these biomarkers and mild to moderate aortic valve stenosis (AS). METHODS: In 374 patients with mild to moderate AS, we investigated the relationship of fibulin-1 with NT-proBNP, levels of suPAR and the degree...... of AS at baseline and after one and four years of treatment with Simvastatin 40 mg and Ezetimibe 10 mg or placebo. RESULTS: During treatment, fibulin-1 became more closely associated with NT-proBNP (βyear0 = 0.10, p = 0.08, βyear1 = 0.16, p = 0.005, βyear4 = 0.22, p

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

    Science.gov (United States)

    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 TVG, AVR was associated with significantly improved survival.

  5. Internal mammary artery dilatation in a patient with aortic coarctation, aortic stenosis, and coronary disease. Case report

    Directory of Open Access Journals (Sweden)

    Martinez Cereijo Jose M

    2011-04-01

    Full Text Available Abstract The ideal surgical approach is unclear in adult patients with coarctation of the aorta that is associated with other cardiovascular pathologies that require intervention. Standard median sternotomy allows simultaneous, coronary revascularization surgery, valve replacement and repair of aortic coarctation. However the collateral circulation and the anatomy of the mammary arteries must be determined, to avoid possible complications. We report a case of a 69 year-old man with aortic coarctation, aortic stenosis, coronary artery disease and internal mammary artery dilatation who underwent concomitant surgical procedures through a median sternotomy.

  6. Left ventricular remodeling and hypertrophy in patients with aortic stenosis: insights from cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Dweck Marc R

    2012-07-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR is the gold standard non-invasive method for determining left ventricular (LV mass and volume but has not been used previously to characterise the LV remodeling response in aortic stenosis. We sought to investigate the degree and patterns of hypertrophy in aortic stenosis using CMR. Methods Patients with moderate or severe aortic stenosis, normal coronary arteries and no other significant valve lesions or cardiomyopathy were scanned by CMR with valve severity assessed by planimetry and velocity mapping. The extent and patterns of hypertrophy were investigated using measurements of the LV mass index, indexed LV volumes and the LV mass/volume ratio. Asymmetric forms of remodeling and hypertrophy were defined by a regional wall thickening ≥13 mm and >1.5-fold the thickness of the opposing myocardial segment. Results Ninety-one patients (61±21 years; 57 male with aortic stenosis (aortic valve area 0.93±0.32cm2 were recruited. The severity of aortic stenosis was unrelated to the degree (r2=0.012, P=0.43 and pattern (P=0.22 of hypertrophy. By univariate analysis, only male sex demonstrated an association with LV mass index (P=0.02. Six patterns of LV adaption were observed: normal ventricular geometry (n=11, concentric remodeling (n=11, asymmetric remodeling (n=11, concentric hypertrophy (n=34, asymmetric hypertrophy (n=14 and LV decompensation (n=10. Asymmetric patterns displayed considerable overlap in appearances (wall thickness 17±2mm with hypertrophic cardiomyopathy. Conclusions We have demonstrated that in patients with moderate and severe aortic stenosis, the pattern of LV adaption and degree of hypertrophy do not closely correlate with the severity of valve narrowing and that asymmetric patterns of wall thickening are common. Trial registration ClinicalTrials.gov Reference Number: NCT00930735

  7. Dysregulation of ossification-related miRNAs in circulating osteogenic progenitor cells obtained from patients with aortic stenosis.

    Science.gov (United States)

    Takahashi, Kan; Satoh, Mamoru; Takahashi, Yuji; Osaki, Takuya; Nasu, Takahito; Tamada, Makiko; Okabayashi, Hitoshi; Nakamura, Motoyuki; Morino, Yoshihiro

    2016-07-01

    CAVD (calcific aortic valve disease) is the defining feature of AS (aortic stenosis). The present study aimed to determine whether expression of ossification-related miRNAs is related to differentiation intro COPCs (circulating osteogenic progenitor cells) in patients with CAVD. The present study included 46 patients with AS and 46 controls. Twenty-nine patients underwent surgical AVR (aortic valve replacement) and 17 underwent TAVI (transcatheter aortic valve implantation). The number of COPCs was higher in the AS group than in the controls (Pperipheral blood mononuclear cells transfected with each ossification-related miRNA showed that these miRNAs controlled levels of osteocalcin protein. In conclusion, dysregulation of ossification-related miRNAs may be related to the differentiation into COPCs and may play a significant role in the pathogenesis of CAVD. PMID:27129184

  8. Low-flow aortic stenosis in asymptomatic patients: valvular-arterial impedance and systolic function from the SEAS Substudy

    DEFF Research Database (Denmark)

    Cramariuc, Dana; Cioffi, Giovanni; Rieck, Ashild E;

    2009-01-01

    OBJECTIVES: This study sought to assess the impact of valvuloarterial impedance on left ventricular (LV) myocardial systolic function in asymptomatic aortic valve stenosis (AS). BACKGROUND: In atherosclerotic AS, LV global load consists of combined valvular and arterial resistance to LV ejection...... Ezetimibe in Aortic Stenosis) study evaluating placebo-controlled combined simvastatin and ezetimibe treatment in AS were used to assess LV global load as valvuloarterial impedance and LV myocardial function as stress-corrected midwall shortening. The study population was divided into tertiles of global...... load. Stress-corrected midwall shortening was considered low if <87% in men and <90% in women. Low-flow AS was defined as stroke volume index <22 ml/m(2.04). RESULTS: Energy loss index decreased (0.85 cm(2)/m(2) vs. 0.77 and 0.75 cm(2)/m(2)) and the prevalence of low stress-corrected midwall shortening...

  9. In-Graft Endovascular Stenting Repair for Supravalvular Stenosis From Aortic Rupture After Balloon-Expanding Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Furukawa, Nobuyuki; Scholtz, Werner; Haas, Nikolaus; Ensminger, Stephan; Gummert, Jan; Börgermann, Jochen

    2015-01-01

    An 81-year-old man with high-grade aortic valve stenosis and status post-coronary artery bypass grafting and supracoronary replacement of the ascending aorta was referred for transcatheter aortic valve implantation. He was in New York Heart Association class III and had dyspnea. After appropriate screening, we implanted a 29-mm SAPIEN XT valve (Edwards Lifesciences, Irvine, CA USA) through a transapical approach because of severe peripheral arterial occlusive disease. Postinterventional aortography revealed correct positioning and function of the valve and free coronary ostia but contrast extravasation in the vicinity of the interposed vascular prosthesis, resulting in severe luminal narrowing. We chose to manage the stenosis with an endovascular stent. After stenting, extravascular compression was markedly reduced, and the pressure gradient disappeared. The patient was discharged home on the 20th postoperative day. Three months later, computed tomography depicted correct positioning of both grafts. The patient's general health is good, and he is now in New York Heart Association class II. This case illustrates a complication of transcatheter aortic valve implantation specific for patients with an ascending aortic graft. Although stenting may be a good solution, as depicted by this case, self-expanding transcatheter aortic valves should be preferred in patients with ascending aortic grafts to avoid the described complication. PMID:26355692

  10. Elevated lipoprotein(a) and risk of aortic valve stenosis in the general population

    DEFF Research Database (Denmark)

    Kamstrup, Pia R; Tybjærg-Hansen, Anne; Nordestgaard, Børge G

    2014-01-01

    OBJECTIVES: The purpose of this study was to determine whether elevated lipoprotein(a) levels and corresponding LPA risk genotypes (rs10455872, rs3798220, kringle IV type 2 repeat polymorphism) prospectively associate with increased risk of aortic valve stenosis (AVS). BACKGROUND: The etiologic...... basis of AVS is unclear. Recent data implicate an LPA genetic variant (rs10455872), associated with Lp(a) levels, in calcific AVS. METHODS: We combined data from 2 prospective general population studies, the Copenhagen City Heart Study (1991 to 2011; n = 10,803) and the Copenhagen General Population...... Study (2003 to 2011; n = 66,877), following up 77,680 Danish participants for as long as 20 years, during which time 454 were diagnosed with AVS. We conducted observational and genetic instrumental variable analyses in a Mendelian randomization study design. RESULTS: Elevated Lp(a) levels were...

  11. Study of Coronary Artery Disease in Single Aortic Valvular Disease

    Institute of Scientific and Technical Information of China (English)

    张斌; 杨伟民; 占亚平

    2003-01-01

    Objectives To analyze the results of coronary angiographies (GAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p <0.01).Conclusions Angina pectoris is not sensitive for diagnosis of CAD in single aortic valve heart disease.The probability of combination of CAD in degenerative aortic valve disease is higher than that in aortic valve disease with other causes. Coronary angiography is strongly suggested for these patients.

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

    Directory of Open Access Journals (Sweden)

    Subrata Podder

    2015-01-01

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

  13. Protective Effect of Aortic Stenosis on the Coronary Arteries. Hypothetic Considerations to an Old Enigma.

    Science.gov (United States)

    Evora, Paulo Roberto Barbosa; Arcêncio, Livia; Rodrigues, Alfredo José; Schmidt, André

    2016-04-01

    A literature overview of angiographic studies has shown that the prevalence of significant coronary disease in patients with aortic stenosis (AS) varies from 20 to 60%. Early necropsy studies suggested that patients with AS had a lower than expected incidence of coronary artery disease (CAD), originating the concept of a protective effect of AS on the coronary arteries. The myth of AS protection against CAD would be better explained as endothelium-myocardial interaction (crosstalk) protection triggered by left ventricular overload. Therefore, the cGMP/NO pathway induced by the AS overload pressure would explain the low incidence of CAD, which is compatible with the amazing natural long-term evolution of this cardiac valve disease. PMID:27142794

  14. Supravalvular aortic stenosis associated to infectious endocarditis and cerebral vascular disease in a patient with Williams-Beuren Syndrome.

    Science.gov (United States)

    De Rubens Figueroa, Jesús; Marhx, Alfonso; López Terrazas, Javier; Palacios Macedo, Alexis

    2015-01-01

    The Williams-Beuren syndrome is a rare genetic disease characterized by: (a) typical facial features; (b) psychomotor retardation with a specific neurocognitive profile; (c) cardiovascular condition and (d) likely transient hypocalcemia in infancy. The objective of this study was to describe the clinic evolution and diagnosis of patient with this syndrome that was associated with endocarditis caused by Streptococcus parasanguis in the ascending aorta and an aneurism located in the fronto-temporal area, which produced a parenchymal hematoma in the left lobe, and subarachnoid hemorrhage. He was treated with ceftriaxone and dicloxacillin. Then we proceeded to correct the aneurysm and perform vegetation resection in aortic arteries with supravalvular aortic stenosis correction. The evolution after one year has been favorable and is currently without neurologic sequelae. A 5-year-old male patient presented a diagnosis of supravalvular aortic stenosis. After cardiac catheterization was performed, he presented a fever and right side paresis. The echocardiogram showed multiple vegetations in the ascendant aortic arch and the supraortic arteries. The blood cultures reported S. parasanguis. The magnetic resonance showed a subarachnoid hemorrhage with an aneurysm and a hematoma. PMID:25882107

  15. A Clinicopathological Study on Aortic Valves in Children

    Institute of Scientific and Technical Information of China (English)

    HUANG Ping; WANG Hongwei; ZHANG Zhenlu; HU Xiufen; LI Yanping; CHENG Peixuan; LIU Jianying

    2007-01-01

    In order to investigate the clinicopathological characteristics of aortic valve disease in children, all the native surgically excised aortic valves obtained between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. According to preoperative echocardiography, intraoperative assessment, and postoperative pathology, combined with clinical symptoms and signs, aortic valve diseases were divided into three categories: aortic stenosis (AS), aortic insufficiency (AI), and aortic stenosis with insufficiency (AS-AI). The etiology was determined according to the macroscopic, microscopic and clinical findings. The results showed that among 70 aortic valves, patient age ranged from 6 to 18 years, with a mean of 15.4 years, and there were 56 boys and 14 girts (male: female=4:1). Forty-four children only had pure aortic valve disease, and the other 26 children had aortic valve disease associated with other heart valve diseases. There were 5 cases of AS (7.14%), 60 cases of AI (85.71%) and 5 cases of AS-AI (7.14%). The causes were congenital aortic valve malformation (32 cases, 45.71%), rheumatic disease (28 cases, 40%), infective endocarditis (7 cases,10%), Marfan syndrome (2 cases, 2.86%), and undetermined (1 case, 1.43%). It was concluded that the common causes of aortic valve disease in order of frequency in children were congenital aortic valve malformation, rheumatic disease, infective endocarditis, and Marfan syndrome. AI was more common in children with aortic valve disease. Compared with adult patients, congenital bicuspid aortic valve in children was often AI. Histologically, the leaflets of congenital bicuspid aortic valve were mainly myxomatous, fibrosis and calcification less seen. AI was frequently found in rheumatic disease, mostly associated with other heart valve diseases. Macroscopic and microscopic examinations together with clinical

  16. Site-specific association between distal aortic pulse wave velocity and peripheral arterial stenosis severity: a prospective cardiovascular magnetic resonance study

    OpenAIRE

    van den Bosch, Harrie C M; Westenberg, Jos J. M.; Setz-Pels, Wikke; Wondergem, John; Wolterbeek, Ron; Duijm, Lucien E M; Teijink, Joep A.W.; de Roos, Albert

    2015-01-01

    Background Vascular disease expression in one location may not be representative for disease severity in other vascular territories, however, strong correlation between disease expression and severity within the same vascular segment may be expected. Therefore, we hypothesized that aortic stiffening is more strongly associated with disease expression in a vascular territory directly linked to that aortic segment rather than in a more remote segment. We prospectively compared the association b...

  17. Adjusting parameters of aortic valve stenosis severity by body size

    DEFF Research Database (Denmark)

    Minners, Jan; Gohlke-Baerwolf, Christa; Kaufmann, Beat A;

    2014-01-01

    (Pearson correlation coefficient (r) 0.319, 0.281, 0.317 and 0.126, respectively, all p<0.001) to the effect that larger patients presented with larger AVA (less severe stenosis). Of the anthropometric measures used for linear adjustment, BSA was most effective in eliminating the correlation between AVA...

  18. Follow-up study of morphology and cardiac function in rats undergoing induction of supravalvular aortic stenosis Estudo evolutivo da morfologia e função cardíaca em ratos submetidos a estenose aórtica supravalvar

    OpenAIRE

    Henrique Barbosa Ribeiro; Katashi Okoshi; Antonio Carlos Cicogna; Edson Antonio Bregagnollo; Maria Aparecida Marchesan Rodrigues; Carlos Roberto Padovani; Flávio Ferrari Aragon; Elenize Jamas; Marina Politi Okoshi

    2003-01-01

    OBJECTIVE: To characterize the follow-up of an experimental model of left ventricular hypertrophy (LVH) induced by supravalvular ascending aortic stenosis in young rats. METHODS: Wistar rats were submitted to thoracotomy and aortic stenosis was created by placing a clip on the ascending aorta (AoS group, n=12). Age-matched control animals underwent a sham operation (C group, n=12). Cardiac function was analysed by echocardiograms performed 6, 12, and 21 weeks after aortic banding. Myocardial ...

  19. Noninvasive assessment of filling pressure and left atrial pressure overload in severe aortic valve stenosis: relation to ventricular remodeling and clinical outcome after aortic valve replacement

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbæk, Lars; Poulsen, Mikael K;

    2011-01-01

    One of the hemodynamic consequences of aortic valve stenosis is pressure overload leading to left atrial dilatation. Left atrial size is a known risk factor providing prognostic information in several cardiac conditions. It is not known if this is also the case in patients with aortic valve steno...

  20. Quantification of aortic valve area at 256-slice computed tomography: Comparison with transesophageal echocardiography and cardiac catheterization in subjects with high-grade aortic valve stenosis prior to percutaneous valve replacement

    International Nuclear Information System (INIS)

    Purpose: The purpose of this study was to compare planimetric aortic valve area (AVA) measurements from 256-slice CT to those derived from transesophageal echocardiography (TEE) and cardiac catheterization in high-risk subjects with known high-grade calcified aortic stenosis. Methods and materials: The study included 26 subjects (10 males, mean age: 79 ± 6; range, 61-88 years). All subjects were clinically referred for aortic valve imaging prior to percutaneous aortic valve replacement from April 2008 to March 2009. Two radiologists, blinded to the results of TEE and cardiac catheterization, independently selected the systolic cardiac phase of maximum aortic valve area and independently performed manual CT AVA planimetry for all subjects. Repeated AVA measurements were made to establish CT intra- and interobserver repeatability. In addition, the image quality of the aortic valve was rated by both observers. Aortic valve calcification was also quantified. Results: All 26 subjects had a high-grade aortic valve stenosis (systolic opening area 2) via CT-based planimetry, with a mean AVA of 0.62 ± 0.18. In four subjects, TEE planimetry was precluded due to severe aortic valve calcification, but CT-planimetry was successfully performed with a mean AVA of 0.46 ± 0.23 cm2. Mean aortic valve calcium mass score was 563.8 ± 526.2 mg. Aortic valve area by CT was not correlated with aortic valve calcium mass score. A bias and limits of agreement among CT and TEE, CT and cardiac catheterization, and TEE and cardiac catheterization were -0.07 [-0.37 to 0.24], 0.03 [-0.49 to 0.55], 0.12 [-0.39 to 0.63] cm2, respectively. Differences in AVA among CT and TEE or cardiac catheterization did not differ systematically over the range of measurements and were not correlated with aortic valve calcium mass score. Conclusion: Planimetric aortic valve area measurements from 256-slice CT agree well with those derived from TEE and cardiac catheterization in high-risk subjects with known

  1. Quantification of aortic valve area at 256-slice computed tomography: Comparison with transesophageal echocardiography and cardiac catheterization in subjects with high-grade aortic valve stenosis prior to percutaneous valve replacement

    Energy Technology Data Exchange (ETDEWEB)

    Klass, Oliver, E-mail: oliver.klass@uniklinik-ulm.de [University Hospital of Ulm, Department of Diagnostic and Interventional Radiology, Steinhoevelstr. 9, 89075 Ulm (Germany); Walker, Matthew J.; Olszewski, Mark E. [Philips Healthcare, CT Clinical Science, Cleveland, OH (United States); Bahner, Johannes; Feuerlein, Sebastian; Hoffmann, Martin H.K.; Lang, Alexandra [University Hospital of Ulm, Department of Diagnostic and Interventional Radiology, Steinhoevelstr. 9, 89075 Ulm (Germany)

    2011-10-15

    Purpose: The purpose of this study was to compare planimetric aortic valve area (AVA) measurements from 256-slice CT to those derived from transesophageal echocardiography (TEE) and cardiac catheterization in high-risk subjects with known high-grade calcified aortic stenosis. Methods and materials: The study included 26 subjects (10 males, mean age: 79 {+-} 6; range, 61-88 years). All subjects were clinically referred for aortic valve imaging prior to percutaneous aortic valve replacement from April 2008 to March 2009. Two radiologists, blinded to the results of TEE and cardiac catheterization, independently selected the systolic cardiac phase of maximum aortic valve area and independently performed manual CT AVA planimetry for all subjects. Repeated AVA measurements were made to establish CT intra- and interobserver repeatability. In addition, the image quality of the aortic valve was rated by both observers. Aortic valve calcification was also quantified. Results: All 26 subjects had a high-grade aortic valve stenosis (systolic opening area <1.0 cm{sup 2}) via CT-based planimetry, with a mean AVA of 0.62 {+-} 0.18. In four subjects, TEE planimetry was precluded due to severe aortic valve calcification, but CT-planimetry was successfully performed with a mean AVA of 0.46 {+-} 0.23 cm{sup 2}. Mean aortic valve calcium mass score was 563.8 {+-} 526.2 mg. Aortic valve area by CT was not correlated with aortic valve calcium mass score. A bias and limits of agreement among CT and TEE, CT and cardiac catheterization, and TEE and cardiac catheterization were -0.07 [-0.37 to 0.24], 0.03 [-0.49 to 0.55], 0.12 [-0.39 to 0.63] cm{sup 2}, respectively. Differences in AVA among CT and TEE or cardiac catheterization did not differ systematically over the range of measurements and were not correlated with aortic valve calcium mass score. Conclusion: Planimetric aortic valve area measurements from 256-slice CT agree well with those derived from TEE and cardiac catheterization in

  2. Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav Hørsted; Holmberg, Fredrik; Gerds, Thomas Alexander;

    2016-01-01

    Objectives After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design All adult patients with severe AVS referred to a large tertiary medical centre...... in 2011 were prospectively included. Multivariate regression analysis identified independent factors associated with treatment decisions. Results A total of 487 patients were included (mean age: 75 years, NYHA class III-IV: 47%). The HT proposed medical therapy (MT) in 35 (7%), TAVI in 60 (12%), and...

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

    International Nuclear Information System (INIS)

    Highlights: ► Oxidative stress has been implicated in the pathomechanism of calcific aortic valve stenosis. ► We assessed the transcript levels for PARP-1 (poly(ADP-ribose) polymerase), acts as a DNA damage nick sensor in stenotic valves. ► Early stage of diseased tricuspid valves exhibited higher mRNA levels for PARP-1 compared to bicuspid valves. ► The mRNA levels for PARP-1 inversely correlated with the clinical stenosis severity in tricuspid valves. ► 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 C4 (LTC4) 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. LTC4 (1 nM) significantly elevated the mRNA levels of PARP-1 by 2.38-fold in VICs. Taken together, these data suggest that valvular

  4. Valve area and cardiac output in aortic stenosis: quantification by magnetic resonance velocity mapping

    DEFF Research Database (Denmark)

    Søndergaard, Lise; Hildebrandt, P; Lindvig, K;

    1993-01-01

    Valve area and cardiac output were determined with magnetic resonance (MR) velocity mapping in 12 patients with aortic stenosis. Heart catheterization, Doppler echocardiography, and indicator dilution were performed for comparison. Left ventricle could be catheterized in only nine patients; in...... material, MR measured a mean area of 1.1 cm2 compared with 1.2 cm2 derived from Doppler echocardiography data, with a mean difference of 0.1 cm2 and [-0.5, +0.6] cm2 as limits of agreement. In 11 patients the cardiac output was quantified by MR to a mean of 4.9 L/min and by indicator dilution to 5.0 L......--the valvular area and the cardiac output--may be quantified, MR has potential to become a clinical tool in assessment of severity in aortic stenosis....

  5. Simultaneous surgery for critical aortic stenosis and gastric cancer: A case report

    Directory of Open Access Journals (Sweden)

    Jacek Zielinski, Radoslaw Jaworski, Rafal Pawlaczyk, Maciej Swierblewski, Pawel Kabata, Janusz Jaskiewicz, Jan Rogowski

    2010-03-01

    Full Text Available We describe simultaneous surgery performed on a 71-year-old woman with critical aortic stenosis and gastric cancer that were diagnosed at the same time. The patient qualified for simultaneous surgery for both these diseases. Good early outcome was achieved. There is a lack of standards for treatment of patients with coexistence of two life-threatening conditions. We discuss surgical tactics and potential benefits of such management.

  6. A Multidisciplinary Approach to Anesthetic Management of a Parturient with Severe Aortic Stenosis

    OpenAIRE

    Kalpana Tyagaraj; Gutman, David A.; Lynn Belliveau; Adnan Sadiq; Alok Bhutada; Feierman, Dennis E

    2015-01-01

    In order to optimize anesthetic management and avoid adverse maternal and fetal outcomes, a clear understanding of the changes in cardiovascular physiology that occur during pregnancy is paramount. The effects of normal gestation on the cardiovascular system are particularly significant in a parturient with cardiac valvular pathology. We present a case of a 27-year-old G2P0 at 37 weeks with a past medical history of diabetes, macrosomia, congenital bicuspid aortic valve with severe stenosis (...

  7. Simulation of Exercise-Induced Syncope in a Heart Model with Severe Aortic Valve Stenosis

    OpenAIRE

    Matjaž Sever; Samo Ribarič; Marjan Kordaš

    2012-01-01

    Severe aortic valve stenosis (AVS) can cause an exercise-induced reflex syncope (RS). The precise mechanism of this syncope is not known. The changes in hemodynamics are variable, including arrhythmias and myocardial ischemia, and one of the few consistent changes is a sudden fall in systemic and pulmonary arterial pressures (suggesting a reduced vascular resistance) followed by a decline in heart rate. The contribution of the cardioinhibitory and vasodepressor components of the RS to hemodyn...

  8. A CASE OF OSTEOPOROSIS OF THE SPINE IN AN ELDERLY MALE WITH CALCIFIC AORTIC STENOSIS

    Directory of Open Access Journals (Sweden)

    N. Yu. Karpova

    2014-07-01

    Full Text Available The given clinical example presents a case of concomitant diseases of the heart and axial skeleton. Calcific aortic stenosis detected by chance in an elderly male was associated with osteoporosis of the lumbar spine with moderate perturbation of the calcium–vitamin D–parathyroid hormone axis and with no classical risk factors for impaired bone mineral density. Possible approaches to pathogenetic therapy are described.

  9. What is the real practice of exercise echocardiographic testing inasymptomatic patients with severe aortic stenosis?

    Institute of Scientific and Technical Information of China (English)

    Eun Jeong Cho; Sung-Ji Park; Jung-Eun Song; Seol-Hwa Kim; Yung-Joo Lee; Ji-Hye Gak; Sung-A Chang

    2013-01-01

    Background Although exercise testing has been suggested to help predict clinical outcome,limited data are available to guide how exercise Doppler echocardiography (ECG) can be used clinically in asymptomatic patients with aortic stenosis (AS).The aim of this study was to assess the clinical value of exercise echocardiographic testing in asymptomatic patients with severe AS.Methods Symptom-limited treadmill exercise testing using the modified Bruce protocol was performed in 31 asymptomatic patients (mean age (62±11) years) with severe AS (aortic valve area <1 cm2,peak aortic velocity (AV Vmax) >4 m/sec,or a mean transaortic pressure gradient (AV mean PG) >40 mmHg (1 mmHg=0.133 kPa)) with normal left ventricular (LV)systolic function (LV ejection fraction (EF) >50%).Clinical symptoms,vital signs,ECG,and Doppler hemodynamics were obtained during and/or immediately after exercise.Results Aortic valve replacement (AVR) was performed in 18 patients during follow-up.The patients who had AVR exhibited higher baseline AV mean PG (51 (35-84) vs.44 (25.2-57.0) mmHg; P=0.031).There were no significant differences between the AVR group and non-AVR group including exercise duration (7.47 (2.32-11.59) vs.7.25 (4.06-10.52) minutes,P=0.917),exercise capacity (10.1 (4.6-12.8) vs.10.1 (7.0-12.8) metabolic equivalents,P=0.675),and an increment in AV mean PG by exercise (18.5 (3.2-48.0) vs.12.6 (4.4-32.1) mmHg,P=0.366).Univariate regression analysis revealed that independent determinant of AVR was the baseline AV mean PG (P=0.031).Conclusions Although additional value of exercise ECG was demonstrated,baseline transaortic mean pressure gradient is the major determinant of AVR.Further large-scale prospective studies are required to determine whether surgery should be recommended in the presence of an abnormal exercise ECG in asymptomatic severe AS.

  10. Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis

    DEFF Research Database (Denmark)

    Henein, Michael; Hällgren, Peter; Holmgren, Anders; Sörensen, Karen; Ibrahimi, Pranvera; Kofoed, Klaus Fuglsang; Larsen, Linnea Hornbech; Hassager, Christian

    2015-01-01

    calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue. MATERIAL AND METHODS: We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector...... cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve. RESULTS: CAC was present in 92%, AVC in 100% and ARC in 82% of...... patients. CAC correlated with ARC (rho = 0.51, p < 0.001) but not with AVC. The number of calcified coronary arteries correlated with ARC (rho = 0.45, p < 0.001) but not with AVC. 29/152 patients had echocardiographic evidence of BAV and 123 TAV, who were older (p < 0.001) but CAC was associated with TAV...

  11. Discrete subaortic stenosis. Operative age and gradient as predictors of late aortic valve incompetence.

    Science.gov (United States)

    Rizzoli, G; Tiso, E; Mazzucco, A; Daliento, L; Rubino, M; Tursi, V; Fracasso, A

    1993-07-01

    Between January 1969 and May 1990, 100 patients were operated on for discrete subaortic stenosis. Three patients died in the perioperative period. Patients with intrinsic lesions, prosthetic replacement, or extensive operative remodeling of the aortic valve were excluded from the analysis. The 67 remaining patients had a median follow-up of 62 months. Preoperatively, 8 patients had aortic valve competence, 51 had mild incompetence, and 8 patients moderate aortic valve incompetence. At follow-up mild incompetence persisted in 27 and moderate incompetence in 6 patients. In 1 patient it worsened from no incompetence to mild and in another patient from mild to moderate. The probability of aortic incompetence at follow-up was significantly and simultaneously related (multivariate ordinal logistic model) to (1) older age at operation (logarithm of months, p = 0.007), (2) higher preoperative gradient (third power of milligrams of mercury, p = 0.0004), (3) preoperative cardiomegaly (p = 0.04), and (4) surgical myectomy (p = 0.002). There was an interaction between age and gradient (p = 0.03). Two nomograms are proposed as a generalizable aid to decision making. The data support the policy of early repair of subaortic stenosis. PMID:8321008

  12. Surgery for severe aortic stenosis with low transvalvular gradient and poor left ventricular function – a single centre experience and review of the literature

    Directory of Open Access Journals (Sweden)

    Vchivkov Ilja

    2007-01-01

    Full Text Available Abstract Background A retrospective comparative study was designed to determine whether the transvalvular gradient has a predictive value in the assessment of operative outcome in patients with severe aortic stenosis and poor left ventricular function. Methods From a surgical database, a series of 30 consecutive patients, who underwent isolated aortic valve replacement for severe aortic stenosis with depressed left ventricular (LV function (EF 40 mmHg (n = 17. Both groups were then comparatively assessed with respect to perioperative organ functions and mortality. Results Both groups were well matched with respect to the preoperative clinical status. LG-Group had a larger aortic valve area, higher LVEDP, larger LVESD and LVEDD, and higher mean pulmonary pressures. The immediate postoperative outcome, hospital morbidity and mortality did not differ significantly among the groups. Conclusion In patients with severe aortic stenosis and poor LV function, the mean transvalvular gradient, although corresponds to reduced LV performance, has a limited prognostic value in the assessment of surgical outcome. Generally, operating on this select group of patients is safe.

  13. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

    DEFF Research Database (Denmark)

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-01-01

    An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoraci...

  14. Effect of End-Stage Renal Disease on Rate of Progression of Aortic Stenosis.

    Science.gov (United States)

    Kim, Darae; Shim, Chi Young; Hong, Geu-Ru; Cho, In Jeong; Chang, Hyuk-Jae; Ha, Jong-Won; Chung, Namsik

    2016-06-15

    This study aimed to investigate the progression of mild-to-moderate aortic stenosis (AS) in patients with end-stage renal disease (ESRD) and determine its metabolic and hemodynamic contributors and clinical outcomes. A total of 74 patients with ESRD (50 men, age 72 ± 11 years) with mild-to-moderate AS were compared with 79 age- and gender-matched controls with normal kidney function. Clinical, laboratory, and echocardiographic features and clinical outcomes including aortic valve (AV) intervention, hospitalization due to heart failure, and cardiovascular death were analyzed. Patients with ESRD were divided into 2 subgroups according to their rate of AV area changes (group 1 [n = 28], rapid progression; and group 2 [n = 46], slow progression). Progression in the degree of AS was noted in 38% of patients with ESRD and 18% of controls (p <0.01) during comparable echocardiographic follow-up durations (29 ± 15 vs 27 ± 24 months, respectively, p = 0.57). In ESRD, patients in group 1 were older (p <0.01) with higher baseline log parathyroid hormone (p <0.01) and larger stroke volume (p = 0.03) than those in group 2. During clinical follow-up (48 ± 23 months), patients in group 1 showed poorer clinical outcomes than those in group 2 and controls (log-rank p <0.01). Age, left atrial volume index ≥42 ml/m(2), and annual increases of peak pressure gradient across the AV (mm Hg/year) demonstrated additive predictive values for prognosis. AS in ESRD progresses in an accelerated manner along with higher metabolic and hemodynamic loads on AV compared with those with normal kidney function. Accelerated progression of mild-to-moderate AS in ESRD results in poor prognosis. PMID:27138183

  15. Gender difference in ventricular response to aortic stenosis: insight from cardiovascular magnetic resonance.

    Directory of Open Access Journals (Sweden)

    Joo Myung Lee

    Full Text Available Although left ventricular hypertrophy (LVH and remodeling is associated with cardiac mortality and morbidity, little is known about the impact of gender on the ventricular response in aortic stenosis (AS patients. This study aimed to analyze the differential effect of gender on ventricular remodeling in moderate to severe AS patients.A total of 118 consecutive patients (67±9 years; 63 males with moderate or severe AS (severe 81.4% underwent transthoracic echocardiography and cardiovascular magnetic resonance (CMR within a 1-month period in this two-center prospective registry. The pattern of LV remodeling was assessed using the LV mass index (LVMI and LV remodeling index (LVRI; LV mass/LV end-diastolic volume by CMR. Although there were no differences in AS severity parameters nor baseline characteristics between genders, males showed a significantly higher LVMI (102.6±29.1 g/m2 vs. 86.1±29.2 g/m2, p=0.003 and LVRI (1.1±0.2 vs. 1.0±0.3, p=0.018, regardless of AS severity. The LVMI was significantly associated with aortic valve area (AVA index and valvuloarterial impedance in females, whereas it was not in males, resulting in significant interaction between genders (PInteraction=0.007/0.014 for AVA index/valvuloarterial impedance, respectively. Similarly, the LVRI also showed a significantly different association between male and female subjects with the change in AS severity parameters (PInteraction=0.033/<0.001/0.029 for AVA index/transaortic mean pressure gradient/valvuloarterial impedance, respectively.Males are associated with greater degree of LVH and higher LVRI compared to females at moderate to severe AS. However, females showed a more exaggerated LV remodeling response, with increased severity of AS and hemodynamic loads, than males.

  16. Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    Eun Jeong Cho; Sung-Ji Park; Sung-A Chang; Dong Seop Jeong; Sang-Chol Lee; Seung Woo Park; Pyo Won Park

    2014-01-01

    Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS),even in patients without significant coronary artery disease (CAD).However,the incidence of angina pectoris and related CAD in such patients is controversial.There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS.The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.Methods Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995.Clinical and echocardiographic follow-up data were recorded into the database annually.Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography.We excluded patients with multiple valve disease,significant aortic regurgitation,or prior CAD or valve surgery.Results Totally 574 patients with severe AS (mean age,(65.9±9.6) years) were enrolled in this study.Significant CAD was found in 61 patients (10.6%).Factors associated with increased likelihood of CAD were age,hypertension,diabetes mellitus,chronic renal failure,carotid disease,and aorta calcification.In Logistic regression analysis,the independent predictor of the presence of CAD was age (P=0.011).The incidence of CAD increased significantly at 69.2 years of age.Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.Conclusions There was a low incidence of significant CAD in a population of Korean patients with severe AS.Therefore,coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than

  17. Left ventricular diastolic function is associated with symptom status in severe aortic valve stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Christensen, Nicolaj L; Videbæk, Lars;

    2014-01-01

    BACKGROUND: In aortic valve stenosis (AS), the occurrence of heart failure symptoms does not always correlate with severity of valve stenosis and left ventricular (LV) function. Therefore, we tested the hypothesis that symptomatic patients with AS have impaired diastolic, longitudinal systolic......%. Independent predictors of symptomatic state were identified using logistic regression analysis. Symptomatic patients were younger (72±10 versus 76±12 years of age; P=0.002), presented less often with atrial fibrillation (13% versus 24%; P=0.05) and chronic obstructive pulmonary disease (2% versus 19%; P<0......±58 versus 268±62 ms; P<0.0001), and increased left atrial volume index (49±18 versus 42±15 mL/m2; P=0.02). When adjusting for age, history of hypertension, atrial fibrillation, and chronic obstructive pulmonary disease in a multivariable logistic regression analysis, LV mass index, relative wall thickness...

  18. Aortic stenosis and mitral regurgitation as predictors of atrial fibrillation during 11 years of follow-up

    Directory of Open Access Journals (Sweden)

    Widgren Veronica

    2012-10-01

    Full Text Available Abstract Background There is limited information about any association between the onset of atrial fibrillation (AF and the presence of valvular disease. Methods We retrospectively examined 940 patients in sinus rhythm, examined by echocardiography in 1996. During 11 years of follow-up, we assessed the incidence of AF and outcome defined as valvular surgery or death, in relation to baseline valvular function. AS (aortic stenosis severity at baseline examination was assessed using peak transaortic valve pressure gradient. Results In univariate analysis, the risk of developing AF was related to AS (significant AS versus no significant AS; hazard ratio (HR 3.73, 95% confidence interval (CI 2.39-5.61, p Conclusions AS, but not MR, was independently predictive of development of AF and combined valvular surgery or death. In patients with combined AS and MR, the grade of AS, more than the grade of MR, determined the risk of AF and combination of valvular surgery or death. Further studies using contemporary echocardiographic quantification of aortic stenosis are warranted to confirm these retrospective data based on peak transaortic valve pressure gradient.

  19. Myocardial Injury Following Aortic Valve Replacement for Severe Aortic Stenosis: Risk Factor of Postoperative Myocardial Injury and Its Impact on Long-Term Outcomes

    OpenAIRE

    Lee, Chee-Hoon; Ju, Min Ho; Kim, Joon Bum; Chung, Cheol Hyun; Jung, Sung Ho; Choo, Suk Jung; Lee, Jae Won

    2014-01-01

    Background As hypertrophied myocardium predisposes the patient to decreased tolerance to ischemia and increased reperfusion injury, myocardial protection is of utmost importance in patients undergoing aortic valve replacement (AVR) for severe aortic valve stenosis (AS). Methods Consecutive 314 patients (mean age, 62.5±10.8 years; 143 females) with severe AS undergoing isolated AVR were included. Postoperative myocardial injury (PMI) was defined as 1) maximum postoperative creatinine kinase is...

  20. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Steinbrüchel, Daniel Andreas; Ihlemann, Nikolaj;

    2015-01-01

    conduction abnormalities requiring pacemaker implantation, larger improvement in effective orifice area, more total aortic valve regurgitation, and higher New York Heart Association functional class at 1 year. SAVR-treated patients had more major or life-threatening bleeding, cardiogenic shock, acute kidney...... injury (stage II or III), and new-onset or worsening atrial fibrillation at 30 days than did TAVR-treated patients. CONCLUSIONS: In the NOTION trial, no significant difference between TAVR and SAVR was found for the composite rate of death from any cause, stroke, or MI after 1 year. (Nordic Aortic Valve...

  1. Severe Gastrointestinal Bleeding in a Patient With Subvalvular Aortic Stenosis Treated With Thalidomide and Octreotide

    DEFF Research Database (Denmark)

    Hvid-Jensen, Helene S; Poulsen, Steen H; Agnholt, Jørgen S

    2015-01-01

    resolve bleeding, especially in patients with large numbers of angiodysplasias. In patients with aortic stenosis and GB, the main treatment is aortic valve replacement but the patients may be unfit to undergo surgery due to the complicating anemia. In this case story, we present a patient with severe, GB...... due to hypertrophic subvalvular obstructive cardiomyopathy. Endoscopic procedures with argon beaming were performed without effect on bleeding. The patient was treated with a combination of both thalidomide and octreotide. Within 3 months, the patient recovered from the anemia and was able to undergo...... transcoronary ethanol ablation. No further bleeding episodes occurred, and thalidomide and octreotide were arrested. To our knowledge, this case report is the first to describe how this new drug combination therapy is an effective treatment of GB from angiodysplasias and can be used to bridge to surgical or...

  2. The spectrum of low-output low-gradient aortic stenosis with normal ejection fraction.

    Science.gov (United States)

    Pislaru, Sorin V; Pellikka, Patricia A

    2016-05-01

    Low-flow, low-gradient (LF/LG) severe aortic stenosis (AS) with preserved ejection fraction refers to the condition of AS with aortic valve area ≤1 cm(2), stroke volume index measurement error probably being the most common cause of marked inconsistency between gradient, valve area and patient presentation. The presence of LG severe AS may be overestimated in petite patients, who may have aortic valve area slightly less than 1 cm(2)with only moderate AS. Concomitant cardiac conditions besides AS, including significant mitral and tricuspid regurgitation, intracardiac shunts and constrictive pericarditis, may contribute to reduced stroke volume, and evidence for these must be sought at the time of echocardiography. True LF/LG severe AS is associated with a unique and probably maladaptive remodelling pattern with smaller ventricles, increasing relative wall thickness, progressive worsening of diastolic function and higher afterload, as demonstrated by lower systemic arterial compliance, higher systemic vascular resistance and higher valvuloarterial impedance. Control of hypertension is essential to the appropriate management of patients with AS. Aortic valve replacement should be considered in patients with compelling evidence of severe AS who remain symptomatic despite optimal treatment of hypertension. PMID:26822426

  3. Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction

    DEFF Research Database (Denmark)

    Jander, Nikolaus; Minners, Jan; Holme, Ingar;

    2011-01-01

    Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area <1.0 cm² and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early sur...

  4. Medial arterial calcification, calcific aortic stenosis and mitral annular calcification in a diabetic patient with severe autonomic neuropathy.

    LENUS (Irish Health Repository)

    Cronin, C C

    2012-02-03

    Medial arterial calcification (Monckeberg\\'s arteriosclerosis) is well described in diabetic patients with autonomic neuropathy. There is also a high prevalence of diabetes mellitus among subjects with calcific aortic stenosis and mitral annular calcification. We describe a diabetic patient with autonomic neuropathy and extensive medial arterial calcification who also had calcification of the aortic valve and of the mitral valve annulus. We propose that autonomic neuropathy may play a role in calcification of these structures at the base of the heart.

  5. Modification of the secretion pattern of proteases, inflammatory mediators, and extracellular matrix proteins by human aortic valve is key in severe aortic stenosis.

    Science.gov (United States)

    Alvarez-Llamas, Gloria; Martín-Rojas, Tatiana; de la Cuesta, Fernando; Calvo, Enrique; Gil-Dones, Felix; Dardé, Veronica M; Lopez-Almodovar, Luis F; Padial, Luis R; Lopez, Juan-Antonio; Vivanco, Fernando; Barderas, Maria G

    2013-09-01

    One of the major challenges in cardiovascular medicine is to identify candidate biomarker proteins. Secretome analysis is particularly relevant in this search as it focuses on a subset of proteins released by a cell or tissue under certain conditions. The sample can be considered as a plasma subproteome and it provides a more direct approximation to the in vivo situation. Degenerative aortic stenosis is the most common worldwide cause of valve replacement. Using a proteomic analysis of the secretome from aortic stenosis valves we could identify candidate markers related to this pathology, which may facilitate early diagnosis and treatment. For this purpose, we have designed a method to validate the origin of secreted proteins, demonstrating their synthesis and release by the tissue and ruling out blood origin. The nLC-MS/MS analysis showed the labeling of 61 proteins, 82% of which incorporated the label in only one group. Western blot and selective reaction monitoring differential analysis, revealed a notable role of the extracellular matrix. Variation in particular proteins such as PEDF, cystatin and clusterin emphasizes the link between aortic stenosis and atherosclerosis. In particular, certain proteins variation in secretome levels correlates well, not only with label incorporation trend (only labeled in aortic stenosis group) but, more importantly, with alterations found in plasma from an independent cohort of samples, pointing to specific candidate markers to follow up in diagnosis, prognosis, and therapeutic intervention. PMID:23704777

  6. Modification of the Secretion Pattern of Proteases, Inflammatory Mediators, and Extracellular Matrix Proteins by Human Aortic Valve is Key in Severe Aortic Stenosis*

    Science.gov (United States)

    Alvarez-Llamas, Gloria; Martín-Rojas, Tatiana; de la Cuesta, Fernando; Calvo, Enrique; Gil-Dones, Felix; Dardé, Veronica M.; Lopez-Almodovar, Luis F.; Padial, Luis R.; Lopez, Juan-Antonio; Vivanco, Fernando; Barderas, Maria G.

    2013-01-01

    One of the major challenges in cardiovascular medicine is to identify candidate biomarker proteins. Secretome analysis is particularly relevant in this search as it focuses on a subset of proteins released by a cell or tissue under certain conditions. The sample can be considered as a plasma subproteome and it provides a more direct approximation to the in vivo situation. Degenerative aortic stenosis is the most common worldwide cause of valve replacement. Using a proteomic analysis of the secretome from aortic stenosis valves we could identify candidate markers related to this pathology, which may facilitate early diagnosis and treatment. For this purpose, we have designed a method to validate the origin of secreted proteins, demonstrating their synthesis and release by the tissue and ruling out blood origin. The nLC-MS/MS analysis showed the labeling of 61 proteins, 82% of which incorporated the label in only one group. Western blot and selective reaction monitoring differential analysis, revealed a notable role of the extracellular matrix. Variation in particular proteins such as PEDF, cystatin and clusterin emphasizes the link between aortic stenosis and atherosclerosis. In particular, certain proteins variation in secretome levels correlates well, not only with label incorporation trend (only labeled in aortic stenosis group) but, more importantly, with alterations found in plasma from an independent cohort of samples, pointing to specific candidate markers to follow up in diagnosis, prognosis, and therapeutic intervention. PMID:23704777

  7. Cardiovascular magnetic resonance evaluation of aortic stenosis severity using single plane measurement of effective orifice area

    Directory of Open Access Journals (Sweden)

    Garcia Julio

    2012-04-01

    Full Text Available Abstract Background Transthoracic echocardiography (TTE is the standard method for the evaluation of the severity of aortic stenosis (AS. Valve effective orifice area (EOA measured by the continuity equation is one of the most frequently used stenotic indices. However, TTE measurement of aortic valve EOA is not feasible or not reliable in a significant proportion of patients. Cardiovascular magnetic resonance (CMR has emerged as a non-invasive alternative to evaluate EOA using velocity measurements. The objectives of this study were: 1 to validate a new CMR method using jet shear layer detection (JSLD based on acoustical source term (AST concept to estimate the valve EOA; 2 to introduce a simplified JSLD method not requiring vorticity field derivation. Methods and results We performed an in vitro study where EOA was measured by CMR in 4 fixed stenoses (EOA = 0.48, 1.00, 1.38 and 2.11 cm2 under the same steady flow conditions (4-20 L/min. The in vivo study included eight (8 healthy subjects and 37 patients with mild to severe AS (0.72 cm2 ≤ EOA ≤ 1.71 cm2. All subjects underwent TTE and CMR examinations. EOA was determinated by TTE with the use of continuity equation method (TTECONT. For CMR estimation of EOA, we used 3 methods: 1 Continuity equation (CMRCONT; 2 Shear layer detection (CMRJSLD, which was computed from the velocity field of a single CMR velocity profile at the peak systolic phase; 3 Single plane velocity truncation (CMRSPVT, which is a simplified version of CMRJSLD method. There was a good agreement between the EOAs obtained in vitro by the different CMR methods and the EOA predicted from the potential flow theory. In the in vivo study, there was good correlation and concordance between the EOA measured by the TTECONT method versus those measured by each of the CMR methods: CMRCONT (r = 0.88, CMRJSLD (r = 0.93 and CMRSPVT (r = 0.93. The intra- and inter- observer variability of EOA measurements was 5 ± 5% and 9 ± 5% for

  8. Percutaneous Implantation of the self-expanding valve Prosthesis a patient with homozygous familial hypercholesterolemia severe aortic stenosis and porcelain aorta.

    Science.gov (United States)

    Sahiner, Levent; Asil, Serkan; Kaya, Ergün Baris; Ozer, Necla; Aytemir, Kudret

    2016-10-01

    Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or inappropriate for open heart surgery. However, concerns exist over treating patients who have porcelain aorta and familial hypercholesterolemia, due to the potential complications of aortic root and aortic annulus. In this case report, we present a patient with familial hypercholesterolemia, symptomatic severe aortic stenosis, previous coronary artery bypass grafting and porcelain aorta, who was successfully treated with TAVI using a CoreValve. PMID:27393846

  9. Apicoaortic Valve Conduit for a Patient with Aortic Valve Stenosis and Patent Coronary Bypass Grafts Using Cardiopulmonary Bypass.

    Science.gov (United States)

    Shackelford, Anthony G; Relle, Margaret A; Lombardi, Sarah A

    2015-12-01

    In adults over 65 years of age, aortic valve stenosis has been found to be present in 2-9% within this group. Furthermore, aortic valve replacements in patients whom have had a previous coronary artery bypass grafting surgery have a mortality rate as high as 18%. A non-conventional effective surgical approach of bypassing the aortic valve by inserting an apicoaortic valve conduit (AVC) connecting the left ventricular apex to the descending thoracic aorta has been previously documented. We describe the case of a successful implantation of an AVC in a 64-year-old Caucasian male using cardiopulmonary bypass. PMID:26834287

  10. The Edwards SAPIEN Transcatheter Heart Valve for Calcific Aortic Stenosis: A Review of the Valve, Procedure, and Current Literature

    OpenAIRE

    Holoshitz, Noa; Kavinsky, Clifford J.; Hijazi, Ziyad M.

    2012-01-01

    The Edwards SAPIEN™ transcatheter heart valve (Edwards Lifesciences LLC, Irvine, CA, USA) is approved by the US Food and drug administration for use in the aortic position in patients with severe aortic stenosis who are not surgical candidates. This approval was backed by data from the Placement of AoRTic TraNscathetER Valve (PARTNER) I clinical trial, which showed the valve to be superior to standard medical therapy in high-risk nonoperative patients in cohort B of the trial. Although insert...

  11. Classification of Aortic Stenosis by Flow and Gradient Patterns Provides Insights into the Pathophysiology of Disease.

    Science.gov (United States)

    Bhattacharyya, Sanjeev; Mittal, Tarun; Abayalingam, Mayavan; Kabir, Tito; Dalby, Miles; Cleland, John G; Baltabaeva, Aigul; Rahman Haley, Shelley

    2016-08-01

    Different patterns of flow and valve gradients can lead to diagnostic uncertainty about the severity of aortic stenosis (AS). Consecutive patients with severe AS (valve area <1 cm(2)) underwent echocardiography and computed tomography. Patients were classified into 4 groups (high-gradient/normal flow [HGNF], high-gradient/low flow [HGLF], low-gradient/normal flow [LGNF], and low-gradient/low flow [LGLF]). Low flow was defined as stroke volume index <35 mL/m(2) and low gradient as a mean aortic gradient <40 mm Hg. Aortic valve calcification (AVC) was calculated using the Agatston score. Of 181 patients, 56, 30, 46, and 49 had HGNF, HGLF, LGNF and LGLF with median AVC of 2048, 2015, 1366, and 1178 AU/m(2) (P < .0001) and valvuloarterial impedance of 4.5, 6.4, 4.2, and 5.9, respectively (P < .0001). Among those with LGLF, AVC was lower in patients with preserved compared to reduced left ventricular ejection fraction (1018 vs 2550 AU/m(2); P < .0001), but valvuloarterial impedance was similar (P = .33). The LGLF AS with preserved ejection fraction is associated with lower AVC and may identify patients with less severe AS in association with an adaptive ventricular response to high afterload. PMID:26475710

  12. Rapidly progressed aortic stenosis in a patient with previous diagnosis of polycythemia vera and post-polycythemia vera myelofibrosis.

    Science.gov (United States)

    Kiso, Shohei; Naito, Ryo; Fukao, Kosuke; Hiki, Makoto; Miyazaki, Tetsuro; Takagi, Atsutoshi; Miyauchi, Katsumi; Daida, Hiroyuki

    2016-06-01

    Polycythemia vera (PV) is a chronic myeloproliferative disease that is often complicated with thromboembolism. However, aortic stenosis (AS) could be a manifestation of the cardiovascular complications of PV possibly through shear stress and atherosclerosis. We report a rare case of rapidly progressed AS in a patient with PV. PMID:27398203

  13. Rapidly progressed aortic stenosis in a patient with previous diagnosis of polycythemia vera and post‐polycythemia vera myelofibrosis

    OpenAIRE

    Kiso, Shohei; Naito, Ryo; Fukao, Kosuke; Hiki, Makoto; Miyazaki, Tetsuro; Takagi, Atsutoshi; MIYAUCHI, KATSUMI; Daida, Hiroyuki

    2016-01-01

    Key Clinical Message Polycythemia vera (PV) is a chronic myeloproliferative disease that is often complicated with thromboembolism. However, aortic stenosis (AS) could be a manifestation of the cardiovascular complications of PV possibly through shear stress and atherosclerosis. We report a rare case of rapidly progressed AS in a patient with PV.

  14. Flow and peak velocity measurements in patients with aortic valve stenosis using phase contrast MR accelerated with k-t BLAST

    International Nuclear Information System (INIS)

    Objective: To investigate the accuracy of velocity measurements in patients with aortic valve stenosis using phase contrast (PC) imaging accelerated with SENSE (Sensitivity Encoding) and k-t BLAST (Broad-use Linear Acquisition Speed-up Technique). Methods: Accelerated quantitative breath hold PC measurements, using SENSE and k-t BLAST, were performed in twelve patients whose aortic valve stenosis had been initially diagnosed using echocardiography. Stroke volume (SV) and peak velocity measurements were performed on each subject in three adjacent slices using both accelerating methods. Results: The peak velocities measured with PC MRI using SENSE were −8.0 ± 9.5% lower (p 0.05). Conclusions: In this study higher peak velocities were measured in patients with aortic stenosis when combining k-t BLAST with PC MRI compared to PC MRI using SENSE. A probable explanation of this difference is the higher temporal resolution achieved in the k-t BLAST measurement. There was, however, no significant difference between calculated SV based on PC MRI using SENSE and k-t BLAST, respectively

  15. Fetal critical aortic stenosis with natural improvement of hydrops fetalis due to spontaneous relief of severe restrictive atrial communication.

    Science.gov (United States)

    Ide, Tetsuya; Miyoshi, Takekazu; Kitano, Masataka; Kurosaki, Ken-ichi; Yoshimatsu, Jun

    2015-07-01

    We describe a rare case of fetal critical aortic stenosis with spontaneous relief of severe restrictive atrial communication, resulting in complete resolution of hydrops fetalis in utero. Fetal ultrasonography showed hydrops fetalis caused by critical aortic stenosis with a severely restrictive foramen ovale and severe mitral regurgitation at 23 weeks of gestation. Hydrops fetalis, however, spontaneously resolved, showing an obvious increase of flow through the foramen ovale and pulmonary vein at 26 weeks of gestation. The neonate required balloon dilation of the aortic valve and balloon atrioseptostomy immediately after birth and also received bilateral pulmonary artery banding and arterial duct stenting 1 week later. The patient was in good condition after conversion to biventricular circulation via Ross procedure at 8 months old. The present case suggests that atrioseptostomy as a fetal intervention may improve outcome in even a hydropic condition. PMID:25772579

  16. Value of cardiac multislice spiral CT for the assessment of degenerative aortic stenosis: comparison with echocardiography

    International Nuclear Information System (INIS)

    Objective: To non-invasively assess the severity of aortic valve stenosis (AS) by the determination of aortic valve calcification (AVC) using multislice spiral computed tomography (MSCT). Materials and Methods: Forty-one consecutive patients (17 male, 24 female, mean age 71.0±7.9 years) with a history of AS and an aortic valve area ≤2 cm2 underwent retrospectively ECG-gated 4-slice MSCT and echocardiography. The AVCs were quantitatively assessed using the score described by Agatston as well as by calculating the calcium mass. The echocardiographically determined aortic valve area (AVA) and the severity of AS according to the ACC/AHA guidelines were compared to the degree of a aortic valve calcifications. Pearson's correlation coefficient, cut-off values, kappa test and F-test with post hoc Boneferroni t-tests were calculated. Results: Calcium scores were significantly higher in patients with severe AS, when compared to mild or moderate AS (p<0.001). In patients suffering from severe AS, the mean Agatston score was 4125.5±1168.9 (calcium mass 904.1±263.3) while in patients with moderate and mild AS the corresponding values were 1596.3±987.0 (319.1±208.3) and 785.9±390.1 (149.1±90.2), respectively. Pearson's correlation coefficients were r-=0.75 for the Agatston score and r=-0.72 for the calcium mass. There was a moderate agreement between severity of AS according to the ACC/AHA guidelines and the degree of AS determined from AVC scores with κ=0.6091 and κ=0.6985, respectively. Conclusion: Severe AS may be differentiated from moderate or mild AS using cardiac MSCT. Extensive calcifications of the aortic valve presenting with an Agatston-Score ≥2824 (calcium mass ≥611) indicate a severe AS and should be taken as an indication for further diagnostic workup. (orig.)

  17. Comparison of Electrocardiographic QTc Duration in Patients With Supravalvar Aortic Stenosis With Versus Without Williams Syndrome

    Science.gov (United States)

    McCarty, Hollyn M.; Tang, Xinyu; Swearingen, Christopher J.; Collins, R. Thomas

    2014-01-01

    Cardiovascular abnormalities in Williams syndrome (WS) are largely attributable to elastin haploinsufficiency resulting from a large deletion of the elastin-containing region on chromosome 7q11.23. The risk of sudden death in patients with WS is 25- to 100-fold greater than that in the general population. The corrected QT (QTc) interval is prolonged in 14% of patients with WS. Patients with nonsyndromic supravalvar aortic stenosis (NSVAS) have elastin mutations resulting in elastin haploinsufficiency and a vascular phenotype nearly identical to that of WS. No previous studies have evaluated the QTc duration in NSVAS. A retrospective review of all electrocardiograms (ECGs) performed on consecutive patients with NSVAS at Arkansas Children's Hospital from January 1, 1985 to January 1, 2012 was completed. ECGs with nonsinus rhythm or unmeasurable intervals were excluded. The ECGs were read by 1 reader who was unaware of previous readings. A QTc interval of ≥460 ms was defined as prolonged. The NSVAS cohort was compared to previously published WS and control groups using the mixed model for continuous electrocardiographic variables and the generalized estimating equation for binary indicators for prolonged QTc. The generalized estimating equation used bootstrapping with 1,000 replicates. A total of 300 ECGs (median 6, range 1 to 27) from the 35 identified patients with NSVAS met the inclusion criteria. A total of 482 ECGs from patients with WS and 1,522 ECGs from controls were included. The mean age of the patients with NSVAS at ECG was 7.3 ± 6.9 years; 64% were male. The mean QTc duration was 409 ± 20 ms in the NSVAS group, 418 ± 17 ms in the control group (p <0.001), and 436 ± 27 ms in the WS group (p <0.001 compared to the control group). The prevalence of QTc prolongation was 0.3% in the NSVAS group, 2.0% in the control group (p <0.001), and 14.8% in the WS group (p <0.001 compared to controls). No patients with NSVAS died. In conclusion, cardiac

  18. 小儿先天性主动脉瓣上狭窄的超声诊断%Echocardiographic diagnosis of congenital supravalvular aortic stenosis in children

    Institute of Scientific and Technical Information of China (English)

    钱晶晶; 蒋国平; 何瑾; 叶菁菁

    2008-01-01

    目的 探讨小儿先天性主动脉瓣上狭窄(SVAS)的超声心动图特点及其诊断价值.方法 超声心动图在多个切面上检查诊断为主动脉瓣上狭窄的31例息儿,与心导管、手术及基因检测相对照.超声重点观察主动脉瓣、瓣上、主动脉弓降部、肺动脉瓣、主肺动脉及其左右分支、冠状动脉的超声改变.结果 沙漏样环形狭窄26例,全段管型狭窄4例,隔膜型狭窄1例.极轻度狭窄[狭窄处的最大瞬时压差(△P)75 mm Hg)4例.19例患儿基因检测诊断为Williams综合征.合并主动脉瓣狭窄3例,其中1例首次检查时漏诊.合并肺动脉狭窄10例,占32.26%.其中肺动脉瓣狭窄6例,左、右肺动脉狭窄3例,左右肺动脉分叉处狭窄1例.合并冠状动脉扩张6例.结论 胸骨旁及心尖五腔切面为诊断SVAS较好的切面,SVAS好发于Williams综合征的患儿,32.26%的患儿伴有肺动脉狭窄.对于SVAS患儿需常规检查冠状动脉的改变.%Objective To study the echocardiographic characteristics and its diagnosis value on congenital supravalvular aortic stenosis (SVAS) in children. Methods Thirty-one patients with SVAS diagnosed by multiplane echocardiography were enrolled in the study. Their echocardiographic characteristics were compared with cardiac catheterization, operation, and gene detection results. Echocardiographic changes were mainly observed in aortic valve, supravalve, descending aortic arch, pulmonary artery valve, main pulmonary artery and its branches,and coronary artery. Results Of the 31 patients,26 had hourglass type SVAS,4 hypoplastic type,and 1 membranous type; 2 patients had extremely mild stenosis (defined as a Doppler gradient 75 mm Hg) ones. Nineteen patients were diagnosed with Williams syndrome by gene detection. Three patients were associated with aortic valve stenosis including one missed at the initial diagnosis; 10(32.26%) patients with pulmonary stenosis, including pulmonary valve stenosis in 6, left and

  19. Surgical Treatment of 13-year-old Patient with Coronary Artery Disease and Supravalvular Aortic Stenosis with Familial Hypercholesterolemia

    Directory of Open Access Journals (Sweden)

    Yüksel Atay

    2011-12-01

    Full Text Available Familial hypercholesterolemia is a genetic disorder caused by a mutation in low density lipoprotein (LDL gene. The homozygous type of the disease is rare and causes tendon xanthomas and coronary artery disease during the early years of life. Because of that, some of these patients needs early coronary revascularization. We presented 13-year-old patient who underwent coronary artery bypass graft due to familial hypercholesterolemia and repair of supravalvular aortic stenosis at the same time.

  20. Surgical Treatment of 13-year-old Patient with Coronary Artery Disease and Supravalvular Aortic Stenosis with Familial Hypercholesterolemia

    OpenAIRE

    Yüksel Atay; Mirali Mecidov; Fatih Ayık; Emrah Oğuz

    2011-01-01

    Familial hypercholesterolemia is a genetic disorder caused by a mutation in low density lipoprotein (LDL) gene. The homozygous type of the disease is rare and causes tendon xanthomas and coronary artery disease during the early years of life. Because of that, some of these patients needs early coronary revascularization. We presented 13-year-old patient who underwent coronary artery bypass graft due to familial hypercholesterolemia and repair of supravalvular aortic stenosis at the same time.

  1. PROSPECTS FOR CYTOPROTECTORS USE IN THE ELDERLY PATIENTS THROUGH THE EXAMPLE OF CALCIFIED AORTIC STENOSIS AND ISCHEMIC HEART DISEASE

    OpenAIRE

    N Yu Karpova; Rashid, M.A.; N A Shostak; I. V. Pogonchenkova; T V Kazakova

    2015-01-01

    Issues of pathogenesis of the calcified aortic stenosis and ischemic heart disease in the elderly are considered. The relevance of early detection of angina, syncope, and dyspnea in view of their non-specific and subclinical course for early detection of heart disease is specified. Current scientific views on the myocardial bioenergy and its role in the genesis of chronic heart failure are presented. Particular attention is paid to the place of cytoprotectors, especially trimetazidine, in the...

  2. Calcification at orifices of aortic arch branches is a reliable and significant marker of stenosis at carotid bifurcation and intracranial arteries

    International Nuclear Information System (INIS)

    Purpose: Simple rating scale for calcification in the cervical arteries and the aortic arch on multi-detector computed tomography angiography (MDCTA) was evaluated its reliability and validity. Additionally, we investigated where is the most representative location for evaluating the calcification risk of carotid bifurcation stenosis and atherosclerotic infarction in the overall cervical arteries covering from the aortic arch to the carotid bifurcation. Method: The aortic arch and cervical arteries among 518 patients (292 men, 226 women) were evaluated the extent of calcification using a 4-point grading scale for MDCTA. Reliability, validity and the concomitant risk with vascular stenosis and atherosclerotic infarction were assessed. Results: Calcification was most frequently observed in the aortic arch itself, the orifices from the aortic arch, and the carotid bifurcation. Compared with the bilateral carotid bifurcations, the aortic arch itself had a stronger inter-observer agreement for the calcification score (Fleiss’ kappa coefficients; 0.77), but weaker associations with stenosis and atherosclerotic infarction. Calcification at the orifices of the aortic arch branches had a stronger inter-observer agreement (0.74) and enough associations with carotid bifurcation stenosis and intracranial stenosis. In addition, the extensive calcification at the orifices from the aortic arch was significantly associated with atherosclerotic infarction, similar to the calcification at the bilateral carotid bifurcations. Conclusions: The orifices of the aortic arch branches were the novel representative location of the aortic arch and overall cervical arteries for evaluating the calcification extent. Thus, calcification at the aortic arch should be evaluated with focus on the orifices of 3 main branches

  3. Molecular genetic analysis of individuals with Williams syndrome and supravalvar aortic stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Smoot, L.B.; Lacro, R.V.; Kunkel, L.M. [Children`s Hospital, Boston, MA (United States); Pober, B. [Yale Univ., New Haven, CT (United States)

    1994-09-01

    Mutations at the elastin locus (chromosome 7q11.23) have been demonstrated in individuals with Williams syndrome (WS) and familial supravalvar aortic stenosis (SVAS). Relationships between elastin mutations and vascular and/or neurodevelopmental pathology have yet to be defined. In determining phenotype-genotype correlations in WS/SVAS, we examined 35 individuals with sporadic WS, families with SVAS affecting multiple members, and sporadic cases of isolated obstructive vascular disease. Full length elastin cDNA was used to probe a human genomic library from which multiple elastin genomic clones have been isolated and ordered relative to the elastin gene, covering a minimum of 35 kb. (Additional genomic clones are being obtained by {open_quote}walking{close_quote} 5{prime} and 3{prime} to elastin.) Elastin genomic clones were used as probes in fluorescent in situ hybridization of metaphase chromosomes from WS/SVAS patients. Preliminary analysis confirms elastin deletions in WS patients, but have not yet been demonstrated in patients with isolated vascular disease using this technique. Results of deletional analysis in individuals representing a wide spectrum of phenotypes will be presented.

  4. Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion

    International Nuclear Information System (INIS)

    The objective is to determine cardiac computed tomography (CCT) features capable of differentiating between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in severe aortic stenosis (AS) patients with fused cusp and without elliptical-shaped systolic orifices. We retrospectively enrolled 53 patients who had severe AS with fused cusps and without an elliptical-shaped systolic orifice on CCT and who had undergone surgery. CCT features were analyzed using: (1) aortic valve findings including cusp size, cusp area, opening shape, midline calcification, fusion length, calcium volume score, and calcium grade; (2) diameters of ascending and descending aorta, and main pulmonary artery; and (3) rheumatic mitral valve findings. The variables were evaluated using univariate and multivariate logistic regression analyses. At surgery, 19 patients had BAV and 34 had TAV. CCT features including uneven cusp size, uneven cusp area, round-shaped systolic orifice, longer cusp fusion, and dilatation of ascending aorta were significantly associated with BAV (P < 0.05). In particular, fusion length (OR, 1.76; P = 0.001), uneven cusp area (OR, 10.46; P = 0.012), and midline calcification (OR, 0.08; P = 0.013) were strongly associated with BAV. CCT provides diagnostic clues that helps differentiate between BAV with raphe and TAV with commissural fusion in patients with severe AS. (orig.)

  5. Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion

    Energy Technology Data Exchange (ETDEWEB)

    Bak, So Hyeon; Ko, Sung Min [Konkuk University School of Medicine, Departments of Radiology, Konkuk University Medical Center, Seoul (Korea, Republic of); Song, Meong Gun; Shin, Je Kyoun; Chee, Hyun Kun; Kim, Jun Suk [Konkuk University School of Medicine, Departments of Thoracic Surgery, Konkuk University Medical Center, Seoul (Korea, Republic of)

    2015-04-01

    The objective is to determine cardiac computed tomography (CCT) features capable of differentiating between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in severe aortic stenosis (AS) patients with fused cusp and without elliptical-shaped systolic orifices. We retrospectively enrolled 53 patients who had severe AS with fused cusps and without an elliptical-shaped systolic orifice on CCT and who had undergone surgery. CCT features were analyzed using: (1) aortic valve findings including cusp size, cusp area, opening shape, midline calcification, fusion length, calcium volume score, and calcium grade; (2) diameters of ascending and descending aorta, and main pulmonary artery; and (3) rheumatic mitral valve findings. The variables were evaluated using univariate and multivariate logistic regression analyses. At surgery, 19 patients had BAV and 34 had TAV. CCT features including uneven cusp size, uneven cusp area, round-shaped systolic orifice, longer cusp fusion, and dilatation of ascending aorta were significantly associated with BAV (P < 0.05). In particular, fusion length (OR, 1.76; P = 0.001), uneven cusp area (OR, 10.46; P = 0.012), and midline calcification (OR, 0.08; P = 0.013) were strongly associated with BAV. CCT provides diagnostic clues that helps differentiate between BAV with raphe and TAV with commissural fusion in patients with severe AS. (orig.)

  6. Histopathological study of congenital aortic valve malformations in 32 children

    Institute of Scientific and Technical Information of China (English)

    HUANG Ping; WANG Hongwei; LI Yanping; CHENG Peixuan; LIU Qingjun; ZHANG Zhenlu; LIU Jianying

    2007-01-01

    The histopathological characteristics of congenital aortic valve malformations in children were investigated.All the native surgically excised aortic valves from 32 pediatric patients suffering from symptomatic aortic valve dysfunction due to congenital aortic valve malformations between January 2003 and December 2005 were studied macroscopically and microscopically.The patients' medical records were reviewed and the clinical information was extracted.The diagnosis was made by the clinical presentation,preoperative echocardiography,intraoperative examination,and postoperative histopathological study,excluding rheumatic ot degenerative aortic valve diseases,infective endocarditis and primary connective tissue disorders,e.g.Marfan syndrome.Among 32 children with congenital aortic valve malformations,the age was ranged from six to 18 years,with a mean of 14.9 years,and there were 27 boys and five girls (male:female = 5.4:1).There were five cases of aortic stenosis (AS,15.62%),25 cases of aortic insufficiency (AI,78.13 %)and two cases of AS-AI (6.25%),without other valve diseases.Twenty cases still had other congenital heart diseases:ventricular septal defect (19 cases),patent ductus arteriosus (two cases),double-chambered right ventricle (one case),aneurysm of the right anterior aortic sinus of valsalva (three cases).Histopathological examination indicated that the cusps became thickening with unequal size,irregular shape (coiling and prolapse edge),enhanced hardness,and partly calcification.Microscopic investigation revealed the unsharp structure of valve tissue,fibrosis,myxomatous,reduced collagen fiber,rupture of elastic fibers,different degrees of infiltration of inflammatory cells,secondary calcareous and lipid deposit,and secondary fibrosis.Congenital aortic valve malformations in children involve males more than females,mostly associated with other congenital heart diseases.Aortic insufficiency is more common in children with congenital aortic valve

  7. Validation of the severity index by cardiac catheterization and Doppler echocardiography in patients with aortic sclerosis and stenosis

    Directory of Open Access Journals (Sweden)

    Rosales Joseph

    2006-03-01

    Full Text Available Abstract The severity index is a new echocardiographic measure that is thought to be an accurate indicator of aortic leaflet pathology in patients with AS. However, it has not been validated against cardiac catheterization or Doppler echocardiographic measures of AS severity nor has it been applied to patients with aortic sclerosis. The purposes of this study were to compare the severity index to invasive hemodynamics and Doppler echocardiography across the spectrum of calcific aortic valve disease, including aortic sclerosis and AS. 48 patients with aortic sclerosis and AS undergoing echocardiography and cardiac catheterization comprised the study population. The aortic valve leaflets were assessed for mobility (scale 1 to 6 and calcification (scale 1 to 4 and the severity index was calculated as the sum of the mobility and calcification scores according to the methods of Bahler et al. The severity index increased with increasing severity of aortic valve disease; the severity indices for patients with aortic sclerosis, mild to moderate AS and severe AS were 3.38 ± 1.06, 6.45 ± 2.16 and 8.38 ± 1.41, respectively. The aortic jet velocity by echocardiography and the square root of the maximum aortic valve gradient by cardiac catheterization correlated well with the severity index (r = 0.84, p

  8. Refined multiscale entropy: application to 24-h Holter recordings of heart period variability in healthy and aortic stenosis subjects.

    Science.gov (United States)

    Valencia, José Fernando; Porta, Alberto; Vallverdú, Montserrat; Clarià, Francesc; Baranowski, Rafal; Orłowska-Baranowska, Ewa; Caminal, Pere

    2009-09-01

    Multiscale entropy (MSE) was proposed to characterize complexity as a function of the time-scale factor tau. Despite its broad use, this technique suffers from two limitations: 1) the artificial MSE reduction due to the coarse graining procedure and 2) the introduction of spurious MSE oscillations due to the suboptimal procedure for the elimination of the fast temporal scales. We propose a refined MSE (RMSE), and we apply it to simulations and to 24-h Holter recordings of heart rate variability (HRV) obtained from healthy and aortic stenosis (AS) groups. The study showed that the refinement relevant to the elimination of the fast temporal scales was more helpful at short scales (spanning the range of short-term HRV oscillations), while that relevant to the procedure of coarse graining was more useful at large scales. In healthy subjects, during daytime, RMSE was smaller at short scales (i.e., tau = 1-2) and larger at longer scales (i.e., tau = 4-20) than during nighttime. In AS population, RMSE was smaller during daytime both at short and long time scales (i.e., tau = 1 -11) than during nighttime. RMSE was larger in healthy group than in AS population during both daytime (i.e., tau = 2 -9) and nighttime (i.e., tau = 2). RMSE overcomes two limitations of MSE and confirms the complementary information that can be derived by observing complexity as a function of the temporal scale. PMID:19457745

  9. Echocardiography as a Predicting Method in Diagnosis, Evaluation and Assessment of Children with Subvalvar Aortic Stenosis

    Science.gov (United States)

    Bejiqi, Ramush; Bejiqi, Hana; Retkoceri, Ragip

    2016-01-01

    BACKGROUND: Obstruction to the left ventricular outflow of the heart may be above the aortic valve (5%), at the valve (74%), or in the subvalvar region (23%). These anomalies represent 3 to 6% of all patients with congenital heart defects (CHD), and it occurs more often in males (male-female ratio of 4:1). AIM: The purpose of this study was to determine the sensitivity and specificity of transthoracic echocardiography in diagnosis of discrete subaortic membrane, to determine convenient time for surgical intervention, and for identifying involvement of the aortic valve by subaortic shelf. MATERIAL AND METHODS: A retrospective review of the medical records and echocardiograms of 18 patients [14 male (77%) and 4 female (23%)] with discrete subaortic membrane, aged 11 month to 12 years, with mean age of 5 years and 3 month, diagnosed at the Pediatric Clinic in Prishtina, during the period September, 1999 and December, 2010 were done. RESULTS: Four patients, in neonatal age were operated from critical coarctation of the aorta and, initial signs of congestive heart failure were presented. 2 of them were operated in Belgrade, Serbia and 2 in Lausanne, Switzerland. CONCLUSION: In all presented patients bicuspid aortic valve was noted, but none of them subaortic membrane was registered.

  10. Experimental Study and Early Clinical Application Of a Sutureless Aortic Bioprosthesis

    Directory of Open Access Journals (Sweden)

    Walter J. Gomes

    2015-10-01

    Full Text Available ABSTRACT INTRODUCTION: The conventional aortic valve replacement is the treatment of choice for symptomatic severe aortic stenosis. Transcatheter technique is a viable alternative with promising results for inoperable patients. Sutureless bioprostheses have shown benefits in high-risk patients, such as reduction of aortic clamping and cardiopulmonary bypass, decreasing risks and adverse effects. OBJECTIVE: The objective of this study was to experimentally evaluate the implantation of a novel balloon-expandable aortic valve with sutureless bioprosthesis in sheep and report the early clinical application. METHODS: The bioprosthesis is made of a metal frame and bovine pericardium leaflets, encapsulated in a catheter. The animals underwent left thoracotomy and the cardiopulmonary bypass was established. The sutureless bioprosthesis was deployed to the aortic valve, with 1/3 of the structure on the left ventricular face. Cardiopulmonary bypass, aortic clamping and deployment times were recorded. Echocardiograms were performed before, during and after the surgery. The bioprosthesis was initially implanted in an 85 year-old patient with aortic stenosis and high risk for conventional surgery, EuroSCORE 40 and multiple comorbidities. RESULTS: The sutureless bioprosthesis was rapidly deployed (50-170 seconds; average=95 seconds. The aortic clamping time ranged from 6-10 minutes, average of 7 minutes; the mean cardiopulmonary bypass time was 71 minutes. Bioprostheses were properly positioned without perivalvar leak. In the first operated patient the aortic clamp time was 39 minutes and the patient had good postoperative course. CONCLUSION: The deployment of the sutureless bioprosthesis was safe and effective, thereby representing a new alternative to conventional surgery or transcatheter in moderate- to high-risk patients with severe aortic stenosis.

  11. PROSPECTS FOR CYTOPROTECTORS USE IN THE ELDERLY PATIENTS THROUGH THE EXAMPLE OF CALCIFIED AORTIC STENOSIS AND ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    N. Yu. Karpova

    2015-09-01

    Full Text Available Issues of pathogenesis of the calcified aortic stenosis and ischemic heart disease in the elderly are considered. The relevance of early detection of angina, syncope, and dyspnea in view of their non-specific and subclinical course for early detection of heart disease is specified. Current scientific views on the myocardial bioenergy and its role in the genesis of chronic heart failure are presented. Particular attention is paid to the place of cytoprotectors, especially trimetazidine, in the management of patients with cardiac N.Yu. Karpova1diseases.

  12. Iatrogenic coronary ostial stenosis of left main stem following aortic valve replacement: Visualization with optical coherence tomography

    Energy Technology Data Exchange (ETDEWEB)

    Khan, Muhammad A. [Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, M13 9WL Manchester (United Kingdom); Prati, Francesco [Interventional Cardiology, San Giovanni Hospital, Via dell’Amba Aradam 8, 00184 Rome (Italy); El-Omar, Magdi, E-mail: magdi.el-omar@cmft.nhs.uk [Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, M13 9WL Manchester (United Kingdom)

    2013-09-15

    Iatrogenic coronary ostial stenosis following aortic valve replacement (AVR) occurs in up to 3.4% of cases and usually presents within the first 6 months following surgery. We present the case of an 85 year old man who developed an acute coronary syndrome 2 months following AVR. Coronary angiography revealed a severe de novo lesion in the left main stem, which, on optical coherence tomography, was shown to be due to severe intimal hyperplasia. The most likely underlying mechanism is vessel wall trauma caused by the rigid tip cannula used for administration of cardioplegia solution. Surgeons should be aware of this possibility when administering this solution via the antegrade approach.

  13. Interventional treatment of common congenital heart diseases: the common view of Chinese medical experts. Part Four: Percutaneous balloon valvuloplasty for pulmonary and aortic valve stenosis

    International Nuclear Information System (INIS)

    Percutaneous balloon valvuloplasty has become the treatment of first choice for pulmonary valve stenosis. Congenital aortic valve stenosis can also be relieved by percutaneous balloon dilatation. Percutaneous valvuloplasty is indicated for patients with isolated pulmonary valve stenosis when the transvalvular peak systolic pressure gradient is over 40 mmHg and for patients with aortic valve stenosis when the pressure gradient exceeds 60 mmHg. A careful selection of patients, standardized procedure, individualized selection of the balloon type, size and length, and careful avoidance of any damage to chorda tendineae and to surrounding tissue are keys to achieving a successful procedure. Balloon valvuloplasty should be selectively performed in new-born and in infant since complications of the procedure are inversely related to age. (authors)

  14. A prospective, non-randomized comparison of SAPIEN XT and CoreValve implantation in two sequential cohorts of patients with severe aortic stenosis

    OpenAIRE

    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 1...

  15. Study on the dynamic change of endothelin in the development of stenosis of aorta after balloon injury in rabbits

    International Nuclear Information System (INIS)

    Objective: To study the dynamic change of endothelin (ET) in the blood with pathological and immunohistochemical changes of ET(ET-immunoreaction, ET-IR) in the development of stenosis of rabbit aorta after transluminal angioplasty. Methods: According to the different periods of being killed after micro-balloon angioplasty, 30 rabbits were divided randomly into 6 groups including 6-hour group, 1-day group, 3-day group, 7-day group, 15-day group and 22-day group. 3 out of 5 rabbits in each group were created as models of aortic endothelium injury by micro-balloon angioplasty, the rest 2 rabbits were taken as control. ET levels in the plasma were measured by ELISA before, as well as after micro-balloon angioplasty. Pathomorphological examination of the local traumatic aorta was carried out to observe the intimal thickness and the extent of lumen stenosis, and ET-IR was assessed by immunohistochemical technique performed on aortic wall after micro-balloon angioplasty. Results: (1) The major change of vascular stenosis was proliferation of vascular smooth muscle cell (VSMC) and endothelium. (2) ET levels in the plasma and ET-IR on the local aortic wall were significantly increased after micro-balloon angioplasty. Conclusions: The experimental results show that the major pathologic change of vascular stenosis is the obvionus proliferation of VSMC and endothelium. Further more, ET is a key factor in the development of vascular stenosis. (authors)

  16. Percutaneous implantation of self-expandable aortic valve in high risk patients with severe aortic stenosis: The first experiences in Serbia

    Directory of Open Access Journals (Sweden)

    Nedeljković Milan A.

    2016-01-01

    Full Text Available Background/Aim. Aortic stenosis (AS is the most common valvular heart disease in elderly people, with rather poor prognosis in symptomatic patients. Surgical valve replacement is the therapy of choice, but a significant number of patients cannot undergo surgical procedure. We presented initial experience of transcatheter aortic valve implantation (TAVI performed in Catheterization Laboratory of the Clinic for Cardiology, Clinical Center of Serbia. Methods. The procedures were performed in 5 patients (mean age 76 ± 6 years, 2 males, 3 female with severe and symptomatic AS with contraindication to surgery or high surgical risk. The decision to perform TAVI was made by the heart team. Pre-procedure screening included detailed clinical and echocardiographic evaluation, coronary angiography and computed tomography scan. In all the patients we implanted a self-expandable aortic valve (Core Valve, Medtronic, USA. Six months follow-up was available for all the patients. Results. All interventions were successfully performed without significant periprocedural complications. Immediate hemodynamic improvement was obtained in all the patients (peak gradient 94.2 ± 27.6 to 17.6 ± 5.2 mmHg, p < 0.001, mean pressure gradient 52.8 ± 14.5 to 8.0 ± 2.1 mmHg, p < 0.001. None of the patients developed heart block, stroke, vascular complication or significant aortic regurgitation. After 6 months, the survival was 100% with New York Heart Association (NYHA functional improvement in all the patients. Conclusion. This successful initial experience provides a solid basis to treat larger number of patients with symptomatic AS and high surgical risk who are left untreated. [Projekat Ministarstva nauke Republike Srbije, br. ON 175 020

  17. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... to help prevent aortic stenosis? There's no prophylactic methods that anybody can take to prevent aortic stenosis ... to progression and aortic sclerosis is not a reason to need an operation or aggressive management at ...

  18. Assessment of aortic stenosis after aortic valve replacement. Comparative evaluation of dual-source CT and echocardiography

    International Nuclear Information System (INIS)

    Purpose: To prospectively evaluate whether planimetric measurements of aortic valve area (AVA) with dual-source computed tomography (DSCT) correlate with measurements obtained by echocardiography and to correlate the amount of calcification of the aortic valve with AVA in a group of patients after aortic valve replacement. Materials and Method: 23 patients underwent dual-source computed tomography (DSCT) of the heart (Somatom Definition, Siemens Medical Solutions, Forchheim, Germany), without heart rate control (heart rate 52-113 beats/minute). All patients had undergone aortic valve replacement (homografts, mean time after surgery: 7±3 years). The AVA of the transplanted aortic valve graft was measured planimetrically by means of DSCT and compared with echocardiography as a standard of reference, to exclude post-surgical restenosis of the valve. Maximum AVA in systole planimetrically measured with CT was compared with calculated AVA values determined with the continuity equation, using transvalvular pressure gradients. The amount of calcification of the aortic valve was quantified and correlated (Spearman's R) with the AVA. To assess intra- and inter-reader reproducibility, the DCST data was re-analyzed by two readers 4 weeks after the initial review. Results: All DSCT datasets were of diagnostic image quality concerning valve depiction. The mean AVA as measured by DSCT was 2.7±0.9 cm2 compared to 1.8±0.5 cm2 by echocardiography (p<0.05). The planimetric evaluation of the CT data as compared to results of echocardiography showed a significant correlation of the results (Pearson's correlation coefficient R=0.78, p<0.001). Intra- and inter-reader reproducibility was good with intra-class correlation coefficients of 0.86 and 0.81, respectively (p<0.001). There was a significant negative correlation between the amount of aortic valve calcification and AVA as measured by echocardiography (R=-0.42; p<0.05) and as measured by DSCT (R=-0.67; p=0.001). (orig.)

  19. Severe Gastrointestinal Bleeding in a Patient With Subvalvular Aortic Stenosis Treated With Thalidomide and Octreotide: Bridging to Transcoronary Ablation of Septal Hypertrophy

    OpenAIRE

    Hvid-Jensen, Helene S.; Poulsen, Steen H.; Agnholt, Jorgen S.

    2015-01-01

    Gastrointestinal bleeding (GB) due to angiodysplasias can cause severe, recurrent bleeding, especially in elderly patients. Angiodysplastic bleedings in the gastrointestinal tract have been associated with aortic stenosis and, more recently, hypertrophic obstructive cardiomyopathy, caused by an acquired coagulopathy known as Heyde’s syndrome. Multiple factors are involved in the pathogenesis of angiodysplastic bleeding including genetic factors and increased levels of vascular intestinal grow...

  20. Modificação técnica na cirurgia da estenose aórtica supravalvar Technical modifications in the surgery of supravalvar aortic stenosis

    Directory of Open Access Journals (Sweden)

    Magaly Arrais dos Santos

    1996-12-01

    cardioplegia in the 3 last ones. The ascending aorta was widely dissected till the supra-aortic vessels. After the aorta total transection and the resection of the stenosis f ibrotic tissue, longitudinal incisions were performed at the edge of the aortic proximal portion till the bottom of the Valsalva sinuses. Next to it, longitudinal incisions were performed in the distal portion, in the regions corresponding to the comissural points, in such a way that each stretching of the distal aorta may widen a bottom of Valsalva sinus, in this way obtaining an aortic root with an anatomic aspect and regular sizes. Presently, no death has occurred in a post-operative period from 3 months to 4 years and 5 months. All the patients are asymptomatic, having a satisfactory evolution, checked by Doppler Echocardiogram, Magnetic Nuclear Ressonance and Hemodynamic study. These results allow us to conclude that this technique is suitable to the surgical correction of the localized supravalvar aortic stenosis, by the point of not using artificial grafts and accomplishing the aorta suture in a sinusoidal line, avoiding reestenosis.

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

    Science.gov (United States)

    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

  2. Prognostic utility of biomarkers in predicting of one-year outcomes in patients with aortic stenosis treated with transcatheter or surgical aortic valve implantation.

    Directory of Open Access Journals (Sweden)

    Jiri Parenica

    Full Text Available OBJECTIVES: The aim of the work was to find biomarkers identifying patients at high risk of adverse clinical outcomes after TAVI and SAVR in addition to currently used predictive model (EuroSCORE. BACKGROUND: There is limited data about the role of biomarkers in predicting prognosis, especially when TAVI is available. METHODS: The multi-biomarker sub-study included 42 consecutive high-risk patients (average age 82.0 years; logistic EuroSCORE 21.0% allocated to TAVI transfemoral and transapical using the Edwards-Sapien valve (n = 29, or SAVR with the Edwards Perimount bioprosthesis (n = 13. Standardized endpoints were prospectively followed during the 12-month follow-up. RESULTS: The clinical outcomes after both TAVI and SAVR were comparable. Malondialdehyde served as the best predictor of a combined endpoint at 1 year with AUC (ROC analysis = 0.872 for TAVI group, resp. 0.765 (p<0.05 for both TAVI and SAVR groups. Increased levels of MDA, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase (TIMP1, ferritin-reducing ability of plasma, homocysteine, cysteine and 8-hydroxy-2-deoxyguanosine were all predictors of the occurrence of combined safety endpoints at 30 days (AUC 0.750-0.948; p<0.05 for all. The addition of MDA to a currently used clinical model (EuroSCORE significantly improved prediction of a combined safety endpoint at 30 days and a combined endpoint (0-365 days by the net reclassification improvement (NRI and the integrated discrimination improvement (IDI (p<0.05. Cystatin C, glutathione, cysteinylglycine, asymmetric dimethylarginine, nitrite/nitrate and MMP9 did not prove to be significant. Total of 14.3% died during 1-year follow-up. CONCLUSION: We identified malondialdehyde, a marker of oxidative stress, as the most promising predictor of adverse outcomes during the 30-day and 1-year follow-up in high-risk patients with symptomatic, severe aortic stenosis treated with TAVI. The development of a clinical

  3. [Fragility in severe aortic stenosis patient: a multidimensional assessment from nursing].

    Science.gov (United States)

    Melero-Lacasia, Amaia

    2016-01-01

    The interest in studying frailty in older adults is an emerging fact in cardiology due to the incidence of patients undergoing valve replacement procedures in conditions difficult to quantify from the purely clinical point of view. In this regard, the profile of patients has been changing and often elderly people identify with greater vulnerability shown by different aspects such as walking speed, grip strength, independence for activities of daily living or emotional issues that condition their quality of life. These patients need to be identified prior to surgery in order to offer the best therapeutic option. Therefore, in our centre we set out to identify this group of fragile population with a multidimensional assessment where the nurse, through a specific assessment test, can set the degree of fragility of those patients who have an increased vulnerability. In this article we describe the multidimensional assessment in a pilot experience with 115 patients, where patient characteristics were analyzed, providing an overview of the profile of frailty in the elderly with aortic valve heart disease. PMID:26708824

  4. Left Ventricular Dynamics after Aortic Valve Replacement: A Long-term, Combined Radionuclide Angiographic and Ultrasonographic Study

    OpenAIRE

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

    1992-01-01

    Between January 1985 and July 1990, we studied 71 patients at our institution who underwent aortic valve replacement for either aortic valve regurgitation (40 patients) or stenosis (31 patients). The following prostheses were implanted: 25 St. Jude Medical valves (bileaflet), 16 Björk-Shiley (monoleaflet, tilting disc, 60° convexo-concave), 16 Medtronic-Hall (monoleaflet, tilting disc), and 14 Starr-Edwards (caged ball). The patients were evaluated pre-and postoperatively by means of gated bl...

  5. Experimental study of effect of stenosis geometry on flow parameters

    Directory of Open Access Journals (Sweden)

    Veselý Ondřej

    2015-01-01

    Full Text Available A stenosis is a narrowing in a tubular organ or structure. In medicine, vessel stenosis poses health risks for people. In this work, experimental investigations of pressure loss coefficient for varying stenosis eccentricity and shape were performed. Five models of different geometry were studied; all models were stenosis of 75 % area reduction. The flow conditions approximate physiological flow. The measuring range of Reynolds number was from 130 to 2730, measured values of pressure loss coefficient were from 12 to 20. The steady experimental results indicated that static pressure loss coefficient is affected by the shape of stenosis, but it was affected more significantly by the eccentricity. Visualization experiments have been performed in Polycarbonate models.

  6. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... the primary reason that we end up offering patients aortic valve surgery in our community. Aortic stenosis ... a picture of the aortic valve from a patient who had a very diseased aortic valve. And ...

  7. Quantification of aortic valve stenosis in MRI - comparison of steady-state free precession and fast low-angle shot sequences

    International Nuclear Information System (INIS)

    We compared two different magnetic resonance (MR) sequences [steady-state free precession (SSFP) and gradient echo fast low-angle shot (FLASH)] for the assessment of aortic valve areas in aortic stenosis using transesophageal echocardiography (TEE) as the standard of reference. Thirty-two patients with known aortic stenosis underwent MR (1.5 T) using a cine SSFP sequence and a cine FLASH sequence. Planimetry was performed in cross-sectional images and compared to the results of the TEE. In seven patients the grade of stenosis was additionally assessed by invasive cardiac catheterization (ICC). The mean aortic valve area measured by TEE was 0.97±0.19 mm2, 1.00±0.25 mm2 for SSFP and 1.25±0.23 mm2 based on FLASH images. The mean difference between the valve areas assessed based on SSFP and TEE images was 0.15±0.13 cm2 (FLASH vs TEE: 0.29±0.17 cm2). Bland-Altman analysis demonstrated that measurements using FLASH images overestimated the aortic valve area compared to TEE. Comparing ICC with MRI and TEE, only a weak to moderate correlation was found (ICC vs TEE: R=0.52, p=0.22; ICC vs SSFP: R=0.20, p=0.65; ICC vs FLASH: R=0.16, p=0.70). Measurements of the aortic valve area based on SSFP images correlate better with TEE compared to FLASH images. (orig.)

  8. Severe symptomatic aortic stenosis: medical therapy and transcatheter aortic valve implantation (TAVI)—a real-world retrospective cohort analysis of outcomes and cost-effectiveness using national data

    Science.gov (United States)

    Aldalati, Omar; Lacey, Arron; King, William; Anderson, Richard A; Smith, Dave

    2016-01-01

    Objectives Determine the real-world difference between 2 groups of patients with severe aortic stenosis and similar baseline comorbidities: surgical turn down (STD) patients, who were managed medically prior to the availability of transcatheter aortic valve implantation (TAVI) following formal surgical outpatient assessment, and patients managed with a TAVI implant. Design Retrospective cohort study from real-world data. Setting Electronic patient letters were searched for patients with a diagnosis of severe aortic stenosis and a formal outpatient STD prior to the availability of TAVI (1999–2009). The second group comprised the first 90 cases of TAVI in South Wales (2009 onwards). 2 years prior to and 5 years following TAVI/STD were assessed. Patient data were pseudoanonymised, using the Secure Anonymized Information Linkage (SAIL) databank, and extracted from Office National Statistics (ONS), Patient-Episode Database for Wales (PEDW) and general practitioner databases. Population 90 patients who had undergone TAVI in South Wales, and 65 STD patients who were medically managed. Main outcome measures Survival, hospital admission frequency and length of stay, primary care visits, and cost-effectiveness. Results TAVI patients were significantly older (81.8 vs 79.2), more likely to be male (59.1% vs 49.3%), baseline comorbidities were balanced. Mortality in TAVI versus STD was 28% vs 70% at 1000 days follow-up. There were significantly more hospital admissions per year in the TAVI group prior to TAVI/STD (1.5 (IQR 1.0–2.4) vs 1.0 IQR (0.5–1.5)). Post TAVI/STD, the TAVI group had significantly lower hospital admissions (0.3 (IQR 0.0–1.0) vs 1.2 (IQR 0.7–3.0)) and lengths of stay (0.4 (IQR 0.0–13.8) vs 11.0 (IQR 2.5–28.5), p<0.05). The incremental cost-effectiveness ratio (ICER) for TAVI was £10 533 per quality-adjusted life year (QALY). Conclusions TAVI patients were more likely to survive and avoid hospital admissions compared with the medically

  9. Pulmonary artery stenosis caused by a large aortic arch pseudoaneurysm detected 10 years after a minor trauma

    Directory of Open Access Journals (Sweden)

    Jalal Zamani

    2016-03-01

    Full Text Available Pseudoaneurysm of aorta is a rare condition usually seen after aortic surgeries or serious accidents. Here we report a 60 years old man without any previous medical condition who presented with non-specific symptoms and underwent different investigations for more than 1 year, until the presence of a continuous murmur raised suspicion toward his cardiovascular system. In echocardiographic and computed tomography (CT angiographic studies a large pseudoaneurysm of aortic arch with compression effect on pulmonary artery was detected. At this stage he remembered having suffered a minor trauma 10 years ago. He finally underwent operation and his aortic wall was repaired successfully with a patch. This case highlights the importance of thorough history taking and physical examination in patients irrespective of symptoms and high index of suspicion to detect this life-threatening condition.

  10. Circulating activated and effector memory T cells are associated with calcification and clonal expansions in bicuspid and tricuspid valves of calcific aortic stenosis*

    OpenAIRE

    Winchester, Robert; Wiesendanger, Margrit; O’Brien, Will; Zhang, Hui-Zhu; Maurer, Mathew S.; Gillam, Linda D.; Schwartz, Allan; Marboe, Charles; Allan S. Stewart

    2011-01-01

    We sought to delineate further the immunological significance of T lymphocytes infiltrating the valve leaflets in calcific aortic stenosis (CAS) and determine whether there were associated alterations in circulating T cells. Using clonotypic TCR β-chain length and sequence analysis we confirmed the repertoire of tricuspid CAS valves contains numerous expanded T cell clones with varying degrees of additional polyclonality, which was greatest in cases with severe calcification. We now report a ...

  11. Congenital hepatic arteriovenous fistula with intrahepatic portosystemic shunt and aortic stenosis in a dog

    International Nuclear Information System (INIS)

    Examination of a 2-month-old male golden retriever presented to the hospital revealed malnutrition, ascites, cardiac murmur and hyperammonemia. Identification of subaortic stenosis and hepatic arteriovenous fistula was made through ultrasonography and angiocardiography. In addition, intrasurgical mesenteric portography showed an intrahepatic portosystemic shunt. The dog did not show portal hypertension and secondary multiple extrahepatic portosystemic shunts. Surgical correction was attempted after medical treatment. The hepatic artery branch which was connected to the hepatic arteriovenous fistula was separated, and completely ligated using silk ligature. However, the separation of the intrahepatic shunt blood vessel was unsuccessful and the dog died 15 hr postoperatively

  12. Aortic replacement in aorto-occlusive disease: an observational study

    Directory of Open Access Journals (Sweden)

    Winter Richard K

    2008-10-01

    Full Text Available Abstract Background For many patients with aorto-occlusive disease, where stent deployment is not possible, surgery remains the only treatment option available. The aim of this study was to assess the results of aortic reconstruction surgery performed in patients with critical ischaemia. Methods All patients with critical ischaemia undergoing surgery during 1991–2004 were identified from a prospectively maintained database. Mortality data was verified against death certificate data. Demographic and clinical data were obtained from the clinical notes and the radiology database. Disease was classified as: type I – limited to aorta and common iliac arteries; type II – external iliac disease and type III combined aortic, iliac and infra-inguinal disease. Results 86 patients underwent aortic replacement surgery all of whom had critical ischaemia consisting of: type I (n = 16; type II (n = 37 and type III (n = 33. The 30-day mortality rate was 10.4%, the one-year patient survival was 80%, and the 1-year graft survival was 80%. At 2 years the actual patient survival was 73% and no additional graft losses were identified. All patients surviving 30 days reported excellent symptomatic relief. Early, complications occurred in 6 (7% patients: thrombosis within diseased superficial femoral arteries (n = 4; haemorrhage and subsequent death (n = 2. Ten (14% late complications (> 12 months occurred in the 69 surviving patients and included: anastomotic stenosis (n = 3; graft thrombosis (n = 4, graft infection (n = 3. Four patients developed claudication as a result of more distal disease in the presence of a patent graft, and 1 patient who continued smoking required an amputation for progressive distal disease. Conclusion Aortic reconstruction for patients with extensive aorto-occlussive disease provides long-standing symptomatic relief for the majority of patients. After the first year, there is continued patient attrition due to co

  13. A decision tree – based method for the differential diagnosis of Aortic Stenosis from Mitral Regurgitation using heart sounds

    Directory of Open Access Journals (Sweden)

    Loukis Euripides N

    2004-06-01

    Full Text Available Abstract Background New technologies like echocardiography, color Doppler, CT, and MRI provide more direct and accurate evidence of heart disease than heart auscultation. However, these modalities are costly, large in size and operationally complex and therefore are not suitable for use in rural areas, in homecare and generally in primary healthcare set-ups. Furthermore the majority of internal medicine and cardiology training programs underestimate the value of cardiac auscultation and junior clinicians are not adequately trained in this field. Therefore efficient decision support systems would be very useful for supporting clinicians to make better heart sound diagnosis. In this study a rule-based method, based on decision trees, has been developed for differential diagnosis between "clear" Aortic Stenosis (AS and "clear" Mitral Regurgitation (MR using heart sounds. Methods For the purposes of our experiment we used a collection of 84 heart sound signals including 41 heart sound signals with "clear" AS systolic murmur and 43 with "clear" MR systolic murmur. Signals were initially preprocessed to detect 1st and 2nd heart sounds. Next a total of 100 features were determined for every heart sound signal and relevance to the differentiation between AS and MR was estimated. The performance of fully expanded decision tree classifiers and Pruned decision tree classifiers were studied based on various training and test datasets. Similarly, pruned decision tree classifiers were used to examine their differentiation capabilities. In order to build a generalized decision support system for heart sound diagnosis, we have divided the problem into sub problems, dealing with either one morphological characteristic of the heart-sound waveform or with difficult to distinguish cases. Results Relevance analysis on the different heart sound features demonstrated that the most relevant features are the frequency features and the morphological features that

  14. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... aortic stenosis, are there any activities that I should avoid doing? That's a great question, Jim. Generally ... do not have symptoms but have aortic stenosis should be considered for surgery. Age, in and of ...

  15. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... to help prevent aortic stenosis? There's no prophylactic methods that anybody can take to prevent aortic stenosis ... it will be archived on the ORlive Web site and ORlive.com and, of course, a link ...

  16. Prevention of atrial fibrillation in patients with aortic valve stenosis with candesartan treatment after aortic valve replacement

    DEFF Research Database (Denmark)

    Dahl, J. S.; Videbaek, L.; Poulsen, M. K.;

    2013-01-01

    Background: Accumulating data has suggested that treatment with Angiotensin-II receptor antagonists can prevent the new onset of atrial fibrillation (AF). The aim of this study was to evaluate whether treatment with candesartan on top of conventional treatment could prevent new onset AF in patients......, treatment with candesartan may prevent the new onset of atrial fibrillation. (C) 2011 Elsevier Ireland Ltd. All rights reserved....

  17. Severe Gastrointestinal Bleeding in a Patient With Subvalvular Aortic Stenosis Treated With Thalidomide and Octreotide: Bridging to Transcoronary Ablation of Septal Hypertrophy.

    Science.gov (United States)

    Hvid-Jensen, Helene S; Poulsen, Steen H; Agnholt, Jorgen S

    2015-11-01

    Gastrointestinal bleeding (GB) due to angiodysplasias can cause severe, recurrent bleeding, especially in elderly patients. Angiodysplastic bleedings in the gastrointestinal tract have been associated with aortic stenosis and, more recently, hypertrophic obstructive cardiomyopathy, caused by an acquired coagulopathy known as Heyde's syndrome. Multiple factors are involved in the pathogenesis of angiodysplastic bleeding including genetic factors and increased levels of vascular intestinal growth factor at tissue levels. Endoscopic coagulation therapy is the primary treatment but often fails to resolve bleeding, especially in patients with large numbers of angiodysplasias. In patients with aortic stenosis and GB, the main treatment is aortic valve replacement but the patients may be unfit to undergo surgery due to the complicating anemia. In this case story, we present a patient with severe, GB due to hypertrophic subvalvular obstructive cardiomyopathy. Endoscopic procedures with argon beaming were performed without effect on bleeding. The patient was treated with a combination of both thalidomide and octreotide. Within 3 months, the patient recovered from the anemia and was able to undergo transcoronary ethanol ablation. No further bleeding episodes occurred, and thalidomide and octreotide were arrested. To our knowledge, this case report is the first to describe how this new drug combination therapy is an effective treatment of GB from angiodysplasias and can be used to bridge to surgical or endovascular treatment. PMID:26491506

  18. Effects of Restoration of Blood Flow on the Development of Aortic Atherosclerosis in ApoE−/− Mice With Unilateral Renal Artery Stenosis

    OpenAIRE

    Pathak, Alokkumar S.; Huang, Jianhua; Rojas, Mauricio; Bazemore, Taylor C.; Zhou, Ruihai; Stouffer, George A.

    2016-01-01

    Background Chronic unilateral renal artery stenosis (RAS) causes accelerated atherosclerosis in apolipoprotein E–deficient (ApoE−/−) mice, but effects of restoration of renal blood flow on aortic atherosclerosis are unknown. Methods and Results Male ApoE−/− mice underwent sham surgery (n=16) or had partial ligation of the right renal artery (n=41) with the ligature being removed 4 days later (D4LR; n=6), 8 days later (D8LR; n=11), or left in place for 90 days (chronic RAS; n=24). Ligature rem...

  19. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... surgery in our community. Aortic stenosis is a process by which the aortic valve, which is the ... and does not open easily or appropriately. This process starts out as a disease we call aortic ...

  20. Ross-Konno and Endocardial Fibroelastosis Resection After Hybrid Stage I Palliation in Infancy: Successful Staged Left-Ventricular Rehabilitation and Conversion to Biventricular Circulation After Fetal Diagnosis of Aortic Stenosis

    OpenAIRE

    Moon-Grady, Anita J.; Moore, Phillip; Azakie, Anthony

    2010-01-01

    We report a patient who presented during fetal life with severe aortic stenosis, left-ventricular dysfunction, and endocardial fibroelastosis (evolving hypoplastic left heart syndrome). Management involved in utero and postnatal balloon aortic valvuloplasty for partial relief of obstruction and early postnatal hybrid stage I palliation until recovery of left-ventricular systolic function had occurred. The infant subsequently had successful conversion to a biventricular circulation by combinin...

  1. Study on the dynamic change of endothelin and the effect of treatment by captopril in the development of stenosis of aorta after balloon injury in rabbits

    International Nuclear Information System (INIS)

    Objective: To study the dynamic change of endothelin (ET) in the blood, the pathological change, and the ET-IR (ET-immunoreaction, ET-IR) in the development of stenosis after balloon injury of rabbit aorta, and to investigate the effect of captopril on the prevention of restenosis after transluminal angioplasty. Methods: According to the different time of being killed after micro-balloon angioplasty, 48 rabbits were divided randomly into 6 groups such as 6-hour group, 1-day group, 3-day group, 7-day group, 15-day group, and 22-day group. 6 out of 8 rabbits of each group were created models of aortic endothelium injury by micro-balloon angioplasty, and 3 of them were given captopril (2 mg·kg-1·d-1 p. o.) from 1 day before balloon injury to the day being killed. The rest 2 rabbits in each group were controls. ET level in the plasma was measured by ELISA before, as well as after micro-balloon angioplasty, and pathomorphological examination of local aorta was carried out to observe the intimal thickness and the extent of lumen stenosis, and ET-IR was assessed by immunohistochemical technique in the aortic wall. Results: (1) The major change of vascular stenosis was the proliferation of vascular smooth muscle cell (VSMC) and endothelium. (2) ET levels in the plasma and ET-IR in the local aortic wall were significantly increased after micro-balloon angioplasty. (3) The intimal thickness and extent of lumen stenosis in the group of medical treatment by captopril were significantly lower than those in injury group. Conclusions: The experimental results show that the major pathologic change of vascular stenosis is the significant proliferation of VSMC and endothelium. Further more, ET is a key factor in the development of vascular stenosis, and captopril can prevent restenosis after angioplasty. (author)

  2. Detection of coronary artery disease by thallium imaging using a combined intravenous dipyridamole and isometric handgrip test in patients with aortic valve stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Huikuri, H.V.; Korhonen, U.R.; Ikaeheimo, M.J.H.; Heikkilae, J.T.; Takkunen, J.T.

    1987-02-01

    Detection of coronary artery disease (CAD) in patients with aortic valve stenosis (AS) is clinically difficult. Thallium-201 images were generated in 27 patients with AS during combined intravenous dipyridamole and handgrip test, which induces a marked acute increase in coronary blood flow. Isolated AS was noted in 21 patients and combined AS and aortic regurgitation in 6. Thirteen patients had more than 50% diameter stenosis in 1 or more coronary arteries on angiography. Eleven of them had reversible perfusion defects on post-stress thallium scans (sensitivity 85%). Two patients had thallium defects without angiographic evidence of significant CAD (specificity 86%). In the other 12 patients with normal coronary angiographic findings, the thallium scans were normal. Two patients had dizziness and hypotension after dipyridamole infusion, which disappeared during the handgrip test; 2 others had chest pain during handgrip. One of them was treated with aminophylline and the other with aminophylline and nitroglycerin. No other adverse effects were reported by the patients and no major complications occurred during stress testing. Thus, thallium imaging during combined intravenous dipyridamole and handgrip test appears to be a promising noninvasive method of revealing CAD in patients with AS.

  3. Prognostic value of circulating microRNA-210 levels in patients with moderate to severe aortic stenosis.

    Directory of Open Access Journals (Sweden)

    Helge Røsjø

    Full Text Available Circulating micro-RNAs have been proposed as a novel class of cardiovascular (CV biomarkers, but whether they meet analytical requirements and provide additional information to establish risk indices have not been established. miR-210 levels are increased in subjects with low VO2 max, which is a recognized risk factor in patients with aortic stenosis (AS, and we hypothesized that circulating miR-210 levels may be increased in patients with AS and associated with a poor prognosis.We measured circulating miR-210 levels by real-time PCR in 57 patients with moderate to severe AS and in 10 age- and gender-matched healthy controls. The merit of miR-210 as a biomarker was assessed according to established criteria, including by comparing miR-210 levels with NT-proBNP and miR-22 levels, which is another miRNA biomarker candidate.All patients and control subjects had miR-210 levels within the range of detection (Cq<35 and the analytical variability was low. Circulating miR-210 levels were 2.0±0.2 [mean±SEM] fold increased in AS patients compared to controls (p = 0.002, whereas miR-22 levels were not differently expressed in the AS patients (0.12±0.06 fold increase, p = 0.45. The increase in miR-210 levels in AS patients was comparable to the increment in NT-proBNP levels: [AUC] 0.82 (95% CI 0.70-0.90 vs. 0.85 (0.75-0.93, respectively, p = 0.71. During a median follow-up of 1287 days, 15 patients (26% died. There was a significant association between higher circulating levels of miR-210 and increased mortality during follow-up: hazard ratio [supra- vs. inframedian levels] 3.3 (95% CI 1.1-10.5, p = 0.039. Adjusting for other risk indices in multivariate analysis did not attenuate the prognostic merit of circulating miR-210 levels.Circulating miR-210 levels are increased in patients with AS and provide independent prognostic information to established risk indices. Analytical characteristics were also excellent supporting the potential of

  4. Aortic valve bypass

    DEFF Research Database (Denmark)

    Lund, Jens T; Jensen, Maiken Brit; Arendrup, Henrik; Ihlemann, Nikolaj

    2013-01-01

    In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI...

  5. Relationship of PON1 192 and 55 gene polymorphisms to calcific valvular aortic stenosis

    DEFF Research Database (Denmark)

    Moura, Luis M; Faria, Susana; Brito, Miguel;

    2012-01-01

    Paraoxonases may exert anti-atherogenic action by reducing lipid peroxidation. Previous studies examined associations between polymorphisms in the paraoxonase 1 (PON1) gene and development of coronary artery disease (CAD), with inconsistent results. Given the similarities in clinical and pathophy...

  6. Comparison of 1-Year Outcome in Patients With Severe Aorta Stenosis Treated Conservatively or by Aortic Valve Replacement or by Percutaneous Transcatheter Aortic Valve Implantation (Data from a Multicenter Spanish Registry).

    Science.gov (United States)

    González-Saldivar, Hugo; Rodriguez-Pascual, Carlos; de la Morena, Gonzalo; Fernández-Golfín, Covadonga; Amorós, Carmen; Alonso, Mario Baquero; Dolz, Luis Martínez; Solé, Albert Ariza; Guzmán-Martínez, Gabriela; Gómez-Doblas, Juan José; Jiménez, Antonio Arribas; Fuentes, María Eugenia; Gay, Laura Galian; Ortiz, Martin Ruiz; Avanzas, Pablo; Abu-Assi, Emad; Ripoll-Vera, Tomás; Díaz-Castro, Oscar; Osinalde, Eduardo P; Martínez-Sellés, Manuel

    2016-07-15

    The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p <0.001). The 2 main reasons to choose conservative management were the absence of significant symptoms (136% to 29.1%) and the presence of co-morbidity (128% to 27.4%). During 1-year follow-up, 132 patients died (18.2%). The main causes of death were heart failure (60% to 45.5%) and noncardiac diseases (46% to 34.9%). One-year survival for patients treated conservatively, with TAVI, and with AVR was 76.3%, 94.9%, and 92.5%, respectively, p <0.001. One-year survival of patients treated conservatively in the absence of significant symptoms was 97.1%. In conclusion, most patients with severe AS are treated conservatively. The outcome in asymptomatic patients managed conservatively was acceptable. Management in tertiary hospitals is associated with valve intervention. One-year survival was similar with both interventional strategies. PMID:27239021

  7. Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis

    DEFF Research Database (Denmark)

    Ersboll, Mads; Samad, Zainab; Al Enezi, Fawaz;

    2015-01-01

    BACKGROUND: Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population. METHODS AND RESULTS: We identified the temporal trends in referral patterns, disease severity, and assoc...... risk at referral. Health-care resource planning should account for an increasing number of patients in need of high-risk aortic valve replacements in the near future....... associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased...... significantly over time (P = 0.009) with the most substantial increase occurring from 2010 and onward. Median age upon referral (P < 0.001) and attendant predicted surgical risk (P < 0.001) increased significantly in the observation period among patients with a finding of severe AS. Among patients with a...

  8. Case Study: Giant Cell Arteritis with Vertebral Artery Stenosis

    OpenAIRE

    Daniel Chomlak, R.; Ghazanfari, Farshad; Datta, Mineesh

    2016-01-01

    In giant cell arteritis (GCA), involvement of the vertebral arteries is rare with reported rates of 3%–4% for ischemic events secondary to vertebral artery stenosis or occlusion for those patients with GCA. This case study describes a patient who initially presented with acute onset of vertigo but was also found to have transient, side-alternating upper limb neurological findings. While initial imaging showed no vascular abnormalities, it was not until GCA was eventually confirmed with a temp...

  9. Haemodynamics in microarterial stenosis: an experimental study in rats using the Doppler technique.

    Science.gov (United States)

    Hoynck van Papendrecht, A; Van Bemmelen, P; Nieuborg, L

    1983-01-01

    Little is known about the effects of stenosis on the blood flow in small arteries. The purpose of this study was to determine the critical stenosis in the rat aorta. Artificial stenoses were deliberately created in the aorta and the influence on the blood flow through the femoral arteries was measured using a non-invasive Doppler technique. The degree of stenosis was assessed by microarteriographic and casting techniques. The use of the Doppler device proved to be a simple and reliable technique and the critical stenosis level was found to be 40%. In cases of severe stenosis an increase in the collateral circulation was seen. PMID:6821736

  10. Assessment of coronary artery disease using coronary computed tomography angiography in patients with aortic valve stenosis referred for surgical aortic valve replacement

    DEFF Research Database (Denmark)

    Larsen, Linnea Hornbech; Kofoed, K Fuglsang; Dalsgaard, M;

    2013-01-01

    were performed blinded to each other. RESULTS: The mean±SD age of the included patients was 71±9years and 59% were male. The prevalence of significant coronary artery stenosis >70% by ICA was 36%. Average heart rate during coronary CTA was 65±16bpm. In a patient based analysis 94% of the patients (171...

  11. Delayed hyperenhancement in magnetic resonance imaging of left ventricular hypertrophy caused by aortic stenosis and hypertrophic cardiomyopathy: visualisation of focal fibrosis

    Science.gov (United States)

    Debl, K; Djavidani, B; Buchner, S; Lipke, C; Nitz, W; Feuerbach, S; Riegger, G; Luchner, A

    2006-01-01

    Objective To compare the extent and distribution of focal fibrosis by gadolinium contrast‐enhanced magnetic resonance imaging (MRI; delayed hyperenhancement) in severe left ventricular (LV) hypertrophy in patients with pressure overload caused by aortic stenosis (AS) and with genetically determined hypertrophic cardiomyopathy (HCM). Methods 44 patients with symptomatic valvular AS (n  =  22) and HCM (n  =  22) were studied. Cine images were acquired with fast imaging with steady‐state precession (trueFISP) on a 1.5 T scanner (Sonata, Siemens Medical Solutions). Gadolinium contrast‐enhanced MRI was performed with a segmented inversion–recovery sequence. The location, extent and enhancement pattern of hyperenhanced myocardium was analysed in a 12‐segment model. Results Mean LV mass was 238.6 (SD 75.3) g in AS and 205.4 (SD 80.5) g in HCM (p  =  0.17). Hyperenhancement was observed in 27% of patients with AS and in 73% of patients with HCM (p < 0.01). In AS, hyperenhancement was observed in 60% of patients with a maximum diastolic wall thickness ⩾ 18 mm, whereas no patient with a maximum diastolic wall thickness < 18 mm had hyperenhancement (p < 0.05). Patients with hyperenhancement had more severe AS than patients without hyperenhancement (aortic valve area 0.80 (0.09) cm2v 0.99 (0.3) cm2, p < 0.05; maximum gradient 98 (22) mm Hg v 74 (24) mm Hg, p < 0.05). In HCM, hyperenhancement was predominant in the anteroseptal regions and patients with hyperenhancement had higher end diastolic (125.4 (36.9) ml v 98.8 (16.9) ml, p < 0.05) and end systolic volumes (38.9 (18.2) ml v 25.2 (1.7) ml, p < 0.05). The volume of hyperenhancement (percentage of total LV myocardium), where present, was lower in AS than in HCM (4.3 (1.9)% v 8.6 (7.4)%, p< 0.05). Hyperenhancement was observed in 4.5 (3.1) and 4.6 (2.7) segments in AS and HCM, respectively (p  =  0.93), and the enhancement

  12. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... aortic stenosis and even tricuspid stenosis from rheumatic causes are much more common. To expand upon that ... out of the bloodstream and is thought to cause less untoward effects to the brain and other ...

  13. Differences in cardiovascular risk profile between electrocardiographic hypertrophy versus strain in asymptomatic patients with aortic stenosis (from SEAS data)

    DEFF Research Database (Denmark)

    Greve, Anders M; Gerdts, Eva; Boman, Kurt;

    2011-01-01

    -Lyon voltage and Cornell voltage-duration criteria; and strain by T-wave inversion and ST-segment depression. Degree of AS severity was evaluated by echocardiography as peak aortic jet velocity and LV mass was indexed by body surface area. After adjustment for age, gender, LV mass index, heart rate, systolic...

  14. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... who have symptomatic aortic stenosis of a severe nature. It's even been liberalized in some patient populations ... the heart. The aortic valve, because of its nature being in back of the heart, is not ...

  15. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... up offering patients aortic valve surgery in our community. Aortic stenosis is a process by which the ... basic valve types that we use in our practice, those being tissue valves and mechanical valves. Tissue ...

  16. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... North Carolina. My name is John Streitman and I'm a cardiothoracic surgeon here at the Heart ... the corrective surgery of aortic valve replacement. If I have aortic stenosis, are there any activities that ...

  17. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... conditions or other significant medical problems, the American College of Cardiology recommends aortic valve replacement for basically ... more likely we see aortic stenosis. Again, patient education is part of the evaluation and management of ...

  18. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... see aortic stenosis in patients younger, in their 40s and 50s, if they have congenitally bicuspid, or ... a year and, you know, probably 30 to 40 minimally invasive aortic valve replacements a year. So ...

  19. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... Hospital in Pinehurst, North Carolina. During the program, it's easy for you to learn about the procedure. ... the aortic valve, and proceeds to aortic stenosis. It's really not felt to be due to wear ...

  20. Recent developments for surgical aortic valve replacement: the concept of sutureless valve technology

    OpenAIRE

    Carrel, Thierry; Englberger, Lars; Stalder, Mario

    2013-01-01

    Aortic stenosis has become the most frequent type of valvular heart disease in Europe and North America and presents in the large majority of patients as calcified aortic stenosis in adults of advanced age. Surgical aortic valve replacement has been recognized to be the definitive therapy which improves considerably survival for severe aortic stenosis since more than 40 years. In the most recent period, operative mortality of isolated aortic valve replacement for aortic stenosis varies betwee...

  1. Puérpera com trombose de prótese mecânica e estenose supravalvar aórtica adquirida Postpartum patient with thrombosis of mechanical prostheses and acquired supravalvular aortic stenosis

    Directory of Open Access Journals (Sweden)

    Ricardo Adala Benfatti

    2011-06-01

    Full Text Available A hipercoagulabilidade sanguínea proporcionada na gravidez aumenta consideravelmente a incidência de trombose de valvas mecânicas. A estenose supravalvar aórtica adquirida é extremamente rara. Relata-se o caso de uma puérpera imediata, portadora de prótese mecânica aórtica e estenose supravalvar aórtica adquirida, submetida à cirurgia cardíaca de emergência, com instabilidade hemodinâmica grave, por meio de técnica operatória adaptada para a correção da estenose supravalvar aórtica, com evolução clínica e resultados ecocardiográficos pós-operatórios satisfatórios.The blood hypercoagulability in pregnancy increases significantly the incidence of thrombosis of mechanical valves. Acquired supravalvular aortic stenosis is extremely rare. We report the case of an immediate postpartum patient with aortic mechanical prostheses and acquired supravalvular aortic stenosis who underwent emergency heart surgery, with severe hemodynamic instability, using adapted surgical technique for correction of supravalvular stenosis with satisfactory clinical and echocardiography results.

  2. A case of William's syndrome associated peripheral pulmonary arterial stenosis

    International Nuclear Information System (INIS)

    William's syndrome, in order to more completely delineate the total spectrum of the disorder, indicates that 'infantile hypercalcemia', 'peculiar facies' and 'supravalvular aortic stenosis.' In has other many vascular anomalies, such as peripheral pulmonary arterial stenosis, coronary arterial stenosis, celiac arterial stenosis, and renal aterial stenosis. Only 32% of the patients have evidence of supravalvular aortic stenosis. And it is very rare disease entity that has been reported rarely in Korea. Recently authors experienced a case that was questioned William's syndrome with peripheral pulmonary arterial stenosis, clinically and preliminary radiologically and this case was confirmed by operation. Here we report a case of William's syndrome with peripheral pulmonary arterial stenosis and reviewed literatures

  3. Cardiovascular syphilis with coronary stenosis and aneurysm.

    Science.gov (United States)

    Tewari, Satyendra; Moorthy, Nagaraja

    2014-01-01

    Cardiovascular manifestations of tertiary syphilis include aortitis, aortic root dilation, aneurysm formation, aortic regurgitation, and coronary ostial stenosis. Coronary ostial lesions have been detected in as many as 26% of patients with syphilitic aortitis. However nonostial coronary stenosis and coronary aneurysms in same patient is rarely described in cardiovascular syphilis. PMID:25634420

  4. Case Study: Giant Cell Arteritis with Vertebral Artery Stenosis

    Science.gov (United States)

    Daniel Chomlak, R.; Ghazanfari, Farshad; Datta, Mineesh

    2016-01-01

    In giant cell arteritis (GCA), involvement of the vertebral arteries is rare with reported rates of 3%–4% for ischemic events secondary to vertebral artery stenosis or occlusion for those patients with GCA. This case study describes a patient who initially presented with acute onset of vertigo but was also found to have transient, side-alternating upper limb neurological findings. While initial imaging showed no vascular abnormalities, it was not until GCA was eventually confirmed with a temporal artery biopsy that the initial scans were shown to have bilateral narrowing of the vertebral arteries. While rare, vertebral artery involvement is an important complication to consider in the setting of GCA due to the high rate of associated mortality, despite immunosuppressive therapy. PMID:27279753

  5. Left ventricular filling pressure estimation at rest and during exercise in patients with severe aortic valve stenosis: comparison of echocardiographic and invasive measurements

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Kjaergaard, Jesper; Pecini, Redi;

    2009-01-01

    . PCWP, E/e'(septal), and E/e'(lateral) were determined simultaneously by echocardiography at rest and at maximal tolerated workload. RESULTS: PCWP increased significantly from 18+/-8 mm Hg at rest to 39+/-10 mm Hg at peak exercise (P < .0001). E, e'(septal), and e'(lateral) increased with exercise...... exercise (r=0.66, P=.0003, and r=0.47, P=.02, respectively), with nearly similar slopes of the linear regression lines. The intercepts, however, increased by 18 mm Hg (P=.01) and by 19 mm Hg (P=.01) at peak exercise, respectively. Changes in E/e'(septal) and E/e'(lateral) were not related to changes in...... for the lateral side were r=0.50 (P=.01) and r=0.44 (P=.03), respectively. CONCLUSIONS: E/e' is well correlated with PCWP at rest. However, E/e' cannot be used to detect exercise-induced changes in PCWP in patients with severe aortic stenosis. Using the ratio of E during exercise to e' at rest may...

  6. frequency of severe mitral stenosis in young female patients having pure mitral stenosis secondary to rheumatic heart disease

    International Nuclear Information System (INIS)

    High morbidity and mortality due to Rheumatic heart disease (RHD) associated with females is mainly because of late diagnosis on one hand and socioeconomic reasons on the other hand. Poor referral to tertiary care centres leads to delayed diagnosis which results in complications. The objectives of this cross-sectional descriptive study was to assess the frequency of severe mitral stenosis in woman of child bearing age, having pure mitral stenosis (MS) secondary to rheumatic heart disease. Methods: Two hundred and fifty women of child bearing age with RHD were enrolled in the study using consecutive non-probability sampling technique. Out of these 250 patients, cases of pure MS were selected. Patients with associated mitral regurgitation and aortic valve disease were excluded. After admission, assessment of mitral valve stenosis was done with 2D colour Doppler echocardiography. Results: Out of 250 consecutive patients of rheumatic carditis, 110 (44%) patients had pure mitral valve stenosis, 85 (34%) had stenosis with mitral regurgitation and 55 (22%) patients had both mitral and aortic valve problem of varying severity. Among 110 patients with pure mitral valve stenosis, 48 (43.6%) had severe mitral valve stenosis. Severe mitral valve gradient (MVG) and high pulmonary artery pressure (PAP) was observed in 66 (60%) and 49 (44.5%) of the patients respectively. Conclusion: This high frequency can be linked to lack of early detection of the disease at primary level, poor management of throat infections and poor rheumatic fever prophylaxis at community level. (author )

  7. A historical prospective cohort study of carotid artery stenosis after radiotherapy for head and neck malignancies

    International Nuclear Information System (INIS)

    Purpose: To determine carotid artery stenosis incidence after radiotherapy for head-and-neck neoplasms. Methods and Materials: This historical prospective cohort study comprised 44 head-and-neck cancer survivors who received unilateral neck radiotherapy between 1974 and 1999. They underwent bilateral carotid duplex ultrasonography to detect carotid artery stenosis. Results: The incidence of significant carotid stenosis (8 of 44 [18%]) in the irradiated neck was higher than that in the contralateral unirradiated neck (3 of 44 [7%]), although this difference was not statistically significant (p = 0.13). The rate of significant carotid stenosis events increased as the time after radiotherapy increased. The risk of ipsilateral carotid artery stenosis was higher in patients who had undergone a neck dissection vs. those who had not. Patients with significant ipsilateral stenosis also tended to be older than those without significant stenosis. No other patient or treatment variables correlated with risk of carotid artery stenosis. Conclusions: For long-term survivors after neck dissection and irradiation, especially those who are symptomatic, ultrasonographic carotid artery screening should be considered

  8. Bilateral coronary ostial stenosis secondary to syphilitic aortitis.

    Science.gov (United States)

    Cheng, Zhaoping; Zhao, Shihua; Bi, Wanli; Wang, Ximing

    2014-01-01

    Cardiovascular syphilis is associated with the tertiary stage of syphilis infection; it involves the ascending aorta and can cause aortic aneurysm, aortic regurgitation, and coronary ostial stenosis. We report here a case in which bilateral coronary ostial stenosis and aortic regurgitation due to syphilitic aortitis was diagnosed; coronary artery bypass graft was then performed. PMID:25151925

  9. Short-term and medium-term outcomes of transapical aortic valve implantation as a single-strategy approach: one center's experience

    OpenAIRE

    Čanádyová, Júlia; Mokráček, Aleš; Pešl, Ladislav; KURFIRST, Vojtěch; Šulda, Mirek

    2015-01-01

    Introduction Transcatheter aortic valve replacement has been developed as an alternative option for surgical high-risk or inoperable patients with severe symptomatic aortic stenosis. Aim of the study Aim of the study was to evaluate the outcomes of patients undergoing transapical aortic valve replacement as a single-strategy option by a single-center multidisciplinary heart team. Material and methods Between June 2009 and December 2014, 41 patients underwent transapical transcatheter aortic v...

  10. Diabetes Mellitus, a New Risk Factor for Lumbar Spinal Stenosis: A Case–Control Study

    Science.gov (United States)

    Asadian, Leila; Haddadi, Kaveh; Aarabi, Mohsen; Zare, Amirhossein

    2016-01-01

    OBJECTIVES This study aimed to determine the prevalence of diabetes mellitus in patients with spinal stenosis and lumbar vertebral disk degeneration, and the correlation of diabetes with these diseases. STUDY DESIGN This is a cross-sectional study. METHODS This case–control study was performed during 2012–2014 with 110 patients suffering from lumbar spinal stenosis and 110 patients with lumbar disk herniation, who were diagnosed using clinical and radiological evidences. Additionally, 110 participants who were referred to the clinic and did not show clinical signs of degenerative diseases of the lumbar spine entered the study as a control group. Demographic data and medical histories of the patients were collected using checklists. RESULTS A total of 50 patients (15.2%) were diagnosed with diabetes, which comprised 32 (29.1%) in the stenosis group, 7 (6.4%) in the lumbar disk herniation group, and 11 (10%) in the control group. The prevalence of diabetes in women with spinal stenosis and women with lumbar disk herniation was 35.9% and 10.3%, respectively, whereas prevalence of diabetes in women was 10.9% in the control group. This difference was statistically significant in the spinal stenosis group in comparison with the controls (P diabetes and lumbar spinal stenosis. Diabetes mellitus may be a predisposing factor for the development of lumbar spinal stenosis.

  11. Unicuspid aortic valve disease: a magnetic resonance imaging study

    Energy Technology Data Exchange (ETDEWEB)

    Debl, K.; Buchner, S.; Heinicke, N.; Riegger, G.; Luchner, A. [Klinik und Poliklinik fuer Innere Medizin II, Universitaetsklinikum Regensburg (Germany); Djavidani, B.; Poschenrieder, F.; Feuerbach, S. [Inst. fuer Roentgendiagnostik, Universitaetsklinikum Regensburg (Germany); Schmid, C.; Kobuch, R. [Klinik und Poliklinik fuer Herz-, Thorax- und herznahe Gefaesschirurgie, Universitaetsklinikum Regensburg (Germany)

    2008-11-15

    Purpose: congenitally malformed aortic valves are a common finding in adults with aortic valve disease. Most of these patients have bicuspid aortic valve disease. Unicuspid aortic valve disease (UAV) is rare. The aim of our study was to describe valve morphology and the dimensions of the proximal aorta in a cohort of 12 patients with UAV in comparison to tricuspid aortic valve disease (TAV) using magnetic resonance imaging (MRI). Materials and methods/results: MRI studies were performed on a 1.5 T scanner in a total of 288 consecutive patients with aortic valve disease. 12 aortic valves were retrospectively classified as UAV. Annulus areas and dimensions of the thoracic aorta were retrospectively compared to a cohort of 103 patients with TAV. In UAV, valve morphology was unicuspid unicommissural with a posterior commissure in all patients. Mean annulus areas and mean diameters of the ascending aorta were significantly greater in UAV compared to TAV (12.6 {+-} 4.7 cm{sup 2} vs. 8.7 {+-} 2.3 cm{sup 2}, p < 0.01 and 4.6 {+-} 0.7 cm vs. 3.6 {+-} 0.5 cm, p < 0.0001, respectively), while no differences were observed in the mean diameters of the aortic arch (2.3 {+-} 0.6 cm vs. 2.3 {+-} 0.4 cm, p = 0.69). The diameters of the descending aorta were slightly smaller in UAV compared to TAV (2.2 {+-} 0.5 cm vs. 2.6 {+-} 0.3 cm, p < 0.05). (orig.)

  12. Unicuspid aortic valve disease: a magnetic resonance imaging study

    International Nuclear Information System (INIS)

    Purpose: congenitally malformed aortic valves are a common finding in adults with aortic valve disease. Most of these patients have bicuspid aortic valve disease. Unicuspid aortic valve disease (UAV) is rare. The aim of our study was to describe valve morphology and the dimensions of the proximal aorta in a cohort of 12 patients with UAV in comparison to tricuspid aortic valve disease (TAV) using magnetic resonance imaging (MRI). Materials and methods/results: MRI studies were performed on a 1.5 T scanner in a total of 288 consecutive patients with aortic valve disease. 12 aortic valves were retrospectively classified as UAV. Annulus areas and dimensions of the thoracic aorta were retrospectively compared to a cohort of 103 patients with TAV. In UAV, valve morphology was unicuspid unicommissural with a posterior commissure in all patients. Mean annulus areas and mean diameters of the ascending aorta were significantly greater in UAV compared to TAV (12.6 ± 4.7 cm2 vs. 8.7 ± 2.3 cm2, p < 0.01 and 4.6 ± 0.7 cm vs. 3.6 ± 0.5 cm, p < 0.0001, respectively), while no differences were observed in the mean diameters of the aortic arch (2.3 ± 0.6 cm vs. 2.3 ± 0.4 cm, p = 0.69). The diameters of the descending aorta were slightly smaller in UAV compared to TAV (2.2 ± 0.5 cm vs. 2.6 ± 0.3 cm, p < 0.05). (orig.)

  13. Modificação técnica na cirurgia da estenose aórtica supravalvar New tecnical modification for supravalvar aortic stenosis surgical treatment

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Bento de Souza

    1992-06-01

    aorta de aspecto anatômico e dimensões normais. Todos os casos, tiveram evolução favorável. Atualmente, com um período de pós-operatório de até seis meses, estão assintomáticosThe standard surgical treatment of the supravalvar aortic stenosis is characterized by the ampliation of one or more sinus of Valsalva utilizing patch of prosthetic material (Dacron, bovine pericardium with or without transsection of the aorta. One possible limitation on late results with these procedures is the fact of graft thickening or calcification, difficulting the aortic root growing, mainly when the patient is a child. In order to avoid this complication, we propose a new technical modification that effectivelly increases the aortic diameter, without the use of prosthetic material, using only the normal ascending aortic wall to reconstruct and enlarge the stenotic area. We performed this procedure in 4 patients with ages ranging from 23 months to 38 years old (m - 14, 5, Y. O,, weighing from 10 to 56 kg (m - 26,2 kg. The three young patients had sings of Williams syndrome. The gradients between left ventricle and aorta were 50, 70, 100 and 100 mmHg. Cristaloid cardioplegia was infunded antegrately. The ascending aorta was entirely mobilized. After aortic transsection immediately above the stenotic point, we made vertical incisions from the free edge to the botton of the Valsalva sinuses. Sometimes the size and position of the left coronary ostium impedes the incision on the left Valsalva sinus. On the distal aorta we made three longitudinal incisions in the position corresponding to the comissures of the aortic valve. Suturing these two parts we reconstructed the aortic root anatomicaly. The four patients had uneventful hospitalization and were discharged in good clinical condition. With a follow-up from 1 to 6 months, all the patients are assymptomatic.

  14. Diabetes Mellitus, a New Risk Factor for Lumbar Spinal Stenosis: A Case–Control Study

    OpenAIRE

    Leila Asadian; Kaveh Haddadi; Mohsen Aarabi; Amirhossein Zare

    2016-01-01

    OBJECTIVES This study aimed to determine the prevalence of diabetes mellitus in patients with spinal stenosis and lumbar vertebral disk degeneration, and the correlation of diabetes with these diseases. STUDY DESIGN This is a cross-sectional study. METHODS This case–control study was performed during 2012–2014 with 110 patients suffering from lumbar spinal stenosis and 110 patients with lumbar disk herniation, who were diagnosed using clinical and radiological evidences. Additionally, 110 par...

  15. Association between Carotid Artery Stenosis and Cognitive Impairment in Stroke Patients: A Cross-Sectional Study.

    Directory of Open Access Journals (Sweden)

    Wei Yue

    Full Text Available To investigate potential associations between carotid artery stenosis and cognitive impairment among patients with acute ischemic stroke and to provide important clinical implications. We measured the degree of carotid artery stenosis and recorded the Mini-Mental State Examination score (MMSE at admission in 3116 acute ischemic stroke patients. The association between carotid stenosis and cognitive impairment assessed by MMSE was tested using multivariate regression analysis. Other clinical variables of interest were also studied. After adjusting for age, gender, education level, marriage, alcohol use, tobacco use, physical activity, hypertension, diabetes, hypercholesterolemia, atrial fibrillation, myocardial infarction and NIHSS (National Institutes of Health Stroke Scale score, we found that participants with high-grade stenosis of the carotid artery had a higher likelihood of cognitive impairment compared to those without carotid artery stenosis (OR = 1.49, 95%CI: 1.05-2.11, p<0.001. Left common carotid artery stenosis was associated with cognitive impairment in the univariate analysis, although this effect did not persist after adjustment for the NIHSS score. Cognitive impairment was associated with high-grade stenosis of the right carotid artery.

  16. Two Portal Percutaneous Endoscopic Decompression for Lumbar Spinal Stenosis: Preliminary Study

    OpenAIRE

    Torudom, Yingyong; Dilokhuttakarn, Thitinut

    2016-01-01

    Study Design Retrospective. Purpose To report the outcomes of patients with lumbar spinal stenosis treated with percutaneous endoscopic decompression, focusing on the results of clinical evaluations. Overview of Literature There are no studies about two portal percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis. Methods Medical and surgical complications were examined and clinical results were analyzed for 30 patients who consecutively underwent two portal percuta...

  17. A clinical study of thrombectomy and interventional treatment of iliac vein stenosis concomitant with thrombosis

    International Nuclear Information System (INIS)

    Objective: To study the effect of thrombectomy and interventional treatment of iliac vein stenosis concomitant with thrombosis. Methods: We adopt filter placing, thrombectomy, provistionality artery vein fistula and implanted stents and balloon-expansion to treat patients. Results: Symptoms disappeared in 18 patients, were significantly improved in 3 patients. Conclusion: The effect of thrombectomy and interventional treatmen of iliac vein stenosis concomitant with thrombosis is safe and satisfactory. (authors)

  18. LUMBAR SPINAL STENOSIS. A REVIEW OF BIOMECHANICAL STUDIES

    Institute of Scientific and Technical Information of China (English)

    戴力扬; 徐印坎

    1998-01-01

    ObjectS. To investigate the biomechanical aspects of etiology, pathology, clinical manifestation, diagnosis and surgical treatment of the lumbar spinal stenosis. Methods. A series of biomechanical methods, such as three-dimensional finite element models, threedimensional kinematic measurement, cadeveric evaluation, and imaging assessment was applied to correlate lumbar biomechanics and lumber spinal stenosls. Surgery of lumber spinal stenosis has been improved. Results.The stresses significantly concentrate on the posterolateral part of the annulus fibrcsms of disc, the posterior surface of vertebral body, the pedlcle, the interarticularis and the beet joints. This trend is intensified by disc degeneration and lumber backward extension. Posterior elcxnent resection has a definite effect upon the biomechanical behavior of lumbar vertebrae. The improved operations proved satisfactory. Conclusion. Stress concentration in the lumber vertebrae is of importance to the etiology of degenerative lumbar spinal stenosls, and disc degeneratkm is the initial key of this process. Than these will be aggravatnd by backward extension. Functloval radiography and myelography are of assistance to the diagnosis of the lumhar spinal stenosls. For the surgcal treatment of the lumber spinal stenosis, destruction of the posterior element should be avoid as far as possible based upon the thorough decmnpression. Maintaining the lumbar spine in flexion by fusion after decorapression has been proved a useftd method. When developmental spinal stenoals is combined with disc herniation, discectoray through laminotomy is recommend for decompression.

  19. Left ventricular muscle mass regression after aortic valve replacement.

    OpenAIRE

    Lee, J. W.; Choi, K. J.; Lee, S G; Choo, S. J.; Kim, J.O.; Kang, D H; Song, J.K.; Song, M. G.

    1999-01-01

    Implanting a valve that will reduce left ventricular mass is critical in aortic stenosis. Regression of left ventricular hypertrophy in 46 aortic valve replacement (AVR) patients receiving a St. Jude Medical (SJM) valve was assessed by serial electrocardiographic and echocardiographic studies during the preoperative, immediate, and late postoperative periods. The patients were divided into three groups according to valve size; 19 mm group (n=9), 21 mm group (n=20), and 23+mm group (n=17). The...

  20. Efectos del ejercicio isométrico sobre la función diastólica en pacientes con estenosis aortica severa Effect of isometric exercise on diastolic function in patients with severe aortic stenosis

    Directory of Open Access Journals (Sweden)

    M. Donato

    2003-01-01

    Full Text Available El objetivo del estudio fue determinar los efectos del ejercicio isométrico sobre la función diastólica, en pacientes con estenosis aórtica sin lesión coronaria (grupo 1, G2, n= 9 y con lesión coronaria (grupo 2, G2, n=11. Pacientes sometidos a un cateterismo cardíaco realizaron ejercicio isométrico hasta que la frecuencia cardíaca se incrementó un 32±9%, con respecto a su valor basal. Se midieron la presión sistólica ventricular izquierda (PSVI y la presión de fin de diástole (PDFVI y se calculó la constante de tiempo de caída de la presión ventricular (tau, t, y la máxima velocidad de ascenso de la presión (+dP/dt máx. La +dP/dt máx aumentó en G1 y G2, durante el ejercicio, desde un valor de 1989±190 y 2428±220 mmHg/seg, hasta un valor de 2286±214 y 2661±230 mmHg/seg, respectivamente; retornando luego a su valor basal. La PDFVI aumentó, durante el ejercicio, en G1 y G2 desde un valor de 30.1±2.7 y 26.5±2.2 mmHg hasta 38.4±1.7 y 36.1±4.0 mmHg, respectivamente (pThe objective of the study was to determine the effects of isometric exercise on the diastolic function in patients with aortic stenosis without coronary lesion (group 1, G1, n = 9 and with coronary lesion (group 2, G2, n=11. Patients subjected to a cardiac catheterization performed isometric exercise until their heart rate increased in 32±9 % compared to baseline. The left ventricular systolic pressure, the +dP/dt max, and the end diastolic pressure (LVEDP were measured, and the time constant of pressure decay (tau, t was calculated. The +dP/dt max increased in G1 and G2 during exercise, from a value of 1989±190 and 2428±220 mmHg/sec up to 2286±214 y 2661±230 mmHg/sec, respectively, returning afterwards to its baseline value. The LVEDP increased during exercise in G1 and G2 from a value of 30.1±2.7 and 26.5±2.2 mmHg up to 38.4±1.7 and 36.1±4.0 mmHg, respectively (p<0.05, returning to its baseline value only in G1. The tau (t increased during

  1. Comparison between three types of stented pericardial aortic valves (Trivalve trial): study protocol for a randomized controlled trial

    OpenAIRE

    Azarnoush, Kasra; Pereira, Bruno; Duale, Christian; Dorigo, Enrica; Farhat, Mehdi; Innorta, Andrea; Dauphin, Nicolas; Geoffroy, Etienne; Chabrot, Pascal; Camilleri, Lionel

    2013-01-01

    BackgroundAortic valve stenosis is one of the most common heart diseases in older patients. Nowadays, surgical aortic valve replacement is the 'gold standard' treatment for this pathology and the most implanted prostheses are biological ones. The three most implanted bovine bioprostheses are the Trifecta valve (St. Jude Medical, Minneapolis, MN, USA), the Mitroflow valve (Sorin Group, Saluggia, Italy), and the Carpentier-Edwards Magna Ease valve (Edwards Lifesciences, Irvine, CA, USA). We pro...

  2. Comparison between three types of stented pericardial aortic valves (Trivalve trial): study protocol for a randomized controlled trial

    OpenAIRE

    Azarnoush, Kasra; Pereira, Bruno; Dualé, Christian; Dorigo, Enrica; Farhat, Mehdi; Innorta, Andrea; Dauphin, Nicolas; Geoffroy, Etienne; Chabrot, Pascal; Camilleri, Lionel

    2013-01-01

    International audience BackgroundAortic valve stenosis is one of the most common heart diseases in older patients. Nowadays, surgical aortic valve replacement is the 'gold standard' treatment for this pathology and the most implanted prostheses are biological ones. The three most implanted bovine bioprostheses are the Trifecta valve (St. Jude Medical, Minneapolis, MN, USA), the Mitroflow valve (Sorin Group, Saluggia, Italy), and the Carpentier-Edwards Magna Ease valve (Edwards Lifesciences...

  3. An experimental and clinical study on the dissecting aortic aneurysm

    International Nuclear Information System (INIS)

    In the treatment of dissecting aortic aneurysm, it is important to understand the exact conditions of the disease. For this purpose Aortography (AOG) and X-ray computorized tomography (CT) have been used. Magnetic Resonance Imaging (MRI) and the ultrasonic pulsed Doppler duplex system are completely non-invasive and may be used instead of AOG and CT. Experimental aortic dissection was done surgically using modified Blanton's method in 8 mongrel dogs. MRI and the ultrasonic pulsed Doppler duplex system were used on these dogs before and after surgery which consisted of surgical closure of entry and insertion of Ivalon Sponge to false lumen. MRI patterns were classified into three: i.e, low, middle, and high intensity. The ultrasonic pulsed Doppler duplex system patterns were classified into four: i.e, normal flow, to and fro, turbulent flow and wall motion patterns respectively. These patterns of MRI and the ultrasonic pulsed Doppler duplex system were closely correlated to autopsy findings. These results indicated that MRI and the ultrasonic pulsed Doppler duplex system are useful to evaluate the changes of figures and hemodynamics of the false lumen. In the clinical study, MRI was performed on 26 patients of dissecting aortic aneurysm before and after surgery. These results were compared with those of AOG and CT. In the detection of the intimal flap, the main arterial branches, and the location of the entry and reentry, MRI was superior to CT and almost equal to AOG. key words: dissecting aortic aneurysm, hemodynamics of aortic dissection, the Ivalon Sponge Occlusion method, MRI, the ultrasonic pulsed Doppler duplex system. (author)

  4. Congenital Aortic Stenosis and Aneurysms

    NARCIS (Netherlands)

    D. van der Linde (Denise)

    2013-01-01

    textabstractDue to improvements in pediatric cardio-thoracic surgery, anesthesia and diagnostics over the past decades, the number of adult patients with congenital heart disease (CHD) is growing. This causes an increasing demand in clinical practice for insight in long term outcome in both non-oper

  5. Analysis of Renal Artery Stenosis in Patients with Heart Failure: A RASHEF Study

    Institute of Scientific and Technical Information of China (English)

    Bin Zheng; Qin Ma; Li-Hong Zheng; Qiang Yong; Yi-Hua He; Jing-Hua Liu

    2015-01-01

    Background:Previous data are controversial about the association of renal artery stenosis (RAS) with clinical outcome in patients with heart failure.Definition of RAS in previous studies might not be appropriate.By definition of RAS with renal duplex sonography,we investigated the association of RAS with clinical outcome in patients with heart failure.Methods:In this retrospective study,we identified 164 patients with heart failure (New York Heart Association classification ≥Ⅱ;left ventricular ejection fraction <50%) who had received renal duplex sonography during hospital stay.RAS was defined as renal-aortic ratio ≥3.5 or a peak systolic velocity ≥200 cm/s (or both),or occlusion of the renal artery.Categorical data of patients were compared using the Chi-square test or Fisher's exact test.Cox proportional hazards regression modeling technique was used to investigate the prognostic significance of possible predictors.Results:Finally,143 patients were enrolled.Median follow-up time was 32 months (1-53 months).Twenty-two patients were diagnosed as RAS by renal duplex sonography,including 13 unilateral RAS (3 left RAS,10 right RAS) and 9 bilateral RAS.There were more all-cause mortality and cardiovascular death in patients with RAS than patients without RAS.By multivariate analysis,RAS was a significant predictor for all-cause death and cardiovascular death (hazard ratio [HR] =4.155,95% confidence interval [CI]:1.546-11.164,P =0.005;and HR =3.483,95% CI:1.200-10.104,P =0.022,respectively).As for composite endpoint events,including death,nonfatal myocardial infarction,ischemic stroke or intracranial hemorrhage,rehospitalization for cardiac failure,and renal replacement therapy,only angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker was significant predictor.RAS was not a significant predictor for composite endpoint events.Conclusions:Our data suggested that RAS is associated with a poorer clinical outcome in patients with heart

  6. Is it time for medical therapy for aortic valve disease?

    OpenAIRE

    Rajamannan, Nalini M

    2004-01-01

    Calcific aortic stenosis is the most common indication for surgical valve replacement. Currently there are no medical therapies approved for the treatment of this disease. This review will summarize the clinical and experimental studies published over the past 5 years that indicate that medical therapy may be an option for this patient population.

  7. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... to requiring surgery for aortic stenosis, left ventricular hypertrophy is a common manifestation. By that, I mean generally speaking any muscle that works harder in the body gets thicker ...

  8. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... symptoms and ultimately surgery may be in the future. The symptoms seen primarily with aortic stenosis at ... echocardiography is? Echocardiography is the use of ultrasound technology. Ultrasound technology is a form of the same ...

  9. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... in severe aortic stenosis, as it's probably more stress than the patient's heart should have to undergo. ... There's been a lot of work done by academic cardiac surgeons and cardiologists to try to define ...

  10. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... more likely we see aortic stenosis. Again, patient education is part of the evaluation and management of ... for patients who would not tolerate well a traditional open operation or a less invasive operation, as ...

  11. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... more likely we see aortic stenosis. Again, patient education is part of the evaluation and management of ... likely than patients who don't have other cardiovascular conditions: coronary artery disease, peripheral vascular disease, et ...

  12. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... in severe aortic stenosis, as it's probably more stress than the patient's heart should have to undergo. ... these series, when you critically look at the literature, the operative times can be significantly longer and ...

  13. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... to minimize their symptoms, but that doesn't impact the course of the disease itself. When I' ... more likely we see aortic stenosis. Again, patient education is part of the evaluation and management of ...

  14. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... somebody for this operation. Again, there's no medical therapy that has been proven to slow or reverse ... to their physician. This may lead to earlier treatment and better outcomes as well. Aortic stenosis, as ...

  15. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... more likely we see aortic stenosis. Again, patient education is part of the evaluation and management of ... surgery we, as surgeons, know from our anatomy training during our course of training, we know where ...

  16. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... John, is there anything you can do to help prevent aortic stenosis? There's no prophylactic methods that ... very good looks. It's a great tool to help cardiac surgeons. Thanks, Jim. And I would underscore ...

  17. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... in severe aortic stenosis, as it's probably more stress than the patient's heart should have to undergo. ... in younger patients who want to return to work and activity more quickly, we feel that this ...

  18. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... No medications as such have been proven to slow that disease path life. Again, it's a progressive ... no medical therapy that has been proven to slow or reverse the process of aortic stenosis. Clearly, ...

  19. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... including heart attack and increased risk of cardiovascular death. John, is there anything you can do to ... aortic stenosis, there's a pretty rapid progression into death if no intervention is taken. We feel that ...

  20. Diagnostic capabilities of ultrasound study in stenosis of the spinal canal lumbar portion

    International Nuclear Information System (INIS)

    The performed investigations showed that ultrasound study allows easy and accurate calculation of the area of the spinal canal at the level f the disk as well as takes into consideration the characteristics of the hernia localization and its influence on the size of stenosis

  1. Primary Infrarenal Aortic Stenting With or Without Iliac Stenting for Isolated and Aortoiliac Stenoses: Single-Centre Experience With Long-Term Follow-Up

    Energy Technology Data Exchange (ETDEWEB)

    Tapping, C. R.; Ahmed, M.; Scott, P. M.; Lakshminarayan, R.; Robinson, G. J.; Ettles, D. F.; Shrivastava, V., E-mail: vivek.shrivastava@hey.nhs.uk [Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Department of Radiology (United Kingdom)

    2013-02-15

    The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 {+-} 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 {+-} -0.15 (right) and 0.61 {+-} -0.16 (left). After the procedure they were 0.86 {+-} -0.07 (right) and 0.90 {+-} -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic

  2. Unilateral and bilateral internal carotid artery stenosis or occlusion: a study of the secondary collateral circulation

    International Nuclear Information System (INIS)

    Objective: It's a study of the collateral circulation secondary to unilateral and bilateral internal carotid artery (ICA) severe stenosis or occlusion using digital subtract angiography (DSA) and magnetic resonance angiography (MRA). Methods: Ninty-five patients with ICA stenosis or occlusion were diagnosed by DSA or MRA. Forty-four patients were assessed by DSA, and fifty-one patients were evaluated by MRA, who were divided into two groups of the unilateral and bilateral involvement. DSA, MRA findings were analyzed, by which the patterns of the collateral circulation were comparatively studied. Results: The presence rate of anterior communicating artery (AcoA) in the unilateral group on DSA and MRA was significantly higher than that in the bilateral group (P0.05). On DSA, the presence rate of ophthalmic artery (OphA) in the unilateral and bilateral groups had no significant difference between the two groups. The augmentation rate of the OphA in the bilateral group was significantly higher than that in the unilateral group (P<0.05). The presence rate of leptomeningeal anastomosis in the bilateral group was significantly higher than that in the unilateral group on DSA and MRA (P<0.01). Conclusion: In patients with the unilateral and bilateral ICA stenosis or occlusion, the collateral circulation formats in different patterns. The major collateral pathways secondary to the unilateral ICA stenosis or occlusion are AcoA and ispilateral PCoA, while to the bilateral ICA stenosis or' occlusion are PCoA, OPhA, and leptomeningeal anastomosis. (authors)

  3. Study Protocol- Lumbar Epidural Steroid Injections for Spinal Stenosis (LESS: a double-blind randomized controlled trial of epidural steroid injections for lumbar spinal stenosis among older adults

    Directory of Open Access Journals (Sweden)

    Friedly Janna L

    2012-03-01

    and costs to assess cost-effectiveness of epidural steroid injection. Discussion This study is the first multi-center, double-blind RCT to evaluate the effectiveness of epidural steroid injections in improving pain and function among older adults with lumbar spinal stenosis. The study will also yield data on the safety and cost-effectiveness of this procedure for older adults. Trial Registration Clinicaltrials.gov NCT01238536

  4. Relationship of Metabolic Syndrome With Incident Aortic Valve Calcium and Aortic Valve Calcium Progression

    OpenAIRE

    Katz, Ronit; Budoff, Matthew J.; Takasu, Junichiro; Shavelle, David M; Bertoni, Alain; Blumenthal, Roger S.; Ouyang, Pamela; Wong, Nathan D.; O'Brien, Kevin D.

    2009-01-01

    OBJECTIVE Metabolic syndrome (MetS) has been associated with increased prevalence of aortic valve calcium (AVC) and with increased progression of aortic stenosis. The purpose of this study was to determine whether MetS is associated with increased risks for the development of new (“incident”) AVC or for progression of established AVC as assessed by CT. RESEARCH DESIGN AND METHODS The relationships of MetS or its components as well as of diabetes to risks for incident AVC or AVC progression we...

  5. Increased platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study.

    LENUS (Irish Health Repository)

    Kinsella, Ja

    2013-04-26

    BACKGROUND: Cerebral microembolic signals (MES) may predict increased stroke risk in carotid stenosis. However, the relationship between platelet counts or platelet activation status and MES in symptomatic versus asymptomatic carotid stenosis has not been comprehensively assessed. SETTING: University teaching hospitals. METHODS: This prospective, pilot observational study assessed platelet counts and platelet activation status, and the relationship between platelet activation and MES in asymptomatic versus early (≤4 weeks after TIA\\/stroke) and late phase (≥3 months) symptomatic moderate or severe (≥50%) carotid stenosis patients. Full blood count measurements were performed, and whole blood flow cytometry was used to quantify platelet surface activation marker expression (CD62P and CD63) and circulating leucocyte-platelet complexes. Bilateral simultaneous transcranial Doppler ultrasound monitoring of the middle cerebral arteries was performed for 1 hour to classify patients as MES-positive or MES-negative. RESULTS: Data from 31 asymptomatic patients were compared with 46 symptomatic patients in the early phase, and 35 of these patients followed up to the late phase after symptom onset. The median platelet count (211 vs. 200 x 10(9) \\/L; p=0.03) and the median% lymphocyte-platelet complexes were higher in early symptomatic than asymptomatic patients (2.8 vs. 2.4%, p=0.001). The% lymphocyte-platelet complexes was higher in early symptomatic than asymptomatic patients with ≥70% carotid stenosis (p=0.0005), and in symptomatic patients recruited within 7 days of symptom onset (p=0.028). Complete TCD data were available in 25 asymptomatic and 31 early phase symptomatic, and 27 late phase symptomatic patients. 12% of asymptomatic versus 32% of early phase symptomatic (p=0.02) and 19% of late phase symptomatic patients (p=0.2) were MES-positive. Early symptomatic MES-negative patients had a higher% lymphocyte-platelet complexes than asymptomatic MES

  6. Regulation of aortic wall mechanics and stress : An experimental study in man

    OpenAIRE

    Åstrand, Håkan

    2008-01-01

    The abdominal aorta (AA) in man is a vulnerable artery prone to atherosclerosis as well as aneurysmatic dilation. The underlying aortic composition, mechanical properties as well as the mechanisms responsible for age-related changes and vascular disease are however largely unknown. The aims of this study were 1) to characterize the age- and gender-related changes of the aortic wall components in vivo, using a mechanical model based on ultrasound measurements of pulsatile aortic diameter chang...

  7. Mitroflow DL Post Approval Study- North America

    Science.gov (United States)

    2015-05-19

    Aortic Stenosis; Aortic Regurgitation; Aortic Valve Insufficiency; Heart Valve Diseases; Cardiovascular Abnormalities; Cardiovascular Diseases; Congenital Abnormalities; Heart Diseases; Pathological Conditions, Anatomical

  8. The Effects of Metabolic Syndrome on Left Main Coronary Artery Stenosis in Coronary Angiograms of Patients: A Two Year Study

    Directory of Open Access Journals (Sweden)

    Panahi A

    2011-12-01

    Full Text Available Background: Left main coronary artery (LMCA stenosis is a leading cause of mortality and morbidity in many countries. Metabolic syndrome (MS is a risk factor for coronary artery disease (CAD. The effects of MS on left main coronary artery stenosis are not well-defined. The aim of this study was to examine the effects of MS on left main coronary artery stenosis.Methods: A total number of 495 patients who underwent elective coronary angiography in the Catheter Laboratory of Cardiovascular in Shariati Hospital 2008-2010 were included in the study. MS definition was based on the National Cholesterol Education Program (NCEP- Adult Treatment Panel III (ATP III criteria. The stenosis in left main coronary arteries was determined by examining the coronary angiograms of the patients.Results: The study population consisted of 249 (50.3% men, and 246 (49.7% women. The mean age of the participants was 58.01±10 years. MS was present in 86 (17.4% of the patients based on NCEP- ATP III criteria. LMCA stenosis was seen in 25 (5% patients. A positive correlation was found between MS and LMCA stenosis (r=0.305, P=0.012. Moreover, a positive correlation was found between age (r=0.192, P=0.05, sex (r=0.334, P=0.007, smoking (r=0.336, P=0.01 and diabetes (r=0.253, P=0.03 and LMCA stenosis.Conclusion: The metabolic syndrome correlates with LMCA stenosis. LMCA stenosis and its correlation with MS is precipitated by high FBG, age, male sex, and smoking which may synergistically increase the risk for the disease.

  9. Prevalence of renal artery stenosis in subjects with moderate hypertension. A population-based study

    DEFF Research Database (Denmark)

    Andersen, Ulrik B; Borglykke, Anders; Jørgensen, Torben

    2011-01-01

    Abstract Aim. To examine the prevalence of significant renal artery stenosis (RAS) in subjects with moderate to severe hypertension. Materials and methods. Subjects aged 50-66 years with blood pressure >160/100 mmHg or receiving antihypertensive treatment were selected from the population study...... balloon angioplasty. Two patients had reduced size and function of the affected kidney. Among the non-invasively treated patients, one showed stenosis progression at the 2-year follow-up examination. Conclusion. In subjects aged 50-66 years with hypertension grade II-III, RAS is rare among men, but not...... among women. These women may suffer from fibromuscular dysplasia. They are at risk of losing kidney function and developing severe hypertension, but they would not have been considered for screening according to present criteria....

  10. The relationship between aortic calcification on chest radiography and ionizing radiation in RERF's Adult Health Study

    International Nuclear Information System (INIS)

    Aortic calcification has been reported to be an indicator of atherosclerosis and a predictor of coronary heart disease. However, the relationship between aortic calcification and conventional coronary risk factors or recently reported coronary risk factors including ionizing radiation, which is one kind of oxidative stress, has not been established. Objective: To investigate the relationship between aortic calcification and ionizing radiation in a longitudinal study design. The study cohort comprises the Radiation Effects Research Foundation's Adult Health Study participants which include atomic-bomb survivors and sex- and age-matched controls. A total of 522 men and 938 women identified as not having aortic calcification based on plain chest X-ray examinations at baseline examination between 1991 and 1993 were assessed regarding the presence of aortic calcification (mild/ severe calcification) about 10 years later. The relationship between cumulative incidence of aortic calcification and atomic-bomb radiation was analyzed using logistic regression analysis after adjusting for sex, age, and other coronary risk factors such as blood pressure, total cholesterol, and inflammation markers. Age-adjusted cumulative incidence of aortic calcification showed a possible increase with atomic-bomb radiation dose for both total aortic calcification and severe aortic calcification. But after adjusting for other coronary risk factors such as smoking, SBP, total cholesterol, HDL-cholesterol, hemoglobin A1c, and leukocyte neutropils, radiation dose was not a significant predictor of cumulative incidence of severe aortic calcification. Age-adjusted increase of cumulative incidence of aortic calcification with atomic-bomb radiation dose suggests ionizing radiation is one predictor of atheroscelerosis. Nevertheless, its predictive impact may not be as significant as conventional coronary risk factors

  11. The roentgenographic study of aortic calcification in Korean

    International Nuclear Information System (INIS)

    Arteriosclerosis generally has various changes such as thickening and hypertrophy of the intima, fatty infiltration and calcium deposition in the arterial wall and atheroma, which lead to their loss of elasticity. Numerous experiments in animals have demonstrated with production of atheromatous lesions following the administration of large amount of lipoid substances such as cholesterol. However, many other factors such as hypertension, aging, heredity, maleness arterial anatomy play an important role in the genesis of atherosclerosis. Atherosclerotic involvement of aorta usually produces no subjective symptoms unless involvement of the medium sized arteries arising from the aorta. In asymptomatic cases of atherosclerosis no method of antemortem diagnosis is available except roentgenographic detection of aortic calcification. Schilling, et al insisted that the lateral abdominal roentgenogram appeared to be not only useful in detecting large vessel atherosclerosis, but also in the detection of asymptomatic aortic aneurysms, which are of more significance to the internist and surgeon. This study included reviews of 5166 chest roentgenograms (Thoracic group) and 1062 lateral roentgenograms of lumbar spine (Abdominal group) which were taken in Hanyang University Hospital during the period of May 1972 to April 1977. The age of these cases were 40 or more.

  12. Endovascular Treatment of Thoracic Aortic Dissection: Hemodynamic Shear Stress Study

    Science.gov (United States)

    Tang, Yik Sau; Lai, Siu Kai; Cheng, Stephen Wing Keung; Chow, Kwok Wing

    2012-11-01

    Thoracic Aortic Dissection (TAD), a life threatening cardiovascular disease, occurs when blood intrudes into the layers of the aortic wall, creating a new artificial channel (the false lumen) beside the original true lumen. The weakened false lumen wall may expand, enhancing the risk of rupture and resulting in high mortality. Endovascular treatment involves the deployment of a stent graft into the aorta, thus blocking blood from entering the false lumen. Due to the irregular geometry of the aorta, the stent graft, however, may fail to conform to the vessel curvature, and would create a ``bird-beak'' configuration, a wedge-shaped domain between the graft and the vessel wall. Computational fluid dynamics analysis is employed to study the hemodynamics of this pathological condition. With the `beaking' configuration, the local hemodynamic shear stress will drop below the threshold of safety reported earlier in the literature. The oscillating behavior of the shear stress might lead to local inflammation, atherosclerosis and other undesirable consequences. Supported by the Innovation and Technology Fund of the Hong Kong Government.

  13. Aortic valve replacement through right thoracotomy.

    OpenAIRE

    Rao, P N; A S Kumar

    1993-01-01

    There has never, to our knowledge, been a report of aortic valve replacement via a right thoracotomy. However, we recently used this approach in 2 young women with severe aortic stenosis. Exposure of the aortic valve was excellent, and we encountered neither technical difficulties nor sequelae related to the right thoracotomy. We believe that right thoracotomy provides adequate access for safe aortic valve replacement and yields cosmetically more appealing results than does median sternotomy.

  14. Aortic stiffness is associated with atherosclerosis of the coronary arteries in older adults : the Rotterdam Study

    NARCIS (Netherlands)

    van Popele, Nicole M.; Mattace-Raso, Francesco U. S.; Vliegenthart, Rozemarijn; Grobbee, Diederick E.; Asmar, Roland; van der Kuip, Deirdre A. M.; Hofman, Albert; de Feijter, Pim J.; Oudkerk, Matthijs; Witteman, Jacqueline C. M.

    2006-01-01

    Objective Aortic stiffness can lead to low diastolic blood pressure, thereby possibly limiting coronary perfusion. Therefore, the simultaneous occurrence of both aortic stiffness and coronary atherosclerosis can lead to an increased risk of subendocardial ischaemia. The aim of the present study was

  15. Aortic stiffness is associated with atherosclerosis of the coronary arteries in older adults: the Rotterdam Study

    NARCIS (Netherlands)

    van Popele, N.M.; Mattace-Raso, F.U.S.; Vliegenthart, R.; Grobbee, D.E.; Asmar, R.; van der Kuip, D.A.M.; Hofman, A.; de Feijter, P.J.; Oudkerk, M.; Witteman, J.C.M.

    2006-01-01

    Objective Aortic stiffness can lead to low diastolic blood pressure, thereby possibly limiting coronary perfusion. Therefore, the simultaneous occurrence of both aortic stiffness and coronary atherosclerosis can lead to an increased risk of subendocardial ischaemia. The aim of the present study was

  16. Long-term outcome after surgery for pulmonary stenosis (a longitudinal study of 22-33 years)

    OpenAIRE

    Roos-Hesselink, Jolien; Meijboom, Folkert; Spitaels, Silja; VanDomburg, R.; VanRijen, E. H M; Utens, Elisabeth; Bogers, Ad; Simoons, Maarten

    2006-01-01

    textabstractAims: Long-term (>20 years) survival and clinical outcome are only partly documented in patients who underwent surgical repair for isolated pulmonary stenosis. Yet, such data are of critical importance for the future perspectives, medical care, employability, and insurability of these patients. Methods and results: Ninety consecutive patients underwent surgery for pulmonary stenosis between 1968 and 1980 at the Thoraxcenter. A systematic follow-up study was performed in 1990 and a...

  17. The implantation of separating aortic stent-graft into the canine thoracic aorta: an experimental study

    International Nuclear Information System (INIS)

    Objective: to assess the technical feasibility of implanting separating stent-graft into the canine thoracic aorta and to study its biocompatibility. Methods: Twelve adult dogs were randomly and equally divided into three groups. The right femoral artery was cut open, through which the separating stent-graft was inserted and deployed in the canine thoracic aorta, with the proximal end of the graft being quite close to the origin of the left subclavian artery. the technical feasibility of the deployment process was assessed. Angiography was performed at 4, 8 and 12 weeks after stent-graft placement to evaluate the position and patency of the stent-graft. Then the dogs were sacrificed and the specimens were collected for pathologic study. Both gross and microscopic examinations were made to evaluate the fixation of the stent-graft with the vessel wall, the endothelialization of stent-graft surface and the pathologic changes of the vascular wall. Results: A total of ten separating stent-grafts were successfully deployed in the canine thoracic aorta, no migration or deformation occurred. One dog died of massive bleeding due to the rupture of the right femoral artery which occurred when the delivery system containing the inner bare stent was inserted through the right femoral artery. Death occurred in another dog as a result of the ascending aorta rupture caused by the migration of outer-layer stent-graft. Angiography was conducted at 4, 8 and 12 weeks after stent-graft placement. No migration, deformation, rupture or stenosis of the implanted stent-grafts were observed. The formation of intima on the inner surface of the bare stent appeared at 4 weeks, which became more and more obvious with the time passing, and at 12 weeks complete endothelialization of stent-graft surface was observed. Conclusion: Technically, it is feasible to deploy the separating aortic stent-graft into the canine thoracic aorta. Moreover, the separating aortic stent-graft carries excellent

  18. [The use of metabolic therapy in the treatment of ischemic heart disease in hemodynamically formed insignificant aortic stenosis with chronic heart failure].

    Science.gov (United States)

    Kuriata, A V; Karavanskaia, I L; Kushnir, Iu S

    2011-01-01

    Analysis of medical treatment was conducted with justified using of the metabolic component in a complex therapy of ischemic heart disease with chronic heart failure in hemodynamically formed insignificant aortic stenoses. The effect of metabolic correction is shown for pharmaceutical compounds Meldoniya in the form of Vasonat manufactured by "OlainFarm" (Latvia). Positive results of maintenance of systolic activity and prevention of diastolic dysfunction of myocardium were presented. The application of Vasonat in appropriate for the stabilization of adaptive properties of the myocardium and prophylaxis of the development of critical indicators of heart failure in this combined. PMID:22768738

  19. Determinants of aortic stiffness: 16-year follow-up of the Whitehall II study.

    Directory of Open Access Journals (Sweden)

    Nanna B Johansen

    Full Text Available BACKGROUND: Aortic stiffness is a strong predictor of cardiovascular disease endpoints. Cross-sectional studies have shown associations of various cardiovascular risk factors with aortic pulse wave velocity, a measure of aortic stiffness, but the long-term impact of these factors on aortic stiffness is unknown. METHODS: In 3,769 men and women from the Whitehall II cohort, a wide range of traditional and novel cardiovascular risk factors were determined at baseline (1991-1993 and aortic pulse wave velocity was measured at follow-up (2007-2009. The prospective associations between each baseline risk factor and aortic pulse wave velocity at follow-up were assessed through sex stratified linear regression analysis adjusted for relevant confounders. Missing data on baseline determinants were imputed using the Multivariate Imputation by Chained Equations. RESULTS: Among men, the strongest predictors were waist circumference, waist-hip ratio, heart rate and interleukin 1 receptor antagonist, and among women, adiponectin, triglycerides, pulse pressure and waist-hip ratio. The impact of 10 centimeter increase in waist circumference on aortic pulse wave velocity was twice as large for men compared with women (men: 0.40 m/s (95%-CI: 0.24;0.56; women: 0.17 m/s (95%-CI: -0.01;0.35, whereas the opposite was true for the impact of a two-fold increase in adiponectin (men: -0.30 m/s (95%-CI: -0.51;-0.10; women: 0.61 m/s (95%-CI: -0.86;-0.35. CONCLUSION: In this large prospective study, central obesity was a strong predictor of aortic stiffness. Additionally, heart rate in men and adiponectin in women predicted aortic pulse wave velocity suggesting that strategies to prevent aortic stiffening should be focused differently by sex.

  20. Cost effectiveness of aortic valve therapies: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Suzanne Battaglia

    2013-10-01

    Full Text Available Background: we performed a systematic review on the cost effectiveness of transcatheter aortic valve implantation (TAVI to standard aortic valve replacement and medical management in high-risk elderly patients with severe aortic stenosis.Methods: in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses, a systematic review on current literature for cost-effectiveness of TAVI, standard aortic valve replacement, and medical management for elderly patients with high-risk severe aortic stenosis was performed. Incremental cost effectiveness ratio is used to measure effectiveness through life years gained or quality adjusted life years. Drummond checklist was used to further assess the quality of the included studies.Results: the systematic literature search identified 4 primary publications (derived from 52 citations that fulfilled the inclusion criteria. Tremendous discrepancy in incremental cost effectiveness ratio is demonstrated with operable patients similar to Cohort A of the PARTNER trial (€ 749 416 and € 39 577. Inoperable patients similar to Cohort B of the PARTNER trial suggest notable differences in favour for transcatheter aortic valve implantation with an increase in quality adjusted life years (0.06 versus 1.6, respectively. With lifetime horizon to transcatheter aortic valve implantation there is a more comparable incremental cost effectiveness ratio in the literature (€ 38 260 and € 37 432. Lowest incremental cost effectiveness ratio witnessed in the technical inoperable group at € 26 482. Lifetime horizon of 10 years with transcatheter aortic valve implantation differ (€ 39 388 versus € 19 947. Overall, a review of the literature suggests TAVI usage in patients for severe aortic stenosis whom are not eligible for surgery. All the studies were overall judged of medium-high quality.Conclusions: transcatheter aortic valve replacement is more cost effective with a lifetime horizon for the

  1. Correlation between single nucleotide polymorphisms of the ACTA2 gene and coronary artery stenosis in patients with type 2 diabetes mellitus

    OpenAIRE

    Fang, Hui; LUO, XIAOLI; Wang, Yan; Liu, Nian; Fu, Chunjiang; Wang, Hongyong; Fang, Yuqiang; Shi, Weibin; Zhang, Ye; Zeng, Chunyu; Wang, Xukai

    2014-01-01

    This study aimed to analyze the correlation between single nucleotide polymorphisms (SNPs) of the actin, aortic smooth muscle (ACTA2) gene and coronary artery stenosis in patients with type 2 diabetes mellitus (T2DM). Eight SNPs from the promoter region of the ACTA2 gene were screened. Patients with T2DM (n=251) were divided into two groups, those with severe coronary stenosis (SCS+ group; n=168) and those without severe coronary stenosis (SCS− group; n=83). Patients were also divided accordi...

  2. Mitral stenosis

    Science.gov (United States)

    ... valve disease. Treat strep infections promptly to prevent rheumatic fever. Tell your provider if you have a family history of congenital heart diseases. Other than treating strep infections, mitral stenosis itself ...

  3. Spinal stenosis

    Science.gov (United States)

    ... medicine directly into the space around your spinal nerves or spinal cord. Spinal stenosis symptoms often become worse over ... Surgery is done to relieve pressure on the nerves or spinal cord. You and your doctor can decide when ...

  4. Cervical Stenosis

    Science.gov (United States)

    ... Accumulation of pus in the uterus is called pyometra. Symptoms Before menopause, cervical stenosis may cause menstrual ... present but not cause symptoms. A hematometra or pyometra can cause pain or cause the uterus to ...

  5. Studies on intracranial collateral circulation with multi-slice CT angiography in patients with symptomatic cerebral artery stenosis

    Directory of Open Access Journals (Sweden)

    Shu-qing ZHOU

    2011-06-01

    Full Text Available Objective To explore the features of intracranial collateral circulation in patients with symptomatic cerebral artery stenosis.Method Ninety-four patients with ischemic cerebrovascular disease admitted from Apr.2004 to Jun.2009 were involved in present study.All the patients were examined with cerebral multi-slice CT angiography,and the features of cerebral artery stenosis and intracranial collateral circulation were evaluated using maximum intensity projection(MIP and volume rendering(VR images of CT angiography.Result Of the 94 patients involved,48 were diagnosed as cerebral artery stenosis,including 29 cases of cerebral infarction,18 of transient ischemic attack(TIA and 1 of moyamoya disease(MMD.Among the 14 cases of severe cerebral artery stenosis or occlusion,cerebral infarction was found in 6 cases with lesser intracranial collateral vessels(including massive cerebral infarction in 4 cases and watershed infarction in 2 cases,and focal infarction of central semi-ovale in 1 case and TIA in 7 cases were found with abundant intracranial collateral vessels.Multiple lacunar infarction was found in 22 cases of mild or moderate cerebral artery stenosis,but there was no significant correlation between the stenosed arteries and infarction sites.Abundant intracranial collateral vessels were found in one patient with Moyamoya disease but no infarction was observed.Conclusions Intracranial collateral circulation plays an important role of compensation in patients with severe cerebral artery stenosis or occlusion.Cerebral angiography with multi-slice CT is of great significance in evaluation of cerebral artery stenosis and intracranial collateral circulation.

  6. Are Aortic Stent Grafts Safe in Pregnancy?

    OpenAIRE

    Nader Khandanpour; Mehta, Tapan A.; Adiseshiah, M; Meyer, Felicity J.

    2015-01-01

    Aortic stent grafts are increasingly used to treat aortic aneurysms and also other aortic pathologies. The safety of aortic stent grafts in pregnancy has never been studied or reported. We report on two cases of aortic stent grafts in pregnant women and discuss the effect of pregnancy on these aortic stent grafts.

  7. Transcatheter aortic valve implantation today and tomorrow.

    Science.gov (United States)

    Wenaweser, Peter; Praz, Fabien; Stortecky, Stefan

    2016-01-01

    Aortic stenosis is the most common valvular heart disease in Western industrial countries (including Switzerland) with a prevalence of about 5% in the population aged 75 and over. If left untreated, symptomatic patients have a rate of death of more than 50% within 2 years. As a result of age and elevated surgical risk, an important proportion of elderly patients are not referred to surgery. Thus, the introduction of transcatheter aortic valve implantation (TAVI) in 2002 has initiated a paradigm shift in the treatment of patients with symptomatic, severe aortic stenosis. The early technical and procedural success of this minimal invasive treatment in high-risk patients has promoted further innovation and development of transcatheter heart valve (THV) systems during the last 13 years. Downsizing of the delivery catheters along with technical improvements aiming to reduce postprocedural paravalvular regurgitation have resulted in a significant reduction in mortality. As a consequence, TAVI is nowadays established as safe and effective treatment for selected inoperable and high-risk patients. Ongoing studies are investigating the outcome of intermediate risk patients allocated to either surgical aortic valve replacement (SAVR) or TAVI. Despite these advancements, some specific areas of concern still require attention and need further investigations including conduction disturbances, valve degeneration and antithrombotic management. Although the off-label use of TAVI devices in the mitral, tricuspid or pulmonary position has recently developed, important limitations still apply and careful patient selection remains crucial. This review aims to summarise the available clinical evidence of transcatheter aortic valve treatment during the last 13 years and to provide a glimpse of future technologies. PMID:26999727

  8. Prva vstavitev biološke aortne zaklopke preko femoralne arterije v Sloveniji: First transfemoral biologic aortic valve implantation in Slovenia: First transfemoral biologic aortic valve implantation in Slovenia:

    OpenAIRE

    Ambrožič, Jana; Ažman-Juvan, Katja; Bunc, Matjaž; Cerar, Andraž; Kontestabile, Bojan; Lakič, Nikola; Lopatič, Irena; Mušič, Špela; Zorman, Darko

    2010-01-01

    Calcified aortic stenosis is the most frequent valvular heart disease in the Western world. It is a progressive, degenerative, atheroscleroticlike process that involves the aortic valve with increasing prevalence as the population ages. Surgical aortic valve replacement is the treatment of choice for patients with severe, symptomatic aortic stenosis, but it has limitations in old patients with high perioperative risk and in patients with comorbidities. A new method of percutanous aortic valve...

  9. Three-Year Outcomes of Transcatheter Aortic Valve Implantation in Patients With Varying Levels of Surgical Risk (from the CoreValve ADVANCE Study).

    Science.gov (United States)

    Barbanti, Marco; Schiltgen, Molly; Verdoliva, Sarah; Bosmans, Johan; Bleiziffer, Sabine; Gerckens, Ulrich; Wenaweser, Peter; Brecker, Stephen; Gulino, Simona; Tamburino, Corrado; Linke, Axel

    2016-03-01

    This study compared 3-year clinical outcomes of patients who underwent transcatheter aortic valve implantation with the Society of Thoracic Surgeons (STS) score ≤7% to those of patients with a score >7%. Data were drawn from the ADVANCE study, a multinational post-market clinical trial that enrolled real-world patients with severe aortic stenosis treated with the CoreValve bioprosthesis. Events were independently adjudicated using Valve Academic Research Consortium-1 definitions. A total of 996 patients were implanted: STS ≤7% (n = 697, median STS 4.3%, interquartile range 3.1% to 5.4%) and STS >7% (n = 298, median STS 9.7%, interquartile range 8.0% to 12.4%). At 3 years, the STS ≤7% group had lower rates of all-cause mortality (28.6 vs 45.9, p 7% group. No differences were observed in cerebrovascular accidents, vascular complications, bleeding, or myocardial infarction. In patients with STS ≤7%, mortality at 3 years was higher in those with moderate or severe aortic regurgitation (AR) at discharge than in those with mild or less AR (39.9% vs 22.9%; hazard ratio 1.98; 95% confidence interval 1.37 to 2.86; p 7% (42.9% vs 44.6%, moderate/severe vs mild/less; hazard ratio 1.04; 95% confidence interval, 0.62 to 1.75; p = 0.861; p for interaction = 0.047). In conclusion, patients with STS ≤7% had lower rates of all-cause and cardiovascular mortality at 3 years after transcatheter aortic valve implantation. Complication rates were low and stable in both groups, demonstrating the safety of this procedure for patients at various levels of surgical risk. PMID:26762727

  10. Controlled transient respiratory arrest along with rapid right ventricular pacing for improving balloon stability during balloon valvuloplasty in pediatric patients with congenital aortic stenosis - A retrospective case series analysis

    Directory of Open Access Journals (Sweden)

    Gupta Sampa

    2010-01-01

    Full Text Available Rapid right ventricular pacing is safe, effective, and established method to provide balloon stability during balloon aortic valvuloplasty (BAV. Controlled transient respiratory arrest at this point of time may further reduce left ventricular stroke volume, providing an additional benefit to maintain balloon stability. Two groups were studied. Among the 10 patients, five had rapid pacing alone (Group A, while the other five were provided with cessation of positive pressure breathing as well (Group B. The outcomes of BAV in the two groups of patients were studied. One patient in Group A had failed balloon dilatation even after the fourth attempt, while in Group B there were no failures. The peak systolic gradient reduction was higher in Group B (70.05% in comparison to 52.16% of group A. In Group A, five subjects developed aortic regurgitation (grade 2 in four and grade 3 in one, while no grade 3 aortic regurgitation developed in any patient in Group B. Controlled transient respiratory arrest along with rapid ventricular pacing may be effective in maintaining balloon stability and improve the outcome of BAV.

  11. Controlled transient respiratory arrest along with rapid right ventricular pacing for improving balloon stability during balloon valvuloplasty in pediatric patients with congenital aortic stenosis--a retrospective case series analysis.

    Science.gov (United States)

    Gupta, Sampa Dutta; Das, Soumi; Ghose, Tapas; Sarkar, Achyut; Goswami, Anupam; Kundu, Sudeshna

    2010-01-01

    Rapid right ventricular pacing is safe, effective, and established method to provide balloon stability during balloon aortic valvuloplasty (BAV). Controlled transient respiratory arrest at this point of time may further reduce left ventricular stroke volume, providing an additional benefit to maintain balloon stability. Two groups were studied. Among the 10 patients, five had rapid pacing alone (Group A), while the other five were provided with cessation of positive pressure breathing as well (Group B). The outcomes of BAV in the two groups of patients were studied. One patient in Group A had failed balloon dilatation even after the fourth attempt, while in Group B there were no failures. The peak systolic gradient reduction was higher in Group B (70.05% in comparison to 52.16% of group A). In Group A, five subjects developed aortic regurgitation (grade 2 in four and grade 3 in one, while no grade 3 aortic regurgitation developed in any patient in Group B). Controlled transient respiratory arrest along with rapid ventricular pacing may be effective in maintaining balloon stability and improve the outcome of BAV. PMID:20826965

  12. Usefulness of abdominal aortic calcification for screening of peripheral vascular disease

    International Nuclear Information System (INIS)

    We wanted to evaluate the value of abdominal aortic calcification (AAC), as detected on CT, as a predictor of atherosclerotic stenotic disease of the lower extremity arteries. One hundred three patients who had CT angiography performed for the evaluation of peripheral vascular disease were enrolled in this retrospective study. The volume (mm3) of the AAC was measured on CT. Each lower extremity was divided into 8 segments. The extent of stenosis of the lower extremity artery was manifested as the sum of the stenosis scores for 16 segments (total stenosis score: TSS). The significant stenosis scores (SSS-50 and SSS-75) were defined as the sum of scores for the lower extremity artery segments that had significant stenosis of more than 50% and 75%, respectively. AAC was correlated to the TSS, SSS-50 and SSS-75 with using Spearman's correlation coefficient. The diagnostic performance of AAC for stenosis of a lower extremity artery of more than 50% and 75%, respectively, was evaluated by using the receiver operating characteristic (ROC) curve. The Spearman's correlation coefficients were 0.728 (AAC vs. TSS), 0.662 (AAC vs. SSS-50), and 0.602 (AAC vs. SSS-75), respectively. For significant stenosis more than 50% and 75%, the areas under the ROC curve were 0.898 and 0.866, respectively. The cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 1030 mm3, 87%, 88%, 89%. 86% and 87% for stenosis more than 50% and 1030 mm3, 87%, 80%, 79%, 88% and 84% for stenosis more than 75%, respectively. Abdominal aortic calcification detected on CT may be a useful predictor of atherosclerotic stenotic disease of lower extremity arteries

  13. Recurrent tamponade and aortic dissection in syphilis.

    Science.gov (United States)

    Stansal, Audrey; Mirault, Tristan; Rossi, Aude; Dupin, Nicolas; Bruneval, Patrick; Bel, Alain; Azarine, Arshid; Minozzi, Catherine; Deman, Anne Laure; Messas, Emmanuel

    2013-11-01

    Syphilitic cardiovascular disease has been described since the 19th century, mainly on autopsy series. Major clinical manifestations are aortic aneurysm, aortic insufficiency, and coronary ostial stenosis. The diagnosis of syphilitic cardiovascular disease is based mainly on positive serologic tests and overt clinical manifestations. We present here a rare and unusual clinical presentation of a tertiary syphilis with recurrent tamponade and type B aortic dissection, whose positive diagnosis was made by polymerase chain reaction on pericardial fluid analysis. PMID:24182507

  14. Simulation study and function analysis of the dynamic aortic valve

    Institute of Scientific and Technical Information of China (English)

    XIA Dongdong; BAI Jing

    2006-01-01

    The dynamic aortic valve (DAV) is a new left ventricular assist device, a micro-axial blood pump implemented at the position of the aortic valve, pumping blood from the left ventricle into the aortic artery. The present dynamic aortic valve operates at 7 different rotation speeds, ranging from 3000 r/min (speed 1) to 9000 r/min (speed 7). Because in vivo experiments need a lot of live animals and take a long period of time, modeling and simulation have been widely used to simulate and analyze hydra-dynamic property of the DAV and its assisting effects. With the measurements from the mock circulatory loop, a mathematic model of the DAV is established and embedded into the previously developed canine circulatory system. Using this model, the effect of the DAV on the failing heart at each rotation speed level is investigated. The vital cardiac variables are computed and compared with in vivo experimental results, which are in good agreement with an acceptable difference mostly 15 %. The establishment of the DAV model and its simulation are useful for further improvement of the DAV device.

  15. A case of William's syndrome associated peripheral pulmonary arterial stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Kyung Hwa; Hwang, Mi Soo; Kim, Sun Yong; Chang, Jae Chun; Park, Bok Hwan [College of Medicine, Yeungam University, Daegu (Korea, Republic of)

    1988-06-15

    William's syndrome, in order to more completely delineate the total spectrum of the disorder, indicates that 'infantile hypercalcemia', 'peculiar facies' and 'supravalvular aortic stenosis.' In has other many vascular anomalies, such as peripheral pulmonary arterial stenosis, coronary arterial stenosis, celiac arterial stenosis, and renal aterial stenosis. Only 32% of the patients have evidence of supravalvular aortic stenosis. And it is very rare disease entity that has been reported rarely in Korea. Recently authors experienced a case that was questioned William's syndrome with peripheral pulmonary arterial stenosis, clinically and preliminary radiologically and this case was confirmed by operation. Here we report a case of William's syndrome with peripheral pulmonary arterial stenosis and reviewed literatures.

  16. Immediate post-operative responses to transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Nielsen, Susanne; Lisby, Karen H.;

    2015-01-01

    Background:Conventional treatment for patients with severe symptomatic aortic stenosis is surgical aortic valve replacement (SAVR), but transcatheter aortic valve implantation (TAVI) has become a reliable alternative in high-risk patients.Aims:The aim of our study was to describe the post-operati......, predominantly continuous and at rest. We recommend the development of an evidence-based pathway to address the immediate post-operative issues in TAVI patients. Non-pharmacological interventions to prevent pain and promote sleep need to be explored.......-operative patient response to TAVI on the evening of the procedure and the following day before discharge from the coronary care unit. A secondary aim was to compare responses of patients younger and older than 80 years of age.Methods:A prospective, comparative observational study triangulating nurse assessment and...

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

    Science.gov (United States)

    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; de la Cuesta, Fernando; 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

  18. Ex vitro experimental study on concentration polari-zation of macromolecules (LDL) at an arterial stenosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    To verify the previous theoretical prediction that the disturbed flow distal to a stenosis enhances lipid accumulation at the blood/arterial wall interface, we designed a canine carotid arterial stenosis model and measured ex vitro the luminal surface concentration of bovine serum albumin (as a tracer mac-romolecule) by directly taking liquid samples from the luminal surface of the artery. The experimental results showed that due to the presence of a filtration flow, the luminal surface albumin concentration cw was higher than the bulk concentration co as predicted by our theory. The measurement revealed that the luminal surface concentration of macromolecules was indeed enhanced significantly in re-gions of the disturbed flow. At Re = 50, the relative luminal surface concentration cw/co was 1.66 ± 0.10 in the vortex region, while the cw/co was 1.37 ± 0.06 in the laminar flow region. When Re increased to 100, the cw/co in the vortex flow region and the laminar flow region reduced to 1.39 ± 0.07 and 1.24 ± 0.04, respectively. The effect of the filtration rate, vw, on the luminal surface concentration of albumin was remarkably apparent. At Re = 50 and 100, when vw = 8.9 ± 1.7 × 10-6 cm/s, cw in the vortex region was 77% and 52% higher than co respectively, meanwhile when vw = 4.8 ± 0.6 × 10-6 cm/s, cw in the vortex region was only 66 % and 39% higher than co respectively. In summary, the present study has provided further experimental evidence that concentration polarization can occur in the arterial system and fluid layer with highly concentrated lipids in the area of flow separation point may be responsible for the formation and development of atherosclerosis.

  19. Estenose carotídea acima de 70% em pacientes no pré-operatório de cirurgia da aorta abdominal: freqüência e fatores de risco Frequency and risk factors for carotid stenosis above 70% in patients undergoing abdominal aortic surgery

    Directory of Open Access Journals (Sweden)

    André Ventura Ferreira

    2006-03-01

    Full Text Available OBJETIVO: Analisar a freqüência e os fatores de risco associados à estenose carotídea acima de 70% em pacientes que serão submetidos a cirurgias de aorta abdominal. MATERIAL E MÉTODO: Foram analisados 94 pacientes que realizaram ultra-som Doppler de carótidas no pré-operatório de cirurgias de aorta abdominal entre janeiro de 2000 e janeiro de 2003, pela disciplina de Cirurgia Vascular da Santa Casa de São Paulo. RESULTADOS: Sessenta e sete pacientes (71% eram homens. Dentre os 94 pacientes, 42 (44,6% tinham doença oclusiva aorto-ilíaca, e 52 (53,4%, aneurismas da aorta abdominal (AAA. A análise dos dados mostrou uma prevalência de estenose de carótidas acima de 70% em 8,33% dos pacientes com AAA e em 13,51% dos pacientes com doença oclusiva aorto-ilíaca, diferença esta sem significância estatística (P = 0,5. Nos pacientes que apresentavam antecedente de isquemia cerebral - acidente vascular cerebral (AVC ou ataque isquêmico transitório (AIT -, houve uma prevalência estatisticamente maior de estenose carotídea entre 70 e 99%. Outros fatores de risco para aterosclerose, como sexo masculino, diabetes, hipertensão arterial e tabagismo, não foram preditivos da presença de estenose carotídea acima de 70%. CONCLUSÃO: A freqüência de estenose da carótida acima de 70% em pacientes no pré-operatório de cirurgia de aorta foi de 9,57%, e a presença de antecedente de AVC ou AIT na história foi preditiva de estenose acima de 70% neste grupo de pacientes.OBJECTIVE: To analyze the frequency and risk factors of carotid stenosis above 70% in patients undergoing abdominal aortic reconstruction. MATERIAL AND METHOD: Ninety-four patients who underwent Doppler ultrasound preoperative screening for abdominal aortic surgery between January 2000 and January 2003 were analyzed by the Vascular Surgery Unit of the Santa Casa of São Paulo (Faculty of Medical Sciences. RESULTS: Sixty-seven (71% patients were male. Of the 94 patients, 42

  20. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... more likely we see aortic stenosis. Again, patient education is part of the evaluation and management of ... want to embrace less invasive or more progressive technology, you want to make ... with that information and certainly shouldn't be insulted by that. ...

  1. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... well. I want to underscore again that exercise testing is really not recommended in patient with classic symptoms in severe aortic stenosis, as it's probably more stress than the patient's heart should have to undergo. Once again, serial evaluations, as with any chronic disease process, are ...

  2. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... or in most patients who come to requiring surgery for aortic stenosis, left ventricular hypertrophy is a common manifestation. By that, I mean generally speaking any muscle that works harder in the body gets thicker and bigger over time and that's ...

  3. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... county more likely we see aortic stenosis. Again, patient education is part of the evaluation and management of valvular disease prior to surgery is paramount. It's important for a patient to understand really with any chronic condition what ...

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

    OpenAIRE

    Hamm, Christian W.; Möllmann, Helge; Holzhey, David; Beckmann, Andreas; Veit, Christof; Figulla, Hans-Reiner; Cremer, J; Kuck, Karl-Heinz; Lange, Rüdiger; Zahn, Ralf; Sack, Stefan; Schuler, Gerhard; Walther, Thomas; Beyersdorf, Friedhelm; Böhm, Michael

    2013-01-01

    Background Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis. Methods and results A total of 13 860 consecutive patients undergoing repair for aortic valve d...

  5. Prevalence Study of Proximal Vertebral Artery Stenosis Using High-Resolution Contrast-Enhanced Magnetic Resonance Angiography

    International Nuclear Information System (INIS)

    Purpose: To evaluate the prevalence of proximal vertebral artery stenosis, compared with those of the distal vertebral/basilar artery and extracranial internal carotid artery, in a large population of stroke and non-stroke patients. Material and Methods: Nine-hundred-and-thirty-five patients who underwent high-resolution contrast-enhanced magnetic resonance angiography in a regional general hospital were categorized into six groups based on neurological symptoms and disease: an asymptomatic group (n ∼ 182), a minor symptom group with headache or dizziness (n ∼ 519), a cardiac group with coronary artery steno-occlusive disease (n ∼ 15), a hemorrhagic group with old cerebral hemorrhage (n ∼ 26), an anterior circulation infarct group (n ∼ 121), and posterior circulation infarct group (n ∼ 72). Prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was analyzed. Results: The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 12.9%, 5.5%, and 7.2%, respectively, in the study population, and rose as the age increased (P <0.0001 for all arteries). The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 3.3%, 0.5%, and.1%, respectively, in the asymptomatic group; 8.3%, 2.1%, and 3.7%, respectively, in the minor symptom group; 13.3%, 6.7%, and 6.7%, respectively, in the cardiac group; 19.2%, 7.7%, and 7.7%, respectively, in the hemorrhagic group; 27.3%, 8.3%, and 25.6%, respectively, in the anterior circulation infarct group; and 44.4%, 36.1%, and 16.7%, respectively, in the posterior circulation infarct group. This increasing tendency of stenosis accordingly was statistically significant ( P <0.0001 for all arteries). Conclusion: The prevalence of proximal vertebral artery stenosis was highest, compared with those of the distal vertebral/basilar artery and

  6. Prevalence Study of Proximal Vertebral Artery Stenosis Using High-Resolution Contrast-Enhanced Magnetic Resonance Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S.H.; Lee, J.S.; Kwon, O.K.; Han, M.K.; Kim, J.H. [Seoul National Univ. (Korea, Republic of). Depts. of Radiology, Neurosurgery, and Neurology

    2005-05-01

    Purpose: To evaluate the prevalence of proximal vertebral artery stenosis, compared with those of the distal vertebral/basilar artery and extracranial internal carotid artery, in a large population of stroke and non-stroke patients. Material and Methods: Nine-hundred-and-thirty-five patients who underwent high-resolution contrast-enhanced magnetic resonance angiography in a regional general hospital were categorized into six groups based on neurological symptoms and disease: an asymptomatic group (n {approx} 182), a minor symptom group with headache or dizziness (n {approx} 519), a cardiac group with coronary artery steno-occlusive disease (n {approx} 15), a hemorrhagic group with old cerebral hemorrhage (n {approx} 26), an anterior circulation infarct group (n {approx} 121), and posterior circulation infarct group (n {approx} 72). Prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was analyzed. Results: The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 12.9%, 5.5%, and 7.2%, respectively, in the study population, and rose as the age increased (P <0.0001 for all arteries). The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 3.3%, 0.5%, and.1%, respectively, in the asymptomatic group; 8.3%, 2.1%, and 3.7%, respectively, in the minor symptom group; 13.3%, 6.7%, and 6.7%, respectively, in the cardiac group; 19.2%, 7.7%, and 7.7%, respectively, in the hemorrhagic group; 27.3%, 8.3%, and 25.6%, respectively, in the anterior circulation infarct group; and 44.4%, 36.1%, and 16.7%, respectively, in the posterior circulation infarct group. This increasing tendency of stenosis accordingly was statistically significant ( P <0.0001 for all arteries). Conclusion: The prevalence of proximal vertebral artery stenosis was highest, compared with those of the distal

  7. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  8. Endovascular therapy for abdominal aortic aneurysm and iliac artery aneurysm using SEAL aortic stent-graft: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Park, Su Young; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin Mo; Choi, Sang Tae; Park, Jae Hyung [Gachon University Gil Hospital, Incheon (Korea, Republic of)

    2015-03-15

    The aim of this study was to evaluate the safety and efficacy of SEAL aortic stent-graft for abdominal aortoiliac aneurysms. Between October 2007 and January 2014, 33 patients with abdominal aortoiliac aneurysms were treated with SEAL aortic stent-graft. We evaluated the technical success rate, clinical and CT follow-up periods, major complications, need for additional interventional treatment, aneurysm-related mortality and clinical success rate. SEAL bifurcated aortic stent-graft was successfully placed in 32 patients (97%). Clinical and CT follow-up periods were 24 and 14 months, respectively. Endoleak developed in 13 patients (41%): spontaneous regression or decrease in 6, need for additional treatment in 4 and follow-up loss in 3. Significant stenosis of stent-graft occurred in 4 patients (12%) and was treated with stenting in 3. Migration of stent-graft was noted in 3 patients (9%) and treated with additional stent-grafting. Aneurysm-related mortality was 9% (3 of 33). The placement of SEAL stent-graft was effective in 26 patients (79%). The placement of SEAL aortic stent-graft was safe and effective in patients with aneurysms of abdominal aorta and iliac arteries. However, complicating endoleaks, stenosis and migration of the stent-graft developed during the follow-up. Therefore, regular CT follow-up seems to be mandatory.

  9. Subglottic stenosis.

    Science.gov (United States)

    Jefferson, Niall D; Cohen, Aliza P; Rutter, Michael J

    2016-06-01

    Subglottic stenosis (SGS) is a congenital or acquired condition characterized by a narrowing of the upper airway extending from just below the vocal folds to the lower border of the cricoid cartilage. With the introduction of prolonged intubation in neonates (mid 1960s), acquired SGS became the most frequent cause of laryngeal stenosis; unlike congenital SGS, it does not improve with time. Laryngeal reconstruction surgery evolved as a consequence of the need to manage these otherwise healthy but tracheotomized children. Ongoing innovations in neonatal care have gradually led to the salvage of premature and medically fragile infants in whom laryngeal pathology is often more severe, and in whom stenosis often involves not only the subglottis, but also the supraglottis or glottis-causing significant morbidity and mortality. The primary objective of intervention in these children is decannulation or preventing the need for tracheotomy. The aim of this article is to present a more detailed description of both congenital and acquired SGS, highlighting the essentials of diagnostic assessment and familiarizing the reader with contemporary management approaches. PMID:27301599

  10. Relationship between coronary atherosclerotic stenosis and cerebral atherosclerotic stenosis

    Institute of Scientific and Technical Information of China (English)

    Jiaping Wei; Shenmao Li; Zhiyong Zhang; Feng Ling; Kang Li; Hong Zhao; Jifang He; Liqing Xu; Jing Wen; Chunyan Zhou; Xiaoguang Wu; Jiarui Wang

    2008-01-01

    To investigate the relationship between severity of cerebrovascular atherosclerosis stenosis and that of coronary atherosclerosis stenosis.Methods Cerebral angiography and coronary angiography were performed in 34 patients who had coronary disease with cerebral ischemia.Patients were divided into 3 subgroups according to the degree ofstenosis on angiography,concomitant diseases,risk factors and biochemical data.Results The follow-up study showed that the incidence of cardiac and cerebrovascular death increased significantly in patients with moderate to severe stenosis of coronary and cerebral arteries;the severity of stenosis in the coronary artery parallels that in the solitary carotid artery,or dual carotid and vertebral arteries.Conclusions Patients with coronary and cerebral artery stenosis,especially those with multi-risk factors,such as hypertension,diabetes and cigarette smoking,should receive intensive treatment to reduce cardiac and cerebrovascular events.(J Geriatr Cardiol 2008;5:227-229)

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

    OpenAIRE

    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...

  12. Infantile hypertrophic pyloric stenosis

    DEFF Research Database (Denmark)

    Pedersen, Rikke Neess; Garne, Ester; Loane, Maria;

    2008-01-01

    OBJECTIVE: The objective of this study was to present epidemiologic data on infantile hypertrophic pyloric stenosis (IHPS) from seven well-defined European regions, and to compare incidence and changes in incidence over time between these regions. METHODS: This was a population-based study using...

  13. Normal values of aortic dimensions, distensibility, and pulse wave velocity in children and young adults: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Voges Inga

    2012-11-01

    Full Text Available Abstract Background Aortic enlargement and impaired bioelasticity are of interest in several cardiac and non-cardiac diseases as they can lead to cardiovascular complications. Cardiovascular magnetic resonance (CMR is increasingly accepted as a noninvasive tool in cardiovascular evaluation. Assessment of aortic anatomy and bioelasticity, namely aortic distensibility and pulse wave velocity (PWV, by CMR is accurate and reproducible and could help to identify anatomical and bioelastic abnormalities of the aorta. However, normal CMR values for healthy children and young adults are lacking. Methods Seventy-one heart-healthy subjects (age 16.4 ± 7.6 years, range 2.3 - 28.3 years were examined using a 3.0 Tesla CMR scanner. Aortic cross-sectional areas and aortic distensibility were measured at four positions of the ascending and descending thoracic aorta. PWV was assessed from aortic blood flow velocity measurements in a aortic segment between the ascending aorta and the proximal descending aorta. The Lambda-Mu-Sigma (LMS method was used to obtain percentile curves for aortic cross-sectional areas, aortic distensibility and PWV according to age. Results Aortic areas, PWV and aortic distensibility (aortic cross-sectional areas: r = 0.8 to 0.9, p  Conclusions This study provides percentile curves for cross-sectional areas, distensibility and pulse wave velocity of the thoracic aorta in children and young adolescents between their 3rd and 29th year of life. These data may serve as a reference for the detection of pathological changes of the aorta in cardiovascular disease.

  14. Transcatheter aortic valve replacement in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Dimytri Siqueira; Alexandre Abizaid; Magaly Arrais J.; Eduardo Sousa

    2012-01-01

    Aortic stenosis is the most common native valve disease, affecting up to 5% of the elderly population. Surgical aortic valve replacement reduces symptoms and improves survival, and is the definitive therapy in patients with symptomatic severe aortic stenosis. However, despite the good results of classic surgery, risk is markedly increased in elderly patients with co-morbidities. Transcatheter aortic valve replacement (TAVR) allows implantation of a prosthetic heart valve within the diseased native aortic valve without the need for open heart surgery and cardiopulmonary bypass, offering a new therapeutic option to elderly patients considered at high surgical risk or with contraindications to surgery. To date, several multicenter registries and a randomized trial have confirmed the safety and efficacy of TAVR in those patients. In this chapter, we review the background and clinical applications of TAVR in elderly patients.

  15. Aortic insufficiency

    Science.gov (United States)

    ... Heart valve - aortic regurgitation; Valvular disease - aortic regurgitation; AI - aortic insufficiency ... BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: ...

  16. Cardiac failure due to arteriovenous fistula with brachiocephalic stenosis: a gated heart case study

    International Nuclear Information System (INIS)

    Full text: There are numerous causes of cardiac failure of which the commonest in our community include ischaemic cardiomyopathy, post-viral cardiomyopathy, alcohol-induced cardiomyopathy and drug-induced cardiomyopathy. All these entities cause low output cardiac failure however high output cardiac failure is also well recognised. This includes heart failure related to such conditions as hyperthyroidism, anaemia, pregnancy, beri-beri, and Paget's disease. A rare cause of high output cardiac failure is an arteriovenous fistula. We present an unusual case of a patient with end-stage renal failure on haemodialysis who developed extensive dilatation of their left arm arteriovenous fistula secondary to bachiocephalic vein stenosis. The labelled red blood cell gated heart blood pool study demonstrated decreased left ventricular function and extensive pooling of blood within the tortuous dilated left arm vessels. A follow-up study post-ligation of the arteriovenous fistula showed improvement of the left ventricular ejection fraction. The associated contrast venography findings are also demonstrated. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc

  17. Shared and discrepant susceptibility for carotid artery and aortic arch calcification: A genetic association study.

    Science.gov (United States)

    Zhang, Yumeng; Wang, Li; Zhang, Zhizhong; Zhang, Zongjun; Zhou, Shuyu; Cao, Liping; Cai, Biyang; Liu, Keting; Bai, Wen; Xie, Xia; Fan, Wenping; Liu, Xinfeng; Lu, Guangming; Xu, Gelin

    2015-08-01

    Genome-wide association studies (GWASs) have identified several risk loci for coronary artery calcification. Four single-nucleotide polymorphisms (SNPs, rs1537370, rs1333049, rs2026458 and rs9349379) were associated with coronary artery calcification with P values less than 5 × 10(-8) in GWASs. It is unclear if these associations exist in other vascular beds. Thus, we evaluated the impacts of these four SNPs on carotid artery and aortic arch calcification in this study. Computed tomography was applied to quantify the calcification of carotid artery and aortic arch. 860 patients with stroke completed calcification quantification and genotype testing were included in data analysis. Each SNP was evaluated for the association with carotid artery calcification, and with aortic arch calcification using generalized linear model. Among the four tested SNPs, rs2026458 was associated with calcification in both carotid artery (β = 0.31, 95% confidence interval [CI] 0.10-0.52, P = 0.003) and aortic arch (β = 0.32, 95% CI 0.10-0.54, P = 0.004), while rs1333049 was only associated with carotid artery calcification (β = 0.28, 95% CI 0.06-0.50, P = 0.011). In gender-stratified analyses, rs2026458 had significant impacts on carotid artery (P = 0.003) and aortic arch calcification (P = 0.008) in male, but not in female patients; while rs1537370 was significantly associated with carotid artery calcification in female (P = 0.013), but not in male patients. In conclusion, SNPs associated with coronary artery calcification may also increase the risk of calcification in other arteries such as carotid artery and aortic arch. PMID:26071660

  18. The study of accuracy of color Doppler ultrasonography in detecting the grade of stenosis of cervical carotid arteries in comparison to angiography

    Directory of Open Access Journals (Sweden)

    Mostaan M

    2000-09-01

    Full Text Available This is retrospective double-blind research, which was carried out in Imam Khomeini hospital in order to study the accuracy of color Doppler ultrasonography for detecting the site and grade of stenosis in cervical carotid artery. 40 patients with mean age of 62 years studied with color Doppler before DSA angiography. The most common sites of stenosis were left internal carotid (39.5% and right internal carotid arteries (38.4%. We measured peak systolic and end-diastolic velocities (PSA and EDV and ratios of PSA and EDV at stenosis sites to CCA (PSV ratio and EDV ratio. Results showed that PSA has the highest sensitivity and accuracy in all grades of stenosis: Mild to moderate stenosis: Sensitivity (90.5%, accuracy (89.5%; Severe stenosis: Sensitivity (82.1%, accuracy (92.8%; Total occlusion: Sensitivity (93.8%, accuracy (96.5%. There is no difference between accuracy of Doppler parameters for detection of total occlusion (96.5% but in other grades after PSV, EDV (Mild-moderate 86%, severe 87.2%. EDV ratio and PSV ratio (Mild-moderate both 84.8%, severe both 86% have the highest accuracies. We concluded that color Doppler sonography can reliability detect stenosis in carotid arteries & PSV has the highest accuracy.

  19. 家族性高胆固醇血症并发主动脉瓣上及颈动脉狭窄报告并文献复习%Familial Hypercholesterolemia Complicated with Aortic Valve Stenosis and Carotid Stenosis:A Case Report and Lit-erature Review

    Institute of Scientific and Technical Information of China (English)

    周佳君; 邵森

    2015-01-01

    目的:探讨家族性高胆固醇血症( familial hypercholesterolemia, FH)的临床特点及诊治要点。方法对我院收治的1例FH临床资料进行回顾性分析。结果本例17岁女性,因活动后胸闷、气促5年,加重1个月入院。4岁时皮肤出现黄色瘤,手术治疗后复发。病程中于外院就诊,考虑先天性心脏病及高脂血症,并予降血脂治疗未见明显效果入我院。经查血脂升高,心脏及颈动脉超声检查示主动脉瓣上狭窄及颈动脉狭窄,并结合有黄色瘤病史,确诊为纯合子型FH,给予降血脂、强心、利尿、抗血小板聚集等治疗,病情好转,因拒绝血浆置换治疗,继续上述治疗,随访1年血脂控制不佳,症状反复发作。结论 FH易出现心血管并发症,预后差,早期容易漏诊,早期诊断与治疗是延缓疾病进展的关键。%Objective To explore the clinical characteristics, and key points of diagnosis and treatment of familial hypercholesterolemia ( FH) . Methods Clinical date of one patient with FH in our hospital was retrospectively analyzed, and related literature was reviewed. Results A 17-year-old female patient was admitted for chest distress and shortness of breath after exercise for 5 years and aggravated for 1 month. The patient developed xanthomas at the elbows at the age of 4 and under-went surgery. However, one year later, the xanthomas relapsed. The patient was diagnosed as having congenital heart disease and hyperglycemia before admission to our hospital. Although she had been given by, the patient failed to respond to lipid-low-ering treatment. After transfer to our hospital, her concentration of cholesterol was elevated significantly. The ultrasound ex-amination indicated aortic valve stenosis and carotid stenosis. In addition, her family members were found to have hyperglyce-mia or xanthoma, then the diagnosis of homozygous FH was made. The symptoms were alleviated after the treatment of cardio-tonic, diuretic, lipid

  20. Factors influencing long-term survival after aortic valve replacement.

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1980-06-01

    Full Text Available In the aortic stenosis group, the left ventricular (LV muscle mass index was a good parameter for predicting the prognosis. Associated mitral valve disease had no influence on long term survival after aortic valve replacement. In the aortic insufficiency group, associated mitral valve disease had a marked influence on the results of aortic valve replacement. In general, the aortic insufficiency group had less clinical improvement postoperatively than the aortic stenosis group. In the annuloaortic ectasia group, left ventricular enddiastolic pressure (LVEDP might be the predictor to the prognosis. This group had the worst prognosis, of the three groups. Early operation should be considered for patients who have no, or only mild symptoms of, aortic valve disease.

  1. Pregabalin for Refractory Radicular Leg Pain due to Lumbar Spinal Stenosis: A Preliminary Prospective Study

    Directory of Open Access Journals (Sweden)

    Sumihisa Orita

    2016-01-01

    Full Text Available We investigated the efficacy of pregabalin (PGB for neuropathic leg pain in lumbar spinal stenosis (LSS patients with disturbed activities of daily living (ADL/quality of life (QOL in a prospective observational study. Subjects were a total of 104 LSS patients with neuropathic pain (NeP in leg and neurological intermittent claudication (IMC refractory to nonsteroidal anti-inflammatory drugs (NSAIDs for at least a month. NeP was identified using screening tool, Pain DETECT questionnaire. Visual analog scale (VAS scores and responses to the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ were assessed before and 6 weeks after PGB treatment initiation. Changes in IMC distance and adverse events were also recorded. PGB significantly improved their VAS scores for pain and sleep quality (P<0.001. With respect to JOABPEQ, significant improvements were observed with regard to the following dimensions: pain-related disorders (P<0.01, lumbar spine dysfunction (P=0.031, gait disturbance (P=0.028, and psychological disorders (P=0.014. The IMC distance showed an improvement tendency after PGB treatment, albeit with no significance (P=0.063. Minor adverse events such as dizziness were observed. PGB can be effective for neuropathic leg pain refractory to NSAIDs in LSS patients, resulting in not only pain control but also improving lower back pain-related ADL/QOL scores.

  2. Deep Crater in Heavily Calcified Aortic Valve Leaflet: A “Smoking Gun” for Embolic Stroke

    OpenAIRE

    Xu, Sarah Chaoying; Canter, Lisa; Zeeshan, Ahmad; Elefteriades, John A.

    2015-01-01

    The association of severe calcific aortic stenosis with clinically significant stroke has not been well established. This case vividly describes the relationship with clinical and pathological (gross and microscopic) findings in a 62-year-old man with a severely calcified bicuspid aortic valve. Eleven months prior to aortic valve surgery, the patient had stigmata of cerebral embolic events in the absence of any other embolic source. During the aortic valve replacement surgery for aortic steno...

  3. Stenosis Asymmetry Index (SAI) between symptomatic and asymptomatic patients in the analysis of carotid arteries. A study using CT angiography

    International Nuclear Information System (INIS)

    Purpose: Extracranial carotid artery stenosis is accepted as a significant risk factor for cerebrovascular events. The purpose of this paper was to evaluate whether the Stenosis Asymmetry Index (SAI) between carotid arteries (in symptomatic and asymptomatic patients) can be considered a further parameter in the stroke risk stratification. Materials and methods: 60 consecutive symptomatic (males 36; median age 64) patients and 60 non symptomatic patients matched for gender and age, were analyzed using a 40-detector-row CT angiography. Each patient was analyzed by injecting 80 mL of contrast material at a 5 mL/s flow rate. Stenosis degree of 240 carotids was calculated according to NASCET method. For each patient, the ratio between the most severe stenosis and the contralateral was calculated to obtain the SAI. Multiple logistic regression analysis was performed and ROC curve was also calculated. Results: Results of our study indicate a mean SAI of 1.48 (±0.35 SD) in the asymptomatic group and a mean SAI of 1.69 (±0.53 SD) in the symptomatic group with a statistically significant difference (p value = 0.0204). The multiple logistic regression analysis did not find statistically significant association between SAI and symptoms. The ROC curve analysis indicated that an SAI value of 1.8 has a specificity of 84.31% presence of cerebral symptoms whereas using a 1.2 SAI we obtained a sensitivity of 88.24%. Conclusion: Results of our study suggest that a SAI > 1.8 has a good sensitivity in identifying the association with cerebrovascular events.

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

    Science.gov (United States)

    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, pAVC 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

  5. Stenosis of the branches of the neopulmonary artery after the arterial switch operation: A cardiac magnetic resonance imaging study

    International Nuclear Information System (INIS)

    The neonatal arterial switch operation (ASO) is now the standard of care for children born with transposition of the great arteries. Stenosis of the neopulmonary artery on long-term follow up is a known complication. We performed a retrospective analysis of eleven patients who underwent a cardiac magnetic resonance imaging (MRI) due to echocardiographic evidence suggestive of stenosis of the neopulmonary artery or its branches (mean estimated Doppler gradient 48 mmHg, min 30 mmHg, max 70 mmHg). A comprehensive evaluation of anatomy and perfusion was done by cardiac MRI. The branches of the neopulmonary artery (neo PA) showed decreased caliber in three patients unilaterally and in two patients, bilaterally. Magnetic resonance (MR) perfusion studies showed concomitant decreased flow, with discrepancy between the two lungs of 35/65% or worse, only in the three patients with unilateral obstruction, by two different MR perfusion methods. Cardiac MR can be used as a comprehensive non-invasive imaging technique to diagnose stenosis of the branches of the neopulmonary after the ASO, allowing evaluation of anatomy and function of the neoPA, its branches, and the differential perfusion to each lung, thus facilitating clinical decision making

  6. A prospective study of comparison between Open Gastrojejunostomy and Laparoscopic Assisted Gastrojejunostomy in patients of post corrosive ingestion pyloric stenosis.

    Directory of Open Access Journals (Sweden)

    Samir shah

    2016-03-01

    Results: We observed that benign etiology was more common for GOO (58% compared to malignant cause (42% and post corrosive ingestion pyloric stenosis was most common benign cause(42% of GOO, Pancreatic cancer was most common malignant cause(18.5% of GOO. Corrosive ingestion was more common in younger age group (66% in 15 -30 yr age and female gender(63.34% and mostly as a suicidal attempt(86.66% and most common corrosive agent was sanitary cleansing agent(hydrochloric acid (70%.Postprandial nonbillious vomiting and weight loss were consistent symptom and appeared after 6-8 week of corrosive ingestion and 50% of patient of post corrosive ingestion pyloric stenosis had concomitant esophageal stricture. In present study those patient operated with Lap Assisted Gastrojejunostomy had smaller size of incision, reduce intra operative need of blood transfusion, less post-operative pain and less chance of wound infection, early drain and suture removal and early discharged from hospital with minimal post-operative morbidity and without significant increase in total duration and cost of operation. Conclusion : As compared to Open Gastrojejunostomy, Lap Assisted Gastrojejunostomy is better alternative operative method for pyloric stenosis. [Natl J Med Res 2016; 6(1.000: 48-50

  7. A clinical study on perforator stroke resulting from Wingspan stent angioplasty for symptomatic intracranial artery stenosis

    International Nuclear Information System (INIS)

    Objective: To evaluate the incidence, potential hazards and effective countermeasure for perforator stroke (PS) resulting from stent angioplasty of symptomatic intracranial artery stenosis. Methods: Peri-operation PS complications of 258 patients receiving Gateway balloon-Wingspan stenting for severe symptomatic intracranial stenosis were analyzed. The incidence, clinical course, and prognosis of PS resulting from stenting were recorded. Special attention was given to the anatomical features, clinical manifestation and video materials of patients with PS. χ2 test was used for statistics. Results: Two hundred and fifty-five patients received stent angioplasty successfully and 7 patients had PS (incidence rate 2.7%). The patients with basilar artery stenosis had a higher incidence of PS resulting from intracranial stenting (6.1%, 4/66) than patients with middle cerebral artery stenosis (2.5%, 3/118) (χ2=2.320, P= 0.025). The potential hazards for PS included preoperative perforator stroke adjacent to the stenotic segment and prominent dissection during operation. Six patients presented symptoms after awake from general anaesthesia and one had symptoms 3 hours after stenting. One deteriorated gradually and the others reached the maximum deficit almost at once. At the follow-up of 3 months, 3 patients were disabled and scored one, two, two by mRS respectively. Conclusion: The incidence of PS resulting from intracranial stenting was low and the prognosis was not disastrous. Stenosis at basilar artery and preoperative perforator stroke adjacent to the stenotic segment were potential risk factors for PS complication. Proper maneuver of angioplasty may decrease the incidence of PS and improve the prognosis. (authors)

  8. Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

    Directory of Open Access Journals (Sweden)

    Emre Özker

    2012-06-01

    Full Text Available Objective: The aim of this study was to analyze the midterm clinical results of aortic valve replacement with cryopreserved homografts.Materials and Methods: Aortic valve replacement was performed in 40 patients with cryopreserved homograft. The indications were aortic valve endocarditis in 20 patients (50%, truncus arteriosus in 6 patients (15%, and re-stenosis or regurtitation after aortic valve reconstruction in 14 (35% patients. The valve sizes ranged from 10 to 27mm. A full root replacement technique was used for homograft replacement in all patients.Results: The 30-day postoperative mortality rate was 12.5% (5 patients. There were four late deaths. Only one of them was related to cardiac events. Overall mortality was 22.5%. Thirty-three patients were followed up for 67±26 months. Two patients needed reoperation due to aortic aneurysm caused by endocarditis. The mean transvalvular gradient significantly decreased after valve replacement (p<0.003. The last follow up showed that the 27 (82% patients had a normal left ventricular function.Conclusion: Cryopreserved homografts are safe alternatives to mechanical valves that can be used when there are proper indications. Although it has a high perioperative mortality rate, cryopreserved homograft implantation is an alternative for valve replacement, particularly in younger patients and for complex surgical problems such as endocarditis that must be minimalized.

  9. Incidence and Progression of Aortic Valve Calcium in the Multi-Ethnic Study of Atherosclerosis (MESA)

    OpenAIRE

    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 ...

  10. Anesthetic management of transcatheter aortic valve implantation

    OpenAIRE

    Annalisa Franco; Chiara Gerli; Laura Ruggeri; Fabrizio Monaco

    2012-01-01

    Transcatheter aortic valve implantation (TAVI) is an emergent technique for high-risk patients with aortic stenosis. TAVI poses significant challenges about its management because of the procedure itself and the population who undergo the implantation. Two devices are currently available and marketed in Europe and several other technologies are being developed. The retrograde transfemoral approach is the most popular procedure; nevertheless, it may not be feasible in patients with significant ...

  11. Aortic dimensions in girls and young women with turner syndrome: a magnetic resonance imaging study

    DEFF Research Database (Denmark)

    Mortensen, Kristian H; Skouby, Sven O; Leffers, Anne-Mette;

    2010-01-01

    .35-0.52; p < 0.03). The presence of bicuspid aortic valves correlated at the descending part of the aorta (R = 0.38; p < 0.03). The mean thoracic aortic dimensions were not enlarged in girls or young TS patients. The BSA predicted aortic size at all positions. The prevalence of aortic dilation and aneurysm...

  12. Aortic valve area assessed with 320-detector computed tomography

    DEFF Research Database (Denmark)

    Larsen, Linnea Hornbech; Kofoed, Klaus Fuglsang; Carstensen, Helle Gervig; Mejdahl, Mads Rams; Andersen, Mads Jønsson; Kjaergaard, Jesper; Nielsen, Olav Wendelboe; Køber, Lars; Møgelvang, Rasmus; Hassager, Christian

    2014-01-01

    To evaluate the diagnostic accuracy of aortic valve area (AVA) assessment with 320-detector Computed Tomography (MDCT) compared to transthoracic echocardiography (TTE) in a population with mild to severe aortic valve stenosis. AVA was estimated in 169 patients by planimetry on MDCT images (AVA...

  13. Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: the North Dublin TIA study.

    LENUS (Irish Health Repository)

    Sheehan, Orla C

    2010-05-01

    Transient ischemic attack (TIA) etiologic data and the ABCD(2) score may improve early stroke risk prediction, but studies are required in population-based cohorts. We investigated the external validity of the ABCD(2) score, carotid stenosis, and atrial fibrillation for prediction of early recurrent stroke after TIA.

  14. Coronary ostia obstruction after replacement of aortic valve prostesis

    Directory of Open Access Journals (Sweden)

    Riezzo Irene

    2011-08-01

    Full Text Available Abstract Aortic valve replacement (AVR is the gold standard for the treatment of severe symptomatic aortic stenosis. Complications directly related to surgical procedure are relatively infrequent. Coronary ostial stenosis is, generally, referred as late complication. Anecdotal reports concern coronary ostial stenosis as acute complication. A unique fatal case of intraoperative, bilateral coronary ostial obstruction by prosthetic valve leading to an extensive myocardial infarction is reported. Surgeons must have a high level of vigilance regarding the occurrence of acute myocardial ischemia and sudden death soon after AVR.

  15. Transcatheter aortic valve prosthesis surgically replaced 4 months after implantation

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Lund, Jens Teglgaard; Engstrøm, Thomas;

    2010-01-01

    Transcatheter aortic valve implantation is a new and rapidly evolving treatment option for high-risk surgical patients with degenerative aortic valve stenosis. Long-term results with these new valve prostheses are lacking, and potential valve dysfunction and failure would require valve replacemen....... We report the first case of surgical valve replacement in a patient with a dysfunctional transcatheter-implanted aortic valve prosthesis 4 months after implantation....

  16. Surgical approach of endovascular exclusion for thoracic aortic dissection

    International Nuclear Information System (INIS)

    Objective: To evaluate the surgical approach of endovascular exclusion for thoracic dissection. Methods: Thirty-seven cases of Stanford B type thoracic aortic dissection were undergone endovascular exclusion (EVE) and had been studied retrospectively. Preoperative evaluations for delivery arteries, including common femoral artery, iliac artery, and abdominal aorta, were carried out by using duplex ultrasonography (US), computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). Factors such as arterial calibers, stenosis, tortuosity, sclerotic plaque and media dissection were taken into account. Choices of surgical approach were decided after comprehensive consideration of these factors. If the common femoral artery inner diameter was wider than 8 mm, without severe iliac artery stenosis or tortuosity; the common femoral artery should be selected as the delivery artery. In case of severe arterial stenosis and tortuosities, then the common iliac arteries were exposed by retroperitoneal approach and graft was delivered through this artery. Results: Mural sclerotic plaques were more sensitive to be revealed by US, conversely with CTA and MRA in showing stenosis and tortuosity directly and clearly. Utilizing this preoperative evaluating system, all the grafts passed successfully and favourably through the arteries, without any delivery artery associated complications. Conclusions: Using US, CTA and MRA in combination was necessary for preoperative evaluation of the delivery artery. In those with poor femoral artery condition, exposing common iliac artery decidedly is necessary to ensure the procedure favorably and to avoid delivery artery associated complications

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

    International Nuclear Information System (INIS)

    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.

  18. Imaging in aortic dissection

    International Nuclear Information System (INIS)

    Aortic dissection (AD) is a catastrophic aortic disease. Imaging techniques play an invaluable role in the diagnostic evaluation and management of patients with AD. Major signs of AD with different imaging modalities are described in this article with a pertinent discussion on guidelines for the optimized approach of imaging study (13 refs.)

  19. Association of Lumbar Arterial Stenosis with Low Back Symptoms: A Cross-Sectional Study Using Two-Dimensional Time-of-Flight Magnetic Resonance Angiography

    International Nuclear Information System (INIS)

    Background: Recent studies indicate that diminished blood flow may cause low back symptoms and intervertebral disc degeneration. Purpose: To explore the association between lumbar arterial stenosis as detected by two-dimensional time-of-flight magnetic resonance angiography (2D TOF-MRA) and lumbar pain symptoms in an occupational cohort of middle-aged Finnish males. Material and Methods: 228 male subjects aged 36 to 55 years (mean 47 years) were imaged with 2D TOF-MRA. Additionally, 20 randomly selected subjects were scanned with contrast-enhanced MRA (ceMRA). In each subject, the first (L1) to fourth (L4) segmental lumbar arteries were evaluated for lumbar artery stenosis using a dichotomic scale. One subject was excluded because of poor image quality, reducing the study population to 227 subjects. Logistic regression analysis was used to evaluate the association between arterial stenosis in 2D TOF-MRA and low back pain and sciatica symptoms (intensity, duration, frequency). Results: Comparing 2D TOF-MRA and ceMRA images, the kappa value (95% confidence interval) was 0.52 (0.31-0.73). The intraobserver reliability kappa value for 2D TOF-MRA was 0.85 (0.77-0.92), and interobserver kappa was 0.57 (0.49-0.65). The sensitivity of 2D TOF-MRA in detecting stenosis was 0.58, the accuracy 0.89, and the specificity 0.94. In 97 (43%) subjects all arteries were normal, whereas 130 (57%) had at least one stenosed artery. The left L4 artery was most often affected. The degree of arterial stenosis was associated with intensity of low back and sciatic pain, and sciatica pain duration during the past 3 months. Conclusion: 2D TOF-MRA is an acceptable imaging method for arterial stenosis compared to ceMRA. Arterial stenosis was associated with subjective pain symptoms, indicating a role of decreased nutrition in spinal disorders

  20. Association of Lumbar Arterial Stenosis with Low Back Symptoms: A Cross-Sectional Study Using Two-Dimensional Time-of-Flight Magnetic Resonance Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Korkiakoski, A.; Niinimaeki, J.; Karppinen, J.; Korpelainen, R.; Haapea, M.; Natri, A.; Tervonen, O. (Inst. of Clinical Sciences, Dept. of Physical and Rehabilitation Medicine, Univ. of Oulu, Oulu (Finland))

    2009-01-15

    Background: Recent studies indicate that diminished blood flow may cause low back symptoms and intervertebral disc degeneration. Purpose: To explore the association between lumbar arterial stenosis as detected by two-dimensional time-of-flight magnetic resonance angiography (2D TOF-MRA) and lumbar pain symptoms in an occupational cohort of middle-aged Finnish males. Material and Methods: 228 male subjects aged 36 to 55 years (mean 47 years) were imaged with 2D TOF-MRA. Additionally, 20 randomly selected subjects were scanned with contrast-enhanced MRA (ceMRA). In each subject, the first (L1) to fourth (L4) segmental lumbar arteries were evaluated for lumbar artery stenosis using a dichotomic scale. One subject was excluded because of poor image quality, reducing the study population to 227 subjects. Logistic regression analysis was used to evaluate the association between arterial stenosis in 2D TOF-MRA and low back pain and sciatica symptoms (intensity, duration, frequency). Results: Comparing 2D TOF-MRA and ceMRA images, the kappa value (95% confidence interval) was 0.52 (0.31-0.73). The intraobserver reliability kappa value for 2D TOF-MRA was 0.85 (0.77-0.92), and interobserver kappa was 0.57 (0.49-0.65). The sensitivity of 2D TOF-MRA in detecting stenosis was 0.58, the accuracy 0.89, and the specificity 0.94. In 97 (43%) subjects all arteries were normal, whereas 130 (57%) had at least one stenosed artery. The left L4 artery was most often affected. The degree of arterial stenosis was associated with intensity of low back and sciatic pain, and sciatica pain duration during the past 3 months. Conclusion: 2D TOF-MRA is an acceptable imaging method for arterial stenosis compared to ceMRA. Arterial stenosis was associated with subjective pain symptoms, indicating a role of decreased nutrition in spinal disorders

  1. Transcatheter aortic value implantation with self-expandable nitinol valved stent: an experimental study in sheep

    International Nuclear Information System (INIS)

    Objective: to determine the feasibility and safety of transcatheter aortic valve implantation with domestic self-expandable nitinol valved stent in experimental sheep. Methods: A fresh pig pericardium was cross-linked with a 0.6% glutaraldehyde solution for 36 hours and then sutured on a nitinol self-expandable stent. Ten healthy sheep of (46.00±2.60) kg body weight were chosen for the study. Under general anesthesia, the device was delivered through catheter into the native aortic valve of the sheep via the femoral artery or abdominal aorta. The animals were followed up for three months. Results: Six devices were successfully delivered at the desired position in six sheep with no occurrence of complications. Angiographic and hemodynamic studies confirmed that the stents were fixed at correct position with competent valve function immediately and 90 days after the procedure. Technical failure or fatal complications occurred in the remaining four sheep. Conclusion: Implantation of a domestic nitinol self-expandable stent at the aortic valve position through a transcatheter approach is feasible in experimental sheep. (authors)

  2. Aortic pressure wave reconstruction during exercise is improved by adaptive filtering: a pilot study.

    Science.gov (United States)

    Stok, Wim J; Westerhof, Berend E; Guelen, Ilja; Karemaker, John M

    2011-08-01

    Reconstruction of central aortic pressure from a peripheral measurement by a generalized transfer function (genTF) works well at rest and mild exercise at lower heart rates, but becomes less accurate during heavy exercise. Particularly, systolic and pulse pressure estimations deteriorate, thereby underestimating central pressure. We tested individualization of the TF (indTF) by adapting its resonance frequency at the various levels of exercise. In seven males (age 44-57) with coronary artery disease, central and peripheral pressures were measured simultaneously. The optimal resonance frequency was predicted from regression formulas using variables derived from the individual's peripheral pressure pulse, including a pulse contour estimation of cardiac output (pcCO). In addition, reconstructed pressures were calibrated to central mean and diastolic pressure at each exercise level. Using a genTF and without calibration, the error in estimated aortic pulse pressure was -7.5 ± 6.4 mmHg, which was reduced to 0.2 ± 5.7 mmHg with the indTFs using pcCO for prediction. Calibration resulted in less scatter at the cost of a small bias (2.7 mmHg). In exercise, the indTFs predict systolic and pulse pressure better than the genTF. This pilot study shows that it is possible to individualize the peripheral to aortic pressure transfer function, thereby improving accuracy in central blood pressure assessment during exercise. PMID:21720842

  3. Cine magnetic resonance imaging study of blood flow and wall motion of the aortic arch

    International Nuclear Information System (INIS)

    The aortic arch has 3D distortions in the transverse arch in the axial view, and we previously reported that this distortion is a risk factor in the pathogenesis of arch aneurysms. In this study, we evaluated blood flow and movement of the aortic arch. In 10 healthy young volunteers, ECG-gated cine magnetic resonance imaging was carried out in the axial plane of the transverse arch, the coronal plane of the ascending arch, and the long axial plane along the entire arch. Left anterolateral movements around the midpoint of the transverse arch in the systolic phase were observed in all of the men (6.3±1.59 mm) and women (4.8±0.73 mm). A jet flow was detected in the systolic phase along the right side of the aortic wall. At the top of the plane, this jet flow turned to the left in a clockwise rotation in the anterior view. In the long axial plane, a turbulent flow in the systolic phase was observed distal to the left subclavian arterial orifice in 6 of the 7 cases. In conclusion, this turbulent flow and left anterolateral wall motion of the transverse arch are due to anatomical three-dimensional distortion of the transverse arch. We propose that these phenomena may be important risk factors in the pathogenesis of arch aneurysms. (author)

  4. A survivor of late prosthesis migration and rotation following percutaneous transcatheter aortic valve implantation.

    Science.gov (United States)

    Pang, Philip Y K; Chiam, Paul T L; Chua, Yeow Leng; Sin, Yoong Kong

    2012-05-01

    Transcatheter aortic valve implantation (TAVI) has emerged as a viable alternative endovascular technique in selected patients with severe aortic stenosis, who are either inoperable or at high risk for surgical aortic valve replacement. We report a case of delayed displacement and rotation of an aortic bioprosthesis, 43 days after successful TAVI via the transfemoral approach, with the patient surviving the subsequent open heart surgery required for device retrieval. PMID:22228843

  5. Using The Descending Aortic Wall Thickness Measured In Transesophageal Echocardiography As A Risk Marker For Aortic Dissection

    OpenAIRE

    Zaher Fanari; Sumaya Hammami; Muhammad Baraa Hammami; Safa Hammami; Chete Eze-Nliam; Weintraub, William S.

    2015-01-01

    Objective: The aim of this study is to estimate whether aortic wall thickness is increased in patients with Aortic dissection (AD) compared to low risk control group and can be used in addition to aortic diameter as a risk marker of AD. Background: AD occurs due to pathologies that may increase thickness of the aortic wall. Transesophageal echocardiography (TEE) has the ability to visualise both the thoracic aortic wall and lumen. Aortic diameter has been used to predict aortic dissection...

  6. Studies on the pathogenesis of degenerative lumbar canal stenosis by computed tomography, 2

    International Nuclear Information System (INIS)

    To evaluate the significance of measurement parameters for the lumbar canal (LC), a retrospective analysis was made of computed tomography (CT) scans in a total of 129 patients, including 20 with degenerative lumbar canal stenosis (DLCS), 65 with degenerative spondylosis, 21 with disc hernia, and 23 with lumbar pain. The shape of the transverse LC was not reflected by the anteroposterior and transverse diameters of LC, but was somewhat reflected by the transverse area of LC. The transverse area of dural sac (DS) was considered important in determining the degree of stenosis. Regarding the transverse area, the DS correlated more strongly with the LC with soft-tissue windows than that with bone windows. The angle of intervertebral joint was likely to be related to the pathophysiology of the LC. In particular, sagittal tendency was seen at the levels of L3-4 and L4-5 in the DLCS group. There was correlation between the angle of intervertebral joint and the transverse areas of both soft-tissue LC and DS at the levels of L4-5. A multivariate analysis suggested the possibility that the significance of measurement parameters might vary depending on the vertebral level for the lower lumbar spine. The following criteria for indicating DLCS were obtained: 1) a transverse area of ≤ 100 mm2 for DS or ≤ 118 mm2 for soft-tissue LC at the levels of L3-4; 2) a transverse area of ≤ 90 mm2 for DS and an angle of ≤ 90 deg for the intervertebral joint at the levels of L4-5; and 3) lateral recess of ≤ 3 mm in anteroposterior diameter at the levels of L5-S1. (Namekawa, K.)

  7. The influence of artery wall curvature on the anatomical assessment of stenosis severity derived from fractional flow reserve: a computational fluid dynamics study.

    Science.gov (United States)

    Govindaraju, Kalimuthu; Viswanathan, Girish N; Badruddin, Irfan Anjum; Kamangar, Sarfaraz; Salman Ahmed, N J; Al-Rashed, Abdullah A A A

    2016-11-01

    This study aims to investigate the influence of artery wall curvature on the anatomical assessment of stenosis severity and to identify a region of misinterpretation in the assessment of per cent area stenosis (AS) for functionally significant stenosis using fractional flow reserve (FFR) as standard. Five artery models of different per cent AS severity (70, 75, 80, 85 and 90%) were considered. For each per cent AS severity, the angle of curvature of the arterial wall varied from straight to an increasingly curved model (0°, 30°, 60°, 90° and 120°). Computational fluid dynamics was performed under transient physiologic hyperemic flow conditions to investigate the influence of artery wall curvature on the pressure drop and the FFR. The findings in this study may be useful in in vitro anatomical assessment of functionally significant stenosis. The FFR decreased with increasing stenosis severity for a given curvature of the artery wall. Moreover, a significant decrease in FFR was found between straight and curved models discussed for a given severity condition. These findings indicate that the curvature effect was included in the FFR assessment in contrast to minimum lumen area (MLA) or per cent AS assessment. The MLA or per cent AS assessment may lead to underestimation of stenosis severity. From this numerical study, an uncertainty region could be evaluated using the clinical FFR cutoff value of 0.8. This value was observed at 81.98 and 79.10% AS for arteries with curvature angles of 0° and 120° respectively. In conclusion, the curvature of the artery should not be neglected in in vitro anatomical assessment. PMID:27052093

  8. Asymptomatic internal carotid artery stenosis and cerebrovascular risk stratification

    DEFF Research Database (Denmark)

    Nicolaides, Andrew N; Kakkos, Stavros K; Kyriacou, Efthyvoulos;

    2010-01-01

    The purpose of this study was to determine the cerebrovascular risk stratification potential of baseline degree of stenosis, clinical features, and ultrasonic plaque characteristics in patients with asymptomatic internal carotid artery (ICA) stenosis....

  9. The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis

    DEFF Research Database (Denmark)

    Madsen, Rasmus; Jensen, Tue Secher; Pope, Malcolm;

    2007-01-01

    STUDY DESIGN: A method comparison study. OBJECTIVE: To investigate the effect of body position and axial load of the lumbar spine on disc height, lumbar lordosis, and dural sac cross-sectional area (DCSA). SUMMARY OF BACKGROUND DATA.: The effects of flexion and extension on spinal canal diameters...... position with applied axial loading. Disc height, lumbar lordosis, and DCSA were measured and the different positions were compared. RESULTS: In section 1, the only significant difference between positions was a reduced lumbar lordosis during standing when compared with lying (P = 0.04), most probably a...... and DCSA are well documented. However, the effects of axial loading, achieved by upright standing or by a compression device, are still unclear. METHODS: Patients with lumbar spinal stenosis were examined in 2 separate studies, including 16 and 20 patients, respectively. In section 1, magnetic...

  10. Stenosis of calcified carotid artery detected on Panoramic Radiography

    Energy Technology Data Exchange (ETDEWEB)

    Cho, So Yang; Oh, Won Mann; Yoon, Suk Ja; Yoon, Woong; Lee, Jae Seo; Kang, Byung Cheol [School of Dentistry, Chonnam National University, Seoul (Korea, Republic of); Palomo, Juan M. [Department of Orthodontics, School of Dental Medicine, Case Western Reserve University, Cleveland (United States)

    2009-09-15

    This study aimed to investigate the luminal stenosis of the internal carotid artery with calcification detected on panoramic radiographs. This study used fifty carotid arteries of 36 dental patients whose panoramic radiograph and computed tomography angiography (CTA) revealed the presence of carotid artery calcification. A neuroradiologist interpreted CTA to determine the degree of stenosis of the internal carotid arteries. The degree of stenosis was stratified in four stages; normal (no stenosis), mild stenosis (1-49%), moderate stenosis (50-69%) and severe stenosis (70-99%). Among the fifty carotid arteries with calcification detected on both panoramic radiography and CTA, 20 carotid arteries (40%) were normal, 29 carotid arteries (18%) had mild stenosis, 1 carotid artery (2%) had moderate stenosis, and there was none with severe stenosis. Sixty percent of the carotid arteries with calcification detected on both panoramic radiography and CTA had internal luminal stenosis, and two percent had moderate stenosis. When carotid atheroma is detected on panoramic radiograph, it is possible that the dental patient has luminal stenosis of the internal carotid artery.

  11. Stenosis of calcified carotid artery detected on Panoramic Radiography

    International Nuclear Information System (INIS)

    This study aimed to investigate the luminal stenosis of the internal carotid artery with calcification detected on panoramic radiographs. This study used fifty carotid arteries of 36 dental patients whose panoramic radiograph and computed tomography angiography (CTA) revealed the presence of carotid artery calcification. A neuroradiologist interpreted CTA to determine the degree of stenosis of the internal carotid arteries. The degree of stenosis was stratified in four stages; normal (no stenosis), mild stenosis (1-49%), moderate stenosis (50-69%) and severe stenosis (70-99%). Among the fifty carotid arteries with calcification detected on both panoramic radiography and CTA, 20 carotid arteries (40%) were normal, 29 carotid arteries (18%) had mild stenosis, 1 carotid artery (2%) had moderate stenosis, and there was none with severe stenosis. Sixty percent of the carotid arteries with calcification detected on both panoramic radiography and CTA had internal luminal stenosis, and two percent had moderate stenosis. When carotid atheroma is detected on panoramic radiograph, it is possible that the dental patient has luminal stenosis of the internal carotid artery.

  12. The role of the transesofagic echocardiography in the study of the patients with mitral stenosis programmed for mitral valvuloplastia with balloon of Inoue

    International Nuclear Information System (INIS)

    Balloon valvuloplasty (BVP) is the treatment of choice in patients with mitral stenosis (MS) who are not otherwise counter indicated. Trans-esophageal echocardiography (TEE) before a BVP complements the information obtained by trans-thoracic echocardiography (TTE) and allows the diagnosis of counter indications, which may pass unnoticed in the latter. Seven years' experience with TEE in the study of patients with mitral stenosis about to under go BVP is presented. New counter indications are found for this procedure in 30 % of the cases. In the rest of the patients the exam complements the morphological and hemodynamic valuation of the mitral valve

  13. Study Design of PROCEDURE Study. A Randomized Comparison of the Dose-Dependent Effects of Pitavastatin in Patients with Abdominal Aortic Aneurysm with Massive Aortic Atheroma: Prevention of Cholesterol Embolization during Endovascular and Open Aneurysm Repair with Pitavastatin (PROCEDURE) Study

    Science.gov (United States)

    Nemoto, Masaru; Hashimoto, Takuya; Miura, Sumio; Urabe, Go; Nakazawa, Tatsu; Hosaka, Akihiro; Kato, Masaaki; Ohkubo, Nobukazu; Miyairi, Takeshi; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2013-01-01

    Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effects, discovered and developed by a Japanese company because it has shown excellent pleiotropic effects on atheromatous arteries in the Japanese population. A randomized comparison study of dose-dependent effects of pitavastatin in patients with AAA with massive atheromatous aortic thrombus (PROCEDURE study) has begun. PROCEDURE has an enrollment goal of up to 80 patients with AAA with massive aortic atheroma (excluding intrasac atheroma), randomly allocated into 2 groups receiving pitavastatin at a dose of 1 or 4 mg/day. The endpoints of the PROCEDURE study include change in atheroma volume, major adverse events related to shower embolization after aneurysm repair, and lipid-lowering effects. When complete, results of the PROCEDURE study should provide objective evidence to use statins preoperatively for AAA with massive aortic atheroma. PMID:23641286

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

    Directory of Open Access Journals (Sweden)

    Katie L. Losenno

    2012-01-01

    Full Text Available 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.

  15. Quantification of coronary artery stenosis with high-resolution CT in comparison with histopathology in an ex vivo study

    International Nuclear Information System (INIS)

    Purpose: To investigate the ex vivo performance of high-resolution computed tomography (CT) for quantitative assessment of percentage diameter stenosis in coronary arteries compared to histopathology. Materials and methods: High-resolution CT was performed in 26 human heart specimens after the injection of iodinated contrast media into the coronary arteries. Coronary artery plaques were visually identified on CT images and the grade of stenosis for each plaque was measured with electronic calipers. All coronary plaques were characterized by histopathology according to the Stary classification, and the percentage of stenosis was measured. Results: CT depicted 84% (274/326) of all coronary plaques identified by histology. Missed plaques by CT were of Stary type I (n = 31), type II (n = 16), and type III (n = 5). The stenosis degree significantly correlated between CT and histology (r = 0.81, p < 0.001). CT systematically overestimated the stenosis of calcified plaques (mean difference - 11.0 ± 9.5%, p < 0.01) and systematically underestimated the stenosis of non-calcified plaques (mean difference −6.8 ± 10.4%, p < 0.05), while there was no significant difference for mixed-type plaques (mean difference −0.4 ± 11.7%, p = 0.85). There was a significant underestimation of stenosis degree as measured by CT for Stary II plaques (mean difference −14 ± 9%, p < 0.01) and a significant overestimation for Stary VII plaques (mean difference 9 ± 10%, p < 0.05), but there was no significant difference in stenosis degree between both modalities for other plaque types. Conclusions: High-resolution CT reliably depicts advanced stage coronary plaques with an overall good correlation of stenosis degree compared to histology, however, the degree of stenosis is systematically overestimated in calcified and underestimated in non-calcified plaques

  16. Concepts to optimize stent-grafting of abdominal aortic aneurysms based on results of experimental studies

    International Nuclear Information System (INIS)

    Purpose. In the endoluminal therapy of abdominal aortic aneurysms, a short proximal aneurysm neck, endoleaks and the large size and stiffness of the introducer systems are responsible for many of the complications and sub-optimal outcomes. The purpose of the present review article is to to suggest strategies to minimize these complications based on the results of experimental studies in animals. Material and methods. After implanting various types of stents across the renal artery origins, the functional and morphological changes in the kidneys and renal vessels were studied by various authors. In order to prevent progressive widening of the proximal aneurysmal neck and graft dislocation, Sonesson et al. performed a laparoscopic banding around the proximal neck in pigs. To study the effects of endoleaks, Marty, Schurink and Pitton carried out pressure measurements in experimental aneurysms with and without endoleaks. Sakaguchi and Pavcnik developed the 'Twin-tube endografts' (TTEG) and the 'Bifurcated drum occluder endografts' (BDOEG) and tested them in dogs. Results. Up to 3 months after suprarenal stent placement, Chavan et al. detected no significant fall in the mean inulin clearance in sheep (140±46 ml/min before, 137±58 ml/min after). Nasim et al. and Malina et al. reported similar observations with respect to renal function. Suprarenal fixation may result in isolated thrombotic occlusions of the renal arteries and microinfarcts in the kidneys. Mean aortic diameters at the level of banding were significantly smaller in the animals with aortic banding as opposed to those in the control group without banding (8 mm vs 11 mm, p=0.004). The banding caused a secure proximal fixation of the stent-graft. Persistent endoleaks resulted in significantly higher intraaneurysmal pressures. Although the TTEG and the BDOEG stent-grafts required smaller sheaths, occlusions were observed in 8% (TTEG) and 60% (BDOEG) of the graft limbs. (orig.)

  17. Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

    Directory of Open Access Journals (Sweden)

    Marcia Maria Morales

    2010-01-01

    Full Text Available OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty-nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end-diastolic velocity, cm/s were measured 24 hours after the procedures and also at 12 months post-procedure. Residual stenoses (immediately postprocedure and restenoses (within 12 months of procedure were defined as narrowings of >50% on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24-hour and 12-month post-procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34% and the patch closure group (1 case, 1.53%, P = 0.08. At 12 months, 2 stenting patients (6.88% and 2 patch closure patients (3.07% had $50% restenosis (P = 0.58. One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or patched carotids.

  18. Morphological and hemodynamic patterns of carotid stenosis treated by endarterectomy with patch closure versus stenting: a duplex ultrasound study

    Science.gov (United States)

    Morales, Marcia Maria; Anacleto, Alexandre; Buchdid, Marcello Azem; Simeoni, Paulo Ricardo Baggio; Ledesma, Sérgio; Cêntola, Crescêncio; Anacleto, João Carlos; Aldrovani, Marcela; Piccinato, Carlos Eli

    2010-01-01

    OBJECTIVES: A duplex ultrasound study was performed to investigate morphological and hemodynamic patterns of carotid stenoses treated by endarterectomy with patch closure versus stenting. MATERIALS AND METHOD: Twenty‐nine carotid stenoses were treated with stenting and 65 with patch closure. Duplex ultrasound parameters (luminal diameter, mm; peak systolic velocity and end‐diastolic velocity, cm/s) were measured 24 hours after the procedures and also at 12 months post‐procedure. Residual stenoses (immediately post‐procedure) and restenoses (within 12 months of procedure) were defined as narrowings of ≥50% on duplex ultrasound examination. RESULTS: In stented patients, the luminal diameter of the proximal internal carotid artery increased in the interval between the 24‐hour and 12‐month post‐procedure studies, while in the patch closure patients, the diameter decreased. Carotid hemodynamics normalized immediately after both patching and stenting and remained relatively stable thereafter up to 12 months. No statistically elevated flow velocities (in the absence of residual stenosis or restenosis) were observed in the patched or stented carotid arteries. No significant differences in residual stenosis rates were observed between the stenting group (3 cases, 10.34%) and the patch closure group (1 case, 1.53%, P  =  0.08). At 12 months, 2 stenting patients (6.88%) and 2 patch closure patients (3.07%) had ≥50% restenosis (P  =  0.58). One case of late stroke due to restenosis was observed in the stenting group; the patient died 12 months postoperatively, before receiving new intervention. CONCLUSION: Measurements over time in luminal diameter signalized differences in arterial remodeling mechanisms between patched and stented carotids. Both stenting and patch closure were associated with carotid patency and flow restoration. This study does not support a general approach to new velocity criteria indiscriminately applied to stented or

  19. Reduction of myocardial hypertrophy after aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Kostić-Mirković Andrijana

    2007-01-01

    Full Text Available Background/Aim. Aortic valve disease - stenosis and regurgitation are the cause of increased homodynamic stress of the left ventricle (LV which then develops an adaptive mechanism of cardiac muscle hypertrophy. The aim of this study was to establish if aortic valve replacement procedure (AVR reduces myocardial hypertrophy and if it does in what period of time. Methods. Eighty-six patients who had been operated for AVR in the Clinical Center of Serbia were included in this investigation. In the every patient the aortic valve had been replaced with a mechanical valve prosthesis. Transthoracic echocardiography examination (TTE was performed in all of the patients before, and one week after the operation, while 22 patients were followed-up on a long term basis. The LV mass was determined with the formula according to the Pen convention. Results. In the tested group there was significantly more male than female individuals (n = 57-66.3%, 29-337%. Twelve patients (14% were operated for isolated aortic stenosis, 22 patients (25.6% for aortic regurgitation, 48 patients (55.8% for combined aortic valve disease, while 4 patients (4.7% for endocarditis. Student t test did not show any significant difference in diastolic septal thickness before and after the operation (p = 0.88, while it did show that the difference in the LV mass before and after the operation was highly significant (p = 0.000. This test also showed that, taking the mass of 240 g as the border value for hypertrophy of LV, the reduction of LV mass between preoperative and early postoperative finding was not significant (p = 0.5, while the reduction in LV mass between late and early postoperative examination was statistically significant (p = 0.000. In 19 of 22 patients who were followed-up postoperatively over a long period (84 months after the operation significant reduction of LV mass was registered. The mean time of the reduction was 27.5 months. Conclusion. This study showed the

  20. Adiposity, obesity, and arterial aging: longitudinal study of aortic stiffness in the Whitehall II cohort.

    Science.gov (United States)

    Brunner, Eric J; Shipley, Martin J; Ahmadi-Abhari, Sara; Tabak, Adam G; McEniery, Carmel M; Wilkinson, Ian B; Marmot, Michael G; Singh-Manoux, Archana; Kivimaki, Mika

    2015-08-01

    We sought to determine whether adiposity in later midlife is an independent predictor of accelerated stiffening of the aorta. Whitehall II study participants (3789 men; 1383 women) underwent carotid-femoral applanation tonometry at the mean age of 66 and again 4 years later. General adiposity by body mass index, central adiposity by waist circumference and waist:hip ratio, and fat mass percent by body impedance were assessed 5 years before and at baseline. In linear mixed models adjusted for age, sex, ethnicity, and mean arterial pressure, all adiposity measures were associated with aortic stiffening measured as increase in pulse wave velocity (PWV) between baseline and follow-up. The associations were similar in the metabolically healthy and unhealthy, according to Adult Treatment Panel-III criteria excluding waist circumference. C-reactive protein and interleukin-6 levels accounted for part of the longitudinal association between adiposity and PWV change. Adjusting for chronic disease, antihypertensive medication and risk factors, standardized effects of general and central adiposity and fat mass percent on PWV increase (m/s) were similar (0.14, 95% confidence interval: 0.05-0.24, P=0.003; 0.17, 0.08-0.27, P<0.001; 0.14, 0.05-0.22, P=0.002, respectively). Previous adiposity was associated with aortic stiffening independent of change in adiposity, glycaemia, and lipid levels across PWV assessments. We estimated that the body mass index-linked PWV increase will account for 12% of the projected increase in cardiovascular risk because of high body mass index. General and central adiposity in later midlife were strong independent predictors of aortic stiffening. Our findings suggest that adiposity is an important and potentially modifiable determinant of arterial aging. PMID:26056335

  1. Post intubation tracheal stenosis

    OpenAIRE

    De, Sajal; De, Sarmishtha

    2008-01-01

    Tracheal stenosis following prolonged intubation is a relatively rare but a serious problem. However, some degree of airway injury is common following intubation, no matter whether it is prolonged or of short duration. Here, we are reporting a fifty six year old male patient who developed multiple web like tracheal stenosis following intubation with high volume low pressure cuff endotracheal tube. Subsequently, the stenosis was successfully dilated by balloon bronchoplasty.

  2. On Renal Artery Stenosis

    OpenAIRE

    Eklöf, Hampus

    2005-01-01

    Renal artery stenosis (RAS) is a potentially curable cause of hypertension and azotemia. Besides intra-arterial renal angiography there are several non-invasive techniques utilized to diagnose patients with suspicion of renal artery stenosis. Removing the stenosis by revascularization to restore unobstructed blood flow to the kidney is known to improve and even cure hypertension/azotemia, but is associated with a significant complication rate. To visualize renal arteries with x-ray technique...

  3. Using Flat-Panel Perfusion Imaging to Measure Cerebral Hemodynamics: A Pilot Feasibility Study in Patients With Carotid Stenosis.

    Science.gov (United States)

    Lin, Chung-Jung; Guo, Wan-Yuo; Chang, Feng-Chi; Hung, Sheng-Che; Chen, Ko-Kung; Yu, Deuerling-Zheng; Wu, Chun-Hsien Frank; Liou, Jy-Kang Adrian

    2016-05-01

    Flat-detector CT perfusion (FD-CTP) imaging has demonstrated efficacy in qualitatively accessing the penumbra in acute stroke equivalent to that of magnetic resonance perfusion (MRP). The aim of our study was to evaluate the feasibility of quantifying oligemia in the brain in patients with carotid stenosis.Ten patients with unilateral carotid stenosis of >70% were included. All MRPs and FD-CTPs were performed before stenting. Region-of-interests (ROIs) including middle cerebral artery territory at basal ganglia level on both stenotic and contralateral sides were used for quantitative analysis. Relative time to peak (rTTP) was defined as TTP of the stenotic side divided by TTP of the contralateral side, and so as relative cerebral blood volume (rCBV), relative mean transit time (rMTT), and relative cerebral blood flow (rCBF). Absolute and relative TTP, CBV, MTT, CBF between two modalities were compared.For absolute quantitative analysis, the correlation of TTP was highest (r = 0.56), followed by CBV (r = 0.47), MTT (r = 0.47), and CBF (r = 0.43); for relative quantitative analysis, rCBF was the highest (r = 0.79), followed by rTTP (r = 0.75) and rCBV (r = 0.50).We confirmed that relative quantitative assessment of FD-CTP is feasible in chronic ischemic disease. Absolute quantitative measurements between MRP and FD-CTP only expressed moderate correlations. Optimization of acquisitions and algorithms is warranted to achieve better quantification. PMID:27196456

  4. The Erasme Study: A Multicenter Study on the Safety and Technical Results of the Palmaz Stent Used for the Treatment of Atherosclerotic Ostial Renal Artery Stenosis

    International Nuclear Information System (INIS)

    Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis. Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis ≥ 20%) performed for treatment of ostial stenosis ≥ 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up. Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5-18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated. Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up

  5. New frontiers in aortic therapy: focus on current trials and devices in transcatheter aortic valve replacement.

    Science.gov (United States)

    Gutsche, Jacob T; Patel, Prakash A; Walsh, Elizabeth K; Sophocles, Aris; Chern, Sy-Yeu S; Jones, David B; Anwaruddin, Saif; Desai, Nimesh D; Weiss, Stuart J; Augoustides, John G T

    2015-04-01

    The first decade of clinical experience with transcatheter aortic valve replacement since 2002 saw the development of 2 main valve systems, namely the Edwards Sapien balloon-expandable valve series and the Medtronic self-expanding CoreValve. These 2 valve platforms now have achieved commercial approval and application worldwide in patients with severe aortic stenosis whose perioperative risk for surgical intervention is high or extreme. In the second decade of transcatheter aortic valve replacement, clinical experience and refinements in valve design have resulted in clinical drift towards lower patient risk cohorts. There are currently 2 major trials, PARTNER II and SURTAVI, that are both evaluating the role of transcatheter aortic valve replacement in intermediate-risk patient cohorts. The results from these landmark trials may usher in a new clinical paradigm for transcatheter aortic valve replacement in its second decade. PMID:25572322

  6. Aqueduct stenosis and schizophrenia

    OpenAIRE

    Dewan, M J; Bick, P

    1983-01-01

    Three patients with hydrocephalus and aqueduct stenosis are described, who also have schizophrenia defined according to strict diagnostic criteria. There are no previous reports of such an association.

  7. A rare presentation of late right coronary artery spasm following aortic valve replacement

    OpenAIRE

    Alizadeh-Ghavidel, Alireza; Basiri, Hosseinali; Totonchi, Ziae; Mirmesdagh, Yalda; Jalili-Shahandashti, Farshad; Gholizadeh, Behnam

    2015-01-01

    BACKGROUND Coronary artery spasm (CAS) is defined as a reversible, sudden epicardial coronary artery stenosis that causes vessel occlusion or near occlusion. CASE REPORT In this article, we present a clinical case of CAS in a 48-year-old woman undergoing elective aortic valve replacement surgery for aortic stenosis. On the 3rd post-operative day, the patient suffered from chest pain and dyspnea. Emergent coronary angiography demonstrated a significant spasm of the ostium portion of the right ...

  8. Vascular Complications Associated with Transfemoral Aortic Valve Replacement.

    Science.gov (United States)

    Hines, George L; Jaspan, Vita; Kelly, Brian J; Calixte, Rose

    2016-06-01

    Background Transfemoral aortic valve replacement (TAVR) is a novel technique for treating aortic stenosis, yet vascular complications are yet to be delineated. Objectives This study aims to study the vascular complications of TAVR with Edwards Sapien valves (Edwards Lifesciences Corp., Irvine, CA). Methods We performed a retrospective evaluation of TAVR patients. Standard demographics, femoral vessel and sheath size, access type (femoral cut-down [FC], percutaneous access [PFA], and iliac conduit [IC]), and treatment method were recorded. Complications were defined by the Valve Academic Research Consortium Criteria. Logistic regression was used for statistical analysis. Results A total of 99 patients underwent TAVR between February 15, 2012 and July 17, 2013 with an Edwards Sapien valve. Out of which, 48 were males with a mean age of 83 ± 7 years. Overall, 33 had FC, 58 had PFA, and 6 had an IC. A total of 17 major (2 aortic and 15 iliac) and 38 minor complications (36 access and 2 emboli) occurred. Aortic complications were managed by open repair (OR, 1) or percutaneous repair (PR, 1). Overall, 12 iliac injuries were managed by PR and 3 by OR. Out of the 33 groin complications in FC patients 8 (24%) were treated by OR, whereas 30 (52%) of the 58 groin complications in PTA patients were treated by PR. There were no differences in transfusion requirements or length of stay. Conclusion Vascular complications of TAVR are common with most being minor, related to access site and causing no immediate sequelae. Iliac injury can be managed by PR or OR. Aortic injury is associated with significant mortality. These findings increase vascular surgeons' awareness of these complications and how to manage them. PMID:27231425

  9. Causes and clinical significance of intervertebral disk flavus ligamentum space in lumbar stenosis (a comparative study of CT non-contrast and CT-myelography of 83 cases)

    International Nuclear Information System (INIS)

    Objective: To compare the imaging findings of CT non-contrast (CTNOC) and CT-myelography (CTM) in lumbar intervertebral disk, the authors proposed a new concept of intervertebral disk-flavum ligamentum space (DFLS), analyzed the causes of stenosis in lumbar DFLS and evaluated its diagnostic value in compressed lumbar radiculopathy. Methods: The images of CTNOC and CTM of 83 cases were retrospectively analyzed, and the shapes of L3-S1 disk, the width of flavum ligament at each side, the degree of prominence interior of the joint process superior at each side, and the sagittal diameter of the dural sac in L3-S1 were recorded. The relation of these restrictions and parameters to DFLS stenosis and the compressed lumbar nerve roots shown in CTNOC and CTM were analyzed. Results: The herniation of intervertebral disk were found in 138 level with the diameter of the corresponding dural sac 5 mm; 67 joint process superior prominent interior > 2 mm; 157 of 83 cases of mean width DFLS 3.8 mm. Conclusion: The DFLS≤5 mm can be diagnosed as stenosis. The main causes of stenosis are the herniation of intervertebral disk, flavum ligament thicker; and joint process superior prominent interior. It can be used as a valuable criterion in diagnosing lumbar nerve root compression in CT study

  10. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    Science.gov (United States)

    Aktuerk, Dincer; Mishra, Pankaj Kumar; Luckraz, Heyman; Garnham, Andrew; Khazi, Fayaz Mohammed

    2016-01-01

    Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO2, etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our “work in progress,” and we aim to conduct a larger study. PMID:26750675

  11. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    Directory of Open Access Journals (Sweden)

    Dincer Aktuerk

    2016-01-01

    Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

  12. Aortic valve replacement

    DEFF Research Database (Denmark)

    Kapetanakis, Emmanouil I; Athanasiou, Thanos; Mestres, Carlos A;

    2008-01-01

    BACKGROUND AND AIMS OF THE STUDY: Prompted by anecdotal evidence and observations by surgeons, an investigation was undertaken into the potential differences in implanted aortic valve prosthesis sizes, during aortic valve replacement (AVR) procedures, between northern and southern European countr...... southern European countries. Imbalances in the prevalence of rheumatic heart disease, health resource availability and variations in surgical practice throughout Europe might be possible etiological causes....

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

    Science.gov (United States)

    Santarpino, Giuseppe; Fischlein, Theodor

    2014-03-01

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

  14. The expanding indications of transcatheter aortic valve implantation.

    Science.gov (United States)

    Chiam, Paul Tl; Ewe, See Hooi

    2016-03-01

    Transcatheter aortic valve implantation (TAVI), also known as transcatheter aortic valve replacement, is increasingly performed worldwide and is a technology that is here to stay. It has become the treatment of choice for inoperable patients and an alternative option for patients at high surgical risk with severe aortic stenosis. Early results of TAVI in intermediate-risk patients appear promising although larger randomized trial results are awaited before the widespread adoption of this technology in this big pool of patients. In patients with bicuspid aortic stenosis and degenerated surgical bioprostheses, TAVI has been shown to be feasible and relatively safe, though certain important considerations remain. Indications for TAVI are likely to grow as newer generation and improved devices and delivery systems become available. PMID:26916608

  15. Advanced age and the clinical outcomes of transcatheter aortic valve implan-tation

    Institute of Scientific and Technical Information of China (English)

    Osama Alsara; Ahmad Alsarah; Heather Laird-Fick

    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 ef-fect 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 in-jures. 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.

  16. Approach to the patient with bicuspid aortic valve and ascending aorta aneurysm.

    Science.gov (United States)

    Ortiz, José T; Shin, David D; Rajamannan, Nalini M

    2006-12-01

    Bicuspid aortic valve (BAV) disease is a common congenital heart valve abnormality accounting for a large number of valve replacements in the United States. Although still incompletely understood, the natural history of BAV disease is severe aortic stenosis and associated ascending aortic dilatation. In addition to the increased risk of endocarditis, aortic dissection and severe aortic valve dysfunction are responsible for most fatal complications. Thus, early and precise recognition of this condition is mandatory. The new American College of Cardiology/American Heart Association recommendations highlight the role of MRI and CT as complimentary tools to echocardiography for the diagnosis and surveillance of the morphology of the aortic valve and ascending aorta. Moreover, better understanding of the cellular mechanisms, including inflammation, bone formation, atherosclerotic-like processes, and aortic wall abnormalities, as well as the heritability and genetic predisposition for the disease, will define the potential for targeted medical therapies in the future. Currently, the treatment of this condition is primarily surgical. Although combined valve and ascending aorta replacement has been the most common surgical approach in the past, the increased cumulative risk of thrombotic and embolic events among these young patients has led to more conservative approaches. Several valve-sparing approaches with comparable mid-term results compared with the classic procedures have recently been reported. However, longer follow-up studies will be helpful to better define the advantages of these new surgical options. After a quick overview of the natural history of the BAV, this article provides an updated approximation of the current knowledge of the pathophysiology as well as the recommendations for the management and treatment of this disease. PMID:17078910

  17. Genome-wide association study of coronary and aortic calcification in lung cancer screening CT

    Science.gov (United States)

    de Vos, Bob D.; van Setten, Jessica; de Jong, Pim A.; Mali, Willem P.; Oudkerk, Matthijs; Viergever, Max A.; Išgum, Ivana

    2016-03-01

    Arterial calcification has been related to cardiovascular disease (CVD) and osteoporosis. However, little is known about the role of genetics and exact pathways leading to arterial calcification and its relation to bone density changes indicating osteoporosis. In this study, we conducted a genome-wide association study of arterial calcification burden, followed by a look-up of known single nucleotide polymorphisms (SNPs) for coronary artery disease (CAD) and myocardial infarction (MI), and bone mineral density (BMD) to test for a shared genetic basis between the traits. The study included a subcohort of the Dutch-Belgian lung cancer screening trial comprised of 2,561 participants. Participants underwent baseline CT screening in one of two hospitals participating in the trial. Low-dose chest CT images were acquired without contrast enhancement and without ECG-synchronization. In these images coronary and aortic calcifications were identified automatically. Subsequently, the detected calcifications were quantified using coronary artery calcium Agatston and volume scores. Genotype data was available for these participants. A genome-wide association study was conducted on 10,220,814 SNPs using a linear regression model. To reduce multiple testing burden, known CAD/MI and BMD SNPs were specifically tested (45 SNPs from the CARDIoGRAMplusC4D consortium and 60 SNPS from the GEFOS consortium). No novel significant SNPs were found. Significant enrichment for CAD/MI SNPs was observed in testing Agatston and coronary artery calcium volume scores. Moreover, a significant enrichment of BMD SNPs was shown in aortic calcium volume scores. This may indicate genetic relation of BMD SNPs and arterial calcification burden.

  18. Genome-wide joint SNP and CNV analysis of aortic root diameter in African Americans: the HyperGEN study

    Directory of Open Access Journals (Sweden)

    Devereux Richard B

    2011-01-01

    Full Text Available Abstract Background Aortic root diameter is a clinically relevant trait due to its known relationship with the pathogenesis of aortic regurgitation and risk for aortic dissection. African Americans are an understudied population despite a particularly high burden of cardiovascular diseases. We report a genome-wide association study on aortic root diameter among African Americans enrolled in the HyperGEN study. We invoked a two-stage, mixed model procedure to jointly identify SNP allele and copy number variation effects. Results Results suggest novel genetic contributors along a large region between the CRCP and KCTD7 genes on chromosome 7 (p = 4.26 × 10-7; and the SIRPA and PDYN genes on chromosome 20 (p = 3.28 × 10-8. Conclusions The regions we discovered are candidates for future studies on cardiovascular outcomes, particularly in African Americans. The methods we employed can also provide an outline for genetic researchers interested in jointly testing SNP and CNV effects and/or applying mixed model procedures on a genome-wide scale.

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

    Directory of Open Access Journals (Sweden)

    Harish Ramakrishna

    2015-01-01

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

  20. Infective endocarditis following transcatheter aortic valve replacement-

    DEFF Research Database (Denmark)

    Loh, Poay Huan; Bundgaard, Henning; S�ndergaard, Lars

    2013-01-01

    Transcatheter aortic valve replacement (TAVR) can improve the symptoms and prognosis of patients with severe aortic stenosis who, due to a high expected operative risk, would not have otherwise been treated surgically. If these patients develop prosthetic valve endocarditis, their presentations may...... be atypical causing a delay in the diagnosis and treatment. The management is also complicated by their comorbidities, and surgical treatment may not be feasible leading to a significant morbidity and mortality. We describe a case of an 85-year-old man with TAVI prosthetic valve endocarditis...

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

    OpenAIRE

    Mayr, N. Patrick; 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; r...

  2. Assessment of the "long sheath" technique for percutaneous aortic balloon valvuloplasty

    NARCIS (Netherlands)

    S. Plante (Sylvain); K.J. Beatt (Kevin); M.J.B.M. van den Brand (Marcel); C. di Mario (Carlo); B. Meier (Bernard); P.W.J.C. Serruys (Patrick)

    1990-01-01

    textabstractA 100 cm-long 16.5 F valvuloplasty catheter introducer was assessed as an adjunct for percutaneous transluminal aortic valvuloplasty (PTAV) via the femoral artery in 31 patients with severe aortic stenosis. Observed improvements in peak systolic gradient (81.6 +/- 29.9 mm Hg vs. 35.5 +/-

  3. Electrocardiographic imaging-based recognition of possible induced bundle branch blocks during transcatheter aortic valve implantations

    NARCIS (Netherlands)

    Dam, P.M. van; Proniewska, K.; Maugenest, A.M.; Mieghem, N.M. van; Maan, A.C.; Jaegere, P.P. de; Bruining, N.

    2014-01-01

    AIMS: Conventional electrocardiogram (ECG)-based diagnosis of left bundle branch block (LBBB) in patients with left ventricular hypertrophy (LVH) is ambiguous. Left ventricular hypertrophy is often seen in patients with severe aortic stenosis in which a transcatheter aortic valve implantation (TAVI)

  4. Salvage Extracorporeal Membrane Oxygenation Prior to "Bridge" Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Chiu, Peter; Fearon, William F; Raleigh, Lindsay A; Burdon, Grayson; Rao, Vidya; Boyd, Jack H; Yeung, Alan C; Miller, David Craig; Fischbein, Michael P

    2016-06-01

    We describe a patient who presented in profound cardiogenic shock due to bioprosthetic aortic valve stenosis requiring salvage Extracorporeal Membrane Oxygenation followed by a "bridge" valve-in-valve transcatheter aortic valve replacement. doi: 10.1111/jocs.12750 (J Card Surg 2016;31:403-405). PMID:27109017

  5. Aortic stenting.

    Science.gov (United States)

    Droc, Ionel; Calinescu, Francisca Blanca; Droc, Gabriela; Blaj, Catalin; Dammrau, Rolf

    2015-01-01

    The approach to aortic pathology is nowadays more and more endovascular at both thoracic and abdominal levels. Thoracic stenting has gained worldwide acceptance as first intention to treat pathologies of the descending thoracic aorta. Indications have been extended to aortic arch aneurysms and also to diseases of the ascending aorta. The current devices in use for thoracic endovascular repair (TEVAR) are Medtronic Valiant, Gore TAG, Cook Tx2 and Jotec. The choice of the endograft depends on the thoracic aortic pathology and the anatomical suitability. The technological evolution of the abdominal aortic endografts was very rapid, arriving now at the fourth generation. We report the results of 55 elective cases of endovascular abdominal aortic repair (EVAR) performed in two vascular surgical centers in Romania and Germany. The prostheses used were 16 E-vita Abdominal XT, 12 Excluder, eight Talent, seven PowerLink, three Endurant and nine custom-made, fenestrated or branched from Jotec. The mean follow-up was 18 months with CT-scan, duplex ultrasound and contrast-enhanced ultrasound. The mortality was 2%. EVAR tends to become the gold standard for abdominal aortic aneurysm repair. Technological development of the devices with lowest profile introduction systems will permit to extend the anatomical indications to new frontiers. PMID:26200430

  6. In vitro proton NMR study of collagen in human aortic wall.

    Science.gov (United States)

    Vinée, P; Meurer, B; Constantinesco, A; Kohlberger, B; Hauenstein, K H; Laubenberger, J

    1993-03-01

    The authors relate the findings in the 1H solid state line shape (at 60 MHz) of human aortic walls (n = 12) in native state and after histologically controlled selective lysis of collagen and elastin. An analysis of the line shape shows a composite free induction decay (FID) consisting of a low amplitude (3-7%) fast decaying component (T2 approximately 20 microseconds) and a slow decaying one (T2 > 1 ms). The fast component is identified as the protons of the collagen macromolecules. The second moment computed from the experimental fast component of the FID is in agreement with published studies examining the motional characteristics of collagen by multinuclear NMR employing spin labeling. A theoretical second moment is computed for the collagen macromolecular backbone from the atomic positions in the superhelix. Comparison with the observed experimental values allows determination of the step angle (29 degrees) of the fast rotational motion of the collagen strands along their long axis. PMID:8383787

  7. Non-invasive computation of aortic pressure maps: a phantom-based study of two approaches

    Science.gov (United States)

    Delles, Michael; Schalck, Sebastian; Chassein, Yves; Müller, Tobias; Rengier, Fabian; Speidel, Stefanie; von Tengg-Kobligk, Hendrik; Kauczor, Hans-Ulrich; Dillmann, Rüdiger; Unterhinninghofen, Roland

    2014-03-01

    Patient-specific blood pressure values in the human aorta are an important parameter in the management of cardiovascular diseases. A direct measurement of these values is only possible by invasive catheterization at a limited number of measurement sites. To overcome these drawbacks, two non-invasive approaches of computing patient-specific relative aortic blood pressure maps throughout the entire aortic vessel volume are investigated by our group. The first approach uses computations from complete time-resolved, three-dimensional flow velocity fields acquired by phasecontrast magnetic resonance imaging (PC-MRI), whereas the second approach relies on computational fluid dynamics (CFD) simulations with ultrasound-based boundary conditions. A detailed evaluation of these computational methods under realistic conditions is necessary in order to investigate their overall robustness and accuracy as well as their sensitivity to certain algorithmic parameters. We present a comparative study of the two blood pressure computation methods in an experimental phantom setup, which mimics a simplified thoracic aorta. The comparative analysis includes the investigation of the impact of algorithmic parameters on the MRI-based blood pressure computation and the impact of extracting pressure maps in a voxel grid from the CFD simulations. Overall, a very good agreement between the results of the two computational approaches can be observed despite the fact that both methods used completely separate measurements as input data. Therefore, the comparative study of the presented work indicates that both non-invasive pressure computation methods show an excellent robustness and accuracy and can therefore be used for research purposes in the management of cardiovascular diseases.

  8. Magnetic Resonance Elastography of the in vivo Abdominal Aorta: A Feasibility Study for Comparing Aortic Stiffness between Hypertensives and Normotensives

    Science.gov (United States)

    Kolipaka, Arunark; Woodrum, David; Araoz, Philip A.; Ehman, Richard L.

    2011-01-01

    Purpose The purpose of this study is to demonstrate feasibility of using magnetic resonance elastography (MRE) to identify hypertensive changes in the abdominal aorta when compared to normotensives based on the stiffness measurements. Methods MRE was performed on 8 volunteers (4 normotensives and 4 hypertensives) to measure the effective stiffness of the abdominal aorta. MRE wave images are directionally filtered and phase gradient analysis was performed to determine the stiffness of the aorta. Student’s t-test was performed to determine significant difference in stiffness measurements between normotensives and hypertensives. Results The normotensive group demonstrated an average abdominal aortic stiffness of 3.7 ± 0.8 kPa, while the controlled-hypertensive demonstrated an average abdominal aortic stiffness of 9.3 ± 1.9kPa. MRE effective stiffness of abdominal aorta in hypertensives was significantly greater than that of normotensives with p=0.02. Conclusion Feasibility of in vivo aortic MRE is demonstrated. Hypertensives have significantly higher aortic stiffness assessed through MRE than normotensives. PMID:22045617

  9. Bicuspid Aortic Valve Disease: The Role of Oxidative Stress in Lrp5 Bone Formation

    OpenAIRE

    Rajamannan, Nalini M

    2011-01-01

    The bicuspid aortic valve (BAV) is a common congenital cardiac anomaly, having a prevalence of 0.9% to 1.37% in the general population and a male preponderance ratio of 2:1. The recognition of a BAV is clinically relevant because of its association with aortic stenosis or regurgitation, aortic aneurysm or dissection, and infective endocarditis. Although some patients with a BAV may go undetected without clinical complications for a lifetime, the vast majority will require intervention, most o...

  10. Aortic anomalies in an adolescent with the Williams' elfin facies syndrome

    International Nuclear Information System (INIS)

    An adolescent with classical Williams' syndrome who presented with hypertensive encephalopathy is described. He had the unusual combination of supravalvular aortic stenosis, long segment coarctation of the aorta, aortic hypoplasia and a high bifurcation of the abdominal aorta. Surgical resection of the coarctation was required; however, the patient has remained moderately hypertensive. The aortic anomalies in this syndrome are reviewed and their frequency and importance examined. (orig.)

  11. Aortic anomalies in an adolescent with the Williams' elfin facies syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Williams, R.L.; Azouz, E.M.

    1984-02-01

    An adolescent with classical Williams' syndrome who presented with hypertensive encephalopathy is described. He had the unusual combination of supravalvular aortic stenosis, long segment coarctation of the aorta, aortic hypoplasia and a high bifurcation of the abdominal aorta. Surgical resection of the coarctation was required; however, the patient has remained moderately hypertensive. The aortic anomalies in this syndrome are reviewed and their frequency and importance examined.

  12. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten;

    2012-01-01

    from the Copenhagen City Heart Study followed for up to 34years and in 56,211 individuals from the Copenhagen General Population Study followed for up to 7years. RESULTS: During follow-up, 335 and 169 individuals developed aortic aneurysm outcomes in the Copenhagen City Heart Study and Copenhagen...... General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm...... outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic...

  13. Has percutaneous aortic valve replacement taken center stage in the treatment of aortic valve disease?

    Science.gov (United States)

    Kumar, Gideon Praveen; Cui, Fangsen; Mathew, Lazar; Leo, Hwa Liang

    2013-01-01

    Modern biomedical advances have propelled percutaneous valve replacement into an effective and powerful therapy for many heart valve diseases, especially aortic valve stenosis. Experiences so far suggest that outcomes for new percutaneous valve replacement surgery compare favorably with that of traditional valve surgery in selected patients with severe symptomatic aortic stenosis. The inception of percutaneous aortic valve replacement (PAVR) began in 1992 when the potential for treating valve diseases was demonstrated through a modern technique of endoluminal deployment of a catheter-mounted crimped stented heart valve in an animal model. The first successful demonstration of such novel technique of surgical replacement of a heart valve was performed in 2002, when valve implantation in a patient with aortic stenosis was reported. Despite initial stumbles and a perception of being an uphill task, PAVR has emerged as one of the breakthroughs in surgical procedures. More than 1500 citations were found in PubMed, half of which were available after 2011. This is primarily because more than 50,000 procedures are being performed in more than 40 countries worldwide, with encouraging outcomes, and several stented valves have been launched in the market. This review provides a detailed analysis of the current state of the art of PAVR. Moreover, a competitive landscape of various devices available in the market and their design considerations, biomaterial selections, and overall hemodynamic performance are presented. PMID:24941416

  14. Decreased aortic growth and middle aortic syndrome in patients with neuroblastoma after radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Sutton, Elizabeth J. [Harvard University, Department of Radiology, Mount Auburn Hospital, Cambridge, MA (United States); University of California, San Francisco, Department of Radiology, San Francisco, CA (United States); Tong, Ricky T. [Stanford University, Department of Medicine, Palo Alto, CA (United States); Gillis, Amy M.; Haas-Kogan, Daphne A. [University of California, San Francisco, Department of Radiation Oncology, San Francisco, CA (United States); Henning, Tobias D.; Boddington, Sophie; Sha, Vinil; Gooding, Charles; Coakley, Fergus V.; Daldrup-Link, Heike [University of California, San Francisco, Department of Radiology, San Francisco, CA (United States); Weinberg, Vivian A. [University of California, San Francisco, Comprehensive Cancer Center, Biostatistics Core, San Francisco, CA (United States); Matthay, Katherine [University of California, San Francisco, Department of Pediatrics, San Francisco, CA (United States)

    2009-11-15

    Long-term CT follow-up studies are required in pediatric patients who have received intraoperative radiation therapy (IORT) and external beam radiation therapy (EBRT) to assess vascular toxicities and to determine the exact complication rate. To analyze with CT the effects of radiation therapy (RT) on the growth of the aorta in neuroblastoma patients. Abdominal CT scans of 31 patients with intraabdominal neuroblastoma (stage II-IV), treated with RT (20 IORT{+-}EBRT, 11 EBRT alone), were analyzed retrospectively. The diameter of the abdominal aorta was measured before and after RT. These data were compared to normal and predicted normal aortic diameters of children, according to the model of Fitzgerald, Donaldson and Poznanski (aortic diameter in centimeters = 0.844+0.0599 x age in years), and to the diameters of a control group of children who had not undergone RT. Statistical analyses for the primary aims were performed using the chi-squared test, t-test, Mann-Whitney test, nonparametric Wilcoxon matched-pairs test and analysis of variance for repeated measures. Clinical files and imaging studies were evaluated for signs of late vascular complications of neuroblastoma patients who had received RT. The mean diameter before and after RT and the growth of the aorta were significantly lower than expected in patients with neuroblastoma (P<0.05 for each) and when compared to the growth in a control group with normal and nonirradiated aortas. Among the patients who had received RT, there was no difference due to the type of RT. Seven patients from the IORT{+-}EBRT group developed vascular complications, which included hypertension (five), middle aortic syndrome (two), death due to mesenteric ischemia (one) and critical aortic stenosis, which required aortic bypass surgery (two). Patients with neuroblastoma who had received RT showed impaired growth of the abdominal aorta. Significant long-term vascular complications occurred in seven patients who received IORT

  15. Long-term outcome of endovascular treatment versus medical care for carotid artery stenosis in patients not suitable for surgery and randomised in the Carotid and Vertebral Artery Transluminal Angioplasty study (CAVATAS).

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-01-01

    Optimal treatment of carotid stenosis in patients not suitable for surgery is unclear. The Carotid and Vertebral Artery Transluminal Angioplasty study contained a trial comparing medical and endovascular treatment in patients not suitable for surgery.

  16. Implante percutâneo de valva aórtica: mito ou realidade? Percutaneous aortic aortic valve replacement: myth or reality?

    Directory of Open Access Journals (Sweden)

    Eduardo Keller Saadi

    2008-03-01

    Full Text Available A substituição valvar por prótese metálica ou biológica com o auxílio de circulação extracorpórea é o procedimento padrão-ouro para o tratamento da estenose aórtica calcificada. Embora os resultados sejam excelentes com a cirurgia convencional, alguns pacientes com idade avançada, doenças associadas, reoperações e disfunção ventricular esquerda grave apresentam alto risco cirúrgico. Nos últimos anos, técnicas de tratamento percutâneo foram desenvolvidas. A presente revisão tem por objetivo analisar a literatura desde o desenvolvimento experimental até a aplicação clínica desta nova modalidade de tratamento para pacientes com estenose aórtica grave e alto risco cirúrgico. O implante percutâneo de valva aórtica hoje vem sendo realizado por alguns centros e o cirurgião cardiovascular envolvido no tratamento das doenças valvares deve fazer parte deste desenvolvimento.Aortic valve replacement with mechanical or biological prosthesis with extracorporeal circulation is the gold-standard for the treatment of calcific aortic stenosis. Although the results are excellent with the conventional approach some elderly patients, with multiple high-risk comorbid conditions, reoperations and severe left ventricular dysfunction have high surgical risk. During the last years percutaneous techniques have been developed. The present study aim to analyse the literature, since the experimental development untill clinical application of this novel treatment in patients with high surgical risk aortic stenosis. Percutaneous implantation of aortic valve prosthesis is beeing done in some centers and the cardiovascular surgeon that treats valve disease should be involved in this development.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

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

    2014-02-01

    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

  19. A multicentre observational study of the outcomes of screening detected sub-aneurysmal aortic dilatation

    DEFF Research Database (Denmark)

    Wild, J B; Stather, P W; Biancari, F; Choke, E C; Earnshaw, J J; Grant, S W; Hafez, H; Holdsworth, R; Juvonen, T; Lindholt, Jes S.; McCollum, C; Parvin, S; Sayers, R D; Bown, M J

    2013-01-01

    dilatation (aortic diameter 30 mm or greater), progression to size threshold for surgical intervention (55 mm) and aneurysm rupture. RESULTS: Aortic measurements for 1696 men and women (median age 66 years at initial scan) with sub-aneurysmal aortae were obtained, median period of follow up was 4.0 years...... (range 0.1-19.0 years). Following Kaplan Meier and life table analysis 67.7% of patients with 5 complete years of surveillance reached an aortic diameter of 30 mm or greater however 0.9% had an aortic diameter of 54 mm. A total of 26.2% of patients with 10 complete years of follow up had an AAA of...

  20. Stenosis of the branches of the neopulmonary artery after the arterial switch operation: A cardiac magnetic resonance imaging study

    Directory of Open Access Journals (Sweden)

    Boban Thomas

    2013-01-01

    Conclusions: Cardiac MR can be used as a comprehensive non-invasive imaging technique to diagnose stenosis of the branches of the neopulmonary after the ASO, allowing evaluation of anatomy and function of the neoPA, its branches, and the differential perfusion to each lung, thus facilitating clinical decision making.

  1. Novel biaxial tensile test for studying aortic failure phenomena at a microscopic level

    Directory of Open Access Journals (Sweden)

    Sugita Shukei

    2013-01-01

    Full Text Available Abstract Background An aortic aneurysm is a local dilation of the aorta, which tends to expand and often results in a fatal rupture. Although larger aneurysms have a greater risk of rupture, some small aneurysms also rupture. Since the mechanism of aortic rupture is not well understood, clarification of the microstructure influencing the failure to rupture is important. Since aortic tissues are stretched biaxially in vivo, we developed a technique to microscopically observe the failure of an aortic rupture during biaxial stretch. Methods A thinly sliced porcine thoracic aortic specimen was adhered to a circular frame and pushed onto a cylinder with a smaller diameter to stretch the specimen biaxially. To induce failure to rupture at the center, the specimen was thinned at the center of the hole as follows: the specimen was frozen while being compressed with metal plates having holes, which were 3 mm in diameter at their centers; the specimen was then sliced at 50-μm intervals and thawed. Results The ratio of the thickness at the center to the peripheral area was 99.5% for uncompressed specimens. The ratio decreased with an increase in the compression ratio εc and was 47.3% for specimens with εc = 40%. All specimens could be stretched until failure to rupture. The probability for crack initiation within the cylinder was εc εc >30%, respectively. Among specimens ruptured within the cylinder, 93% of those obtained from the mid-media showed crack initiation at the thin center area. Conclusions Aortic tissues were successfully stretched biaxially until failure, and their crack initiation points were successfully observed under a microscope. This could be a very useful and powerful method for clarifying the mechanism of aortic rupture. We are planning to use this technique for a detailed investigation of events occurring at the point of failure when the crack initiates in the aortic aneurysm wall.

  2. Noninvasive measurement of cardiac stroke volume using pulse wave velocity and aortic dimensions: a simulation study

    OpenAIRE

    Charles F. Babbs

    2014-01-01

    Background: Concerns about the cost-effectiveness of invasive hemodynamic monitoring in critically ill patients using pulmonary artery catheters motivate a renewed search for effective noninvasive methods to measure stroke volume. This paper explores a new approach based on noninvasively measured pulse wave velocity, pulse contour, and ultrasonically determined aortic cross sectional area. Methods: The Bramwell-Hill equation relating pulse wave velocity to aortic compliance is applied. At the...

  3. Aortic Dissection and Postpartum Cardiomyopathy in a Postpartum Young Woman: A Case Report Study

    OpenAIRE

    Jalalian, Rozita; Saravi, Mehrdad; Banasaz, Bahar

    2014-01-01

    Introduction: Aortic dissection is a rare condition in young women and usually related with congenital anomalies of aorta and connective tissue disorders. We reported a 34-year-old postpartum woman with aortic dissection. Case Presentation: The patient complained of respiratory distress and weakness with no abdominal pain or chest pain 20 days after delivery and had no history of hypertension during pregnancy and perinatal or prior heart disease. Postpartum cardiomyopathy and left ventricular...

  4. Calcific Aortic Valve Disease: Part 1-Molecular Pathogenetic Aspects, Hemodynamics, and Adaptive Feedbacks.

    Science.gov (United States)

    Pasipoularides, Ares

    2016-04-01

    Aortic valvular stenosis (AVS), produced by calcific aortic valve disease (CAVD) causing reduced cusp opening, afflicts mostly older persons eventually requiring valve replacement. CAVD had been considered "degenerative," but newer investigations implicate active mechanisms similar to atherogenesis-genetic predisposition and signaling pathways, lipoprotein deposits, chronic inflammation, and calcification/osteogenesis. Consequently, CAVD may eventually be controlled/reversed by lifestyle and pharmacogenomics remedies. Its management should be comprehensive, embracing not only the valve but also the left ventricle and the arterial system with their interdependent morphomechanics/hemodynamics, which underlie the ensuing diastolic and systolic LV dysfunction. Compared to even a couple of decades ago, we now have an increased appreciation of genomic and cytomolecular pathogenetic mechanisms underlying CAVD. Future pluridisciplinary studies will characterize better and more completely its pathobiology, evolution, and overall dynamics, encompassing intricate feedback processes involving specific signaling molecules and gene network cascades. They will herald more effective, personalized medicine treatments of CAVD/AVS. PMID:26891845

  5. Spectrum of Aortic Valve Abnormalities Associated with Aortic Dilation Across Age Groups in Turner Syndrome

    Science.gov (United States)

    Olivieri, Laura J.; Baba, Ridhwan Y.; Arai, Andrew E.; Bandettini, W. Patricia; Rosing, Douglas R.; Bakalov, Vladimir; Sachdev, Vandana; Bondy, Carolyn A.

    2014-01-01

    Background Congenital aortic valve fusion is associated with aortic dilation, aneurysm and rupture in girls and women with Turner syndrome (TS). Our objective was to characterize aortic valve structure in subjects with TS, and determine the prevalence of aortic dilation and valve dysfunction associated with different types of aortic valves. Methods and Results The aortic valve and thoracic aorta were characterized by cardiovascular magnetic resonance imaging in 208 subjects with TS in an IRB-approved natural history study. Echocardiography was used to measure peak velocities across the aortic valve, and the degree of aortic regurgitation. Four distinct valve morphologies were identified: tricuspid aortic valve (TAV) 64%(n=133), partially fused aortic valve (PF) 12%(n=25), bicuspid aortic valve (BAV) 23%(n=47), and unicuspid aortic valve (UAV) 1%(n=3). Age and body surface area (BSA) were similar in the 4 valve morphology groups. There was a significant trend, independent of age, towards larger BSA-indexed ascending aortic diameters (AADi) with increasing valve fusion. AADi were (mean +/− SD) 16.9 +/− 3.3 mm/m2, 18.3 +/− 3.3 mm/m2, and 19.8 +/− 3.9 mm/m2 (p<0.0001) for TAV, PF and BAV+UAV respectively. PF, BAV, and UAV were significantly associated with mild aortic regurgitation and elevated peak velocities across the aortic valve. Conclusions Aortic valve abnormalities in TS occur with a spectrum of severity, and are associated with aortic root dilation across age groups. Partial fusion of the aortic valve, traditionally regarded as an acquired valve problem, had an equal age distribution and was associated with an increased AADi. PMID:24084490

  6. New-onset atrial fibrillation after surgical aortic valve replacement and transcatheter aortic valve implantation: a concise review.

    Science.gov (United States)

    Jørgensen, Troels Højsgaard; Thygesen, Julie Bjerre; Thyregod, Hans Gustav; Svendsen, Jesper Hastrup; Søndergaard, Lars

    2015-01-01

    Surgical aortic valve replacement (SAVR) and, more recently, transcatheter aortic valve implantation (TAVI) have been shown to be the only treatments that can improve the natural cause of severe aortic valve stenosis. However, after SAVR and TAVI, the incidence of new-onset atrial fibrillation (NOAF) is 31%-64% and 4%-32%, respectively. NOAF is independently associated with adverse events such as stroke, death, and increased length of hospital stay. Increasing the knowledge of predisposing factors, optimal postprocedural monitoring, and prophylactic antiarrhythmic and antithrombotic therapy may reduce the risk of complications secondary to NOAF. PMID:25589700

  7. Update on Abdominal Aortic Aneurysm Research: From Clinical to Genetic Studies

    Directory of Open Access Journals (Sweden)

    Helena Kuivaniemi

    2014-01-01

    Full Text Available An abdominal aortic aneurysm (AAA is a dilatation of the abdominal aorta with a diameter of at least 3.0 cm. AAAs are often asymptomatic and are discovered as incidental findings in imaging studies or when the AAA ruptures leading to a medical emergency. AAAs are more common in males than females, in individuals of European ancestry, and in those over 65 years of age. Smoking is the most important environmental risk factor. In addition, a positive family history of AAA increases the person’s risk for AAA. Interestingly, diabetes has been shown to be a protective factor for AAA in many large studies. Hallmarks of AAA pathogenesis include inflammation, vascular smooth muscle cell apoptosis, extracellular matrix degradation, and oxidative stress. Autoimmunity may also play a role in AAA development and progression. In this Outlook paper, we summarize our recent studies on AAA including clinical studies related to surgical repair of AAA and genetic risk factor and large-scale gene expression studies. We conclude with a discussion on our research projects using large data sets available through electronic medical records and biobanks.

  8. Annular sizing using real-time three-dimensional intracardiac echocardiography-guided trans-catheter aortic valve replacement

    Science.gov (United States)

    Rendon, Alejandro; Hamid, Tahir; Kanaganayagam, Gajen; Karunaratne, Devinda; Mahadevan, Vaikom S

    2016-01-01

    Objective Transcatheter aortic valve replacement (TAVR) has been established as an alternative therapy for patients with severe aortic stenosis who are unfit for the surgical aortic valve replacements. Pre and periprocedural imaging for the TAVR procedure is the key to procedural success. Currently transesophageal echocardiography (TOE), including real-time three-dimensional (RT-3D) imaging TOE, has been used for peri-interventional monitoring and guidance for TAVR. We describe our initial experience with real-time three-dimensional intracardiac echocardiography (RT-3DICE), imaging technology for the use in the TAVR procedure. Methods We used RT-3DICE using an ACUSON SC2000 2.0v (Siemens Medical Solution), and a 10F AcuNav V catheter (Siemens-Acuson, Inc, Mountain View, California, USA) in addition to preoperative multislice CT (MSCT) in total of five patients undergoing TAVR procedure. Results Aortic annulus and sinus of valsalva diameters were measured using RT-3DICE. Aortic valve measurements obtained using RT-3DICE are comparable to those obtained using MSCT with no significant difference in our patients. Conclusions This small study of five patients shows the safe use of RT-3DICE in TAVR Procedure and may help the procedures performed under local anaesthesia without the need for TOE. PMID:27158522

  9. Fruit Intake and Abdominal Aortic Calcification in Elderly Women: A Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Nicola P. Bondonno

    2016-03-01

    Full Text Available Cardiovascular disease (CVD is the leading cause of death worldwide. There is a consistent inverse relationship between fruit intake with CVD events and mortality in cross-sectional and prospective observational studies, but the relationship of fruit intake with measurements of atherosclerosis in humans is less clear. Nutritional effects on abdominal aortic calcification (AAC, a marker for subclinical intimal and medial atherosclerotic vascular disease, have not been studied previously. The aim of this study was to examine the cross-sectional relationship of total and individual fruit (apple, pear, orange and other citrus, and banana intake with AAC, scored between 0 and 24. The current study assessed baseline data for a cohort of 1052 women over 70 years of age who completed both a food frequency questionnaire assessing fruit intake, and underwent AAC measurement using dual energy X-ray absorptiometry. AAC scores were significantly negatively correlated with total fruit and apple intakes (p < 0.05, but not with pear, orange or banana intakes (p > 0.25. In multivariable-adjusted logistic regression, each standard deviation (SD; 50 g/day increase in apple intake was associated with a 24% lower odds of having severe AAC (AAC score >5 (odd ratio OR: 0.76 (0.62, 0.93, p = 0.009. Total and other individual fruit intake were not associated with increased odds of having severe AAC. Apple but not total or other fruit intake is independently negatively associated with AAC in older women.

  10. Olive Palpation, Sonography and Barium Study in the Diagnosis of Hypertrophic Pyloric Stenosis: Decline in Physicians’ Art

    Directory of Open Access Journals (Sweden)

    A Khatami

    2009-08-01

    Full Text Available Background/Objective: Hypertrophic pyloric stenosis (HPS is the commonest indication of pediatric surgery in neonatal period and early infancy. There are some clinical and radiological methods for the diagnosis of HPS. As an example, a positive "olive sign" in the abdominal examination is diagnostic; however, it seems that performing physical examination for the detection of this sign has been abandoned and that this practice has been replaced by sonography and other paraclinical tests. The aim of this study was to assess the ability of our physicians in finding the palpable olive in clinical examination and the accuracy of sonography and the true positive rate of barium study."nPatients and Methods: We evaluated 84 patients admitted to our hospital during a 7-year period in which the final surgical report was HPS. Clinical examination for the right upper quadrant (RUQ olive like mass, barium study and ultrasound findings of HPS were evaluated. Pediatric residents (junior and senior residents examined all these cases. Twenty-one patients had a barium study and 81 had a sonography, which was performed by an attending radiologist. Data were evaluated for the diagnostic yield (DY of all these diagnostic tools."nResults: The mean age of the patients was 36.1 days on admission and the male/female ratio was 5.4/1. All the patients had a clinical examination, in which the olive sign was detected in only 13 cases (DY= 15.5%, 95% CI: 12%-19%; 81 patients had a sonography, in 71 of whom HPS was detected (DY = 87.7%, 95% CI: 85%-92%; barium study revealed HPS in 16 of 21 patients (DY = 76.2%, 95% CI: 71.4%-82%."nConclusion: Sonography was more precise than clinical examination and barium study in detecting HPS. Due to the crying baby and the distended stomach, less time is spent for clinical examination. Therefore, paraclinical studies such as imaging become the first step in diagnosis and are requested earlier and even as the first diagnostic study on

  11. Newly Shaped Intra-Aortic Balloons Improve the Performance of Counterpulsation at the Semirecumbent Position: An In Vitro Study.

    Science.gov (United States)

    Kolyva, Christina; Pepper, John R; Khir, Ashraf W

    2016-08-01

    The major hemodynamic benefits of intra-aortic balloon pump (IABP) counterpulsation are augmentation in diastolic aortic pressure (Paug ) during inflation, and decrease in end-diastolic aortic pressure (ΔedP) during deflation. When the patient is nursed in the semirecumbent position these benefits are diminished. Attempts to change the shape of the IAB in order to limit or prevent this deterioration have been scarce. The aim of the present study was to investigate the hemodynamic performance of six new IAB shapes, and compare it to that of a traditional cylindrical IAB. A mock circulation system, featuring an artificial left ventricle and an aortic model with 11 branches and physiological resistance and compliance, was used to test one cylindrical and six newly shaped IABs at angles 0, 10, 20, 30, and 40°. Pressure was measured continuously at the aortic root during 1:1 and 1:4 IABP support. Shape 2 was found to consistently achieve, in terms of absolute magnitude, larger ΔedP at angles than the cylindrical IAB. Although ΔedP was gradually diminished with angle, it did so to a lesser degree than the cylindrical IAB; this diminishment was only 53% (with frequency 1:1) and 40% (with frequency 1:4) of that of the cylindrical IAB, when angle increased from 0 to 40°. During inflation Shape 1 displayed a more stable behavior with increasing angle compared to the cylindrical IAB; with an increase in angle from 0 to 40°, diastolic aortic pressure augmentation dropped only by 45% (with frequency 1:1) and by 33% (with frequency 1:4) of the drop reached with the cylindrical IAB. After compensating for differences in nominal IAB volume, Shape 1 generally achieved higher Paug over most angles. Newly shaped IABs could allow for IABP therapy to become more efficient for patients nursed at the semirecumbent position. The findings promote the idea of personalized rather than generalized patient therapy for the achievement of higher IABP therapeutic efficiency, with a choice

  12. Newly Shaped Intra‐Aortic Balloons Improve the Performance of Counterpulsation at the Semirecumbent Position: An In Vitro Study

    Science.gov (United States)

    Kolyva, Christina; Pepper, John R.

    2016-01-01

    Abstract The major hemodynamic benefits of intra‐aortic balloon pump (IABP) counterpulsation are augmentation in diastolic aortic pressure (P aug) during inflation, and decrease in end‐diastolic aortic pressure (ΔedP) during deflation. When the patient is nursed in the semirecumbent position these benefits are diminished. Attempts to change the shape of the IAB in order to limit or prevent this deterioration have been scarce. The aim of the present study was to investigate the hemodynamic performance of six new IAB shapes, and compare it to that of a traditional cylindrical IAB. A mock circulation system, featuring an artificial left ventricle and an aortic model with 11 branches and physiological resistance and compliance, was used to test one cylindrical and six newly shaped IABs at angles 0, 10, 20, 30, and 40°. Pressure was measured continuously at the aortic root during 1:1 and 1:4 IABP support. Shape 2 was found to consistently achieve, in terms of absolute magnitude, larger ΔedP at angles than the cylindrical IAB. Although ΔedP was gradually diminished with angle, it did so to a lesser degree than the cylindrical IAB; this diminishment was only 53% (with frequency 1:1) and 40% (with frequency 1:4) of that of the cylindrical IAB, when angle increased from 0 to 40°. During inflation Shape 1 displayed a more stable behavior with increasing angle compared to the cylindrical IAB; with an increase in angle from 0 to 40°, diastolic aortic pressure augmentation dropped only by 45% (with frequency 1:1) and by 33% (with frequency 1:4) of the drop reached with the cylindrical IAB. After compensating for differences in nominal IAB volume, Shape 1 generally achieved higher P aug over most angles. Newly shaped IABs could allow for IABP therapy to become more efficient for patients nursed at the semirecumbent position. The findings promote the idea of personalized rather than generalized patient therapy for the achievement of higher IABP therapeutic efficiency

  13. Biocompatibility and occlusive efficiency of self-made aortic half-cycle stent-graft:an experimental study in dogs

    International Nuclear Information System (INIS)

    Objective: To explore the biocompatibility of self-made half-cycle stent-graft and the efficiency of occluding unilateral renal artery while retaining other branches of abdominal aorta in experimental dogs. Methods: Fifteen dogs were used in this study. The self-made aortic half-cycle stent-graft was 16 mm x 60 mm in size and the length of vascular-graft was 4 cm. Left or right renal arteries were occluded at random. Then angiography and enhanced spiral CT scan of abdominal aorta were performed. At 1, 4, 8, 12 and 16 weeks after operation, angiography and enhanced spiral CT scan were repeated in all dogs. The animals were sacrificed and aortic specimens were collected for pathological examination. The abdominal aortic specimens of normal aorta,naked stent area and stent-graft area were examined with both microscope and electronic microscope. Results: The self-made aortic half-cycle stent-graft was successfully placed in all 15 dogs. The occlusion site included right renal artery (n=7) and left renal artery (n =8), while other branches of aorta were spared. No vascular rupture occurred during the procedure. Postoperative angiography and CT scan showed that no displacement of the stent occurred, no blood flow was found in the occluded renal artery and other branches of aorta showed normal blood flow. At 16 weeks after operation,the thickness of intima of the normal aorta, naked stenting aorta and stent-grafts area was 85.7 μm, 943.1 μm and 2481.2μm respectively, while the thickness of the adjacent media was 1401.5 μm, 615.1 μm and 593.6μm respectively. The occluded kidney became smaller in size. Conclusion: The self-made aortic half-cycle stent-graft carries excellent biocompatibility and occlusive effect in experimental dogs, which might be employed in clinical practice to treat aortic dissection. (authors)

  14. Is provisional stenting the effective option? The WIDEST study (Wiktor stent in de novo stenosis)

    OpenAIRE

    Fluck, D.; Chenu, P; Mills, P; Davies, A; Street, J.; Paul, E; Balcon, R; Layton, C; Investigators', G

    2000-01-01

    AIM—To compare the immediate and late outcomes of patients treated by a policy of routine stent implantation with routine balloon angioplasty and the use of stents only when an ideal result has not been obtained.
METHODS—A nine centre, multinational, randomised study of 300 patients with coronary artery disease thought suitable for treatment of a single lesion by balloon angioplasty or stent implantation. Only new lesions in patients who had not undergone previous bypass surgery were included...

  15. Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study

    OpenAIRE

    Ueta, Kazuyoshi; Watanabe, Michiko; Iguchi, Naoya; Uchiyama, Akinori; Shirakawa, Yukitoshi; Kuratani, Toru; Sawa, Yoshiki; Fujino, Yuji

    2014-01-01

    Background Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminid...

  16. Three-Dimensional Rotational Angiography in the Pediatric Cath Lab: Optimizing Aortic Interventions.

    Science.gov (United States)

    Stenger, Anna; Dittrich, Sven; Glöckler, Martin

    2016-03-01

    The aim of this study was to evaluate usability and accuracy of three-dimensional rotational angiography (3DRA) during interventions of the aorta in congenital heart disease (CHD). 3DRA is an accurate, encompassing and fast imaging technique in the cath lab. However, there is only few published data about its use during interventions in CHD. Between January 2010 and January 2014, 3DRA was performed in 77 patients with aortic issues: in 65 % cases, an intervention was performed, of which 72 % had aortic isthmus stenosis. Data were obtained retrospectively. The accuracy of 3DRA was evaluated on the basis of comparative measurements (n = 60) of the aortic diameter between 3DRA and conventional biplane angiography. Measurements presented a high accuracy with an average deviation of 3.89 % [±3 %] and a significant correlation of r = 0.99 after Pearson (p fluoroscopy time from 10.2 to 8.30 min (median, p < 0.01) and decreased radiation dose of 0.18 compared to 0.56 Gy cm(2)/kg (median, p < 0.02). The use of 3DRA in patients with aortic anomalies has advantages in comparison with conventional angiography. It improves diagnostic accuracy, and 3D guidance enables a faster and simplified intervention with enhanced patients' safety and the potential to reduce radiation dose. PMID:26667957

  17. Matrix metalloproteinase inhibitor, doxycycline and progression of calcific aortic valve disease in hyperlipidemic mice.

    Science.gov (United States)

    Jung, Jae-Joon; Razavian, Mahmoud; Kim, Hye-Yeong; Ye, Yunpeng; Golestani, Reza; Toczek, Jakub; Zhang, Jiasheng; Sadeghi, Mehran M

    2016-01-01

    Calcific aortic valve disease (CAVD) is the most common cause of aortic stenosis. Currently, there is no non-invasive medical therapy for CAVD. Matrix metalloproteinases (MMPs) are upregulated in CAVD and play a role in its pathogenesis. Here, we evaluated the effect of doxycycline, a nonselective MMP inhibitor on CAVD progression in the mouse. Apolipoprotein (apo)E(-/-) mice (n = 20) were fed a Western diet (WD) to induce CAVD. After 3 months, half of the animals was treated with doxycycline, while the others continued WD alone. After 6 months, we evaluated the effect of doxycycline on CAVD progression by echocardiography, MMP-targeted micro single photon emission computed tomography (SPECT)/computed tomography (CT), and tissue analysis. Despite therapeutic blood levels, doxycycline had no significant effect on MMP activation, aortic valve leaflet separation or flow velocity. This lack of effect on in vivo images was confirmed on tissue analysis which showed a similar level of aortic valve gelatinase activity, and inflammation between the two groups of animals. In conclusion, doxycycline (100 mg/kg/day) had no effect on CAVD progression in apoE(-/-) mice with early disease. Studies with more potent and specific inhibitors are needed to establish any potential role of MMP inhibition in CAVD development and progression. PMID:27619752

  18. Initial hydrodynamic study on a new intraaortic axial flow pump: Dynamic aortic valve

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Rotary blood pumps have been researched as implantableventricular assist devices for years. To further reduce the complex of implanted axial pumps, the authors proposed a new concept of intraaortic axial pump, termed previously as "dynamic aortic valve (DAV)". Instead of being driven by an intraaortic micro-electric motor, it was powered by a magnetic field from outside of body. To ensure the perfusion of coronary artery, the axial flow pump is to be implanted in the position of aortic valve. It could serve as either a blood pump or a mechanical valve depending on the power input. This research tested the feasibility of the new concept in model study. A column, made from permanent magnet, is jointed to an impeller in a concentric way to form a "rotor-impeller". Supported by a hanging shaft cantilevered in the center of a rigid cage, the rotor-impeller can be turned by the magnetic field in the surrounding space. In the present prototype, the rotor is 8 mm in diameter and 15 mm in length, the impeller has 3 vanes with an outer diameter of 18 mm. The supporting cage is 22 mm in outer diameter and 20 mm in length. When tested, the DAV prototype is inserted into the tube of a mock circuit. The alternative magnetic field is produced by a rotating magnet placed side by side with the rotor-impeller at a distance of 30 mm. Once the alternative magnetic field is presented in the surrounding space, the DAV starts to turn, leading to a pressure difference and liquid flow in the tube. The flow rate or pressure difference is proportioned to rotary speed. At the maximal output of hydraulic power, the flow rate reached 5 L/min against an afterload of 100 mmHg. The maximal pressure difference generated by DAV at a rotation rate of 12600 r/min was 147 mmHg. The preliminary results demonstrated the feasibility of "DAV", further research on this concept is justifiable.

  19. Current recommendations for the study of carotid stenosis by doppler ultrasound and other imaging techniques

    International Nuclear Information System (INIS)

    Ischemic cerebrovascular disease has been one of the most frequent causes of death from chronic disease, as well as cause of long-term disabilities, in both the United States, and in Latin American countries during recent years. It is therefore, important to know about it. An updated review of international recommendations to the Costa Rican health system is performed for carotid imaging study in patients at risk of accidents and ischemic cerebrovascular disease; with special emphasis on carotid Doppler ultrasonography, due to its wide availability in the medical field Costa Rican. Furthermore, certain relevant concepts of other imaging techniques currently available are listed to determine the appropriate choice of each method according to the individual patient's condition, such as conventional angiography and tomographic angiography

  20. Spinal canal stenosis

    International Nuclear Information System (INIS)

    Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which can lead to mechanical compression of spinal nerve roots or the dural sac. The lumbal spinal compression of these nerve roots can be symptomatic, resulting in weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain or atypical leg pain and neurogenic claudication. The anatomical presence of spinal canal stenosis is confirmed radiologically with computerized tomography, myelography or magnetic resonance imaging and play a decisive role in optimal patient-oriented therapy decision-making. (orig.)

  1. "Malignant" mitral stenosis

    Directory of Open Access Journals (Sweden)

    Auer Johann

    2012-03-01

    Full Text Available Abstract Symptomatic mitral stenosis caused by a left atrial mass as the first sign of metastasis of a malignant tumor is extremely rare and frequently associated with poor prognosis. We report a case of a 59-year-old man with a history of grade 3 malignant fibrous histiocytoma on his left tigh treated by limb-sparing surgery 17 months earlier, who was admitted with 10-days of worsening dyspnea. Imaging revealed a left atrial mass protruding through the mitral valve that resulted in severe mitral stenosis. Biopsy confirmed metastasis of malignant fibrous histiocytoma.

  2. Lumbar stenosis: clinical case

    Directory of Open Access Journals (Sweden)

    Pedro Sá

    2014-08-01

    Full Text Available Lumbar stenosis is an increasingly common pathological condition that is becoming more frequent with increasing mean life expectancy, with high costs for society. It has many causes, among which degenerative, neoplastic and traumatic causes stand out. Most of the patients respond well to conservative therapy. Surgical treatment is reserved for patients who present symptoms after implementation of conservative measures. Here, a case of severe stenosis of the lumbar spine at several levels, in a female patient with pathological and surgical antecedents in the lumbar spine, is presented. The patient underwent two different decompression techniques within the same operation.

  3. Severe iatrogenic nostril stenosis

    Directory of Open Access Journals (Sweden)

    Ali Ebrahimi

    2015-01-01

    Full Text Available Nostril stenosis (narrowing of the nasal inlet is an uncommon deformity which results in aesthetic and breathing discomfort in patients. The literature review shows that trauma, infection, iatrogenic insults and congenital lesions are major causes of stenosis. Nowadays, rhinoplasty is one of most popular aesthetic surgeries which may have complications such as bleeding, swelling, bruising, asymmetry, obstruction of nasal airways. We present a 30-year-old female patient, who complained about breathing and aesthetic difficulties due to external nasal valve obstruction and nasal deformity. Past medical history showed that the patient had undergone three unsuccessful rhinoplasty surgeries with aesthetic goals.

  4. Foraminal stenosis in spondylolysis

    International Nuclear Information System (INIS)

    This paper reports eighteen patients with spondylolysis evaluated with sagittal MR imaging to correlate the factors and degree of faoraminal stenosis at the level of the lysis with clinical findings. Fifteen presented with low back pain, eight with radiculopathy and one with paresthesia in the lower limbs, and two were asymptomatic. The degree of foraminal stenosis, quantified in three grades, was not correlated with the onset of radiculopathy. Three foraminal herniations were responsible for radiculopathy. Presence of isthmic bony tip and fibrocartilage buildup were not correlated with symptoms. Foraminal compression can be demonstrated by MR imaging, but without clinical correlations

  5. Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root

    Directory of Open Access Journals (Sweden)

    Han Qing-qi

    2013-06-01

    Full Text Available OBJECTIVE: There are debates regarding the optimal approach for AAAD involving the aortic root. We described a modified reinforced aortic root reconstruction approach for treating AAAD involving the aortic root. METHODS: A total of 161 patients with AAAD involving the aortic root were treated by our modified reinforced aortic root reconstruction approach from January 1998 to December 2008. Key features of our modified approach were placement of an autologous pericardial patch in the false lumen, lining of the sinotubular junction lumen with a polyester vascular ring, and wrapping of the vessel with Teflon strips. Outcome measures included post-operative mortality, survival, complications, and level of aortic regurgitation. RESULTS: A total of 161 patients were included in the study (mean age: 43.3 1 15.5 years. The mean duration of follow-up was 5.1 1 2.96 years (2-12 years. A total of 10 (6.2% and 11 (6.8% patients died during hospitalization and during follow-up, respectively. Thirty-one (19.3% patients experienced postoperative complications. The 1-, 3-, 5-, and 10-year survival rates were 99.3%, 98%, 93.8%, and 75.5%, respectively. There were no instances of recurrent aortic dissection, aortic aneurysm, or pseudoaneurysm during the entire study period. The severity of aortic regurgitation dramatically decreased immediately after surgery (from 28.6% to 0% grade 3-4 and thereafter slightly increased (from 0% to 7.2% at 5 years and 9.1% at 10 years. CONCLUSION: This modified reinforced aortic root reconstruction was feasible, safe and durable/effective, as indicated by its low mortality, low postoperative complications and high survival rate.

  6. Natural history of the false channel of type A aortic dissection following surgical repair: CT study

    International Nuclear Information System (INIS)

    Postoperative CT scans were reviewed in 33 patients after surgical repair of type A aortic dissection. Initial CT scans showed persistence of a false channel distal to the site of surgical repair in 26 patients (79%). Serial CT scans showed enlargement of the false channel in four patients and progression of thrombus in the false channel in five patients. Calcification developed within the false channel in six patients (19%). Thirteen patients (39%) required reoperation 2 months to 9 years after the initial surgery. In view of the progressive nature of aortic dissection in the postoperative period, periodic serial CT examinations can contribute important information

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

    DEFF Research Database (Denmark)

    Haaverstad, Rune; Vitale, Nicola; Karevold, Asbjørn;

    2006-01-01

    OBJECTIVE: The aim of this report is the prospective, multicentre evaluation of clinical results and haemodynamic performance of the Medtronic Advantage aortic valve prosthesis. METHODS: From April 2001 to June 2003, 166 patients (male:female 125:41; mean (SD) age 61.8 (11.8) years) received an...... aortic advantage valve prosthesis. Complete cumulative follow-up was 242.7 patient-years (maximum 3.2; mean 1.6 years). Postoperatively, patients underwent early (within 30 days) and 1 year transthoracic echocardiography. RESULTS: 30 day mortality was 2.4% (n = 4). Kaplan-Meier estimates of freedom from...

  8. Renal flow studies after abdominal aortic aneurysmectomy and axillo-bifemoral bypass graft: case report

    Energy Technology Data Exchange (ETDEWEB)

    LaManna, M.M.; Yussen, P.S.

    1988-03-01

    Vascular disorders affecting the kidneys are either acquired or congenital. Included in this category are common multiplicity of renal arteries, the rare arteriovenous malformation, stresses due to fibromuscular disease or atherosclerosis including abdominal aortic aneurysms, arterial thrombosis, venous thrombosis, and infarction. In contrast to the group of cystic and neoplastic kidneys where scintigraphic or pathologic are not diagnostic, scintigraphic or pathologic anatomy in vascular disease is often diagnostic by nuclear medicine techniques. The authors present an interesting case of evaluation of acute renal failure in a patient abdominal aortic aneurysmectomy and axillo-bifemoral bypass graft.

  9. Renal flow studies after abdominal aortic aneurysmectomy and axillo-bifemoral bypass graft: case report

    International Nuclear Information System (INIS)

    Vascular disorders affecting the kidneys are either acquired or congenital. Included in this category are common multiplicity of renal arteries, the rare arteriovenous malformation, stresses due to fibromuscular disease or atherosclerosis including abdominal aortic aneurysms, arterial thrombosis, venous thrombosis, and infarction. In contrast to the group of cystic and neoplastic kidneys where scintigraphic or pathologic are not diagnostic, scintigraphic or pathologic anatomy in vascular disease is often diagnostic by nuclear medicine techniques. The authors present an interesting case of evaluation of acute renal failure in a patient abdominal aortic aneurysmectomy and axillo-bifemoral bypass graft

  10. [Pannus Formation Two Years after Bioprosthetic Aortic Valve Implantation;Report of a Case].

    Science.gov (United States)

    Ono, Kimiyo; Kuroda, Hiroaki

    2015-08-01

    We report a case of early deterioration of the bioprosthetic aortic valve 23 months postoperatively. A 77-year-old man who had undergone aortic valve replacement with a 23-mm Epic valve( St. Jude Medical [SJM])presented to us after a syncopal episode. Echocardiography revealed severe aortic stenosis, and redo aortic valve replacement with a 21-mm SJM mechanical valve was performed. All 3 cusps of the tissue valve were thickened by fibrous pannus overgrowth. Neither calcification nor invasion of inflammatory cells was observed. The cause of pannus formation at such an early stage after implantation remains unknown. PMID:26329714

  11. Three-dimensional transesophageal echocardiography for descending aortic atheroma: a preliminary study.

    Science.gov (United States)

    Hammoudi, Nadjib; Ihaddaden, Malek; Lang, Sylvie; Laveau, Florent; Ederhy, Stephane; Michel, Pierre-Louis; Alamowitch, Sonia; Cohen, Ariel

    2014-12-01

    Transesophageal echocardiography (TEE) is an efficient method for characterization of aortic atherosclerotic plaques (AAP). The aim of our study was to evaluate the feasibility and the additional contribution of three-dimensional (3D) TEE in the evaluation of AAPs in descending thoracic aorta. We studied 82 patients referred for TEE regardless of the indication. All patients underwent two-dimensional (2D) conventional acquisitions. A 3D TEE study was performed for all AAPs localized in the descending thoracic aorta. Thickness, degree of calcification, the presence of ulceration or mobile debris were compared for 2D and 3D modes. From 3D data, three types of AAPs were defined according to their morphological characteristics (surface and contours). Among 192 AAPs found on 2D acquisition, 189 (98.4 %) were also identified by 3D TEE. For AAP characterization, agreement was good between 2D TEE and 2D extracted from 3D with the multiplanar reconstruction mode: 83.6 % (k = 0.69) for thickness and 82.5 % (k = 0.72) for degree of calcification. All AAPs ulcerations (n = 13) and mobile debris (n = 3) seen in 2D were identified in 3D. 2D characteristics of the 3D AAPs' morphological types were different: type I plaques were thin and rarely calcified; type III plaques were thicker and often calcified; and type II presented intermediate characteristics. There was overlap among groups and the 3D morphology could not be predicted from 2D data. 3D TEE is a feasible method for the analysis of AAPs. In addition to conventional characterization, 3D TEE provides a new morphological approach to AAPs. PMID:25056253

  12. The study of aortic stiffness in different hypertension subtypes in patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    布海霞

    2014-01-01

    Objective To investigate whether there is any difference in aortic stiffness among different hypertension subtypes in patients with chronic kidney disease.Methods Six hundred and twenty-six patients with chronic kidney disease were included in the present analysis.They were classified into four groups:normotension(n=391)with systolic blood pressure(SBP)<140 mmHg and diastolic

  13. Diagnostic value of NT-proBNP in identifying aortic stenosis patients with heart failure%N末端B型利钠肽原对单纯主动脉瓣狭窄心力衰竭患者的诊断价值

    Institute of Scientific and Technical Information of China (English)

    吴超; 杨跃进; 赵雪燕; 张健; 黄洁; 韦丙奇; 孙寒松; 王巍; 闫鹏

    2010-01-01

    Objective To evaluate the diagnostic value of NT-proBNP in aortic stenosis (AS) patients with heart failure. Method We measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay (Biomedica, Vienna, Austria) in 40 AS patients with heart failure and 76 normal subjects and assessed the diagnostic value of NT-proBNP for heart failure. Results NT-proBNP levels were significantly higher in AS patients with heart failure compared to controls ( P 0. 05) and significantly (8 times) increased in decompensated heart failure group (P 50 mm group than that in LVEDD^50 mm group (P 60% group than that in LVEF >60% group(P0.05),而临床失代偿心衰升高8倍(P50 mm组显著高于LVEDD≤50mm组(P60%组(P<0.01);在合并心房颤动组显著高于窦性心律组(P<0.05).NT-pmBNP阈值在1360 ng/L时,是诊断心衰(ROC曲线下面积=0.762,P<0.01)及失代偿心衰(ROC曲线下面积=0.997,P<0.01)的最佳阈值;心衰与失代偿心衰诊断的敏感性分别为67.50%和100.00%,特异性均为96.05%,准确性分别为86.21%和95.83%.单因素和多元逐步回归分析一致显示,Log(NT-proBNP)与NYHA分级和LVEF呈显著正、负相关(P<0.05),且呈独立相关.结论 NT-pwBNP对单纯As心衰患者也有重要诊断价值.建议临床采用1360 ng/L作为阈值,诊断单纯AS伴心衰者准确性高达86.21%,尤其对失代偿者准确性高达95.83%.

  14. Aortic annulus eccentricity before and after transcatheter aortic valve implantation: Comparison of balloon-expandable and self-expanding prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Schuhbaeck, Annika, E-mail: annika.schuhbaeck@uk-erlangen.de [Department of Cardiology, University of Erlangen, Erlangen (Germany); Weingartner, Christina [Department of Cardiology, University of Gießen, Giessen (Germany); Arnold, Martin; Schmid, Jasmin; Pflederer, Tobias; Marwan, Mohamed [Department of Cardiology, University of Erlangen, Erlangen (Germany); Rixe, Johannes; Nef, Holger [Department of Cardiology, University of Gießen, Giessen (Germany); Schneider, Christian [Department of Radiology, University of Gießen, Giessen (Germany); Lell, Michael; Uder, Michael [Department of Radiology, University of Erlangen, Erlangen (Germany); Ensminger, Stephan [Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen (Germany); Feyrer, Richard; Weyand, Michael [Department of Cardiothoracic Surgery, University of Erlangen, Erlangen (Germany); Achenbach, Stephan [Department of Cardiology, University of Erlangen, Erlangen (Germany)

    2015-07-15

    Highlights: • Post-implant geometry of catheter-based aortic valve prostheses is influenced by aortic valve calcification. • Balloon-expandable prostheses are more circular as compared to self-expanding prostheses. • The impact of post-implant geometry on valve function needs to be investigated. - Abstract: Introduction: The geometry of the aortic annulus and implanted transcatheter aortic valve prosthesis might influence valve function. We investigated the influence of valve type and aortic valve calcification on post-implant geometry of catheter-based aortic valve prostheses. Methods: Eighty consecutive patients with severe aortic valve stenosis (mean age 82 ± 6 years) underwent computed tomography before and after TAVI. Aortic annulus diameters were determined. Influence of prosthesis type and degree of aortic valve calcification on post-implant eccentricity were analysed. Results: Aortic annulus eccentricity was reduced in patients after TAVI (0.21 ± 0.06 vs. 0.08 ± 0.06, p < 0.0001). Post-TAVI eccentricity was significantly lower in 65 patients following implantation of a balloon-expandable prosthesis as compared to 15 patients who received a self-expanding prosthesis (0.06 ± 0.05 vs. 0.15 ± 0.07, p < 0.0001), even though the extent of aortic valve calcification was not different. After TAVI, patients with a higher calcium amount retained a significantly higher eccentricity compared to patients with lower amounts of calcium. Conclusions: Patients undergoing TAVI with a balloon-expandable prosthesis show a more circular shape of the implanted prosthesis as compared to patients with a self-expanding prosthesis. Eccentricity of the deployed prosthesis is affected by the extent of aortic valve calcification.

  15. Aortic annulus eccentricity before and after transcatheter aortic valve implantation: Comparison of balloon-expandable and self-expanding prostheses

    International Nuclear Information System (INIS)

    Highlights: • Post-implant geometry of catheter-based aortic valve prostheses is influenced by aortic valve calcification. • Balloon-expandable prostheses are more circular as compared to self-expanding prostheses. • The impact of post-implant geometry on valve function needs to be investigated. - Abstract: Introduction: The geometry of the aortic annulus and implanted transcatheter aortic valve prosthesis might influence valve function. We investigated the influence of valve type and aortic valve calcification on post-implant geometry of catheter-based aortic valve prostheses. Methods: Eighty consecutive patients with severe aortic valve stenosis (mean age 82 ± 6 years) underwent computed tomography before and after TAVI. Aortic annulus diameters were determined. Influence of prosthesis type and degree of aortic valve calcification on post-implant eccentricity were analysed. Results: Aortic annulus eccentricity was reduced in patients after TAVI (0.21 ± 0.06 vs. 0.08 ± 0.06, p < 0.0001). Post-TAVI eccentricity was significantly lower in 65 patients following implantation of a balloon-expandable prosthesis as compared to 15 patients who received a self-expanding prosthesis (0.06 ± 0.05 vs. 0.15 ± 0.07, p < 0.0001), even though the extent of aortic valve calcification was not different. After TAVI, patients with a higher calcium amount retained a significantly higher eccentricity compared to patients with lower amounts of calcium. Conclusions: Patients undergoing TAVI with a balloon-expandable prosthesis show a more circular shape of the implanted prosthesis as compared to patients with a self-expanding prosthesis. Eccentricity of the deployed prosthesis is affected by the extent of aortic valve calcification

  16. 喉气管狭窄外科治疗效果的分析%Surgical management of laryngotracheal stenosis:a retrospective study of 53 cases

    Institute of Scientific and Technical Information of China (English)

    王春燕; 秦永

    2008-01-01

    Objective To analyze the etiology,means of diagnosis and surgical approaches fur the treatment of laryngotracheal stenosis(LTS),and to evaluate their effects on the outcome of surgical management of LTS.Methods Fifty-three patients with benign LTS were retrospectively studied fur the clinical trial in Peking University.First Hospital,ENT Head & Neck Department between April 1989 and April 2005.The fullow-up ranged from 1 to 16 years.The surgical approaches included endoscopic removal of the obstruction with or without CO2 Laser and open surgical techniques.Open surgical techniques included scar resection,arytenoidectomy,laryngoplasty with hyoid bone and end-to-end anastomosis.A number of grafts(cartilage,hyoid bone)and intraluminal stents were used.Statistical analysis was performed by the X2 tesL Results The overall success was achieved in 38 of 53 patients(71.7%).Three cases were lost of follow-up and 12 cases were lived with endotrachcal tube in place.As for the surgicol approach,19 cases (35.8%)were done by open surgical technique and 34 Cases(64.2%)by endoscopic approach.The successful rates were 73.7%(14/19)and 70.6%(24/34)respectively.There were 31 cases of isolated stenosis with a successful rate of 87.1%(27/31)and 22 cases of multiple sites with a Successful rate of 50.0%(1 1/22).Isolated stenosis had a statistically better result than multiple stenosis through the X2 test (X2=8.727,P=0.003).As for the length of stenosis,47 eases were less than 3 cm with a successful rate of 80.8%(38/47),6 cases were longer than 3 cm with no success.The stenosis of less than 3 cm had a statistically better result than longer stenosis through the X2test(X2=17.140,P=0.000).According to the Cotton grading system of LTS,there were 28 cases of Grade 1 with a suceessful rate of 96.4%(27/28)and 25 cases of Grade Ⅱ-Ⅳ with a Successful rate of 44.0%(11/25).Grade I stenosis according to Cotton grading system of LTS had better prognosis than GradeⅡ-Ⅳ(X2=17.891,P=0.000).As fur

  17. Fixed cord in spinal stenosis

    International Nuclear Information System (INIS)

    This paper evaluates patients with cervical spinal canal compromise due to congenital anomalies (achondroplasia, Chiari malformation) and degenerative diseases using MR cord motion and cerebrospinal fluid (CSF) flow studies. Pulsatile longitudinal motion of the cervical cord was determined by means of cardiac-gated velocity phase contrast methods, including cine. Pathology included dwarfism (n = 15), Chiari malformation (n = 10), spondylosis (n = 10), and acute cord compression (n = 9). Symptomatic cases of congenital cervical stenosis had decreased cord motion, although CSF flow was not always significantly compromised. Postoperative cases demonstrated good cord and CSF motion, unless compression or obstruction was present

  18. Comparative study on the treatment of isolated valvular pulmonary stenosis between percutaneous balloon pulmonary valvuloplasty and surgical valvulotomy

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility of treatment of isolated valvular pulmonary stenosis (IVPS) by percutaneous balloon pulmonary valvuloplasty (PBPV) instead of surgical valvulotomy. Methods: The surgery group included thirty-one patients (16 males, 15 females) treated by surgical valvulotomy, and the PBPV group included one hundred and forty-six patients (75 males, 71 females) treated by PBPV during the same period. The effectiveness and cost of both methods were compared. Results: The technical successful rate of both methods was 100%. There were no severe complications in PBPV group; The major complications in surgical group included middle pleural effusion in 2 patients, atelectasis in 1 patients, pneumothorax in 1 patients, severe tricuspid regurgitation in 1 patients, respectively. The pulmonary stenosis gradients (PG) in pre-procedure, post-procedure, and follow-up had no significant difference respectively between the two groups (P>0.05). The mean total cost in both groups was similar (P>0.05), but the mean drug cost of surgical group was much higher than that of PBPV group while the mean material cost of PBPV group was significantly higher than that of surgical group (P<0.05). Conclusion: PBPV would be the first choice to cure IVPS instead of surgical valvulotomy

  19. Central and foraminal stenosis of the lumbar spine

    International Nuclear Information System (INIS)

    The discussion include clinical presentation, anatomy, imaging techniques, central canal stenosis, iatrogenic stenosis, post-traumatic stenosis, neural foraminal stenosis, facet joint disease, lateral recess disease (15 refs.)

  20. Congenital pyriform aperture stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Osovsky, Micky [Schneider Pediatric Hospital, Department of Neonatology, Petach Tikvah (Israel); Rabin Medical Center, Department of Neonatology, Schneider Children' s Medical Center of Israel, Beilinson Campus, Petah Tikvah (Israel); Aizer-Danon, Anat; Horev, Gadi [Schneider Pediatric Hospital, Department of Pediatric Radiology, Petach Tikvah (Israel); Sirota, Lea [Schneider Pediatric Hospital, Department of Neonatology, Petach Tikvah (Israel)

    2007-01-15

    Nasal airway obstruction is a potentially life-threatening condition in the newborn. Neonates are obligatory nasal breathers. The pyriform aperture is the narrowest, most anterior bony portion of the nasal airway, and a decrease in its cross-sectional area will significantly increase nasal airway resistance. Congenital nasal pyriform aperture stenosis (CNPAS) is a rare, unusual form of nasal obstruction. It should be considered in the differential diagnosis of any neonate or infant with signs and symptoms of upper airway compromise. It is important to differentiate this level of obstruction from the more common posterior choanal stenosis or atresia. CNPAS presents with symptoms of nasal airway obstruction, which are often characterized by episodic apnea and cyclical cyanosis. (orig.)

  1. Surgically treated pulmonary stenosis

    DEFF Research Database (Denmark)

    Nielsen, Eva A; Hjortdal, Vibeke E

    additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most...... re-intervention at the present stage. CONCLUSION: Surgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required......, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured....

  2. Results of surgery for lumbar spinal stenosis in patients aged 80 years or more. A retrospective study of thirty-four cases.

    Science.gov (United States)

    Ishac, R; Alhayek, G; Fournier, D; Mercier, P; Guy, G

    1996-03-01

    As life expectancy increases and spinal imaging techniques improve, surgery is being increasingly viewed as a therapeutic alternative for symptomatic lumbar spinal stenosis in patients older than 80 years. Thirty-four patients (21 men and 13 women) who had surgery for lumbar spinal stenosis in our department between 1979 and 1994 were studied retrospectively. The most common initial symptoms were walking-related disorders (n = 29) and sciatica or femoral neuralgia (n = 34). All 34 patients underwent laminectomy at one or more levels. Ten patients also had a herniated disk. There were no deaths and only two patients had serious complications (persistent foot drop in one and left-sided hemiplegia in the other). Results were evaluated immediately after surgery and after three and 12 months. The overall result on pain and walking-related disorders was good in 53% of cases, acceptable in 32%, and poor in 15%. Our data suggest that surgery is a reasonable alternative in symptomatic elderly patients who are in good general health. Satisfactory results can be obtained although disabling complications can occur. PMID:8731237

  3. The use of covered stents for the endovascular treatment of extracranial internal carotid artery stenosis: a prospective study with a 5-year follow-up

    International Nuclear Information System (INIS)

    To evaluate the safety and feasibility of the use of covered stents for the treatment of extracranial carotid artery stenosis caused by highly embologenic plaques, and to study the long-term outcome of patients receiving such covered stents. Between 2002 and 2007, 46 patients (63% symptomatic, 78.3% male, 67 ± 8.6 years old) with internal carotid artery stenosis caused by embologenic plaques or restenosis were treated with self-expanding covered stents (Symbiot, Boston Scientific). Pre-dilatation or protecting devices were not used. Post-dilatation was applied in every patient. Each patient was followed long-term. The outcome measures were the occurrence of neurological events, and the development of in-stent restenosis, as detected by clinical examination and duplex ultrasound. The technical success rate of stenting was 100%. There were no neurological complications in the peri-procedural period. The mean follow-up period was 34.3 ± 27.7 months (the rate of patients lost to follow-up was 15.2%) during which no stroke or stroke-related deaths occurred. Restenosis was detected in 3 patients (6.5%). Covered stents provide efficient peri- and post-procedural protection against neurological complications due to embolisation from high-risk plaques during carotid artery stenting. Restenosis of covered stents appears to be infrequent during long-term follow-up. (orig.)

  4. Aortic pressure wave reconstruction during exercise is improved by adaptive filtering: a pilot study

    OpenAIRE

    Stok, W.J.; Westerhof, B E; Guelen, I.; Karemaker, J. M.

    2011-01-01

    Reconstruction of central aortic pressure from a peripheral measurement by a generalized transfer function (genTF) works well at rest and mild exercise at lower heart rates, but becomes less accurate during heavy exercise. Particularly, systolic and pulse pressure estimations deteriorate, thereby underestimating central pressure. We tested individualization of the TF (indTF) by adapting its resonance frequency at the various levels of exercise. In seven males (age 44–57) with coronary artery ...

  5. A contribution to the study of pathological biomineralization of aortic valves

    Czech Academy of Sciences Publication Activity Database

    Zeman, Antonín; Šmíd, M.; Kučková, Š.; Hájek, T.; Rokyta, R.

    Gorgonzola : Associazione Italiana per lo Studio delle Argille, 2011 - (Belviso, C.; Fiore, S.; Giannossi, M.), s. 305-314 ISBN 978-88-7522-041-9. [International conference on Medical geo logy /4./. Bari (IT), 20.09.2011-25.09.2011] Institutional research plan: CEZ:AV0Z20710524 Keywords : biomineralization aortic valves * spectroscopy * X-ray Subject RIV: DB - Geo logy ; Mineralogy

  6. The auditory characteristics of children with inner auditory canal stenosis.

    Science.gov (United States)

    Ai, Yu; Xu, Lei; Li, Li; Li, Jianfeng; Luo, Jianfen; Wang, Mingming; Fan, Zhaomin; Wang, Haibo

    2016-07-01

    Conclusions This study shows that the prevalence of auditory neuropathy spectrum disorder (ANSD) in the children with inner auditory canal (IAC) stenosis is much higher than those without IAC stenosis, regardless of whether they have other inner ear anomalies. In addition, the auditory characteristics of ANSD with IAC stenosis are significantly different from those of ANSD without any middle and inner ear malformations. Objectives To describe the auditory characteristics in children with IAC stenosis as well as to examine whether the narrow inner auditory canal is associated with ANSD. Method A total of 21 children, with inner auditory canal stenosis, participated in this study. A series of auditory tests were measured. Meanwhile, a comparative study was conducted on the auditory characteristics of ANSD, based on whether the children were associated with isolated IAC stenosis. Results Wave V in the ABR was not observed in all the patients, while cochlear microphonic (CM) response was detected in 81.1% ears with stenotic IAC. Sixteen of 19 (84.2%) ears with isolated IAC stenosis had CM response present on auditory brainstem responses (ABR) waveforms. There was no significant difference in ANSD characteristics between the children with and without isolated IAC stenosis. PMID:26981851

  7. Assessment of thoracic aortic elasticity: a preliminary study using electrocardiographically gated dual-source CT

    International Nuclear Information System (INIS)

    To gain a new insight into the elastic properties of the thoracic aorta in patients without aortic diseases using electrocardiographically (ECG)-gated dual-source (DS) CT. 56 subjects with no cardiovascular disease, selected from 2,700 people undergoing ECG-gated DSCT examination, were divided into three groups according to their age. CT data were reconstructed in 5% step throughout the RR interval. Diameter and area were measured at the curve of the ascending aorta (AA) and at the same level of the descending aorta (DA). The pulsation and elasticity of the aorta were evaluated. Aortic diameter changes were noted throughout the cardiac cycle. The maximum average diameter was seen at an RR interval of 24.02 ± 4.99% for the AA and 25.63 ± 4.77% for the DA. The minimum was at 93.5 ± 4.04% for the AA and 96.6 ± 4.58% for the DA. There was an age-dependent decrease in elasticity, while different correlation coefficients were found between various age groups and different elastic parameters. The properties of aortic pulsation and wall elasticity could be well shown by ECG-gated DSCT. The new findings regarding segment difference and age relevance were significant and should be taken into account in clinical trials and treatments for the elasticity related cardiovascular diseases. (orig.)

  8. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    . The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose......In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy...... operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P < 0.001), with the intended full-sternotomy group having the shortest times. In conclusion, the mini-aortic valve replacement is an...

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

    Directory of Open Access Journals (Sweden)

    Adam Csordas

    Full Text Available 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.We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population.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.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 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.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.

  10. Cardiovascular effects of right ventricle-pulmonary artery valved conduit implantation in experimental pulmonic stenosis

    International Nuclear Information System (INIS)

    Right ventricle (RV)-pulmonary artery (PA) valved conduit (RPVC) implantation decreases RV systolic pressure in pulmonic stenosis (PS) by forming a bypass route between the RV and the PA. The present study evaluates valved conduits derived from canine aortae in a canine model of PS produced by pulmonary artery banding (PAB). Pulmonary stenosis was elicited using PAB in 10 conditioned beagles aged 8 months. Twelve weeks after PAB, the dogs were assigned to one group that did not undergo surgical intervention and another that underwent RPVC using denacol-treated canine aortic valved grafts (PAB+RPVC). Twelve weeks later, the rate of change in the RV-PA systolic pressure gradient was significantly decreased in the PAB+RPVC, compared with the PAB group (60.5+-16.7% vs. 108.9+-22.9%; p0.01). In addition, the end-diastolic RV free wall thickness (RVFWd) was significantly reduced in the PAB+RPVC, compared with the PAB group (8.2+-0.2 vs. 9.4+-0.7 mm; p0.05). Thereafter, regurgitation was not evident beyond the conduit valve and the decrease in RV pressure overload induced by RPVC was confirmed. The present results indicate that RPVC can be performed under a beating heart without cardiopulmonary bypass and adapted to dogs with various types of PS, including 'supra valvular' PS or PS accompanied by dysplasia of the pulmonary valve. Therefore, we consider that this method is useful for treating PS in small animals

  11. Studies on the pathogenesis of degenerative lumbar canal stenosis by computed tomography, 2. Investigation about measurements of the lumbar canal

    Energy Technology Data Exchange (ETDEWEB)

    Kido, Kenji

    1987-07-01

    To evaluate the significance of measurement parameters for the lumbar canal (LC), a retrospective analysis was made of computed tomography (CT) scans in a total of 129 patients, including 20 with degenerative lumbar canal stenosis (DLCS), 65 with degenerative spondylosis, 21 with disc hernia, and 23 with lumbar pain. The shape of the transverse LC was not reflected by the anteroposterior and transverse diameters of LC, but was somewhat reflected by the transverse area of LC. The transverse area of dural sac (DS) was considered important in determining the degree of stenosis. Regarding the transverse area, the DS correlated more strongly with the LC with soft-tissue windows than that with bone windows. The angle of intervertebral joint was likely to be related to the pathophysiology of the LC. In particular, sagittal tendency was seen at the levels of L3-4 and L4-5 in the DLCS group. There was correlation between the angle of intervertebral joint and the transverse areas of both soft-tissue LC and DS at the levels of L4-5. A multivariate analysis suggested the possibility that the significance of measurement parameters might vary depending on the vertebral level for the lower lumbar spine. The following criteria for indicating DLCS were obtained: 1) a transverse area of less than or equal to 100 mm/sup 2/ for DS or less than or equal to 118 mm/sup 2/ for soft-tissue LC at the levels of L3-4; 2) a transverse area of less than or equal to 90 mm/sup 2/ for DS and an angle of less than or equal to 90 deg for the intervertebral joint at the levels of L4-5; and 3) lateral recess of less than or equal to 3 mm in anteroposterior diameter at the levels of L5-S1. (Namekawa, K.).

  12. Pregnancy after aortic root replacement in Loeys-Dietz syndrome: High risk of aortic dissection.

    Science.gov (United States)

    Braverman, Alan C; Moon, Marc R; Geraghty, Patrick; Willing, Marcia; Bach, Christopher; Kouchoukos, Nicholas T

    2016-08-01

    Loeys-Dietz syndrome due to mutations in TGFBR1 and 2 is associated with early and aggressive aortic aneurysm and branch vessel disease. There are reports of uncomplicated pregnancy in this condition, but there is an increased risk of aortic dissection and uterine rupture. Women with underlying aortic root aneurysm are cautioned about the risk of pregnancy-related aortic dissection. Prophylactic aortic root replacement is recommended in women with aortopathy and aortic root dilatation to lessen the risk of pregnancy. There is limited information in the literature about the outcomes of pregnancy after root replacement in Loeys-Dietz syndrome. We present a case series of three women with Loeys-Dietz syndrome who underwent elective aortic root replacement for aneurysm disease and subsequently became pregnant and underwent Cesarean section delivery. Each of these women were treated with beta blockers throughout pregnancy. Surveillance echocardiograms and noncontrast MRA studies during pregnancy remained stable demonstrating no evidence for aortic enlargement. Despite the normal aortic imaging and careful observation, two of the three women suffered acute aortic dissection in the postpartum period. These cases highlight the high risk of pregnancy following aortic root replacement in Loeys-Dietz syndrome. Women with this disorder are recommended to be counseled accordingly. © 2016 Wiley Periodicals, Inc. PMID:27125181

  13. When and how to replace the aortic root in type A aortic dissection.

    Science.gov (United States)

    Leshnower, Bradley G; Chen, Edward P

    2016-07-01

    Management of aortic root pathology during repair of acute type A aortic dissection (TAAD) requires a comprehensive evaluation of the patient's anatomy, demographics, comorbidities and physiologic status at the time of emergent operative intervention. Surgical options include conservative repair of the root (CRR) (with or without replacement of the aortic valve), replacement of the native valve and aortic root using a composite valve-conduit and valve sparing root replacement (VSRR). The primary objective of this review is to provide data for surgeons to aid in their decision-making process regarding management of the aortic root during repair of TAAD. No time or language restrictions were imposed and references of the selected studies were checked for additional relevant citations. Multiple retrospective reviews have demonstrated equivalent operative mortality between aortic root repair and replacement during TAAD. There is a higher incidence of aortic root reintervention with aortic root repair compared to aortic root replacement (ARR). Experienced, high-volume aortic centers have demonstrated the safety of VSRR in young, hemodynamically stable patients presenting with TAAD. In conclusion, aortic root repair can safely be performed in the vast majority of patients with TAAD. Despite the increased surgical complexity, ARR does not increase operative mortality and improves the freedom from root reintervention. VSRR can be performed in highly selected populations of patients with TAAD with durable mid-term valve function. PMID:27563551

  14. Evaluation of Subfoveal Choroidal Thickness in Internal Carotid Artery Stenosis

    Science.gov (United States)

    Akçay, Betül İlkay Sezgin; Kardeş, Esra; Maçin, Sultan; Ünlü, Cihan; Özgürhan, Engin Bilge; Maçin, Aydın; Bozkurt, Tahir Kansu; Ergin, Ahmet; Surmeli, Reyhan

    2016-01-01

    Purpose. To evaluate the relationship between internal carotid artery (ICA) stenosis and subfoveal choroidal thickness (SFCT) in the elderly population. Methods. A total of 42 eyes of 21 patients with more than 70% ICA stenosis (Group 1) on one side and less than 70% stenosis (Group 2) on the other side were recruited for this study. ICA stenosis was diagnosed using both the B-mode and Doppler ultrasound. The two groups were compared in terms of the percentage of stenosis, SFCT measurements, intraocular pressure, ocular perfusion pressure, refractive error, and peak systolic velocity. Eyes were examined with the RTVue-100 OCT device by the EDI-OCT technique. Results. The mean age of the patients was 71.9 ± 10.8 years. The mean percentage of ICA stenosis was 74 ± 4.9% in Group 1 and 47.5 ± 7.7% in Group 2. The mean SFCT was 231.9 ± 44.6 μm in Group 1 and 216.2 ± 46.8 μm in Group 2, which was significantly lower (P = 0.028). A statistically significant positive correlation was found between the percentage of internal carotid artery stenosis and SFCT (r = 0896, P = 0.001). Conclusions. Compensatory SFCT increase can be seen in ipsilateral internal carotid artery stenosis greater than 70%. PMID:26989500

  15. Expanding TAVI options: elective rotational atherectomy during trans-catheter aortic valve implantation

    Energy Technology Data Exchange (ETDEWEB)

    Piccoli, Anna; Lunardi, Mattia; Ariotti, Sara; Ferrero, Valeria; Vassanelli, Corrado; Ribichini, Flavio, E-mail: flavio.ribichini@univr.it

    2015-01-15

    Summary: Aortic valve stenosis (AVS) in the elderly is frequently associated to coronary artery disease (CAD). In patients with significant coronary stenosis surgical valve replacement is associated to coronary bypass grafting, but whether coronary angioplasty is needed in patients receiving trans-catheter aortic valve implantation (TAVI) is unknown. Given the frequent complexity of CAD in the elderly with calcific AVS, rotational atherectomy (RA) may be needed in some cases. No data are available about feasibility and safety of RA during TAVI. The need for myocardial revascularization in TAVI candidates is discussed, and a series of RA cases performed during TAVI is described.

  16. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B; Olsen, P S; Perko, M J; Agerskov, Kim; Røder, O; Lorentzen, Jørgen Ewald

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 55......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems.......The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553...

  17. An in vitro evaluation of the impact of eccentric deployment on transcatheter aortic valve hemodynamics.

    Science.gov (United States)

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

    2014-06-01

    Patients with aortic stenosis present with calcium deposits on the native aortic valve, which can result in non-concentric expansion of Transcatheter Aortic Valve Replacement (TAVR) stents. The objective of this study is to evaluate whether eccentric deployment of TAVRs lead to turbulent blood flow and blood cell damage. Particle Image Velocimetry was used to quantitatively characterize fluid velocity fields, shear stress and turbulent kinetic energy downstream of TAVRs deployed in circular and eccentric orifices representative of deployed TAVRs in vivo. Effective orifice area (EOA) and mean transvalvular pressure gradient (TVG) values did not differ substantially in circular and eccentric deployed valves, with only a minor decrease in EOA observed in the eccentric valve (2.0 cm(2) for circular, 1.9 cm(2) for eccentric). Eccentric deployed TAVR lead to asymmetric systolic jet formation, with increased shear stresses (circular = 97 N/m(2) vs. eccentric = 119 N/m(2)) and regions of turbulence intensity (circular = 180 N/m(2) vs. eccentric = 230 N/m(2)) downstream that was not present in the circular deployed TAVR. The results of this study indicate that eccentric deployment of TAVRs can lead to altered flow characteristics and may potentially increase the hemolytic potential of the valve, which were not captured through hemodynamic evaluation alone. PMID:24719050

  18. CT and MR imaging of post-aortic left brachiocephalic vein

    International Nuclear Information System (INIS)

    The usefulness of CT and MR imaging (MRI) for the diagnosis of post-aortic left brachiocephalic vein (PALBV) is discussed. The subjects of the present study consisted of five patients with PALBV, two males and three females, aged for months to sixty years. Chest CT and MRI were performed as a follow-up study of other intrathoracic lesions in two cases, and for further examination of congenital heart diseases in two infant cases. The other patient underwent both CT and MRI to evaluate sporadic chest pain. Therefore, all PALBV were found incidentally. PALBV passes below the aortic arch in front of the trachea, draining the superior vena cava behind the ascending aorta. The finding was particularly well documented on consecutive coronal sections on MRI. In patients with intrathoracic malignant or specific inflammatory lesion, differentiation between PALBV and lymphadenopathy is necessary for treatment. From our experience, marked enhancement on CT and no signal intensity on MRI in PALBV could differentiate this anomaly from mediastinal lymphadenopathy. In two infantile cases with congenital cardiovascular anomalies such as tetralogy of Fallot, right aortic arch and pulmonary arterial stenosis, MRI was found to be superior to CT in demonstrating these anomalies. (author)

  19. CT and MR imaging of post-aortic left brachiocephalic vein

    Energy Technology Data Exchange (ETDEWEB)

    Amano, Yasuo; Takagi, Ryo; Hayashi, Hiromitsu; Kumazaki, Tatsuo (Nippon Medical School, Tokyo (Japan))

    1993-10-01

    The usefulness of CT and MR imaging (MRI) for the diagnosis of post-aortic left brachiocephalic vein (PALBV) is discussed. The subjects of the present study consisted of five patients with PALBV, two males and three females, aged for months to sixty years. Chest CT and MRI were performed as a follow-up study of other intrathoracic lesions in two cases, and for further examination of congenital heart diseases in two infant cases. The other patient underwent both CT and MRI to evaluate sporadic chest pain. Therefore, all PALBV were found incidentally. PALBV passes below the aortic arch in front of the trachea, draining the superior vena cava behind the ascending aorta. The finding was particularly well documented on consecutive coronal sections on MRI. In patients with intrathoracic malignant or specific inflammatory lesion, differentiation between PALBV and lymphadenopathy is necessary for treatment. From our experience, marked enhancement on CT and no signal intensity on MRI in PALBV could differentiate this anomaly from mediastinal lymphadenopathy. In two infantile cases with congenital cardiovascular anomalies such as tetralogy of Fallot, right aortic arch and pulmonary arterial stenosis, MRI was found to be superior to CT in demonstrating these anomalies. (author).

  20. Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation

    Science.gov (United States)

    Wijeysundera, Harindra C; Li, Lindsay; Braga, Vevien; Pazhaniappan, Nandhaa; Pardhan, Anar M; Lian, Dana; Leeksma, Aric; Peterson, Ben; Cohen, Eric A; Forsey, Anne; Kingsbury, Kori J

    2016-01-01

    Objective Transcatheter aortic valve implantation (TAVI) is generally more expensive than surgical aortic valve replacement (SAVR) due to the high cost of the device. Our objective was to understand the patient and procedural drivers of cumulative healthcare costs during the index hospitalisation for these procedures. Design All patients undergoing TAVI, isolated SAVR or combined SAVR+coronary artery bypass grafting (CABG) at 7 hospitals in Ontario, Canada were identified during the fiscal year 2012–2013. Data were obtained from a prospective registry. Cumulative healthcare costs during the episode of care were determined using microcosting. To identify drivers of healthcare costs, multivariable hierarchical generalised linear models with a logarithmic link and γ distribution were developed for TAVI, SAVR and SAVR+CABG separately. Results Our cohort consisted of 1310 patients with aortic stenosis, of whom 585 underwent isolated SAVR, 518 had SAVR+CABG and 207 underwent TAVI. The median costs for the index hospitalisation for isolated SAVR were $21 811 (IQR $18 148–$30 498), while those for SAVR+CABG were $27 256 (IQR $21 741–$39 000), compared with $42 742 (IQR $37 295–$56 196) for TAVI. For SAVR, the major patient-level drivers of costs were age >75 years, renal dysfunction and active endocarditis. For TAVI, chronic lung disease was a major patient-level driver. Procedural drivers of cost for TAVI included a non-transfemoral approach. A prolonged intensive care unit stay was associated with increased costs for all procedures. Conclusions We found wide variation in healthcare costs for SAVR compared with TAVI, with different patient-level drivers as well as potentially modifiable procedural factors. These highlight areas of further study to optimise healthcare delivery.

  1. Diagnostic method for lumbar foraminal stenosis based on the clinical results of transforaminal lumbar interbody fusion (TLIF). Utility of the foraminal stenosis score

    International Nuclear Information System (INIS)

    In this study we analyzed 73 cases treated by transforaminal lumbar interbody fusion (TLIF) for lumbar foraminal stenosis or central canal stenosis and foraminal stenosis, and based on the perioperative findings and outcome of treatment, we considered the diagnostic procedure for lumbar foraminal stenosis in the future. In 25 cases (34.2%) cases there was actually no clear perioperative evidence of foraminal stenosis. We compared the preoperative clinical and imaging findings in the group with perioperative findings and the group without perioperative findings performed a multiple logistic regression analysis to identify factors associated with foraminal stenosis. We also calculated the odds ratio for the perioperative findings and proposed a foraminal stenosis scoring system. (author)

  2. Incidence, Causes, and Impact of In-Hospital Infections After Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Tirado-Conte, Gabriela; Freitas-Ferraz, Afonso B; Nombela-Franco, Luis; Jimenez-Quevedo, Pilar; Biagioni, Corina; Cuadrado, Ana; Nuñez-Gil, Ivan; Salinas, Pablo; Gonzalo, Nieves; Ferrera, Carlos; Vivas, David; Higueras, Javier; Viana-Tejedor, Ana; Perez-Vizcayno, Maria Jose; Vilacosta, Isidre; Escaned, Javier; Fernandez-Ortiz, Antonio; Macaya, Carlos

    2016-08-01

    In-hospital infections (IHI) are one of the most common and serious problems after invasive procedures. Transcatheter aortic valve implantation (TAVI) is an increasingly used alternative to surgery in patients with severe symptomatic aortic stenosis. The aim of this study was to determine the incidence, origin, risk factors, and clinical outcomes of IHI after TAVI. A total of 303 consecutive patients with severe aortic stenosis who underwent transfemoral TAVI were included and followed during a median time of 21 months. We examined the occurrence, types, origin, and timing of infections during hospital stay as well as short- and long-term clinical outcomes according to the occurrence of IHI. A total of 51 patients (17%; 62 infectious episodes) experienced IHI after TAVI. Respiratory and urinary tract infections were the most frequent type of infections (44% and 34%, respectively), followed by surgical site infection (8%) and bloodstream infection (5%). Positive cultures were obtained in 74% of the samples, of which 65% were gram-negative bacilli. Modifiable factors such as bleeding (p = 0.005) and length of coronary care unit stay (p <0.001) were independently associated with an increased infection risk. Patients with IHI had a longer hospital stay (14 vs 6 days, p <0.001), an increased mortality (hazard ratio 2.48, 95% CI 1.45 to 4.23) and readmission rate (hazard ratio 2.0, 95% CI 1.27 to 3.14) during the follow-up. In conclusion, IHI is a frequent complication after TAVI with a significant impact on short- and long-term clinical outcomes. The most important risk factors associated with the development of this complication were modifiable periprocedural aspects. These results underline the importance to implement specific preventive strategies to reduce in-hospital-acquired infections after TAVI. PMID:27296559

  3. Surgical treatment of lumbar stenosis in achondroplasia

    NARCIS (Netherlands)

    Thomeer, RTWM; Van Dijk, JMC

    2002-01-01

    Object. The authors conducted a study to evaluate the results of a unique surgical procedure for treating primary lumbar stenosis in patients with achondroplasia, based on its distorted anatomical dimensions. Methods. A consecutive single-center series of 36 achondroplastic dwarfs with symptomatic l

  4. Alterations in aortic antioxidant components in an experimental model of atherosclerosis: a time-course study.

    Science.gov (United States)

    Godin, David V; Nichols, Cathleen R; Hoekstra, Kenneth A; Garnett, Maureen E; Cheng, Kimberly M

    2003-10-01

    Antioxidant component alterations in the aorta during atherogenesis were examined in atherosclerosis-susceptible (SUS) Japanese quail fed a cholesterol-supplemented (0.5% w/w) diet. Birds fed a non-supplemented diet provided information on the effects of aging on endogenous antioxidants. One hundred adult SUS males were used. Birds were sacrificed after 0, 4, 8 and 12 weeks on the diets and were examined for plaque development and corresponding antioxidant component alterations in aorta and myocardium. With aging, superoxide dismutase (SOD) activity was increased in both tissues, whereas aortic glutathione peroxidase (GPx) activity and myocardial glutathione reductase (GRd) activity decreased. Myocardial ascorbate levels increased with aging, with a reciprocal decrease in myocardial tocopherol levels. Following 4 weeks of cholesterol supplementation, aortic GRd decreased, SOD activity increased, but activities of GPx and catalase were unchanged. This same qualitative pattern of antioxidant enzyme changes was also found in myocardium. Thus, although aortic antioxidant enzyme changes produced by cholesterol feeding and aging showed some similarities, the early phase of atherogenesis does not simply reflect accelerated aging. In the late stages of atherogenesis, SOD activity returned to baseline, but other antioxidant enzymes remained unaltered from levels characterizing the early phase of lesion development. There was no detectable functional coupling between changes in GPx and GRd, nor between SOD (which produces hydrogen peroxide) and GPx or catalase (which utilize hydrogen peroxide as substrate). Previously reported alterations in erythrocyte antioxidant enzyme components during atherogenesis in quail were not predictive of changes in the corresponding enzymes in the aorta and myocardium. PMID:14577593

  5. Correlation between single nucleotide polymorphisms of the ACTA2 gene and coronary artery stenosis in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Fang, Hui; Luo, Xiaoli; Wang, Yan; Liu, Nian; Fu, Chunjiang; Wang, Hongyong; Fang, Yuqiang; Shi, Weibin; Zhang, Ye; Zeng, Chunyu; Wang, Xukai

    2014-04-01

    This study aimed to analyze the correlation between single nucleotide polymorphisms (SNPs) of the actin, aortic smooth muscle (ACTA2) gene and coronary artery stenosis in patients with type 2 diabetes mellitus (T2DM). Eight SNPs from the promoter region of the ACTA2 gene were screened. Patients with T2DM (n=251) were divided into two groups, those with severe coronary stenosis (SCS(+) group; n=168) and those without severe coronary stenosis (SCS(-) group; n=83). Patients were also divided according to lesion branching into those whose lesions involved less than three branches (LCA(-) group) and those whose lesions involved at least three branches (LCA(+) group). The clinical and laboratory data of the patients were collected, and the genotyping of eight SNPs was conducted followed by statistical analysis. Of the eight SNPs, only the rs1324551 SNP was identified to be significantly different between the SCS(+) and SCS(-) groups (PLCA(-) and LCA(+) groups. Following the deduction of age, gender and traditional risk factors, the odds ratios of the GG genotype in additive and recessive models were 2.93 [95% confidence interval (CI), 1.05-8.19; P=0.04] and 2.34 (95% CI, 1.09-5.02; P=0.03), respectively, and this relevancy was represented only in patients with low insulin levels. Age and smoking were also found to increase the risk of coronary artery lesions. In conclusion, the rs1324551 SNP in the promoter region of the ACTA2 gene was identified to be independently correlated with the degree of coronary artery stenosis in patients with T2DM and plasma insulin may inhibit coronary artery stenosis during the pathogenic process. PMID:24669260

  6. Transcatheter Aortic Valve Implantation Experience with SAPIEN 3.

    Science.gov (United States)

    Ohno, Y; Tamburino, C; Barbanti, M

    2015-06-01

    Based on randomized trials with first generation devices, transcatheter aortic valve replacement (TAVI) has been included into the treatment strategy for high-risk and inoperable patients with severe aortic stenosis. Procedural complications remain a concern with TAVI, including stroke, vascular complications, paravalvular leak (PVL) and conduction disturbances. Addressing these limitations will support TAVI use in lower risk populations. This review discussed features and most recent clinical evidence of the new balloon-expandable THV (SAPIEN 3, Edwards Lifescience, Irvine, CA, USA). PMID:25900559

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

    OpenAIRE

    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 ...

  8. Long-term follow-up of unusual ball-valve aortic substitute.

    Science.gov (United States)

    Shumacker, H B; Isch, J H; Jolly, W W

    1978-08-01

    On March 19, 1962, prior to the availability of Starr-Edwards ball-valve prostheses for aortic substitution, a mitral valve turned upside down was implanted for marked calcific aortic stenosis. It worked well and the patient was in good health for 15 years. Late annular calcification and loosening of sutures with marked perivalvular regurgitation made valve replacement necessary 16 years after operation. The original valve was perfectly preserved. PMID:682654

  9. Carotid stenosis degree in CT angiography: assessment based on luminal area versus luminal diameter measurements

    International Nuclear Information System (INIS)

    The aim of this study was to investigate CT angiography (CTA) luminal area measurements in the assessment of carotid artery stenosis compared with the current clinically used criteria based on lumen diameter measurements. Seventy-two vessels in 36 patients were evaluated by CTA and digital subtraction angiography (DSA). Two observers measured area and diameter stenosis degrees using automated 3D CTA analysis software. The ratio of the largest/smallest luminal diameter at the level of maximal stenosis (L/S ratio) was used to describe lumen morphology. Diagnostic agreement between CTA and DSA was calculated. For the assessment of area stenosis, interobserver and intraobserver correlation coefficients were 0.898 and 0.906 (p<0.001). The correlation coefficient between the diameter stenosis and area stenosis was lower in stenoses with extremely noncircular lumen (L/S ratio ≥1.5) (r=0.797, p<0.001) compared with stenoses with circular lumen (LS ratio <1.2) (r=0.978, p<0.001). Only satisfactory agreement (κ 0.54-0.77, p<0.001) was obtained between area stenosis on CTA and diameter stenosis on DSA. Assessment of stenosis degree with area measurements on 3D CTA proved to be reproducible. Area stenosis provides a less-severe estimate of the degree of carotid stenosis but might theoretically express the real hemodynamic significance of the lesion better than diameter stenosis, especially in stenoses with noncircular lumen. (orig.)

  10. Possibilities of the prophylaxis of arterial restenoses with dexamethasone - an in-vitro study of human aortic smooth muscle cells

    International Nuclear Information System (INIS)

    Purpose: To evaluate the effect of dexamethasone on the growth of cultured human aortic smooth muscle cells in an in-vitro model depending on the dose applied. Materials and Methods: Commercially available human aortic smooth muscle cells (haSMC) were incubated with different doses of dexamethasone (10-6, 10-8, 10-10 mol/l). For 20 days, the dose-depending effects of dexamethasone on cell growth were studied by analyzing cell proliferation, clonogenic activity as well as cell cycle distribution. In addition, the migratory ability of haSMC was evaluated using a two compartment in-vitro model. Results: Cell growth was reduced in a dose dependent manner. An applied dose of 10-6 M dexamethasone effectively inhibited cell growth for the follow-up period of 20 days. Cell cycle analysis revealed a G1-phase block which was dose dependent and significant for a dose of 10-6M. Also a reduction of haSMC clonogenic activity could be found in the colony formation assays. Finally, dexamethasone reduced the migratory ability of the treated cells significantly for doses of 10-6 and 10-8 M. Conclusion: Depending on the dose applied, incubation with dexamethasone results in a significant growth reduction of cultured haSMC, which may be due to a drug induced G1-phase block. Dexamethasone also reduces the clonogenic activity as well as the migratory ability of cultured haSMC. (orig.)

  11. Effects of statins on the progression of cerebral white matter lesion: Post hoc analysis of the ROCAS (Regression of Cerebral Artery Stenosis) study.

    Science.gov (United States)

    Mok, Vincent C T; Lam, Wynnie W M; Fan, Yu Hua; Wong, Adrian; Ng, Ping Wing; Tsoi, Tak Hon; Yeung, Vincent; Wong, Ka Sing

    2009-05-01

    Arteriosclerotic related cerebral white matter lesion (WML) is associated with increased risk of death, stroke, dementia, depression, gait disturbance, and urinary incontinence. We investigated the effects of statins on WML progression by performing a post hoc analysis on the ROCAS (Regression of Cerebral Artery Stenosis) study, which is a randomized, double-blind, placebo-controlled study evaluating the effects of statins upon asymptomatic middle cerebral artery stenosis progression among stroke-free individuals. Two hundreds and eight randomized subjects were assigned to either placebo (n = 102) or simvastatin 20 mg daily (n = 106) for 2 years. Baseline severity of WML was graded visually into none, mild, and severe. Volume (cm3) of WML was determined quantitatively at baseline and at end of study using a semi-automated method based on MRI. Primary outcome was the change in WML volume over 2 years. After 2 years of follow-up, there was no significant change in WML volume between the active and the placebo group as a whole. However, stratified analysis showed that for those with severe WML at baseline, the median volume increase in the active group (1.9 cm3) was less compared with that in the placebo group (3.0 cm3; P = 0.047). Linear multivariate regression analysis identified that baseline WML volume (beta = 0.63, P < 0.001) and simvastatin treatment (beta = -0.214, P = 0.043) independently predicted change in WML volume. Our findings suggest that statins may delay the progression of cerebral WML only among those who already have severe WML at baseline. PMID:19252811

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

    Directory of Open Access Journals (Sweden)

    James N. Warnock

    2011-01-01

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

  13. Transfemoral Aortic Valve Implantation with the New Edwards Sapien 3 Valve for Treatment of Severe Aortic Stenosis—Impact of Valve Size in a Single Center Experience

    Science.gov (United States)

    Wöhrle, Jochen; Gonska, Birgid; Rodewald, Christoph; Seeger, Julia; Scharnbeck, Dominik; Rottbauer, Wolfgang

    2016-01-01

    Aims The third generation Edwards Sapien 3 (Edwards Lifesciences Inc., Irvine, California) system was optimized to reduce residual aortic regurgitation and vascular complications. Methods and Results 235 patients with severe symptomatic aortic stenosis were prospectively enrolled. Transcatheter aortic valve implantations (TAVI) were performed without general anesthesia by transfemoral approach. Patients were followed for 30 days. Patients received 23mm (N = 77), 26mm (N = 91) or 29mm (N = 67) valve based on pre-procedural 256 multislice computer tomography. Mean oversizing did not differ between the 3 valves. There was no residual moderate or severe aortic regurgitation. Rate of mild aortic regurgitation and regurgitation index did not differ between groups. There was no switch to general anesthesia or conversion to surgery. Rate of major vascular complication was 3.0% with no difference between valve and delivery sheath sizes. Within 30 days rates of all cause mortality (2.6%) and stroke (2.1%) were low. Conclusions In patients with severe aortic stenosis transfemoral TAVI with the Edwards Sapien 3 valve without general anesthesia was associated with a high rate of device success, no moderate or severe residual aortic regurgitation, low rates of major vascular complication, mortality and stroke within 30 days with no difference between the 3 valve sizes. Trial Registration ClinicalTrials.gov NCT02162069 PMID:27003573

  14. Carbon Dioxide in the Aortic Arch: Coronary Effects and Implications in a Swine Study

    International Nuclear Information System (INIS)

    Purpose: CO2 angiography is considered dangerous in the aortic arch where bubbles may cause critical cerebral and cardiac ischemia. We investigated CO2distribution, physiologic effects in the heart, methods of detection and treatments. Methods: Eight pigs had CO2and iodinated contrast arch angiograms in supine and both lateral decubitus positions. An electrocardiogram, physiologic data and cardiac ultrasound were obtained. Therapies included precordial thumps and rolls to lateral decubitus positions. Results: Supine high descending aorta CO2 injections floated retrograde up the arch during diastole and preferentially filled the right coronary artery (RCA): mean score 3.5 (of 4), in nominate artery 2.4, left coronary artery 1.2; n = 17; p = 0.0001. Aortic root injections preferentially filled the RCA when the animal was supine, left coronary in the right decubitus position, and showed a diffuse pattern in the left decubitus position. Right decubitus rolls filled both coronaries causing several lethal arrhythmias. Precordialthumps successfully cleared CO2. Ultrasound is a sensitive detector of myocardial CO2. Conclusion: Arch distribution of CO2 primarily involves the RCA. Diagnostic ultrasound detects cardiac CO2 well. Precordial thumps are an effective treatment

  15. Spinal canal stenosis; Spinalkanalstenose

    Energy Technology Data Exchange (ETDEWEB)

    Papanagiotou, P.; Boutchakova, M. [Klinikum Bremen-Mitte/Bremen-Ost, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Bremen (Germany)

    2014-11-15

    Spinal stenosis is a narrowing of the spinal canal by a combination of bone and soft tissues, which can lead to mechanical compression of spinal nerve roots or the dural sac. The lumbal spinal compression of these nerve roots can be symptomatic, resulting in weakness, reflex alterations, gait disturbances, bowel or bladder dysfunction, motor and sensory changes, radicular pain or atypical leg pain and neurogenic claudication. The anatomical presence of spinal canal stenosis is confirmed radiologically with computerized tomography, myelography or magnetic resonance imaging and play a decisive role in optimal patient-oriented therapy decision-making. (orig.) [German] Die Spinalkanalstenose ist eine umschriebene, knoechern-ligamentaer bedingte Einengung des Spinalkanals, die zur Kompression der Nervenwurzeln oder des Duralsacks fuehren kann. Die lumbale Spinalkanalstenose manifestiert sich klinisch als Komplex aus Rueckenschmerzen sowie sensiblen und motorischen neurologischen Ausfaellen, die in der Regel belastungsabhaengig sind (Claudicatio spinalis). Die bildgebende Diagnostik mittels Magnetresonanztomographie, Computertomographie und Myelographie spielt eine entscheidende Rolle bei der optimalen patientenbezogenen Therapieentscheidung. (orig.)

  16. Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

    NARCIS (Netherlands)

    Boogert, H.F.; Keers, J.C.; Oterdoom, D.L. Marinus; Kuijlen, J.M.

    2015-01-01

    OBJECT The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two pop

  17. Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis : a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

    NARCIS (Netherlands)

    den Boogert, Hugo F.; Keers, Joost C.; Oterdoom, D. L. Marinus; Kuijlen, Jos M. A.

    2015-01-01

    OBJECT The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two pop

  18. Endovascular treatment with angioplasty or stenting versus endarterectomy in patients with carotid artery stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): long-term follow-up of a randomised trial.

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-10-01

    Endovascular treatment (angioplasty with or without stenting) is an alternative to carotid endarterectomy for carotid artery stenosis but there are scarce long-term efficacy data showing that it prevents stroke. We therefore report the long-term results of the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS).

  19. The ETTAA study protocol: a UK-wide observational study of ‘Effective Treatments for Thoracic Aortic Aneurysm’

    Science.gov (United States)

    Sastry, Priya; Hughes, Victoria; Hayes, Paul; Vallabhaneni, Srinivasa; Sharples, Linda; Thompson, Matt; Catarino, Pedro; Moorjani, Narain; Vale, Luke; Gray, Joanne; Cook, Andrew; Elefteriades, John A; Large, Stephen R

    2015-01-01

    Introduction Chronic thoracic aortic aneurysm (CTAA) affecting the arch or descending aorta is an indolent but life-threatening condition with a rising prevalence as the UK population ages. Treatment may be in the form of open surgical repair (OSR) surgery, endovascular stent grafting (ESG) or best medical therapy (BMT). Currently, there is no consensus on the best management strategy, and no UK-specific economic studies that assess outcomes beyond the chosen procedure, but this is required in the context of greater demand for treatment and limited National Health Service (NHS) resources. Methods and analysis This is a prospective, multicentre observational study with statistical and economic modelling of patients with CTAA affecting the arch or descending aorta. We aim to gain an understanding of how treatments are currently chosen, and to determine the clinical effectiveness and cost-effectiveness of the three available treatment strategies (BMT, ESG and OSR). This will be achieved by: (1) following consecutive patients who are referred to the teams collaborating in this proposal and collecting data regarding quality of life (QoL), medical events and hospital stays over a maximum of 5 years; (2) statistical analysis of the comparative effectiveness of the three treatments; and (3) economic modelling of the comparative cost-effectiveness of the three treatments. Primary study outcomes are: aneurysm growth, QoL, freedom from reintervention, freedom from death or permanent neurological injury, incremental cost per quality-adjusted life year gained. Ethics and dissemination The study will generate an evidence base to guide patients and clinicians to determine the indications and timing of treatment, as well as informing healthcare decision-makers about which treatments the NHS should provide. The study has achieved ethical approval and will be disseminated primarily in the form of a Health Technology Assessment monograph at its completion. Trial registration number

  20. Comparing the effects of epidural methylprednisolone acetate injected in patients with pain due to lumbar spinal stenosis or herniated disks: a prospective study

    Directory of Open Access Journals (Sweden)

    Gharibi F

    2011-12-01

    Full Text Available Jafar Mobaleghi1, Faramarz Allahdini2, Karim Nasseri3, Behzad Ahsan3, Shoaleh Shami4, Mansour Faizi5, Fardin Gharibi51Department of Surgery, 2Department of Neurosurgery, 3Department of Anesthesia, 4Faculty of Nursing, 5Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan, IranObjective: Satisfactory results have been seen with epidural steroid injections (ESI in patients with herniated disks (HD, but the role in lumbar spinal stenosis (LSS has been less investigated. We compared long-term effects of ESI in HD and LSS patients.Methods: In a prospective, single-blind uncontrolled study, 60 patients with radicular pain due to HD (n = 32 or LSS (n = 28 were enrolled over a 9-month period. Methylprednisolone acetate 80 mg plus 0.5% bupivacaine 10 mg were diluted in normal saline up to a total volume of 10 mL, and injected into the epidural space. The amount of pain based on numeric pain score, level of activity, and subjective improvement were reported by patients after 2 and 6 months by telephone. Demographic data were analyzed with the chi-square test. The differences in numeric pain scale scores between the two groups at different times were analyzed with the t-test.Results: There were no differences between HD and LSS patients regarding age, sex, and average duration of pain prior to ESI. The degree of pain was significantly higher in LSS patients in comparison with HD patients in the pre-injection period. The amount of pain was significantly reduced in both groups 2 months after injection. This pain reduction period lasted for 6 months in the HD group, but to a lesser extent in LSS patients (P < 0.05.Discussion: Epidural methylprednisolone injection has less analgesic effect in LSS, with less permanent effect in comparison with HD.Keywords: methylprednisolone acetate, lumbar spinal stenosis, herniated disk

  1. Reoperation on aortic disease in patients with previous aortic valve surgery

    Institute of Scientific and Technical Information of China (English)

    SUN Xiao-gang; ZHANG Liang; YU Cun-tao; QIAN Xiang-yang; CHANG Qian

    2013-01-01

    Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Methods Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012,and the mean interval time of re-intervention to aortic disease was 6 years ((6.0± 3.8) years).The secondary aortic surgery included aortic root replacement (14 cases),ascending aorta replacement (10 cases),aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases),and total thoracoabdominal aorta replacement (2 cases).All these patients have received outpatient re-exams or follow-up by phone calls.Results After the initial aortic valve replacement,patients suffered from aortic dissection (25 cases,53%),ascending aortic aneurysm (12 cases,26%) or aortic root aneurysm (10 cases,21%).Diameter in ascending aorta increased (5.2±7.1) mm per year and aortic sinus (3.3±3.1) mm per year.The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P<0.05).All 47 patients have received reoperation on aorta.One patient died in operating room because aortic dissection seriously involved right coronary artery.Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction.All patients were followed up,the mean survival time was (97.25±17.63) months,95% confidence interval was 55.24-73.33 months.Eight cases were died during follow-up and five-year survival rate was 83%.Conclusion To reduce the aortic adverse events after first aortic valve surgery,it is necessary to actively treat and strictly

  2. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to become you to our live webcast. Today we’re going to repair an abdominal aortic aneurysm ... and together as a team of multidisciplinary physicians, we’re going to repair an abdominal aortic aneurysm ...

  3. Aortic Aneurysm Statistics

    Science.gov (United States)

    ... connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. Signs and symptoms of thoracic aortic aneurysm can include Sharp, sudden pain in the chest or upper back. Shortness of ...

  4. Genome-wide association study identifies a sequence variant within the DAB2IP gene conferring susceptibility to abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Gretarsdottir, Solveig; Baas, Annette F; Thorleifsson, Gudmar;

    2010-01-01

    We performed a genome-wide association study on 1,292 individuals with abdominal aortic aneurysms (AAAs) and 30,503 controls from Iceland and The Netherlands, with a follow-up of top markers in up to 3,267 individuals with AAAs and 7,451 controls. The A allele of rs7025486 on 9q33 was found to as...

  5. Aortic growth rates in chronic aortic dissection

    International Nuclear Information System (INIS)

    Aim: To determine and compare rates of descending aortic enlargement and complications in chronic aortic dissection with and without a proximal aortic graft. Methods and materials: Fifty-two patients with dissection involving the descending aorta and who had undergone at least two computed tomography (CT) examinations at our institution between November, 1993 and February, 2004 were identified, including 24 non-operated patients (four type A, 20 type B) and 28 operated patients (type A). CT examinations per patient ranged from two to 10, and follow-up ranged from 1-123 months (mean 49 months, median 38.5 months). On each CT image, the aortic short axis (SA), false lumen (FL), and true lumen (TL) diameters were measured at the longitudinal midpoint of the dissection and at the point of maximum aortic diameter. Complications were tabulated, including aortic rupture and aortic enlargement requiring surgery. Results: For non-operated patients, the midpoint and maximum point SA, TL, and FL diameters increased significantly over time. For operated patients, the midpoint and maximum point SA and FL diameters increased significantly over time. In both groups, aortic enlargement was predominantly due to FL expansion. Diameter increases in non-operated patients were significantly larger than those in operated patients. The rate of change in aortic diameter was constant, regardless of aortic size. Four non-operated and six operated patients developed aortic complications. Conclusions: In patients with a dissection involving the descending thoracic aorta, the FL increased in diameter over time, at a constant rate, and to a greater degree in non-operated patients (mostly type B) compared with operated patients (all type A)

  6. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study) : an interim analysis of a randomised controlled trial

    NARCIS (Netherlands)

    Ederle, Joerg; Dobson, Joanna; Featherstone, Roland L.; Bonati, Leo H.; van der Worp, H. Bart; de Borst, Gert J.; Lo, T. Hauw; Gaines, Peter; Dorman, Paul J.; Macdonald, Sumaira; Lyrer, Philippe A.; Hendriks, Johanna M.; McCollum, Charles; Nederkoorn, Paul J.; Brown, Martin M.; Algra, A.; Bamford, J.; Beard, J.; Bland, M.; Bradbury, A. W.; Brown, M. M.; Clifton, A.; Gaines, P.; Hacke, W.; Halliday, A.; Malik, I.; Mas, J. L.; McGuire, A. J.; Sidhu, P.; Venables, G.; Bradbury, A.; Brown, M. M.; Clifton, A.; Gaines, P.; Collins, R.; Molynewc, A.; Naylor, R.; Warlow, C.; Ferro, J. M.; Thomas, D.; Bonati, L. H.; Coward, L.; Dobson, J.; Ederle, J.; Featherstone, R. F.; Tindall, H.; McCabe, D. J. H.; Wallis, A.; Brooks, M.; Chambers, B.; Chan, A.; Chu, P.; Clark, D.; Dewey, H.; Donnan, G.; Fell, G.; Hoare, M.; Molan, M.; Roberts, A.; Roberts, N.; Beiles, B.; Bladin, C.; Clifford, C.; Fell, G.; Grigg, M.; New, G.; Bell, R.; Bower, S.; Chong, W.; Holt, M.; Saunder, A.; Than, P. G.; Gett, S.; Leggett, D.; McGahan, T.; Quinn, J.; Ray, M.; Wong, A.; Woodruff, P.; Foreman, R.; Schultz, D.; Scroop, R.; Stanley, B.; Allard, B.; Atkinson, N.; Cambell, W.; Davies, S.; Field, P.; Milne, P.; Mitchell, P.; Tress, B.; Yan, B.; Beasley, A.; Dunbabin, D.; Stary, D.; Walker, S.; Cras, P.; d'Archambeau, O.; Hendriks, J. M. H.; Van Schil, P.; Bosiers, M.; Deloose, K.; van Buggenhout, E.; De Letter, J.; Devos, V.; Ghekiere, J.; Vanhooren, G.; Astarci, P.; Hammer, F.; Lacroix, V.; Peeters, A.; Verhelst, R.; DeJaegher, L.; Peeters, A.; Verbist, J.; Blair, J-F; Caron, J. L.; Daneault, N.; Giroux, M-F; Guilbert, F.; Lanthier, S.; Lebrun, L-H; Oliva, V.; Raymond, J.; Roy, D.; Soulez, G.; Weill, A.; Hill, M.; Hu, W.; Hudion, M.; Morrish, W.; Sutherland, G.; Wong, J.; Alback, A.; Harno, H.; Ijas, P.; Kaste, M.; Lepantalo, M.; Mustanoja, S.; Paananen, T.; Porras, M.; Putaala, J.; Railo, M.; Sairanen, T.; Soinne, L.; Vehmas, A.; Vikatmaa, P.; Goertler, M.; Halloul, Z.; Skalej, M.; Brennan, P.; Kelly, C.; Leahy, A.; Moroney, J.; Thornton, J.; Koelemay, M. J. W.; Nederkoorn, P. J.; Reekers, J. A. A.; Roos, Y. B. W. E. M.; Hendriks, J. M.; Koudstaal, P. J.; Pattynama, P. M. T.; van der Lugt, A.; van Dijk, L. C.; van Sambeek, M. R. H. M.; van Urk, H.; Verhagen, H. J. M.; Bruininckx, C. M. A.; de Bruijn, S. F.; Keunen, R.; Knippenberg, B.; Mosch, A.; Treurniet, F.; van Dijk, L.; van Overhagen, H.; Wever, J.; de Beer, F. C.; van den Berg, J. S. P.; van Hasselt, B. A. A. M.; Zeilstra, D. J.; Boiten, J.; van Otterloo, J. C. A. de Mol; de Vries, A. C.; Nieholt, G. J. Lycklama A.; van der Kallen, B. F. W.; Blankensteijn, J. D.; De Leeuw, F. E.; Kool, L. J. Schultze; van der Vliet, J. A.; de Borst, G. J.; de Kort, G. A. P.; Kapelle, L. J.; Lo, T. H.; Mali, W. P. Th M.; Moll, F.; van der Worp, H. Bart; Verhagen, H.; Barber, P. A.; Bourchier, R.; Hill, A.; Holden, A.; Stewart, J.; Bakke, S. J.; Krohg-Sorensen, K.; Skjelland, M.; Tennoe, B.; Bialek, P.; Biejat, Z.; Czepiel, W.; Czlonkowska, A.; Dowzenko, A.; Jedrzejewska, J.; Kobayashi, A.; Lelek, M.; Polanski, J.; Kirbis, J.; Milosevic, Z.; Zvan, B.; Blasco, J.; Chamorro, A.; Macho, J.; Obach, V.; Riambau, V.; San Roman, L.; Branera, J.; Canovas, D.; Estela, Jordi; Gimenez Gaibar, A.; Perendreu, J.; Bjorses, K.; Gottsater, A.; Ivancev, K.; Maetzsch, T.; Sonesson, B.; Berg, B.; Delle, M.; Formgren, J.; Gillgren, P.; Kall, T-B; Konrad, P.; Nyman, N.; Takolander, R.; Andersson, T.; Malmstedt, J.; Soderman, M.; Wahlgren, C.; Wahlgren, N.; Binaghi, S.; Hirt, L.; Michel, P.; Ruchat, P.; Bonati, L. H.; Engelter, S. T.; Fluri, F.; Guerke, L.; Jacob, A. L.; Kirsch, E.; Lyrer, P. A.; Radue, E-W; Stierli, P.; Wasner, M.; Wetzel, S.; Bonvin, C.; Kalangos, A.; Lovblad, K.; Murith, N.; Ruefenacht, D.; Sztajzel, R.; Higgins, N.; Kirkpatrick, P. J.; Martin, P.; Adam, D.; Bell, J.; Bradbury, A. W.; Crowe, P.; Gannon, M.; Henderson, M. J.; Sandler, D.; Shinton, R. A.; Scriven, J. M.; Wilmink, T.; D'Souza, S.; Egun, A.; Guta, R.; Punekar, S.; Seriki, D. M.; Thomson, G.; Brennan, A.; Enevoldson, T. P.; Gilling-Smith, G.; Gould, D. A.; Harris, P. L.; McWilliams, R. G.; Nasser, H-C; White, R.; Prakash, K. G.; Serracino-Inglott, F.; Subramanian, G.; Symth, J. V.; Walker, M. G.; Clarke, M.; Davis, M.; Dixit, S. A.; Dolman, P.; Dyker, A.; Ford, G.; Golkar, A.; Jackson, R.; Jayakrishnan, V.; Lambert, D.; Lees, T.; Louw, S.; Macdonald, S.; Mendelow, A. D.; Rodgers, H.; Rose, J.; Stansby, G.; Wyatt, M.; Baker, T.; Baldwin, N.; Jones, L.; Mitchell, D.; Munro, E.; Thornton, M.; Baker, D.; Davis, N.; Hamilton, G.; McCabe, D.; Platts, A.; Tibballs, J.; Beard, J.; Cleveland, T.; Dodd, D.; Gaines, P.; Lonsdale, R.; Nair, R.; Nassef, A.; Nawaz, S.; Venables, G.; Belli, A.; Clifton, A.; Cloud, G.; Halliday, A.; Markus, H.; McFarland, R.; Morgan, R.; Pereira, A.; Thompson, A.; Chataway, J.; Cheshire, N.; Gibbs, R.; Hammady, M.; Jenkins, M.; Malik, I.; Wolfe, J.; Adiseshiah, M.; Bishop, C.; Brew, S.; Brookes, J.; Brown, M. M.; Jaeger, R.; Kitchen, N.; Ashleigh, R.; Butterfield, S.; Gamble, G. E.; McCollum, C.; Nasim, A.; O'Neill, P.; Wong, J.; Edwards, R. D.; Lees, K. R.; MacKay, A. J.; Moss, J.; Rogers, P.

    2010-01-01

    Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid

  7. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial.

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2010-03-20

    Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy.

  8. Hypertrophic pyloric stenosis

    DEFF Research Database (Denmark)

    Lund Kofoed, P E; Høst, A; Elle, B;

    1988-01-01

    To evaluate the usefulness of ultrasound in hypertrophic pyloric stenosis (HPS) and to analyse the correlation between the dimensions of the pyloric muscle and the age and the weight of the child, 34 children with suspected HPS and 34 controls were examined. An overlap between the dimensions of the...... pyloric muscle in the HPS group and in the controls stresses the need to assess the muscle length, the muscle diameter, and the muscle wall thickness in establishing the sonographic diagnosis of HPS. We found the following criteria useful: muscle length greater than or equal to 19 mm, muscle diameter...... greater than or equal to 10 mm, and muscle wall thickness greater than or equal to 4 mm. The results did not confirm previous reports of increasing dimensions of the pyloric muscle with age and weight....

  9. Calcific aortic valve damage as a risk factor for cardiovascular events

    International Nuclear Information System (INIS)

    Aortic valve calcification (AVC) is a common disease of the elderly. It is a progressive disease ranging from mild valve thickening to severe calcification with aortic valve stenosis. Risk factors for AVC are similar to those for atherosclerosis: age, gender, hypercholesterolemia, diabetes, hypertension, smoking and renal failure. AVC shares many similarities to atherosclerosis, including inflammatory cells and calcium deposits, and correlates with coronary plaque burden. Presence of AVC is associated with increased risk of adverse cardiovascular events. The objective for this review is to discuss the clinical features, natural history and prognostic significance of aortic valve calcifications, including mechanical and hemodynamic factors of flow distribution

  10. [Surgical aortic valve replacement for acute Streptococcus viridans endocarditis with simultaneous moderate hemophilia A].

    Science.gov (United States)

    Krawietz, W; Loracher, C; Struck, E; Schlimok, G; Falk, H

    1988-07-01

    This is a report of a 25-year-old patient with known aortic valve stenosis since early youth and hemophilia A, showing recurrent joint bleeding. Acute Streptococcus endocarditis induced aortic valve insufficiency resulting in cardiac failure. Aortic valve replacement was performed after substitution of factor VIII, during which intra- and postoperative bleeding was prolonged by pericardial adhesions. Heparin was administered during cardiopulmonary-bypass as usual, but usual postoperative cumarin therapy was not initiated due to prolonged PTT time. One year postoperatively, the patient was in an excellent condition and fully rehabilitated. PMID:3145652

  11. Lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis

    OpenAIRE

    Koakutsu, Tomoaki; Morozumi, Naoki; Koizumi, Yutaka; Ishii, Yushin

    2011-01-01

    Study design Case-series study. Objective To describe the clinical presentation, characteristic findings of imaging studies, and treatment of lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis. Background Lumbar lesions in rheumatoid arthritis are relatively rare, with a limited number of systemic reports. Methods Six patients with lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis were treated. The patients were all women with a mean age of 69 ye...

  12. A comparative study of the effect of coronary atherosclerosis and age on aortic and pulmonary arterial pulse wave velocity

    International Nuclear Information System (INIS)

    The effect of coronary artery disease (CAD) and age on aortic (AO-PWV) and pulmonary arterial pulse wave velocity (PA-PWV) was studied. Aortic and pulmonary arterial pressure were measured at two sites (ascending and abdominal aorta, and the main pulmonary trunk and one of its principle branches, respectively) using a catheter-tip micromanometer in 24 patients divided in two groups. Control group (n=12) consisted of patients with normal coronaries, while the CAD group (n=12) consisted of patients with coronary artery disease estimated by coronary angiography. The interval between these two sites was determined by measuring the withdrawal distance of the microtip-catheter. AO-PWV was significantly higher (p<0.02) in the CAD group (12.0±4.1 m/sec) than in the control group (8.2±2.7 m/sec). There was no significant difference between the two groups in PA-PWV. AO-PWV was significantly (r=0.731, p<0.01) increased with age in the control group, while no significant correlation between the two was observed in the CAD group. There was no significant correlation between PA-PWV and age in control group. The results of this study indicate that only coronary atherosclerosis and age have significant predictive value regarding AO-PWV, but there was no significant correlation with PA-PWV for any of these parameters. The PA-PWV invasively measured in the 12 control subjects in this study was 2.3±0.7 m/sec, which is very close to values reported in the recent literatures using MRI. (author)

  13. CT and MR imaging of the aortic valve: radiologic-pathologic correlation.

    Science.gov (United States)

    Bennett, Christopher J; Maleszewski, Joseph J; Araoz, Philip A

    2012-01-01

    Valvular disease is estimated to account for as many as 20% of cardiac surgical procedures performed in the United States. It may be congenital in origin or secondary to another disease process. One congenital anomaly, bicuspid aortic valve, is associated with increased incidence of stenosis, regurgitation, endocarditis, and aneurysmal dilatation of the aorta. A bicuspid valve has two cusps instead of the normal three; resultant fusion or poor excursion of the valve leaflets may lead to aortic stenosis, the presence of which is signaled by dephasing jets on magnetic resonance (MR) images. Surgery is generally recommended for patients with severe stenosis who are symptomatic or who have significant ventricular dysfunction; transcatheter aortic valve implantation (TAVI) is an emerging therapeutic option for patients who are not eligible for surgical treatment. Computed tomography (CT) is an essential component of preoperative planning for TAVI; it is used to determine the aortic root dimensions, severity of peripheral vascular disease, and status of the coronary arteries. Aortic regurgitation, which is caused by incompetent closure of the aortic valve, likewise leads to the appearance of jets on MR images. The severity of regurgitation is graded on the basis of valvular morphologic parameters; qualitative assessment of dephasing jets at Doppler ultrasonography; or measurements of the regurgitant fraction, volume, and orifice area. Mild regurgitation is managed conservatively, whereas severe or symptomatic regurgitation usually leads to valve replacement surgery, especially in the presence of substantial left ventricular enlargement or dysfunction. Bacterial endocarditis, although less common than aortic stenosis and regurgitation, is associated with substantial morbidity and mortality. Electrocardiographically gated CT reliably demonstrates infectious vegetations and benign excrescences of 1 cm or more on the valve surface, allowing the assessment of any embolic

  14. Antral web associated with distal antral hypertrophy and prepyloric stenosis mimicking hypertrophic pyloric stenosis

    Institute of Scientific and Technical Information of China (English)

    Mao-Ming Tiao; Sheung-Fat Ko; Chie-Song Hsieh; Shu-Hang Ng; Chi-Di Liang; Shy Ming Sheen-Chen; Jiin-Haur Chuang; Hsuan-Ying Huang

    2005-01-01

    A 3-year-old boy presented with postprandial vomiting and epigastric pain for 3 wk. Barium meal study suggested hypertrophic pyloric stenosis. Ultrasound of the stomach after water loading revealed an echogenic antral web with an eccentric aperture and distal antral hypertrophy.Subsequent endoscopy confirmed the ultrasound findings.Web resection and antropyloroplasty resulted in excellent recovery. To our knowledge, the barium meal and ultrasound findings of an antral web-associated distal antral hypertrophy and prepyloric stenosis has not previously been described.

  15. Evaluation of Proximal Aortic Elastic Properties in Non-Ischemic Dilated Cardiomyopathy by Trans-Thoracic Echocardiography: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    Alireza Moaref

    2015-06-01

    Full Text Available Background: Stiffening of the large vessels, especially aorta, plays a significant role in increasing the left ventricular work and aggravating the cardiovascular diseases by attenuating the vascular wall distensibility and its buffering effect. Objectives: This study aimed to compare the stiffness of proximal aorta in the patients with established diagnosis of Non-Ischemic Dilated Cardiomyopathy (NIDC and the normal population. Patients and Methods: This case-control study aimed to compare 50 patients with established diagnosis of NIDC and 50 individuals with no history of significant cardiovascular diseases in the outpatient echocardiography clinics affiliated to Shiraz University of Medical Sciences, Shiraz, Iran during a three-month period in 2011. The patients with aortic valve disorders, coronary artery disease, congenital heart disease, diabetes mellitus, hypertension, and renal failure were excluded from the study. Stiffness indices were determined using the data gathered via echocardiography (left ventricular ejection fraction, end-systolic and end-diastolic volumes, and internal aortic diameter and blood pressure measurement. Ordinal and quantitative data were analyzed by Chi-square and independent T-test, respectively using the SPSS statistical software, version 16.0. Besides, P < 0.05 was considered as statistically significant. Results: The results of this study revealed significantly lower aortic strain (0.05 ± 0.02 in the NIDC patients versus 0.20 ± 0.46 in the controls, P < 0.001 and brachial pulse pressure (40.50 ± 9.00 in the NIDC patients versus 45.90 ± 8.08 in the controls, P < 0.001 in the NIDC patients. Conclusions: Aortic stiffness is capable of deteriorating the cardiovascular function by augmenting the afterload. Thus, it should be seriously considered as an issue while approaching NIDC patients since they demonstrate lower aortic distensibility.

  16. A non-surgical approach to the management of lumbar spinal stenosis: A prospective observational cohort study

    Directory of Open Access Journals (Sweden)

    Hurwitz Eric L

    2006-02-01

    Full Text Available Abstract Background While it is widely held that non-surgical management should be the first line of approach in patients with lumbar spinal stenosis (LSS, little is known about the efficacy of non-surgical treatments for this condition. Data are needed to determine the most efficacious and safe non-surgical treatment options for patients with LSS. The purpose of this paper is to describe the clinical outcomes of a novel approach to patients with LSS that focuses on distraction manipulation (DM and neural mobilization (NM. Methods This is a prospective consecutive case series with long term follow up (FU of fifty-seven consecutive patients who were diagnosed with LSS. Two were excluded because of absence of baseline data or failure to remain in treatment to FU. Disability was measured using the Roland Morris Disability Questionnaire (RM and pain intensity was measured using the Three Level Numerical Rating Scale (NRS. Patients were also asked to rate their perceived percentage improvement. Results The mean patient-rated percentage improvement from baseline to the end to treatment was 65.1%. The mean improvement in disability from baseline to the end of treatment was 5.1 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability from baseline to the end of treatment was seen in 66.7% of patients. The mean improvement in "on average" pain intensity was 1.6 points. This did not reach the threshold for clinical meaningfulness. The mean improvement in "at worst" pain was 3.1 points. This was considered to be clinically meaningful. The mean duration of FU was 16.5 months. The mean patient-rated percentage improvement from baseline to long term FU was 75.6%. The mean improvement in disability was 5.2 points. This was considered to be clinically meaningful. Clinically meaningful improvement in disability was seen in 73.2% of patients. The mean improvement in "on average" pain intensity from baseline to long

  17. Increased platelet count and leucocyte-platelet complex formation in acute symptomatic compared with asymptomatic severe carotid stenosis.

    LENUS (Irish Health Repository)

    McCabe, D J H

    2005-09-01

    The risk of stroke in patients with recently symptomatic carotid stenosis is considerably higher than in patients with asymptomatic stenosis. In the present study it was hypothesised that excessive platelet activation might partly contribute to this difference.

  18. Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

    Directory of Open Access Journals (Sweden)

    André Luiz Silveira Souza

    2016-01-01

    Full Text Available Abstract Background: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results: A total of 136 patients with a mean age of 83 years (80-87 underwent heart valve implantation; of these, 49% were women, 131 (96.3% had aortic stenosis, one (0.7% had aortic regurgitation and four (2.9% had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%. The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%. The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003 and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036 were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013 and blood transfusion (relative risk of 8.3; p = 0.0009 were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion: Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality.

  19. Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil

    Science.gov (United States)

    Souza, André Luiz Silveira; Salgado, Constantino González; Mourilhe-Rocha, Ricardo; Mesquita, Evandro Tinoco; Lima, Luciana Cristina Lima Correia; de Mattos, Nelson Durval Ferreira Gomes; Rabischoffsky, Arnaldo; Fagundes, Francisco Eduardo Sampaio; Colafranceschi, Alexandre Siciliano; Carvalho, Luiz Antonio Ferreira

    2016-01-01

    Background Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. Objective To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. Methods Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality. Results A total of 136 patients with a mean age of 83 years (80-87) underwent heart valve implantation; of these, 49% were women, 131 (96.3%) had aortic stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%). The baseline orifice area was 0.67 ± 0.17 cm2 and the mean left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%; in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial hypertension (relative risk of 5.3; p = 0.036) were predictive of in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p = 0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA functional class I/II; at one year, this figure reached 96%. Conclusion Transcatheter aortic valve implantation was performed with a high success rate and low mortality. Blood transfusion was associated with higher in-hospital and one-year mortality. Peak C-reactive protein was associated with one-year mortality. PMID:27192383

  20. Short-term and medium-term outcomes of transapical aortic valve implantation as a single-strategy approach: one center's experience

    Science.gov (United States)

    Mokráček, Aleš; Pešl, Ladislav; Kurfirst, Vojtěch; Šulda, Mirek

    2015-01-01

    Introduction Transcatheter aortic valve replacement has been developed as an alternative option for surgical high-risk or inoperable patients with severe symptomatic aortic stenosis. Aim of the study Aim of the study was to evaluate the outcomes of patients undergoing transapical aortic valve replacement as a single-strategy option by a single-center multidisciplinary heart team. Material and methods Between June 2009 and December 2014, 41 patients underwent transapical transcatheter aortic valve implantation (TA-TAVI) at our institution. All patients received Edwards SAPIEN balloon expandable pericardial valves (Edwards Lifesciences, Irvine, CA, USA). Our center followed a “clear transapical strategy” for all patients. Results The mean age of the patients was 79.6 years, and the mean logistic EuroSCORE was 21.06 ± 12.82%. Fifteen patients (36.6%) underwent redo operations. Complications included stroke (n = 1), re-exploration for bleeding or cardiac tamponade (n = 4), renal failure requiring temporary hemodialysis (n = 4) and permanent pacemaker implantation (n = 3). There were no myocardial infarctions or coronary obstruction. The total 30-day mortality rate was 17.1% (7 patients). Postoperative intensive care unit stay was 4.6 ± 5.7 days, and mean hospitalization was 11.6 ± 7.2 days. Conclusions The TA-TAVI approach provides good results in terms of early and midterm outcomes. This approach is feasible and safe for patients who have high surgical risk. PMID:26336490

  1. Laceration of anterior mitral leaflet postpercutaneous balloon mitral valvuloplasty for rheumatic mitral stenosis

    OpenAIRE

    Jadoon, Mehmood; Roberts, M. J.; Dixon, L.; Jones, Mark

    2012-01-01

    A 37-year-old Caucasian female with known rheumatic mitral stenosis was admitted for Balloon mitral valvuloplasty which was complicated with a laceration of anterior mitral leaflet (A2 scallop) resulting in severe mitral regurgitation. Intra-aortic balloon pump (IABP) was instituted and the patient was referred for emergency mitral surgery. During surgery anterior mitral leaflet was excised. Most of the posterior leaflet was preserved. Mitral valve was replaced with St Jude mitral mechanical ...

  2. Pharmacological study of the mechanisms involved in the vasodilator effect produced by the acute application of triiodothyronine to rat aortic rings

    Science.gov (United States)

    Lozano-Cuenca, J.; López-Canales, O.A.; Aguilar-Carrasco, J.C.; Villagrana-Zesati, J.R.; López-Mayorga, R.M.; Castillo-Henkel, E.F.; López-Canales, J.S.

    2016-01-01

    A relationship between thyroid hormones and the cardiovascular system has been well established in the literature. The present in vitro study aimed to investigate the mechanisms involved in the vasodilator effect produced by the acute application of 10-8–10-4 M triiodothyronine (T3) to isolated rat aortic rings. Thoracic aortic rings from 80 adult male Wistar rats were isolated and mounted in tissue chambers filled with Krebs-Henseleit bicarbonate buffer in order to analyze the influence of endothelial tissue, inhibitors and blockers on the vascular effect produced by T3. T3 induced a vasorelaxant response in phenylephrine-precontracted rat aortic rings at higher concentrations (10-4.5–10-4.0 M). This outcome was unaffected by 3.1×10-7 M glibenclamide, 10-3 M 4-aminopyridine (4-AP), 10-5 M indomethacin, or 10-5 M cycloheximide. Contrarily, vasorelaxant responses to T3 were significantly (PTEA), or 10-7 M apamin plus 10-7 M charybdotoxin. The results suggest the involvement of endothelial mechanisms in the vasodilator effect produced by the acute in vitro application of T3 to rat aortic rings. Possible mechanisms include the stimulation of muscarinic receptors, activation of the NO-cGMP-PKG pathway, and opening of Ca2+-activated K+ channels. PMID:27464023

  3. Efficacy of tranexamic acid in reducing blood loss in posterior lumbar spine surgery for degenerative spinal stenosis with instability: a retrospective case control study

    Directory of Open Access Journals (Sweden)

    Endres Stefan

    2011-11-01

    Full Text Available Abstract Background Degenerative spinal stenosis and instability requiring multilevel spine surgery has been associated with large blood losses. Factors that affect perioperative blood loss include time of surgery, surgical procedure, patient height, combined anterior/posterior approaches, number of levels fused, blood salvage techniques, and the use of anti-fibrinolytic medications. This study was done to evaluate the efficacy of tranexamic acid in reducing blood loss in spine surgery. Methods This retrospective case control study includes 97 patients who had to undergo surgery because of degenerative lumbar spinal stenosis and instability. All operations included spinal decompression, interbody fusion and posterior instrumentation (4-5 segments. Forty-six patients received 1 g tranexamic acid intravenous, preoperative and six hours and twelve hours postoperative; 51 patients without tranexamic acid administration were evaluated as a control group. Based on the records, the intra- and postoperative blood losses were measured by evaluating the drainage and cell saver systems 6, 12 and 24 hours post operation. Additionally, hemoglobin concentration and platelet concentration were reviewed. Furthermore, the number of red cell transfusions given and complications associated with tranexamic acid were assessed. Results The postoperative hemoglobin concentration demonstrated a statistically significant difference with a p value of 0.0130 showing superiority for tranexamic acid use (tranexamic acid group: 11.08 g/dl, SD: 1.68; control group: 10.29 g/dl, SD: 1.39. The intraoperative cell saver volume and drainage volume after 24 h demonstrated a significant difference as well, which indicates a less blood loss in the tranexamic acid group than the control group. The postoperative drainage volume at12 hours showed no significant differences; nor did the platelet concentration Allogenic blood transfusion (two red cell units was needed for eight patients

  4. The role of aortic wall CT attenuation measurements for the diagnosis of acute aortic syndromes

    International Nuclear Information System (INIS)

    Objectives: To determine if measurements of aortic wall attenuation can improve the CT diagnosis of acute aortic syndromes. Methods: CT reports from a ten year period were searched for acute aortic syndromes (AAS). Studies with both an unenhanced and a contrast enhanced (CTA) series that had resulted in the diagnosis of intramural hematoma (IMH) were reviewed. Diagnoses were confirmed by medical records. The attenuation of aortic wall abnormalities was measured. The observed attenuation threshold was validated using studies from 39 new subjects with a variety of aortic conditions. Results: The term “aortic dissection” was identified in 1206, and IMH in 124 patients’ reports. IMH was confirmed in 31 patients, 21 of whom had both unenhanced and contrast enhanced images. All 21 had pathologic CTA findings, and no CTA with IMH was normal. Attenuation of the aortic wall was greater than 45 HUs on the CTA images in all patients with IMH. When this threshold was applied to the new group, sensitivity for diagnosing AAS was 100% (19/19), and specificity 94% (16/17). Addition of unenhanced images did not improve accuracy. Conclusions: Measurements of aortic wall attenuation in CTA have a high negative predictive value for the diagnosis of acute aortic syndromes

  5. Estudo comparativo experimental da estenose esofagogástrica nas suturas manual e mecânica Experimental comparative study of esophagogastric stenosis in manual and mechanic sutures

    Directory of Open Access Journals (Sweden)

    Francisco Américo Fernandes Neto

    2000-04-01

    hemostasia, preservação do aporte sangüíneo, controle de infeção, escolha do fio ou do grampeador apropriado e a adequada coaptação das margens viscerais.Twenty eight pigs were randomly distributed to two groups of 14 animals ("A" and "B". Cardia's anatomic diameter was mouldred and measured with a small latex balloon filled with alginato injection. The animals were then submitted to an esophagogastric section. In group "A", anastomosis was performed with separated sutures using 910 poliglactina "000" and in the group "B" the suture was performed with ILS stapler. Seven pigs, from both subgroups "A1" and "B1", were submitted to a new operation and evaluated after seven days while two other sub-groups from seven animals each ("A2" and "B2" had the operation on the 14th day. The anatomic parts were macroscopically examined, followed by a pressure test, histological study and the identification and measurement moulds. The medial percentual difference of stenosis (delta P, was evaluated by the media of the cardias' diameter before and after manual and mechanics suture. Statistical analysis showed that there is no significant percentual media difference of stenosis and operative time ("deltas Ps". The "delta P" stenosis in the manual suture was 25,44% at the 7th postoperative day and 15,88% at the 14th postoperative day. In the mechanics suture the percentual on the 7th and 14th day were 22,80% and 23,04%. The stenosis did not cause any trouble to the esophagogastric alimentary transit. Macroscopically, there were no free leakage observed in the abdominal cavity, although the microscopic evaluation showed a blocked partial suture ruptures in three animals. Adesions were more prevalent with manual sutures. A bad coaptation between visceral edges of the anastomosis in a few clippings resulted in a fibriform reparation with areater stenosis. Regarding hand made sutures, more perianastomotic inflamatory changes were observed in this subset of animals, while the stapling of

  6. Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.

    Science.gov (United States)

    Sekine, Yuji; Yamamoto, Shin; Fujikawa, Takuya; Oshima, Susumu; Ono, Makoto; Sasaguri, Shiro

    2015-10-01

    Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm. PMID:24000069

  7. Contemporary management of pyloric stenosis.

    Science.gov (United States)

    Jobson, Matthew; Hall, Nigel J

    2016-08-01

    Hypertrophic pyloric stenosis is a common surgical cause of vomiting in infants. Following appropriate fluid resuscitation, the mainstay of treatment is pyloromyotomy. This article reviews the aetiology and pathophysiology of hypertrophic pyloric stenosis, its clinical presentation, the role of imaging, the preoperative and postoperative management, current surgical approaches and non-surgical treatment options. Contemporary postoperative feeding regimens, outcomes and complications are also discussed. PMID:27521712

  8. Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection for the Treatment of Chronic Radicular Pain Caused by Lumbar Foraminal Spinal Stenosis: A Retrospective Comparative Study

    Science.gov (United States)

    Park, Yongbum; Lee, Woo Yong; Ahn, Jae Ki; Nam, Hee-Seung

    2015-01-01

    Objective To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure. Methods This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score. Results ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point. Conclusion Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary. PMID:26798608

  9. Mid-term results of 17-mm St. Jude Medical Regent prosthetic valves in elder patients with small aortic annuli: comparison with 19-mm bioprosthetic valves.

    Science.gov (United States)

    Teshima, Hideki; Ikebuchi, Masahiko; Sano, Toshikazu; Tai, Ryuta; Horio, Naohiro; Irie, Hiroyuki

    2014-09-01

    This study was designed to compare the mid-term outcomes after aortic valve replacement (AVR) between 17-mm mechanical heart valves (MV) and 19-mm bioprosthetic valves (BV) in elderly patients with small aortic annuli. Between 2000 and 2011, 127 consecutive patients (mean age 79 years; 87 % female) underwent AVR for aortic valve stenosis with a small aortic annulus. 19-mm BV (n = 67) was implanted. When the 19-mm BV did not fit the annulus, 17-mm St. Jude Medical Regent prosthetic mechanical valve (n = 60) was used instead of an aortic root-enlargement procedure. The follow-up rate was 94.0 % in the BV group, and 98.5 % in the MV group. No significant differences in survival rate and valve-related complications were found between the 2 groups. In-hospital mortality rates were 1.5 % (n = 1) in the BV group and 5.0 % (n = 3) in the MV group. Late mortality rates were 3.9 % per patient-years (p-y; n = 8) in the BV group, and 6.0 % per p-y (n = 10) in the MV group. Five-year Kaplan-Meier survival rates were 62 % in the BV group, and 72 % in the MV group (log-rank P = 0.280). Freedom from major adverse valve-related stroke and cerebral bleeding events was 92.5 and 98.5 % in the BV group, and 94.7 and 100 % in the MV group. AVR using 17-mm MV in elder patients with small aortic annuli provided equivalent mid-term clinical results to that with 19-mm BV. PMID:24878870

  10. Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

    Institute of Scientific and Technical Information of China (English)

    DING Wen-yuan; YANG Da-long; CAO Lai-zhen; SUN Ya-peng; ZHANG Wei; XU Jia-xin; ZHANG Ying-ze; SHEN Yong

    2011-01-01

    Background Degenerative lumbar scoliosis is common in older patients.Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis.A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed.The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.Methods From January 2001 to August 2010,96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls.Cobb angle,height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides,the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group.The height of L2/L3,L3/L4,L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group.The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups.The bone density of lumbar vertebrae was measured with dual-energy X-ray.Results In scoliosis group,the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001 ).The vertebral body height on the convex side was greater than the height on the concave side (P=0.016).There was a significant difference between the scoliosis group and the control group (P=0.003),and between T-value and the rate of osteoporosis between the two groups (both P <0.001).Results were verified using multiple linear regression analysis.Conclusions Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces.There is a positive correlation between the angle of scoliosis and

  11. Mechanical properties of the aortic arterial wall during 24 hours: a preliminary study in conscious sheep

    International Nuclear Information System (INIS)

    Previous experiences in animals showed a different behavior between the variability of pressure, arterial diameter and elasticity when they were registered for a couple of hours. To better understand arterial mechanics variability, we propose to measure simultaneously aortic pressure and diameter during 24 hours in a sheep. For that purpose, we developed a portable prototype device. It allows continuously recording physiological signals throughout the day and storing them in a solid state memory for later analysis. Pulse wave velocity and Peterson modulus were assessed beat-to-beat as arterial stiffness indexes. We identified 53,762 heart beats during 24 hours that were separated into 2 groups: below or above median mean pressure (71 mmHg). Mean diameter, pulse wave velocity and Peterson modulus increased for higher pressure values (p<0.05) whereas heart rate slowed down (p<0.05). Pressure-diameter loops were successfully recreated all along the experience. This new methodology sets the basis for further experiences involving the estimation of 24 hours arterial mechanics variability.

  12. Evaluation of Computer-Assisted Quantification of Carotid Artery Stenosis

    OpenAIRE

    Biermann, Christina; Tsiflikas, Ilias; Thomas, Christoph; Kasperek, Bernadette; Heuschmid, Martin; Claussen, Claus D

    2011-01-01

    The purpose of this study was to evaluate the influence of advanced software assistance on the assessment of carotid artery stenosis; particularly, the inter-observer variability of readers with different level of experience is to be investigated. Forty patients with suspected carotid artery stenosis received head and neck dual-energy CT angiography as part of their pre-interventional workup. Four blinded readers with different levels of experience performed standard imaging interpretation. A...

  13. Lumbar Spinal Stenosis Has a Negative Impact on Quality of Life Compared with Other Comorbidities: An Epidemiological Cross-Sectional Study of 1862 Community-Dwelling Individuals

    Directory of Open Access Journals (Sweden)

    Koji Otani

    2013-01-01

    Full Text Available Lumbar spinal stenosis (LSS is common in the elderly. However, there have been few reports on its impact on quality of life (QoL in community-dwelling individuals. The purpose of this study was to clarify how symptomatic LSS affects QoL at the community level. A total of 1862 people (697 males and 1165 females, most subjects were between 40 and 85 y.o. agreed to participate and were interviewed. The presence of symptomatic LSS was assessed by a specially designed questionnaire. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36 was also administered. In addition, the presence of comorbid conditions that affect QoL, such as osteoarthritis of the knee and hip, cardiovascular disease, cerebrovascular disease, or respiratory disease, was also analyzed. The prevalence of symptomatic LSS gradually increased with age. Furthermore, the presence of symptomatic LSS had a strong negative effect on all 8 physical and mental domains and the physical component summary (PCS (OR: 1.547–2.544 but not the mental component summary (MCS. In comparison with comorbid conditions, LSS had a much stronger negative impact on health-related QoL (HR-QoL. The current study confirmed that the presence of symptomatic LSS might have a strong negative influence on HR-QoL in the community setting.

  14. [Imaging of lumbar stenosis].

    Science.gov (United States)

    Morvan, G

    2002-09-01

    The spinal canal is a type of articulated pipe, with rigid rings articulated by joints. It can be divided into a central part, which contains the dural sac, and lateral parts, which contain the nerve roots. The role of imaging is to detect the presence and characterize the nature, level, and severity of stenotic lesions and their impact on neural elements. Stenoses can be constitutional or acquired and involve the central and/or lateral canal. Constitutional stenoses affect both rigid and soft segments whereas acquired stenoses affect mainly the mobile segments. Signs of constitutional stenoses at conventional radiography, CT and MRI will be described. Acquired stenoses are multi-factorial in etiology and more difficult to evaluate. Intra-spinal soft tissues and dynamic factors, poorly assessed at CT and MRI (static imaging), play a major role in this type of stenoses. Currently, only myelography with dynamic evaluation is able to demonstrate the importance of these factors or degree of dynamic stenosis. The lateral canal is divided in three parts: two mobile segments (disco-articular interval, and intervertebral foramen) on each side of a fixed bony segment (lateral recess). The different types of stenoses involving these segments and best imaging technique to demonstrate their presence are described. PMID:12223974

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

    Science.gov (United States)

    Mayr, N Patrick; Michel, Jonathan; Bleiziffer, Sabine; Tassani, Peter; Martin, Klaus

    2015-09-01

    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

  16. Shape of the dilated aorta in children with bicuspid aortic valve

    International Nuclear Information System (INIS)

    The dilated aorta in adults with bicuspid aortic valve has been shown to have different shapes, but it is not known if this occurs in children. This observational study was performed to determine if there are different shapes of the dilated aorta in children with bicuspid aortic valve and their association with age, gender, hemodynamic alterations, and degree of aortic enlargement. One hundred and eighty-seven echocardiograms done on pediatric patients (0 – 18 years) for bicuspid aortic valve, during 2008, were reviewed. Aortic valve morphology, shape/size of the aorta, and pertinent hemodynamic alterations were documented. Aortic dilation was felt to be present when at least one aortic segment had a z-score > 2.0; global aortic enlargement was determined by summing the aortic segment z-scores. The aortic shape was assessed by age, gender, valve morphology, and hemodynamic alterations. Aortic dilation was present in 104/187 patients. The aorta had six different shapes designated from S1 through S6. There was no association between the aortic shape and gender, aortic valve morphology, or hemodynamic abnormalities. S3 was the most common after the age of six years and was associated with the most significant degree of global aortic enlargement. The shape of the dilated aorta in children with bicuspid aortic valve does not occur in a uniform manner and multiple shapes are seen. S2 and S3 are most commonly seen. As aortic dilation becomes more significant, a single shape (S3) becomes the dominant pattern

  17. Ischemic Postconditioning Alleviates Neuronal Injury Caused by Relief of Carotid Stenosis in a Rat Model of Cerebral Hypoperfusion

    OpenAIRE

    Pengfei Ge; Yinan Luo; Boyu Wang; Tianfei Luo; Li Qi; Chunsheng Feng

    2012-01-01

    The effects of early relief of heavy bilateral carotid stenosis and ischemic postconditioning on hippocampus CA1 neurons are still unclear. In this study, we used a rat model to imitate severe bilateral carotid stenosis in humans. The rats were divided into sham group, carotid stenosis group, stenosis relief group and ischemic postconditioning group. Ischemic postconditioning consisted of three cycles of 30 s ischemia and 30 s reperfusion. The cerebral blood flow was measured with a laser Dop...

  18. Correlations Between the Gradient of Contrast Density, Evaluated by Cardio CT, and Functional Significance of Coronary Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Orzan Marius

    2016-06-01

    Full Text Available Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.

  19. Aortic Valve Sparing in Different Aortic Valve and Aortic Root Conditions.

    Science.gov (United States)

    David, Tirone E

    2016-08-01

    The development of aortic valve-sparing operations (reimplantation of the aortic valve and remodeling of the aortic root) expanded the surgical armamentarium for treating patients with aortic root dilation caused by a variety of disorders. Young adults with aortic root aneurysms associated with genetic syndromes are ideal candidates for reimplantation of the aortic valve, and the long-term results have been excellent. Incompetent bicuspid aortic valves with dilated aortic annuli are also satisfactorily treated with the same type of operation. Older patients with ascending aortic aneurysm and aortic insufficiency secondary to dilated sinotubular junction and a normal aortic annulus can be treated with remodeling of the aortic root or with reimplantation of the aortic valve. The first procedure is simpler, and both procedures are likely equally effective. As with any heart valve-preserving procedure, patient selection and surgical expertise are keys to successful and durable repairs. PMID:27491910

  20. The ascending aortic image quality and the whole aortic radiation dose of high-pitch dual-source CT angiography

    OpenAIRE

    Liu, Ying; Xu, Jian; Jian LI; Ren, Jing; LIU, HONGTAO; Xu, Junqing; Wei, Mengqi; Hao, Yuewen; Zheng, Minwen

    2013-01-01

    Background Aortic dissection is a lift-threatening medical emergency associated with high rates of morbidity and mortality. The incidence rate of aortic dissection is estimated at 5 to 30 per 1 million people per year. The prompt and correct diagnosis of aortic dissection is critical. This study was to compare the ascending aortic image quality and the whole aortic radiation dose of high-pitch dual-source CT angiography and conventional dual-source CT angiography. Methods A total of 110 conse...

  1. Tolerância ao esforço em ratos com estenose aórtica e disfunção ventricular diastólica e/ou sistólica Exercise tolerance in rats with aortic stenosis and ventricular diastolic and/or systolic dysfunction

    Directory of Open Access Journals (Sweden)

    Olga Castro Mendes

    2013-01-01

    although there is no data available on this parameter in animals with ventricular dysfunction and no signs of HF. OBJECTIVE: Evaluate ST in rats with ventricular diastolic dysfunction isolated or associated with systolic dysfunction induced by ascending aortic stenosis (AoS. METHODS: Young male Wistar rats (20-30 days old, divided in: control group (CG, n=11 and AoSG group, (n=12. Animals were assessed at 6 and 18 weeks after AoS surgery. Treadmill exercise test was until exhaustion and evaluated treadmill speed and lactate concentration [LAC] at lactate threshold, treadmill speed and [LAC] at exhaustion, and total testing time. RESULTS: Echocardiography data revealed remodeling of the left atrium and left ventricular concentric hypertrophy at 6 and 18 weeks. Endocardial fractional shortening was greater in AoSG than CG at 6 and 18 weeks. Midwall fractional shortening was greater in AoSG than in CG only 6 week. Cardiac index was similar in CG and AoSG at 6 and 18 weeks and decreased between from 6 to 18 weeks in both groups. The E wave to A wave ratio was greater in CG than in AoSG at both periods and did not change in both groups between week 6 and 18. Treadmill stress testing parameters were similar in both groups at 6 or 18 weeks. CONCLUSION: Although AoS promotes isolated diastolic dysfunction or associated with systolic dysfunction at 6 or 18 weeks, it is not sufficient to modify physical stress tolerance.

  2. Tolerância ao esforço em ratos com estenose aórtica e disfunção ventricular diastólica e/ou sistólica Exercise tolerance in rats with aortic stenosis and ventricular diastolic and/or systolic dysfunction

    Directory of Open Access Journals (Sweden)

    Olga Castro Mendes

    2012-01-01

    although there is no data available on this parameter in animals with ventricular dysfunction and no signs of HF. OBJECTIVE: Evaluate ST in rats with ventricular diastolic dysfunction isolated or associated with systolic dysfunction induced by ascending aortic stenosis (AoS. METHODS: Young male Wistar rats (20-30 days old, divided in: control group (CG, n=11 and AoSG group, (n=12. Animals were assessed at 6 and 18 weeks after AoS surgery. Treadmill exercise test was until exhaustion and evaluated treadmill speed and lactate concentration [LAC] at lactate threshold, treadmill speed and [LAC] at exhaustion, and total testing time. RESULTS: Echocardiography data revealed remodeling of the left atrium and left ventricular concentric hypertrophy at 6 and 18 weeks. Endocardial fractional shortening was greater in AoSG than CG at 6 and 18 weeks. Midwall fractional shortening was greater in AoSG than in CG only 6 week. Cardiac index was similar in CG and AoSG at 6 and 18 weeks and decreased between from 6 to 18 weeks in both groups. The E wave to A wave ratio was greater in CG than in AoSG at both periods and did not change in both groups between week 6 and 18. Treadmill stress testing parameters were similar in both groups at 6 or 18 weeks. CONCLUSION: Although AoS promotes isolated diastolic dysfunction or associated with systolic dysfunction at 6 or 18 weeks, it is not sufficient to modify physical stress tolerance.

  3. Changes in valvular resistance, power dissipation and myocardial reserve with aortic valvuloplasty.

    Science.gov (United States)

    Feldman, T; Ford, L E; Chiu, Y C; Carroll, J D

    1992-09-01

    Balloon aortic valvuloplasty results in small changes in valve area with great symptomatic improvement in some patients, while others have little relief with greater increases in valve area. Alternative indices to valve area may help explain this clinical discrepancy. A calculation of valve area does not provide a means of assessing the load imposed by a stenotic valve, while the complementary index valve resistance, defined as the quotient of mean pressure difference divided by flow, allows many other hemodynamic calculations and may provide an additional measure of the hemodynamic importance of valvular obstructions. To assess the value of these calculations, we studied hemodynamic changes in thirty elderly patients undergoing valvuloplasty for aortic stenosis. The valve area, as calculated by the Gorlin formula, increased by an average 67% (0.59 cm2 to 0.95 cm2), while hemodynamic resistance decreased by an average 52% (453 to 207 dyne.sec.cm5). The values of resistance were used to predict pressure gradients and work loads at different cardiac outputs. The increase in myocardial reserve with valvuloplasty was calculated as the increase in cardiac output that could be achieved at the pre-valvuloplasty value of either total ventricular pressure or ventricular work. These calculations assumed that valvular resistance did not change with cardiac output and that peripheral resistance varied inversely to cardiac output so as to maintain a constant aortic (systemic) pressure. The increase in myocardial reserve was 18% when ventricular work rate was the limiting factor, and 103% when pressure was limiting. The increase in reserve may be closer to the higher value since the myocardial work rate is probably not limited by myocardial energy in the absence of coronary artery disease. Four patients who did not do well clinically were characterized by small increases in reserve, either because of inadequate dilatation of the valve or because the original stenosis was not

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

    OpenAIRE

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

    2014-01-01

    The use of antiepileptic drugs increases the risk of major congenital malformations during pregnancy. Here, we report an infant who had a history of in-utero carbamazepine exposure and who was born with a cardiac malformation. The infant was born at 39 weeks of gestation vaginally to an epileptic mother who had been treated with carbamazepine throughout her pregnancy. He was referred due to cardiac murmur in the second week of his life. The mother had not received folic acid supplementation. ...

  5. Endarterectomy and Aortic Valve Replacement in a Patient with Aortic Stenosis and Calcified Ascending Aorta

    OpenAIRE

    YAMAMOTO, Masato; NIINAMI, Hiroshi; SUDA, Yuji; TAKEUCHI, Yasuo; 山本, 真人; 新浪, 博; 須田, 優司; 竹内, 靖夫

    2004-01-01

    高度に石灰化した大動脈porcelain aortaと狭小弁輪を伴う大動脈弁狭窄症の合併における手術療法において,大動脈を非遮断下に行う方法や有効弁口面積を確保するための様々な方法が報告されている.今回我々は, porcelain aortaおよび狭小弁輪大動脈弁狭窄症の合併症例に対して一部石灰化の及んでいない健常部の大動脈を遮断し, sinotubular junctionを血管内膜切除術後, 19-mm St. Jude Medical prosthetic HP弁を挿入し良好な結果を得たので報告する.症例は65歳,男性.胸部CTで大動脈弁輪から弓部にかけて全周性の石灰化を認め,心臓カテーテル検査で大動脈圧較差は67mmHgの大動脈弁狭窄症を認めたが,冠動脈および左室の壁運動に異常は認めなかった.手術は超低体温循環停止下で大動脈の非遮断による方法を考慮していたが,人工心肺の確立後一部石灰化の及んでいない健常部の大動脈を触診で見出すことができたため中等度低体温下で大動脈を遮断した. sinotubular junctionの高度石灰化のため19-mmのサイザーが通過せず,そのた...

  6. COUNTERPOINT: Access to transcatheter aortic valve replacement should not be limited to high-volume surgical centers

    OpenAIRE

    Green, Philip; Rosner, Gregg F.; Leon, Martin B; Schwartz, Allan

    2013-01-01

    Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis in high-risk older adults in Europe and has begun to do so in the United States. Recent Food and Drug Administration approval of the Edwards Lifesciences SAPIEN Transcatheter Heart Valve (Irvine, Calif) in inoperable and high-risk patients led to enthusiasm for widespread implementation of this technology. Experts have highlighted the central role of the multidisciplinary heart team in implementing ...

  7. Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study

    International Nuclear Information System (INIS)

    The aim of this paper was to investigate the presence of systemic vascular inflammation and its relationship with risk factors and biomarkers of systemic inflammation related to atherosclerosis in asymptomatic abdominal aortic aneurysm (AAA) patients. Thirty AAA patients and 30 age-matched controls underwent contrast-enhanced 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT. C-reactive protein, erythrocyte sedimentation rate, white blood cell count and differential, serum fibrinogen, D-dimer and full lipid panel were also evaluated. Region of interest analyses were performed to obtain target-to-background (TBR) metabolism of aorta, subclavian, carotid, iliac arteries and AAA. CT-based arterial calcium load (CL) was evaluated. Arterial Metabolism and CL intergroup differences were tested (unpaired t-test). Linear regression analysis was performed only between blood biomarkers on one side and both TBR and ACL of the arterial districts that resulted significantly different between patients and controls on the other. In all the analyses P values <0.05 were considered significant. FDG-uptake was higher with respect to controls in aorta, carotid and iliac arteries (P<0.01, P<0.007, P<0.04 respectively). AAA and aorta metabolism showed an inverse correlation with HDL-chol (P<0.02 and P<0.01, respectively) while only aorta showed a direct correlation with lymphocytes’ count (P<0.02). Carotid metabolism was directly correlated with monocytes’ count and C-reactive protein concentration (P<0.02 and P<0.004, respectively). The present findings support the relevance of systemic vascular inflammation in all phases of atherosclerosis-related disorders. Moreover they confirm the concept that acute ischemic syndromes might represent the local result of a systemic inflammation rather than the focal involvement of a single arterial lesion.

  8. Low-Molecular-Weight Heparin (Reviparin) Reduces the Incidence of Femoropopliteal In-Stent Stenosis: Preliminary Results of an Ongoing Study

    International Nuclear Information System (INIS)

    Purpose: To examine the efficacy of the low-molecular-weight heparin, reviparin, for prevention of femoropopliteal stent restenosis. Methods: Forty-two patients who had implantation of flexible tantalum stents for the treatment of stenosis (n= 24) or occlusion (n= 18) of the femoral (n= 27) or popliteal (n= 15) arteries were included in this study protocol. An intraarterial bolus of 5000 IU heparin was given before percutaneous transluminal angioplasty (PTA), and in the case of stent implantation due to unsuccessful PTA, an additional dose of reviparin (3500 anti-factor Xa IU) was given. Postprocedurally, 10,500 anti-factor Xa IU of reviparin were administered intravenously over 24 hr, followed by 3500 anti-factor Xa IU subcutaneously twice a day for 23 days. Oral aspirin (100 mg/day) was prescribed for the long term. Follow-up criteria (maximum follow-up 37 months) were clinical symptoms, Doppler ankle arm indices, color and duplex sonography, and angiography for suspicion of restenosis. Results: Early stent thromboses were not observed. Overall primary patency rate (PPR) was 88% ± 6.0% (1 year) and 74% ± 10.1% (2 years). Major hemorrhagic complications have not occurred. Conclusion: Reviparin administered in a high dose over a period of 24 days is a safe medication regimen and provides excellent patency rates after stent implantation

  9. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... opens freely when the heart contracts. On the right, we see a picture of the aortic valve ... the aortic valve because the probe is sitting right behind the aortic valve. Lots of patients on ...

  10. Feasibility of investigating the mechanisms of aortic trauma using high-speed cineradiography. A pilot study. Final report, 15 May--31 August 1977

    International Nuclear Information System (INIS)

    A pilot study was performed to evaluate use of the HSRI high-speed cineradiographic system for study of aortic trauma mechanisms. The thoraxes of anesthetized New Zealand white rabbits were impacted by a dropped accelerometer-instrumented, 1.5 kg mass from a height of 2.44 meters. Velocity and force data were obtained from the instrumented impacting mass. High-speed cineradiographs at approximately 1000 frames per second showed thoracic skeletal deformation and heart, diaphragm, and liver displacements. No radiopaque contrast medium was used in this preliminary investigation. Post-impact autopsy revealed rib fracture, localized hemorrhaging, and aortic transection. On the basis of film obtained, this method has potential for the study of internal organ injury mechanisms

  11. Primary Stenting of Focal Atherosclerotic Infrarenal Aortic Stenoses: Long-Term Results in 13 Patients and a Literature Review

    International Nuclear Information System (INIS)

    We conducted this study to investigate the value of primary stent implantation for the endovascular treatment of focal atherosclerotic stenoses of the infrarenal abdominal aorta. The data of 13 patients with a localized complex infrarenal aortic stenosis who underwent primary stenting was retrospectively evaluated. The patients (6 females, 7 males) had a mean age of 57.3 ± 9.1 years (mean ± SD). In all patients, the aortic diameter was measured on CT sections, and a self-expanding endoprosthesis was primarily implanted followed by dilatation with single or double balloons. In 3 patients, additional distal stenoses were also endovascularly treated. The procedure was technically successful in all patients. No complications occurred except for 2 minor groin hematomas. During the 43 ± 23 months (mean ± SD) follow-up (range: 12-96 months), all stented aortic segments remained patent. Clinical patency was lost in 4 patients, which was due to atherosclerosis or restenosis distal to the aorta. In view of the excellent early and long-term results, we believe that primary stenting should be considered the first line treatment in properly selected patients with focal atherosclerotic infrarenal stenoses of the abdominal aorta

  12. MALDI-Imaging Mass Spectrometry: a step forward in the anatomopathological characterization of stenotic aortic valve tissue.

    Science.gov (United States)

    Mourino-Alvarez, Laura; Iloro, Ibon; de la Cuesta, Fernando; Azkargorta, Mikel; Sastre-Oliva, Tamara; Escobes, Iraide; Lopez-Almodovar, Luis F; Sanchez, Pedro L; Urreta, Harkaitz; Fernandez-Aviles, Francisco; Pinto, Angel; Padial, Luis R; Akerström, Finn; Elortza, Felix; Barderas, Maria G

    2016-01-01

    Aortic stenosis (AS) is the most common form of valve disease. Once symptoms develop, there is an inexorable deterioration with a poor prognosis; currently there are no therapies capable of modifying disease progression, and aortic valve replacement is the only available treatment. Our goal is to study the progression of calcification by matrix-assisted laser desorption ionization imaging mass spectrometry (MALDI-IMS) and get new insights at molecular level that could help in the understanding of this disease. In this work, we analyzed consecutive slices from aortic valve tissue by MALDI-IMS, to establish the spatial distribution of proteins and peptides directly from the surface of the histological sections. The analysis showed different structures corresponding to regions observed in conventional histology, including large calcification areas and zones rich in collagen and elastic fibers. Peptide extraction from the tissue, followed by liquid chromatography mass spectrometry analysis, provided the identification of collagen VI α-3 and NDRG2 proteins which correlated with the masses obtained by MALDI-IMS and were confirmed by immunohistochemistry. These results highlighted the molecular mechanism implied in AS using MALDI-IMS, a novel technique never used before in this pathology. In addition, we can define specific regions proving a complementary resolution of the molecular histology. PMID:27256770

  13. Management of Symptomatic Intracranial Stenosis.

    Science.gov (United States)

    Hoak, David A; Lutsep, Helmi L

    2016-09-01

    Intracranial atherosclerotic disease is a common cause of stroke worldwide, causing approximately 10 % of strokes in the USA and up to 50 % in Asian populations. Recurrent stroke risks are particularly high in those with a stenosis of 70 % or more and a recent transient ischemic attack or stroke. Warfarin has been associated with higher major hemorrhage rates and no reduction of recurrent stroke compared to aspirin in patients with symptomatic intracranial stenosis. After early trials showed the feasibility of stenting, two randomized trials compared stenting plus medical management to medical management alone in symptomatic intracranial stenosis. Stenting was linked with increased risk and showed no benefit in any subpopulation of patients. Aggressive medical management in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial was associated with half the risk of stroke compared to that in similar patients in a previous symptomatic intracranial stenosis trial after adjustment of confounding characteristics. Aggressive medical management comprises risk factor control, including a target systolic blood pressure <140 mmHg, a low density lipoprotein <70 mg/dL, hemoglobin A1C <7.0 %, and lifestyle management that incorporates exercise, smoking cessation and weight management, and the use of antithrombotics. PMID:27443379

  14. Dynamic heart phantom with functional mitral and aortic valves

    Science.gov (United States)

    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.

  15. Study Design of PROCEDURE Study. A Randomized Comparison of the Dose-Dependent Effects of Pitavastatin in Patients with Abdominal Aortic Aneurysm with Massive Aortic Atheroma: Prevention of Cholesterol Embolization during Endovascular and Open Aneurysm Repair with Pitavastatin (PROCEDURE) Study

    OpenAIRE

    Hoshina, Katsuyuki; Nemoto, Masaru; Hashimoto, Takuya; Miura, Sumio; Urabe, Go; Nakazawa, Tatsu; Hosaka, Akihiro; Kato, Masaaki; Ohkubo, Nobukazu; Miyairi, Takeshi; Okamoto, Hiroyuki; Shigematsu, Kunihiro; Miyata, Tetsuro

    2013-01-01

    Outcomes of abdominal aortic aneurysm (AAA) repair have improved in the 2 decades since the emergence of endovascular aneurysm repair (EVAR). However, EVAR is considered a contraindication for shaggy aorta because of the high risk of shower embolization. Recently, statins have been implicated in preventing embolization in patients with shaggy aorta via its pleiotropic effects, including atheroma reduction and coronary artery stabilization. We selected pitavastatin, a statin with potent effect...

  16. CT angiography in carotid stenosis

    International Nuclear Information System (INIS)

    Purpose: Prospective evaluation of the accuracy CT angiography (CTA) with different postprocessing for extracranial carotid artery in comparison with DSA. Method: one hundred patients were studied with standarized CTA. For postprocessing, MPR, MIP, and 3D reconstruction based on segmentation with upper and lower threshold were used. Intravascular density profiles were considered. All CTA studies were correlated with intra-arterial angiography. The degree and classification of stenoses was determined using the guidelines established by the NASCET collaborators. Results: Measurement of stenosis was possible by MPR in 82.5%, by MIP in 85%, and 3D in 100%. Correct classification was found in 65.5% for MPR, 66% for MIP and 88.5% for 3D. The sensitivity for severe stenoses was 74% for MPR, 82% for MIP, and 93% for 3D. The specificity of these methods was 98%, 96%, and 97%, respectively. All carotid occlusions were correctly identified, no carotid artery was wrongly classified as occluded. (orig./AJ)

  17. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  18. Gene Expression Study in Positron Emission Tomography–Positive Abdominal Aortic Aneurysms Identifies CCL18 as a Potential Biomarker for Rupture Risk

    OpenAIRE

    Courtois, Audrey; Nusgens-Richelle, Betty; Hustinx, Roland; Namur, Gauthier; Gomez, Pierre; Kuivaniemi, Helena; Defraigne, Jean-Olivier; Colige, Alain; Sakalihasan, Natzi

    2015-01-01

    Rupture of abdominal aortic aneurysm (AAA) is a cause of significant mortality and morbidity in ageing populations. Uptake of 18-fluorodeoxyglucose (FDG) detected by positron emission tomography (PET) is observed in the wall of 12% of AAA (A+), most of them being symptomatic. We previously showed that the metabolically active areas displayed adventitial inflammation, medial degeneration and molecular alterations prefacing wall rupture. The aim of this study was to identify new factors predict...

  19. Bramwell-Hill modeling for local aortic pulse wave velocity estimation: a validation study with velocity-encoded cardiovascular magnetic resonance and invasive pressure assessment

    OpenAIRE

    Westenberg Jos JM; van Poelgeest Eveline P; Steendijk Paul; Grotenhuis Heynric B; Jukema JW; de Roos Albert

    2012-01-01

    Abstract Background The Bramwell-Hill model describes the relation between vascular wall stiffness expressed in aortic distensibility and the pulse wave velocity (PWV), which is the propagation speed of the systolic pressure wave through the aorta. The main objective of this study was to test the validity of this model locally in the aorta by using PWV-assessments based on in-plane velocity-encoded cardiovascular magnetic resonance (CMR), with invasive pressure measurements serving as the gol...

  20. Assessment of abdominal aortic aneurysms using a cone-beam CT system. An experimental phantom study and an initial clinical evaluation before and after stent-graft treatment in patients with an abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    The aim of this study is to conduct a quantitative analysis of cone-beam CT (CBCT) images using a phantom, and then to evaluate the clinical usefulness of CBCT in the assessment of abdominal aortic aneurysms (AAA) before and after stent-grafting, both qualitatively as well as quantitatively. The phantom used in this study was a rectangular plate made of an acrylic resin, which contained eight through-holes to mimic blood vessels. Each columnar cavity was filled with contrast media and the diameter of each was then measured using a cone-beam multiplanar reformation/curved planar reformation (CB-MPR/CPR) technique, and the results were compared with the corresponding results obtained by actual measurement. In the clinical assessment, nine patients with AAA (consisting only of males with an average age of 68 years old: 56-80) were enrolled. The clinical qualitative analysis of CBCT consisted of: for the pre-operative state, the shape of the aortic aneurysm, the relationship between the aneurysm and the aortic branches, and for the post-operative state, the shape of the stent and any endoleakage present. The clinical quantitative analysis of CBCT included, for the aneurysm, its inflection angle, its maximum diameter, the diameter of the proximal and distal necks, and the distance of these two necks from specific reference points. The quantitative analysis using the phantom showed no significant differences between the results based on CB-MPR/CPR and those obtained by actual measurement. In the clinical qualitative analysis three-dimensional CBCT (3D-CBCT) depicted the anatomical relationship between the aneurysm and the aortic branches well, an accomplishment that was not possible by conventional angiography. Cone-beam maximum intensity projection (CB-MIP) was as good in tracing the migration and deformation of the stent following endovascular intervention as plain radiograms and conventional angiograms. CB-MPR/CPR enabled us to obtain any cross-sectional image of the