WorldWideScience

Sample records for aortic valve implantation

  1. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves

    DEFF Research Database (Denmark)

    Dvir, Danny; Webb, John G; Bleiziffer, Sabine;

    2014-01-01

    IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach...... for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING......, AND PARTICIPANTS: Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic...

  2. 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 replacement....... We report the first case of surgical valve replacement in a patient with a dysfunctional transcatheter-implanted aortic valve prosthesis 4 months after implantation....

  3. 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....

  4. 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 ...

  5. Transcatheter valve-in-valve implantation due to severe aortic regurgitation in a degenerated aortic homograft

    DEFF Research Database (Denmark)

    Olsen, Lene Kjaer; Engstrøm, Thomas; Søndergaard, Lars

    2009-01-01

    a successful valve-in-valve implantation of a CoreValve aortic valve prosthesis through the right subclavian artery in a case of severe aortic regurgitation within a degenerated aortic homograft. The case exemplifies the possibilities of expanding the indications for TAVI, as well as other vascular access...

  6. First direct aortic retrievable transcatheter aortic valve implantation in humans.

    Science.gov (United States)

    Chandrasekhar, Jaya; Glover, Chris; Labinaz, Marino; Ruel, Marc

    2014-11-01

    We describe 2 cases in which transcatheter aortic valve implantation was performed with a Portico prosthesis (St Jude Medical, St Paul, MN) through a direct aortic approach. In 1 of the cases, prosthesis retrieval was needed during the procedure and was essential to the successful outcome. This is the first report, to our knowledge, of direct aortic Portico prosthesis implantation, and it highlights the significance of the retrievable nature of this device. PMID:25442452

  7. New-Onset Atrial Fibrillation After Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Implantation

    DEFF Research Database (Denmark)

    Jørgensen, Troels Højsgaard; Thygesen, Julie Bjerre; Thyregod, Hans Gustav;

    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...

  8. New-onset atrial fibrillation after surgical aortic valve replacement and transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Jørgensen, Troels Højsgaard; Thygesen, Julie Bjerre; Thyregod, Hans Gustav;

    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...

  9. Prosthetic valve endocarditis after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H;

    2015-01-01

    BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural...... risk factors. METHODS AND RESULTS: Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years......%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate...

  10. Outcomes after transcatheter aortic valve implantation: transfemoral versus transapical approach

    NARCIS (Netherlands)

    Ewe, S.H.; Delgado, V.; Ng, A.C.; Antoni, M.L.; Kley, F. van der; Marsan, N.A.; Weger, A. de; Tavilla, G.; Holman, E.R.; Schalij, M.J.; Bax, J.J.

    2011-01-01

    BACKGROUND: Transcatheter aortic valve implantation is commonly implanted through a transfemoral (TFA) or transapical approach (TAA) for patients with severe aortic stenosis. This study aimed to describe the clinical and echocardiographic outcomes of TFA versus TAA. METHODS: Clinical and echocardiog

  11. Repositioning of an Intraventricular Dislocated Aortic Valve during Transcatheter Aortic Valve Implantation

    NARCIS (Netherlands)

    Natour, Ehsan; Douglas, Yvonne L.; Jainandunsing, Jayant S.; Schurer, Remco A. J.; van der Werf, Hendrik W.; van den Heuvel, Ad F. M.

    2014-01-01

    The case is presented of a 75-year-old man referred for transcatheter aortic valve implantation. During the procedure the prosthetic aortic valve became dislocated into the left ventricle shortly after expansion. The subsequent steps taken to reposition the valve using only materials at hand are des

  12. The future of transcatheter aortic valve implantation.

    Science.gov (United States)

    Hamm, Christian W; Arsalan, Mani; Mack, Michael J

    2016-03-01

    Since the introduction of transcatheter aortic valve implantation (TAVI) into clinical practice, the treatment of aortic stenosis has changed dramatically. In the past, medical therapy with or without balloon aortic valvuloplasty was the only option for inoperable patients. More recently, TAVI has become the treatment of choice for these patients and the preferred alternative for high-risk operable patients. Surgical aortic valve replacement (SAVR) currently remains the gold standard for patients at low or intermediate operative risk. As randomized trials have demonstrated comparable results between TAVI and SAVR in the high-risk population, there is now a clear trend towards performing TAVI even in intermediate-risk patients while awaiting the results of randomized trials in that population. Nevertheless, there are still questions regarding TAVI involving paravalvular leak (PVL), stroke, pacemaker requirements, and durability that remain to be more definitively answered before TAVI can routinely be performed in a broader, lower risk population. Improvements in patient selection, imaging, and second and third generation devices have decreased the incidence of PVLs and vascular complications that followed the earliest TAVI procedures, but the rates of perioperative stroke and permanent pacemaker implantation must still be addressed. Furthermore, the long-term durability of TAVI devices and a role for post-procedure antithrombotic management remain unanswered. Until these questions are more clearly answered, it is the Heart Team's task to determine the optimal treatment for each patient based on risk scores, frailty metrics, comorbidities, patient preference, and potential for improvement in quality of life.

  13. 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...

  14. The nordic aortic valve intervention (NOTION) trial comparing transcatheter versus surgical valve implantation

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Søndergaard, Lars; Ihlemann, Nikolaj;

    2013-01-01

    Degenerative aortic valve (AV) stenosis is the most prevalent heart valve disease in the western world. Surgical aortic valve replacement (SAVR) has until recently been the standard of treatment for patients with severe AV stenosis. Whether transcatheter aortic valve implantation (TAVI) can...

  15. Distortion of the CoreValve during transcatheter aortic valve-in-valve implantation due to valve dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Souteyrand, Geraud, E-mail: gsouteyrand@chu-clermontferrand.fr [Department of Cardiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Clermont-Ferrand (France); ERIM-EA3295, University of Auvergne, Clermont-Ferrand (France); Wilczek, Krzysztof [Department of Cardiology, Medical University of Silesia, Silesian Centre for Herat Diseases, Zabrze (Poland); Innorta, Andrea; Camilleri, Lionel [Department of Cardiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Clermont-Ferrand (France); ERIM-EA3295, University of Auvergne, Clermont-Ferrand (France); Chodor, Piotr [Department of Cardiology, Medical University of Silesia, Silesian Centre for Herat Diseases, Zabrze (Poland); Lusson, Jean-René; Motreff, Pascal [Department of Cardiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Clermont-Ferrand (France); ERIM-EA3295, University of Auvergne, Clermont-Ferrand (France); Laborde, Jean-Claude [St. George' s Hospital, London (United Kingdom); Chabrot, Pascal; Durel, Nicolas [Department of Cardiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Clermont-Ferrand (France); ERIM-EA3295, University of Auvergne, Clermont-Ferrand (France)

    2013-09-15

    Nowadays transcatheter aortic valve implantation (TAVI) is an accepted alternative to surgical aortic valve replacement for high-risk patients (pts). Successful TAVI procedures for failed aortic surgical bioprosthesis (TAV-in-SAV) have already been reported. In the presented two cases of TAV-in-SAV implantation a strut distortion of the stent was revealed on angiographic imaging and confirmed on control CT scan. In both procedures, a dislocation of the medtronic core valve (MCV) prosthesis during implantation led to valve retrieval, with a necessity of reloading it in the 18F introducer before subsequent implantation of the same valve in correct position.

  16. Anesthetic management of transcatheter aortic valve implantation

    Directory of Open Access Journals (Sweden)

    Annalisa Franco

    2012-01-01

    Full Text Available 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 aortic or ileo-femoral arterial disease. Alternatives include a transaxillary approach, transapical approach, open surgical access to the retroperitoneal iliac artery and the ascending aorta. A complementary approach using both devices and alternative routes tailored to the anatomy and the comorbidities of the single patient is a main component for the successful implementation of a TAVI program. Anesthetic strategies vary in different centers. Local anesthesia or general anesthesia are both valid alternatives and can be applied according to the patient′s characteristics and procedural instances. General anesthesia offers many advantages, mainly regarding the possibility of an early diagnosis and treatment of possible complications through the use of transesophageal echocardiography. However, after the initial experiences, many groups began to employ, routinely, sedation plus local anesthesia for TAVI, and their procedural and periprocedural success demonstrates that it is feasible. TAVI is burdened with potential important complications: vascular injuries, arrhythmias, renal impairment, neurological complications, cardiac tamponade, prosthesis malpositioning and embolization and left main coronary artery occlusion. The aim of this work is to review the anesthetic management of TAVI based on the available literature.

  17. 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.

  18. Endovascular resection of the native aortic valve before transcatheter aortic valve implantation: state of the art and review.

    Science.gov (United States)

    Navarra, Emiliano; Mosala Nezhad, Zahra; Bollen, Xavier; Gielen, Charles-Edouard; Mastrobuoni, Stefano; De Kerchove, Laurent; Raucent, Benoit; Astarci, Parla

    2016-09-01

    Transcatheter aortic valve implantation was introduced into clinical practice in 2002 as a rescue approach in patients presenting with symptomatic severe aortic stenosis but not eligible for conventional aortic valve replacement. This technique allows implantation of a balloon expandable bioprosthesis without resection of the native aortic valve. Several complications are described as a consequence of the residual highly calcified valve being squeezed against the aortic wall by the stent of the implant. This can result in deformation of the metal stent and paravalvular leakage, risk of occlusion of the coronary ostia, or central and peripheral embolization of valvular debris. To avoid these complications, many authors suggest the possibility to resect and remove the native aortic valve before transcatheter aortic valve implantation. In this field, different authors have described possible techniques and different sources of energy to resect the calcified valve. In this article, we review the development of these experimental techniques and discuss future prospects in this field. PMID:27032472

  19. Transfemoral Valve-in-Valve Transcatheter Aortic Valve Implantation (TAVI) in a Patient With Previous Endovascular Aortic Repair (EVAR).

    Science.gov (United States)

    Ruparelia, Neil; Panoulas, Vasileios F; Frame, Angela; Nathan, Anthony W; Ariff, Ben; Jaffer, Usman; Sutaria, Nilesh; Chukwuemeka, Andrew; Mikhail, Ghada W; Malik, Iqbal S

    2016-07-01

    A 90-year-old man presented with increasing exertional breathlessness. He had previous implantation of a Perimount bioprosthetic aortic valve (Edwards Lifesciences) and coronary artery bypass graft surgery. Due to severe transvalvular bioprosthetic regurgitation with preserved left ventricular dimensions and ejection fraction, the heart team decided on valve-in- valve transcatheter aortic valve implantation via the transfemoral route in view of the patient's prohibitively high surgical and anesthetic risk. The patient had an uncomplicated recovery and was symptomatically much improved at 3-month follow-up. PMID:27342209

  20. A planning system for transapical aortic valve implantation

    Science.gov (United States)

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

    2009-02-01

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

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

    OpenAIRE

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

    2014-01-01

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

  2. 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.

  3. Aortic valve bypass

    DEFF Research Database (Denmark)

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

    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...

  4. 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...

  5. Anatomics Knowledges of Aortic Root in the Transcatheter Aortic Valve Implantation.

    OpenAIRE

    Marcelo Cerezo; Omar Bertani; Gisela Panciroli; Sebastián Duhalde; Karina Ferreira; Luciano Honaine

    2010-01-01

    The Aortic Valve is a valvular system that bears different high pressure forces. It takes part of a complex structure called Aortic Root. Nowadays, anatomic knowledge has taken a preponderant role, due to the use of the Transcatether Aortic Valve Implant (TAVI). To describe the patient´s characteristics which exclude them of the TAVI for anatomic reasons in cadaveric dissections and transthoracic echocardiograms. A descriptive retrospective analysis of 67 individuals was performed and divided...

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

    Energy Technology Data Exchange (ETDEWEB)

    Latib, Azeem, E-mail: alatib@gmail.com [Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan (Italy); Maisano, Francesco; Colombo, Antonio [Interventional Cardiology Unit, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus, Milan (Italy); Klugmann, Silvio [Azienda Ospedaliera Niguarda Ca Granda, Piazza Ospedale Maggiore 3, Milan (Italy); Low, Reginald; Smith, Thomas [University of California Davis, Davis, CA 95616 (United States); Davidson, Charles [Northwestern Memorial Hospital, Chicago, IL 60611 (United States); Harreld, John H. [Clinical Imaging Analytics, Guerneville, CA (United States); Bruschi, Giuseppe; DeMarco, Federico [Azienda Ospedaliera Niguarda Ca Granda, Piazza Ospedale Maggiore 3, Milan (Italy)

    2014-06-15

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

  7. Valve-in-valve transcatheter aortic valve implantation overcoming hostile anatomy: Evolut R for the treatment of Mitroflow bioprosthesis dysfunction.

    Science.gov (United States)

    Ruparelia, Neil; Colombo, Antonio; Latib, Azeem

    2016-10-01

    Redo surgery is regarded as the first-line treatment option for patients presenting with prosthetic valve degeneration. However, many patients have concomitant co-morbidities and this option is associated with significant risk. Transcatheter valve-in-valve implantation is an alternative strategy depending on the bioprosthetic valve that is being treated. The Sorin Mitroflow bioprosthetic aortic valve has been regarded as a contraindication to valve-in-valve treatment due to the high risk of coronary obstruction. We here present the case of a patient with small peripheral vasculature who underwent successful transfemoral valve-in-valve implantation and subsequently discuss the challenges and technical aspects that require consideration.

  8. Recently patented and widely used valves for transcatheter aortic valve implantation.

    Science.gov (United States)

    Neragi-Miandoab, Siyamek; Skripochnik, Edvard; Michler, Robert E

    2012-12-01

    Aortic stenosis (AS) is a serious condition in the aging US and European populations. Management of a stenotic valve is crucial as it can become symptomatic quickly leading to ventricular deterioration and overall poor quality of life. Considering that AS is a disease of the elderly patient population, surgical intervention may not be well tolerated by some patients. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative approach for patients who are unsuitable surgical candidates. Since the first balloon-expandable Edwards SAPIEN valve (Edwards Lifesciences, Irvine, CA) was implanted by Dr. Cribier, many other valves have been introduced into clinical practice. Self-expanding valves such as the CoreValve ReValving system (Medtronic, Minneapolis, MN) for retrograde implantation and Symetis TX for antegrade and transapical implantation are the most frequently used self-expanding valves. The SAPIEN valve, on the other hand can be implanted both antegrade as well as retrograde. Overall, the most widely used valves are the Edwards SAPIEN and the CoreValve, which have been implanted in more than 40,000 patients worldwide. The Symetis valve has shown promising results in small series in Europe and may be introduced to the US market in the near future. This manuscript will review these 3 recently patented valves and discuss some of the clinical results that are available. PMID:23095028

  9. 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

  10. 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

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    Ka Sing Paris Lai

    2015-01-01

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

  13. [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

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

    Science.gov (United States)

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

    2015-11-01

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

  15. Anatomics Knowledges of Aortic Root in the Transcatheter Aortic Valve Implantation.

    Directory of Open Access Journals (Sweden)

    Marcelo Cerezo

    2010-12-01

    Full Text Available The Aortic Valve is a valvular system that bears different high pressure forces. It takes part of a complex structure called Aortic Root. Nowadays, anatomic knowledge has taken a preponderant role, due to the use of the Transcatether Aortic Valve Implant (TAVI. To describe the patient´s characteristics which exclude them of the TAVI for anatomic reasons in cadaveric dissections and transthoracic echocardiograms. A descriptive retrospective analysis of 67 individuals was performed and divided into two groups. Group A: Formalized cadaveric dissections with hypertrofic hearts and aortic sclerosis signs from the Chair A of Anatomy of the University of La Plata (UNLP. Group B: Transthoracic Echocardiograms realized at the San Martín Hospital of La Plata between January 2005 and December 2009. Out of 67 individuals assessed, 17 (25% had one or more contraindications for TAVI. Five on Group A (36%, and 12 on Group B (23%. The most common anatomic contraindication was the Ascending Aortic diameter less than 30mm and the aortic annulus less than 20mm, following to the RAo-TSVI Angle more than 145° (2 to Group A, and 4 to Group B and the Septal thickness more than 17mm (no one to Group A, and 3 to Group B. Only just one individual was found with a low implant left coronary artery in the Group A avoiding TAVI. According to this study, the anatomic contraindications to realize TAVI are frequent due to the diagnosis devices available at the moment. The anatomic aortic root knowledge and the aortic valve interindividual variability will allow the improvement of the manufactured devices made in the market.

  16. Practical update on imaging and transcatheter aortic valve implantation

    Institute of Scientific and Technical Information of China (English)

    Gisela; Feltes; Iván; J; Nú?ez-Gil

    2015-01-01

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

  17. Reevaluation of the indications for permanent pacemaker implantation after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Bjerre Thygesen, Julie; Loh, Poay Huan; Cholteesupachai, Jiranut;

    2014-01-01

    AIMS: Conduction abnormalities (CA) requiring permanent pacemaker (PPM) are a well-known complication after transcatheter aortic valve implantation (TAVI). This study aimed to determine the incidence of TAVI-related PPM and reevaluate the indications for PPM after the periprocedural period. METHO...

  18. 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.

  19. 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

  20. 6-month aortic valve implantation of an off-the-shelf tissue-engineered valve in sheep.

    Science.gov (United States)

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

    2015-12-01

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

  1. 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)

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

    Science.gov (United States)

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

    2014-09-01

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

  3. An up-to-date overview of the most recent transcatheter implantable aortic valve prostheses.

    Science.gov (United States)

    Wiegerinck, Esther M A; Van Kesteren, Floortje; Van Mourik, Martijn S; Vis, Marije M; Baan, Jan

    2016-01-01

    Over the past decade transcatheter aortic valve implantation (TAVI) has evolved towards the routine therapy for high-risk patients with severe aortic valve stenosis. Technical refinements in TAVI are rapidly evolving with a simultaneous expansion of the number of available devices. This review will present an overview of the current status of development of TAVI-prostheses; describes the technical features and applicability of each device and the clinical data available.

  4. 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 ...

  5. 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

  6. CMR assessment after a transapical-transcatheter aortic valve implantation

    Energy Technology Data Exchange (ETDEWEB)

    Biere, Loïc, E-mail: lobiere@chu-angers.fr [L’UNAM Université, Angers (France); Université d’Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d’Angers, Service de Cardiologie, Angers (France); Pinaud, Frédéric [L’UNAM Université, Angers (France); Université d’Angers, CHU d’Angers, Service de Chirurgie Cardio-vasculaire et Thoracique, Angers (France); UMR-CNRS 6214, INSERM 1083, faculté de médecine, Angers (France); Delépine, Stéphane; Grall, Sylvain; Viot, Nathalie; Mateus, Victor; Rouleau, Frédéric [L’UNAM Université, Angers (France); Université d’Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d’Angers, Service de Cardiologie, Angers (France); Corbeau, Jean-Jacques [Université d’Angers, CHU d’Angers, Département d’anesthésie-réanimation, Angers (France); Prunier, Fabrice [L’UNAM Université, Angers (France); Université d’Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d’Angers, Service de Cardiologie, Angers (France); and others

    2014-02-15

    Aims: To describe the time course of myocardial scarring after transapical-transcatheter aortic valve implantation (TA-TAVI) with the Edwards SAPIEN XT™ and the Edwards SAPIEN™ prosthesis in a 3-month follow-up study using cardiac magnetic resonance imaging (CMR). Methods: In 20 TA-TAVI patients, CMR was performed at discharge and 3 months (3M). Cine-MRI was used for left ventricular (LV) functional assessment, and late gadolinium enhancement (LGE) imaging was employed for detecting the presence of myocardial scarring. Special attention was given to any artifacts caused by the prosthesis, which were consequently defined using a three-grade artifact scale. Results: We systematically reported the presence of small LGE hyperintensity relating to the apical segment, with no variation found between discharge and 3 M (2.8 ± 1.6 g vs. 2.35 ± 1.1 g). LV ejection fraction, end-diastolic, and end-systolic volumes did not significantly vary. A small area of apical akinesia was observed, with no improvement at follow-up. Whereas the Edwards SAPIEN XT™ prosthesis and the Edwards SAPIEN™ prosthesis are both constituted by metallic stenting structure, the Edwards SAPIEN™ was responsible for a larger signal void, thus potentially limiting the diagnostic performance of CMR. Conclusions: CMR may be performed safely in the context of TA-TAVI. The presence of a very small apical infarction correlating with focal akinesia was observed. As expected, the Edwards SAPIEN XT™ prosthesis was shown to be particularly suitable for CMR assessment.

  7. Transapical perfusion for peri-arrest salvage during transcutaneous aortic valve implantation.

    Science.gov (United States)

    Göbölös, L; Tsang, G M; Curzen, N; Calver, A L; Ohri, S K

    2015-11-01

    An 80-year-old man developed severe haemodynamic instability during a transapical aortic valve implantation. He was not suitable for a conventional surgical approach due to comorbidities and patent aortocoronary bypass grafts also limited further stabilizing actions. As a bail-out procedure, we demonstrate the feasibility of transapical arterial cannulation by crossing a newly implanted TAVI valve in order to establish an emergency bypass circuit.

  8. 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.

  9. Percutaneous implantation of the CoreValve aortic valve prosthesis in patients at high risk or rejected for surgical valve replacement: Clinical evaluation and feasibility of the procedure in the first 30 patients in the AMC-UvA

    NARCIS (Netherlands)

    J. Baan; Z.Y. Yong; K.T. Koch; J.P.S. Henriques; B.J. Bouma; S.G. de Hert; J. van der Meulen; J.G.P. Tijssen; J.J. Piek; B.A.J.M. de Mol

    2010-01-01

    Objective. To report the feasibility, safety and efficacy of percutaneous aortic valve implantation (PAVI) with the CoreValve self-expanding aortic valve bioprosthesis in elderly patients with aortic valve stenosis who are rejected for surgery or have a high surgical risk.Methods. PAVI using the Cor

  10. Direct transcatheter aortic valve implantation with self-expandable bioprosthesis: Feasibility and safety

    Energy Technology Data Exchange (ETDEWEB)

    Fiorina, Claudia, E-mail: clafiorina@yahoo.it [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Maffeo, Diego; Curello, Salvatore [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Lipartiti, Felicia [Division of Cardiology, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Chizzola, Giuliano [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy); D' Aloia, Antonio [Division of Cardiology, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Adamo, Marianna [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Mastropierro, Rosy [Division of Cardiothoracic Anestesiology, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Gavazzi, Emanuele [Department of Radiology, University of Brescia, Spedali Civili, Brescia (Italy); Ciccarese, Camilla; Chiari, Ermanna [Division of Cardiology, Cardiothoracic Department, Spedali Civili, Brescia (Italy); Ettori, Federica [Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia (Italy)

    2014-06-15

    Background: Balloon valvuloplasty has been considered a mandatory step of the transcatheter aortic valve implantation (TAVI), although it is not without risk. The aim of this work was to evaluate the feasibility and safety of TAVI performed without pre-dilation (direct TAVI) of the stenosed aortic valve. Material and Methods: Between June 2012 and June 2013, 55 consecutive TAVI performed without pre-dilation at our institution using the self-expandable CoreValve prosthesis (Medtronic, Minneapolis, MN) were analyzed and compared with 45 pre-dilated TAVI performed the previous year. Inclusion criteria were a symptomatic and severe aortic stenosis. Exclusion criteria were defined as presence of pure aortic regurgitation, degenerated surgical bioprosthesis or bicuspid aortic valve and prior procedure of balloon aortic valvuloplasty performed as a bridge to TAVI. Results: High-burden calcification in the device landing zone, assessed by CT scan, was found in most of the patients. The valve size implanted was similar in both groups. Device success was higher in direct TAVI (85% vs. 64%, p = 0.014), mostly driven by a significant lower incidence of paravalvular leak (PVL ≥2; 9% vs. 33%, p = 0.02). Safety combined end point at 30 days was similar in both groups. Conclusion: Compared to TAVI with pre-dilation, direct TAVI is feasible regardless of the presence of bulky calcified aortic valve and the valve size implanted. Device success was higher in direct TAVI, mostly driven by a lower incidence of paravalvular leak. Safety at 30 days was similar in two groups.

  11. Review of reported causes of device embolization following trans-catheter aortic valve implantation.

    Science.gov (United States)

    Ibebuogu, Uzoma N; Giri, Smith; Bolorunduro, Oluwaseyi; Tartara, Paolo; Kar, Saibal; Holmes, David; Alli, Oluseun

    2015-06-15

    Transcatheter heart valve (THV) embolization is a rare but serious complication of transcatheter aortic valve implantation. Studies, including case reports, case series, and original reports published between 2002 and 2013, with regard to THV embolization were identified with a systemic electronic search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A total of 19 publications describing 71 patients were identified. Most patients (64%) were men, with a mean age of 80 ± 6 years and a mean logistic European System for Cardiac Operative Risk Evaluation score of 22.4 ± 9.3%. Balloon-expandable valves were used in 72% of the patients. The reported transcatheter aortic valve replacement access site was transfemoral in 80% of patients. Most cases (90%) occurred <1 hour after implantation, whereas 10% had late embolization (range 4 hours to 43 days). The most common site of embolization was the ascending aorta (38%), followed by the left ventricle (31%), descending aorta (23%), and aortic arch (8%). Open-heart surgery was required in 28% for valve retrieval and replacement. The 30-day stroke and mortality rates were 11% and 17%, respectively. Ventricular embolization and urgent conversion to open-heart surgery were significantly associated with death during hospitalization (p = 0.017 and p = 0.029, respectively). Likely causes of embolization were identified in 59 patients, with positioning error as the most commonly reported (47%), followed by pacing error (13%). In conclusion, THV embolization occurred early after transcatheter aortic valve implantation. The ascending aorta was the most common site of embolization. Higher 30-day stroke and mortality rates were associated with THV embolization compared with most published series of transcatheter aortic valve implantation outcomes. PMID:25882773

  12. The systemic inflammatory response syndrome predicts short-term outcome after transapical transcatheter aortic valve implantation

    NARCIS (Netherlands)

    Rettig, Thijs C D; Rigter, Sander; Nijenhuis, Vincent J.; Van Kuijk, Jan Peter; Ten Berg, Jurriën M.; Heijmen, Robin H.; Van De Garde, Ewoudt M W; Noordzij, Peter G.

    2015-01-01

    Objective Despite the minimally invasive nature of transcatheter aortic valve implantation (TAVI), the incidence of acute kidney injury (AKI) and mortality is of major concern. Several studies showed that outcome was influenced by the systemic inflammatory response syndrome (SIRS) in patients underg

  13. 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.

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

    International Nuclear Information System (INIS)

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

  15. Efficacy and Safety of Transcatheter Aortic Valve Implantation for Bicuspid Aortic Valves: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Xie, Xiaochuan; Shi, Xiaohan; Xun, Xiaoshuang

    2016-01-01

    Purpose: To elucidate the performance of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) patients through a systematic review and meta-analysis. Methods: A systematic literature review was performed by searching eligible articles in PubMed, Medline, EMBASE, Google Scholar and CNKI. Meta-analysis of included case-control/cohort studies was further conducted. Relative risks (RRs) and the corresponding 95% confidence intervals (CIs) were used to compare clinical outcomes of BAV patients and non-BAV patients. Results: A total of 17 articles including eight case reports, four case series and five case-control/cohort studies with 166 BAV patients were analyzed. Device success rate achieved for TAVI in this cohort of BAV patients was 95.2%. The 30-day mortality rate was 8.4%, and the medium-term (range from 6 months to 2 years) mortality rate reported was 17.9%. Overall, the performance of TAVI in BAV patients was comparable to that in non-BAV patients, as reported by the included case-control/cohort studies (30-day mortality rate: RR = 1.05, 95%CI 0.57–1.95, p = 0.87; Device success rate: RR = 1.00, 95%CI 0.95–1.05, p = 0.94; Incidence of moderate to severe paravalvular regurgitation: RR = 1.25, 95%CI 0.85–1.84, p = 0.25). Conclusion: The present study suggested that TAVI may be a feasible and safe treatment modality for BAV patients. PMID:27098769

  16. Effect of aortic regurgitation following transcatheter aortic valve implantation on outcomes.

    Science.gov (United States)

    Ewe, See Hooi; Muratori, Manuela; van der Kley, Frank; Pepi, Mauro; Delgado, Victoria; Tamborini, Gloria; Fusini, Laura; de Weger, Arend; Gripari, Paola; Bartorelli, Antonio; Bax, Jeroen J; Marsan, Nina Ajmone

    2015-03-01

    The prognosis of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and the changes in AR grade over time remain unclear. This study evaluated the midterm survival associated with AR after TAVI and examined the evolution of AR over time and its effect on cardiac performance. Successful TAVI was performed in 314 patients (age 81 ± 7 years, 36% men). Serial transthoracic echocardiography and clinical assessment were available in 175 patients who survived >12 months. AR was assessed in terms of overall, paravalvular, and intravalvular severity. Significant post-TAVI AR (grade ≥2) was observed in 82 patients (26%), and these patients showed a trend toward reduced survival at 1- (93% vs 91%) and 2-year (89% vs 74%, log-rank p = 0.063) follow-up. Of the 175 patients who survived >12 months, grade ≥2 overall, paravalvular, and intravalvular AR were noted in 47 (27%), 32 (18%), and 8 patients (5%), respectively. Significant overall and paravalvular AR appeared to improve over time, particularly during the first 6 months (p <0.05), whereas intravalvular AR remained unchanged. Although improvements in the echocardiographic parameters were similar among patients with and without significant AR, patients who remained with grade ≥2 AR at 6 months had significantly worse survival than their counterparts at 2 years (80% vs 94%, log-rank p = 0.032). In conclusion, significant overall and paravalvular AR after TAVI appeared to improve over time. Although improvements in the echocardiographic parameters were similar, patients with grade ≥2 AR, both immediately after TAVI and at 6 months, were associated with worse survival. PMID:25591895

  17. 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)

  18. Combined venoarterial extracorporeal membrane oxygenation and transcatheter aortic valve implantation for the treatment of acute aortic prosthesis dysfunction in a high-risk patient.

    Science.gov (United States)

    Pergolini, Amedeo; Zampi, Giordano; Tinti, Maria Denitza; Polizzi, Vincenzo; Pino, Paolo Giuseppe; Pontillo, Daniele; Musumeci, Francesco; Luzi, Giampaolo

    2016-01-01

    We describe the case of a patient with acute bioprosthesis dysfunction in cardiogenic shock, in whom hemodynamic support was provided by venoarterial extracorporeal membrane oxygenation, and successfully treated by transcatheter aortic valve implantation.

  19. Review of patient-specific simulations of transcatheter aortic valve implantation

    OpenAIRE

    Vy, P; Auffret, Vincent; Badel, Pierre; Rochette, Michel; Le Breton, Hervé; Haigron, Pascal; Avril, Stéphane

    2016-01-01

    International audience Transcatheter Aortic Valve Implantation (TAVI) accounts for one of the most promising new cardiovascular procedures. This minimally invasive technique is still at its early stage and is constantly developing thanks to imaging techniques, computer science, biomechanics and technologies of prosthesis and delivery tools. As a result, patient-specific simulation can find an exciting playground in TAVI. It canexpress its potential by providing the clinicians with powerful...

  20. Prevalence of blood type A and risk of vascular complications following transcatheter aortic valve implantation

    OpenAIRE

    Rofe, M.-T.; Shacham, Y; Steinvi, A.; Barak, L.; Hareuveni, M; Banai, S.; Keren, G; Finkelstein, A.; Shmilovich, H.

    2016-01-01

    Objectives To assess the prevalence of blood type A among patients referred for transcatheter aortic valve implantation (TAVI) and whether it is related to vascular complications. Backgrounds Vascular complications following TAVI are associated with adverse outcomes. Various blood types, particularly type A, have been shown to be more prevalent in cardiovascular diseases and to be related to prognosis. Methods The prevalence of various blood types in a cohort of 491 consecutive patients who u...

  1. Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

    OpenAIRE

    Zanettini, Renzo; Gatto, Gemma; Mori, Ileana; Pozzoni, Maria Beatrice; Pelenghi, Stefano; Martinelli, Luigi; Klugmann, Silvio

    2014-01-01

    Background Evaluation of patient outcomes following transcatheter aortic valve implantation (TAVI) has usually been based on survival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lacking. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional assessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cog...

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

    Science.gov (United States)

    Anastasiou, Alexandros; Saatsakis, George

    2015-09-01

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

  3. 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...... countries. METHODS: A multi-institutional, non-randomized, retrospective analysis was conducted among 2,932 patients who underwent AVR surgery at seven tertiary cardiac surgery centers throughout Europe. Demographic and perioperative variables including valve size and type, body surface area (BSA) and early......: Prostheses with diameter valve size was also smaller in southern compared to northern European patients (21.6 +/- 2.1 mm versus 23.4 +/- 2.2 mm, p

  4. Transcatheter aortic valve implantation in a patient with circulatory collapse, using the lucas® chest compression system

    DEFF Research Database (Denmark)

    Jensen, Peter Blom; Andersen, Claus; Nissen, Henrik

    2013-01-01

    We describe a case of Transcatheter Aortic Valve Implantation (TAVI) using the LUCAS® Chest Compression System in an elderly high risk patient with severe aortic stenosis and heart failure. In this case, the patient developed severe aortic regurgitation following predilatation of the native aortic...... valve and automated cardiopulmonary resuscitation (A-CPR) was initiated. The procedure was performed under ongoing A-CPR for a total of 28 min. The patient was transferred to the intensive care unit and to a step down unit the following day. At follow-up 30 days later, she showed no signs of neurologic...

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

    Directory of Open Access Journals (Sweden)

    Thyregod Hans Gustav

    2013-01-01

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

  6. Aortic Annular Enlargement during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Selman Dumani

    2016-09-01

    Full Text Available In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery.

  7. 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

  8. 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.

  9. 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

    -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......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...

  10. Nursing leadership of the transcatheter aortic valve implantation Heart Team: Supporting innovation, excellence, and sustainability.

    Science.gov (United States)

    Lauck, Sandra B; McGladrey, Janis; Lawlor, Cindy; Webb, John G

    2016-05-01

    Transcatheter Aortic Valve Implantation (TAVI) is an innovative and resource-intensive treatment of valvular heart disease. Growing evidence and excellent outcomes are contributing to increased patient demand. The Heart Team is foundational to TAVI programs to manage the complexities of case selection and other aspects of care. The competencies and expertise of nurses are well suited to provide administrative and clinical leadership within the TAVI Heart Team to promote efficient, effective, and sustainable program development. The contributions of nursing administrative and clinical leaders exemplify the leadership roles that nurses can assume in healthcare innovation. PMID:27060802

  11. Nursing leadership of the transcatheter aortic valve implantation Heart Team: Supporting innovation, excellence, and sustainability.

    Science.gov (United States)

    Lauck, Sandra B; McGladrey, Janis; Lawlor, Cindy; Webb, John G

    2016-05-01

    Transcatheter Aortic Valve Implantation (TAVI) is an innovative and resource-intensive treatment of valvular heart disease. Growing evidence and excellent outcomes are contributing to increased patient demand. The Heart Team is foundational to TAVI programs to manage the complexities of case selection and other aspects of care. The competencies and expertise of nurses are well suited to provide administrative and clinical leadership within the TAVI Heart Team to promote efficient, effective, and sustainable program development. The contributions of nursing administrative and clinical leaders exemplify the leadership roles that nurses can assume in healthcare innovation.

  12. Interobserver variability of CT angiography for evaluation of aortic annulus dimensions prior to transcatheter aortic valve implantation (TAVI)

    Energy Technology Data Exchange (ETDEWEB)

    Schmidkonz, C., E-mail: christian.schmidkonz@gmail.com [Department of Internal Medicine 2 (Cardiology), University of Erlangen, Ulmenweg 18, D-91054 Erlangen (Germany); Marwan, M.; Klinghammer, L.; Mitschke, M.; Schuhbaeck, A.; Arnold, M. [Department of Internal Medicine 2 (Cardiology), University of Erlangen, Ulmenweg 18, D-91054 Erlangen (Germany); Lell, M. [Radiological Institute, University of Erlangen, Maximiliansplatz 1, D-91054 Erlangen (Germany); Achenbach, S.; Pflederer, T. [Department of Internal Medicine 2 (Cardiology), University of Erlangen, Ulmenweg 18, D-91054 Erlangen (Germany)

    2014-09-15

    Highlights: • Cardiac CT provides highly reproducible measurements of aortic annulus and root dimensions prior to TAVI. • The perimeter-derived aortic annulus diameter shows the lowest interobserver variability. • If all three CT sizing methods are considered and stated as a “consensus result”, mismatches in prosthesis size selection can be further reduced. - Abstract: Objective: Assessment of aortic annulus dimensions prior to transcatheter aortic valve implantation (TAVI) is crucial for accurate prosthesis sizing in order to avoid prosthesis–annulus-mismatch possibly resulting in complications like valve dislodgement, paravalvular regurgitation or annulus rupture. Contrast-enhanced multidetector computed tomography allows 3-dimensional assessment of aortic annulus dimensions. Only limited data exist about its interobserver variability. Methods: In 100 consecutive patients with symptomatic severe aortic stenosis (51 male, BMI 27 ± 5 kg/m{sup 2}, age 81 ± 7 years, heart rate 72 ± 15 bpm, Logistic Euroscore 31 ± 14%, STS-Score 7 ± 4%), pre-interventional aortic annulus assessment was performed by dual source computed tomography (collimation 2 × 128 × 0.6 mm, high pitch spiral data acquisition mode, 40–60 ml contrast agents, radiation dose 3.5 ± 0.9 mSv). The following aortic annulus characteristics were determined by three independent observers: aortic annulus maximum, minimum and mean diameters (D{sub max}, D{sub min}, D{sub mean}), eccentricity index (EI), effective aortic annulus diameter according to its circumference (D{sub circ}), effective aortic annulus diameter according to its area (D{sub area}), distance from the aortic annulus plane to the left (LCA) and right coronary artery (RCA) ostia, maximum (D{sub max}AR) and minimum aortic root diameter (D{sub min}AR), maximum (D{sub max}STJ) and minimum diameter of the sinotubular junction (D{sub min}STJ). Subsequently, interobserver variabilities were assessed. Results: Correlation between

  13. Valve selection in aortic valve endocarditis

    Science.gov (United States)

    Zubrytska, Yana

    2016-01-01

    Aortic prosthetic valve endocarditis (PVE) is a potentially life-threatening disease. Mortality and incidence of infective endocarditis have been reduced in the past 30 years. Medical treatment of aortic PVE may be successful in patients who have a prompt response after antibiotic treatment and who do not have prosthetic dysfunction. In advanced stages, antibiotic therapy alone is insufficient to control the disease, and surgical intervention is necessary. Surgical treatment may be lifesaving, but it is still associated with considerable morbidity and mortality. The aim of surgery is to perform a radical excision of all infected and necrotic tissue, reconstruction of the left ventricle outflow tract, and replacement of the aortic valve. There is no unanimous consensus on which is the optimal prosthesis to implant in this context, and several surgical techniques have been suggested. We aim to analyze the efficacy of the surgical treatment and discuss the issue of valve selection in patients with aortic valve endocarditis.

  14. Transcatheter aortic valve implantation: the transfemoral access route is the default access.

    Science.gov (United States)

    Stortecky, Stefan; O'Sullivan, Crochan J; Buellesfeld, Lutz; Windecker, Stephan; Wenaweser, Peter

    2013-09-10

    Transcatheter aortic valve implantation (TAVI) is a widely accepted alternative to surgical aortic valve replacement (SAVR) among non-operable patients or selected high-risk patients with degenerative, severe aortic stenosis. TAVI is considered less invasive when compared with SAVR; however, there remain significant differences between different TAVI access routes. The transfemoral approach is considered the least invasive access route, and can be performed as a fully percutaneous procedure in a spontaneously breathing patient under local anaesthesia and mild sedation only. Moreover, transfemoral TAVI patients are typically transferred to coronary care rather than to an intensive care unit after the procedure, and benefit from early ambulation and a reduction in overall length of hospital stay. Considering these patient-specific and health-economic advantages, several TAVI centres follow the least invasive strategy for their patients and have implemented the transfemoral access route as the default access in their institutions. This article provides an overview on the prerequisites for a successful transfemoral TAVI procedure, describes the procedural advantages compared to alternative access routes, and highlights differences in clinical outcomes. PMID:24025952

  15. Multi-detector computed tomography is equivalent to trans-oesophageal echocardiography for the assessment of the aortic annulus before transcatheter aortic valve implantation

    International Nuclear Information System (INIS)

    In transcatheter aortic valve implantation (TAVI), assessment of the aortic annulus is mandatory. We sought to investigate the correlation between trans-oesophageal echocardiography (TEE) and multi-detector computed tomography (MDCT) for annulus diameter assessment before TAVI. A total of 122 patients (67 male, mean age 84 ± 6 years) underwent MDCT and TEE for TAVI planning. In TEE annulus diameters were obtained in a long-axis view at diastole. MDCT data were evaluated using MPR images, and corresponding projections were adjusted for MDCT and TEE. Patients were classified by the predominant localisation of aortic valve calcifications, and annulus diameters between TEE and MDCT were correlated. Additionally, the eccentricity of the aortic annulus was calculated. Mean eccentricity of the aortic annulus determined by MDCT was 0.34 ± 0.17, with no difference according to valve calcification. Regarding the aortic annulus diameter, the mean values measured were 24.3 ± 2.1 mm in MDCT and 24.0 ± 2.5 mm in TEE (P < 0.0001 for agreement). Independent of the pattern of aortic valve calcification, close correlation is found between CT and TEE measurements of the aortic annulus diameter. In addition, CT demonstrates the non-circular shape of the aortic annulus. (orig.)

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  17. Is valve choice a significant determinant of paravalular leak post-transcatheter aortic valve implantation? A systematic review and meta-analysis.

    LENUS (Irish Health Repository)

    O'Sullivan, Katie E

    2013-11-01

    Paravalvular regurgitation (PVR) following transcatheter aortic valve implantation (TAVI) is associated with poor survival. The two main valve delivery systems used to date differ significantly in both structure and deployment technique. The primary objective of this study was to perform a systematic review and meta-analysis of studies identifying PVR in patients post-TAVI using Medtronic CoreValve (MCV) and Edward Sapien (ES) valves in order to identify whether a significant difference exists between valve types. The secondary objective was to identify additional factors predisposing to PVR to provide an overview of the other associated considerations.

  18. Transcatheter Aortic Valve Replacement for Degenerative Bioprosthetic Surgical Valves

    DEFF Research Database (Denmark)

    Dvir, Danny; Webb, John; Brecker, Stephen;

    2012-01-01

    Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry.......Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry....

  19. 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.

  20. 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

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

    Science.gov (United States)

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

    2015-02-01

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

  2. Implante valve-in-valve transcateter em posição aórtica: uma mudança de seleção? Transcatheter aortic valve-in-valve implantation: a selection change?

    Directory of Open Access Journals (Sweden)

    Diego Felipe Gaia

    2012-09-01

    Full Text Available INTRODUÇÃO: A reoperação para substituição de biopróteses aórticas com disfunção é procedimento que envolve considerável risco. Em alguns casos, a mortalidade é elevada e pode contraindicar o procedimento. O implante minimamente invasivo "valve-in-valve" transcateter de valva aórtica parece ser uma alternativa, reduzindo morbimortalidade. O objetivo deste estudo foi avaliar esses implantes utilizando a prótese Braile Inovare. MÉTODOS: A prótese Braile Inovare, transcateter, balão expansível foi utilizada em 14 casos. Euroscore médio foi de 42,9%. Todos os pacientes eram portadores de dupla disfunção de bioprótese aórtica. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Por meio de minitoracotomia esquerda, as próteses foram implantadas através do ápice ventricular, sob estimulação ventricular de alta frequência. Foram realizados controles clínicos e ecocardiográficos seriados. O seguimento variou de 1 a 30 meses. RESULTADOS: A correta liberação protética foi possível em todos os casos. Não ocorreu conversão. Não houve mortalidade operatória. A mortalidade em 30 dias foi de 14,3% (dois casos. A fração de ejeção apresentou aumento significativo após o 7º pós-operatório e o gradiente aórtico apresentou redução significativa. A insuficiência aórtica residual não esteve presente. Não ocorreu complicação vascular periférica ou bloqueio atrioventricular total. CONCLUSÕES: O implante "valve-in-valve" de valva aórtica transcateter em biopróteses com disfunção é um procedimento seguro e com morbimortalidade baixa. Essa possibilidade poderá alterar a indicação de seleção de prótese no procedimento inicial, favorecendo próteses biológicas.OBJECTIVE: Aortic valve replacement for bioprosthesis dysfunction is a procedure involving considerable risk. In some cases, mortality is high and may contraindicate the procedure

  3. Transition to palliative care when transcatheter aortic valve implantation is not an option: opportunities and recommendations

    Science.gov (United States)

    Lauck, Sandra B.; Gibson, Jennifer A.; Baumbusch, Jennifer; Carroll, Sandra L.; Achtem, Leslie; Kimel, Gil; Nordquist, Cindy; Cheung, Anson; Boone, Robert H.; Ye, Jian; Wood, David A.; Webb, John G.

    2016-01-01

    Purpose of review Transcatheter aortic valve implantation (TAVI) is the recommended treatment for most patients with symptomatic aortic stenosis at high surgical risk. However, TAVI may be clinically futile for patients who have multiple comorbidities and excessive frailty. This group benefits from transition to palliative care to maximize quality of life, improve symptoms, and ensure continuity of health services. We discuss the clinical determination of utility and futility, explore the current evidence guiding the integration of palliative care in procedure-focused cardiac programs, and outline recommendations for TAVI programs. Recent findings The determination of futility of treatment in elderly patients with aortic stenosis is challenging. There is a paucity of research available to guide best practices when TAVI is not an option. Opportunities exist to build on the evidence gained in the management of end of life and heart failure. TAVI programs and primary care providers can facilitate improved communication and processes of care to provide decision support and transition to palliative care. Summary The increased availability of transcatheter options for the management of valvular heart disease will increase the assessment of people with life-limiting conditions for whom treatment may not be an option. It is pivotal to bridge cardiac innovation and palliation to optimize patient outcomes. PMID:26716394

  4. 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 ...

  5. 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

  6. Impact of patient-prosthesis mismatch after transcatheter aortic valve-in-valve implantation in degenerated bioprostheses

    DEFF Research Database (Denmark)

    Seiffert, Moritz; Conradi, Lenard; Baldus, Stephan;

    2012-01-01

    Transcatheter valve-in-valve implantation is evolving as an alternative to reoperative valve replacement in high-risk patients with degenerated bioprostheses. Nevertheless, hemodynamic performance is limited by the previously implanted xenograft. We report our experience with patient-prosthesis...

  7. Clinical outcomes of transcatheter aortic valve implantation: from learning curve to proficiency

    Science.gov (United States)

    Lunardi, Mattia; Pesarini, Gabriele; Zivelonghi, Carlo; Piccoli, Anna; Geremia, Giulia; Ariotti, Sara; Rossi, Andrea; Gambaro, Alessia; Gottin, Leonardo; Faggian, Giuseppe; Vassanelli, Corrado; Ribichini, Flavio

    2016-01-01

    Objective The use of transcatheter aortic valve implantation (TAVI) is growing rapidly in countries with a predominantly elderly population, posing a huge challenge to healthcare systems worldwide. The increment of human and economic resource consumption imposes a careful monitoring of clinical outcomes and cost-benefit balance, and this article is aimed at analysing clinical outcomes related to the TAVI learning curve. Methods Outcomes of 177 consecutive transfemoral TAVI procedures performed in 5 years by a single team were analysed by the Cumulative Sum of failures method (CUSUM) according to the clinical events comprised in the Valve Academic Research Consortium (VARC-2) safety end point and the VARC-2 definition of device success. Margins for events acceptance were extrapolated from landmark trials that tested both balloon or self-expandable percutaneous valves. Results 30-day and 1-year survival rates were 97.2% and 89.9%, respectively. Achievement of the primary end point (number of cases needed to provide the acceptable margin of the composite end point of any death, stroke, myocardial infarction, life-threatening bleeding, major vascular complications, stage 2–3 acute kidney injury and valve-related dysfunction requiring a repeat procedure) required the performance of 54 cases, while the learning curve to achieve ‘device success’ identified 32 cases to reach the expected proficiency. In this experience, the baseline clinical risk as assessed by the Society of Thoracic Surgeons (STS) score determined the long-term survival rather than the adverse events related to the learning curve. Conclusions A relatively large number of cases are required to achieve clinical outcomes comparable to those reported in high-volume centres and controlled trials. According to our national workload standards, this represents more than 2 years of continuous activity.

  8. Optimal implantation depth and adherence to guidelines on permanent pacing to improve the results of transcatheter aortic valve replacement with the medtronic corevalve system: The CoreValve prospective, international, post-market ADVANCE-II study

    OpenAIRE

    Petronio, Anna S; Sinning, Jan-Malte; Van Mieghem, Nicolas; Zucchelli, Giulio; Nickenig, Georg; Bekeredjian, Raffi; Bosmans, B.; Bedogni, Francesco; Branny, Marian; Stangl, Karl; Kovac, Jan; Schiltgen, Molly; Kraus, Stacia; De Jaegere, Peter

    2015-01-01

    textabstractObjectives The aim of the CoreValve prospective, international, post-market ADVANCE-II study was to define the rates of conduction disturbances and permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement with the Medtronic CoreValve System (Minneapolis, Minnesota) using optimized implantation techniques and application of international guidelines on cardiac pacing. Background Conduction disturbances are a frequent complication of transcatheter aortic va...

  9. 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

  10. Is Transcatheter Aortic Valve Implantation of Living Tissue-Engineered Valves Feasible? An In Vitro Evaluation Utilizing a Decellularized and Reseeded Biohybrid Valve.

    Science.gov (United States)

    Koenig, Fabian; Lee, Jang-Sun; Akra, Bassil; Hollweck, Trixi; Wintermantel, Erich; Hagl, Christian; Thierfelder, Nikolaus

    2016-08-01

    Transcatheter aortic valve implantation (TAVI) is a fast-growing, exciting field of invasive therapy. During the last years many innovations significantly improved this technique. However, the prostheses are still associated with drawbacks. The aim of this study was to create cell-seeded biohybrid aortic valves (BAVs) as an ideal implant by combination of assets of biological and artificial materials. Furthermore, the influence of TAVI procedure on tissue-engineered BAV was investigated. BAV (n=6) were designed with decellularized homograft cusps and polyurethane walls. They were seeded with fibroblasts and endothelial cells isolated from saphenous veins. Consecutively, BAV were conditioned under low pulsatile flow (500 mL/min) for 5 days in a specialized bioreactor. After conditioning, TAVI-simulation was performed. The procedure was concluded with re-perfusion of the BAV for 2 days at an increased pulsatile flow (1100 mL/min). Functionality was assessed by video-documentation. Samples were taken after each processing step and evaluated by scanning electron microscopy (SEM), immunohistochemical staining (IHC), and Live/Dead-assays. The designed BAV were fully functioning and displayed physiologic behavior. After cell seeding, static cultivation and first conditioning, confluent cell layers were observed in SEM. Additionally, IHC indicated the presence of endothelial cells and fibroblasts. A significant construction of extracellular matrix was detected after the conditioning phase. However, a large number of lethal cells were observed after crimping by Live/Dead staining. Analysis revealed that the cells while still being present directly after crimping were removed in subsequent perfusion. Extensive regions of damaged cell-layers were detected by SEM-analysis substantiating these findings. Furthermore, increased ICAM expression was detected after re-perfusion as manifestation of inflammatory reaction. The approach to generate biohybrid valves is promising. However

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

    Science.gov (United States)

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

    2015-11-01

    Major vascular complications (VC) remain frequent after transcatheter aortic valve implantation (TAVI) and may be associated with unfavorable clinical outcomes. The objective of this study was to evaluate the rate of VC after transfemoral TAVI performed using an exclusive open surgical access strategy. From 2010 to 2014, we included in a monocentric registry all consecutive patients who underwent transfemoral TAVI. The procedures were performed with 16Fr to 20Fr sheath systems. VC were evaluated within 30 days and classified as major or minor according to the Valve Academic Research Consortium 2 definition. The study included 396 patients, 218 were women (55%), median age was 85 years (81 to 88), and the median logistic Euroscore was 15.2% (11 to 23). The balloon-expandable SAPIEN XT and the self-expandable Medtronic Core Valve prosthesis were used in 288 (72.7%) and 108 patients (27.3%), respectively. The total length of the procedure was 68 ± 15 minutes including 13 ± 5 minutes for the open surgical access. Major and minor VC were observed in 9 (2.3%) and 16 patients (4%), respectively, whereas life-threatening and major bleeding concerned 18 patients (4.6%). The median duration of hospitalization was 5 days (interquartile range 2 to 7), significantly higher in patients with VC (7 days [5 to 15], p transfemoral TAVI performed using an exclusive surgical strategy, with a particular advantage observed in high-risk bleeding patients. PMID:26414600

  12. Bentall procedure 39 years after implantation of a Starr-Edwards Aortic Caged- Ball-Valve Prosthesis

    OpenAIRE

    Sohns Christian; Wiese Christoph H; Friedrich Martin; Schotola Hanna; Coskun Kasim O; Popov Aron F; Ortmann Philipp; Schmitto Jan D; Mokashi Suyog A; Didilis Vassilios N; Schoendube Friedrich A

    2010-01-01

    Abstract We report a case of a male patient who received an implantation of a Starr-Edwards-caged-ball-valve-prosthesis in 1967. The surgery and postoperative course were without complications and the patient recovered well after the operation. For the next four decades, the patient remained asymptomatic - no restrictions on his lifestyle and without any complications. In 2006, 39 years after the initial operation, we performed a Bentall-Procedure to treat an aortic ascendens aneurysm with di...

  13. Impact of clinical and procedural factors upon C reactive protein dynamics following transcatheter aortic valve implantation

    Science.gov (United States)

    Ruparelia, Neil; Panoulas, Vasileios F; Frame, Angela; Ariff, Ben; Sutaria, Nilesh; Fertleman, Michael; Cousins, Jonathan; Anderson, Jon; Bicknell, Colin; Chukwuemeka, Andrew; Sen, Sayan; Malik, Iqbal S; Colombo, Antonio; Mikhail, Ghada W

    2016-01-01

    AIM: To determine the effect of procedural and clinical factors upon C reactive protein (CRP) dynamics following transcatheter aortic valve implantation (TAVI). METHODS: Two hundred and eight consecutive patients that underwent transfemoral TAVI at two hospitals (Imperial, College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom and San Raffaele Scientific Institute, Milan, Italy) were included. Daily venous plasma CRP levels were measured for up to 7 d following the procedure (or up to discharge). Procedural factors and 30-d safety outcomes according to the Valve Academic Research Consortium 2 definition were collected. RESULTS: Following TAVI, CRP significantly increased reaching a peak on day 3 of 87.6 ± 5.5 mg/dL, P < 0.001. Patients who developed clinical signs and symptoms of sepsis had significantly increased levels of CRP (P < 0.001). The presence of diabetes mellitus was associated with a significantly higher peak CRP level at day 3 (78.4 ± 3.2 vs 92.2 ± 4.4, P < 0.001). There was no difference in peak CRP release following balloon-expandable or self-expandable TAVI implantation (94.8 ± 9.1 vs 81.9 ± 6.9, P = 0.34) or if post-dilatation was required (86.9 ± 6.3 vs 96.6 ± 5.3, P = 0.42), however, when pre-TAVI balloon aortic valvuloplasty was performed this resulted in a significant increase in the peak CRP (110.1 ± 8.9 vs 51.6 ± 3.7, P < 0.001). The development of a major vascular complication did result in a significantly increased maximal CRP release (153.7 ± 11.9 vs 83.3 ± 7.4, P = 0.02) and there was a trend toward a higher peak CRP following major/life-threatening bleeding (113.2 ± 9.3 vs 82.7 ± 7.5, P = 0.12) although this did not reach statistical significance. CRP was not found to be a predictor of 30-d mortality on univariate analysis. CONCLUSION: Careful attention should be paid to baseline clinical characteristics and procedural factors when interpreting CRP following TAVI to determine their future management. PMID

  14. Transcatheter Aortic Valve Replacement in a Nonagenarian

    OpenAIRE

    Kneitz, Abby; Clifton, William; Kar, Biswajit; Delgado, Reynolds M.

    2013-01-01

    Approximately 30% to 40% of elderly patients with severe, symptomatic aortic valve stenosis are deemed ineligible for surgery because of high perioperative risk. We describe the use of an alternative transfemoral approach known as transcatheter aortic valve implantation in a nonagenarian patient with severe aortic stenosis. Our patient recovered successfully, and by the time of her most recent follow-up visit, 7 months after the procedure, she had regained a substantial degree of function. Th...

  15. Prevalence of De Novo Aortic Valve Insufficiency in Patients After HeartWare VAD Implantation with an Intermittent Low-Speed Algorithm.

    Science.gov (United States)

    Saeed, Diyar; Westenfeld, Ralf; Maxhera, Bujar; Keymel, Stefanie; Sherif, Ahmed; Sadat, Najla; Petrov, GeorGI; Albert, Alexander; Lichtenberg, Artur

    2016-01-01

    De novo aortic valve insufficiency (AI) is a frequent occurrence in patients supported with left ventricular assist device (LVAD). The European version of the HeartWare LVAD has intermittent low-speed software (lavare cycle) to facilitate intermittent aortic valve opening. We examined aortic valve opening status and prevalence of AI in patients supported with HeartWare LVAD and activated lavare cycle. HeartWare LVAD patients were prospectively monitored using serial echocardiograms at different time points after the LVAD implantation. Inclusion criteria were patients with no > mild AI and/or no aortic valve surgery at the time of LVAD implantation and at least 60 days of support. Three of 37 patients had aortic valve surgery and were excluded from the analysis. A total of 34 patients with mean age of 57 ± 12 years met the inclusion criteria. After median support duration of 408 days (77-1250 days), eight patients had trace/mild AI (24%) and one patient developed moderate AI (3%). An average pump flow, speed, and mean arterial pressure of 4.4 ± 0.6 L/min, 2,585 ± 147 rpm, and 88 ± 11 mmHg were documented, respectively. Aortic valve opening was persistently seen in 22 patients (65%). Aortic valve opening is frequent, and the development of > mild AI seems to be rare in patients supported with HeartWare LVAD. PMID:27195744

  16. Optimal implantation depth and adherence to guidelines on permanent pacing to improve the results of transcatheter aortic valve replacement with the medtronic corevalve system: The CoreValve prospective, international, post-market ADVANCE-II study

    NARCIS (Netherlands)

    A.S. Petronio (Anna S.); J.-M. Sinning (Jan-Malte); N.M. van Mieghem (Nicolas); G. Zucchelli (Giulio); G. Nickenig (Georg); R. Bekeredjian (Raffi); B. Bosmans; F. Bedogni (Francesco); M. Branny (Marian); K. Stangl (Karl); J. Kovac (Jan); M. Schiltgen (Molly); S. Kraus (Stacia); P.P.T. de Jaegere (Peter)

    2015-01-01

    textabstractObjectives The aim of the CoreValve prospective, international, post-market ADVANCE-II study was to define the rates of conduction disturbances and permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement with the Medtronic CoreValve System (Minneapolis, Minnes

  17. Aortic regurgitation after transcatheter aortic valve replacement.

    Science.gov (United States)

    Werner, Nikos; Sinning, Jan-Malte

    2014-01-01

    Paravalvular aortic regurgitation (AR) negatively affects prognosis following transcatheter aortic valve replacement (TAVR). As transcatheter heart valves (THV) are anchored using a certain degree of oversizing at the level of the aortic annulus, incomplete stent frame expansion because of heavily annular calcifications, suboptimal placement of the prosthesis, and/or annulus-prosthesis size-mismatch can contribute to paravalvular AR with subsequent increased mortality risk. Echocardiography is essential to differentiate between transvalvular and paravalvular AR and to further elucidate the etiology of AR during the procedure. However, because echocardiographic quantification of AR in TAVR patients remains challenging, especially in the implantation situation, a multimodal approach to the evaluation of AR with use of hemodynamic measurements and imaging modalities is useful to precisely quantify the severity of AR immediately after valve deployment. "Next-generation" THVs are already on the market and first results show that paravalvular AR related to design modifications (eg, paravalvular space-fillers, full repositionability) are rarely seen in these valve types.  PMID:24632758

  18. Cardiac rehabilitation and mid-term follow-up after transcatheter aortic valve implantation

    Institute of Scientific and Technical Information of China (English)

    Renzo Zanettini; Gemma Gatto; Ileana Mori; Maria Beatrice Pozzoni; Stefano Pelenghi; Luigi Martinelli; Silvio Klugmann

    2014-01-01

    Background Evaluation of patient outcomes following transcatheter aortic valve implantation (TAVI) has usually been based on sur-vival and clinical improvement. Studies on quality of life are limited, and data from comprehensive assessments after the procedure are lack-ing. Methods Sixty patients referred for cardiac rehabilitation after TAVI underwent in-hospital and after-discharge multidimensional as-sessments to evaluate clinical, functional, and nutritional statuses, degree of autonomy, cognitive impairment, depression and quality of life. Results On admission to rehabilitation, approximately half of the patients had severe functional impairment and dependence for basic ac-tivities of daily living. During their hospital stay, one-third of the patients suffered significant clinical complications and two had to be trans-ferred to the implantation center. Despite this, the overall outcome was very good. All of the remaining patients were clinically stable at dis-charge and functional status, autonomy and quality of life were improved in most. During a mean follow-up of 540 days (range:192–738 days), five patients died from noncardiac causes, three were hospitalized for cardiac events, and nine for non cardiac reasons. Functional status and autonomy remained satisfactory in the majority of patients and most continued to live independently. Conclusions Patients re-ferred for rehabilitation after TAVI are often very frail, with a high grade of functional impairment, dependence on others and high risk of clinical complications. During a rehabilitation programme, based on a multidimensional assessment and intervention, most patients showed significant improvement in functional status, quality of life, and autonomy, which remained stable in the majority of subjects during mid-term follow-up.

  19. 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

  20. Intraoperative tracking of aortic valve plane

    Science.gov (United States)

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

    2013-01-01

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

  1. 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.

  2. 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

  3. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... of that slide, that demonstrates that patients with New York Heart Association class heart failure 1 and ... right down the aortic valve and that's the new aortic valve that Dr. Streitman's placed. And you ...

  4. Determinants of image quality of rotational angiography for on-line assessment of frame geometry after transcatheter aortic valve implantation.

    Science.gov (United States)

    Rodríguez-Olivares, Ramón; El Faquir, Nahid; Rahhab, Zouhair; Maugenest, Anne-Marie; Van Mieghem, Nicolas M; Schultz, Carl; Lauritsch, Guenter; de Jaegere, Peter P T

    2016-07-01

    To study the determinants of image quality of rotational angiography using dedicated research prototype software for motion compensation without rapid ventricular pacing after the implantation of four commercially available catheter-based valves. Prospective observational study including 179 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with either the Medtronic CoreValve (MCS), Edward-SAPIEN Valve (ESV), Boston Sadra Lotus (BSL) or Saint-Jude Portico Valve (SJP) in whom rotational angiography (R-angio) with motion compensation 3D image reconstruction was performed. Image quality was evaluated from grade 1 (excellent image quality) to grade 5 (strongly degraded). Distinction was made between good (grades 1, 2) and poor image quality (grades 3-5). Clinical (gender, body mass index, Agatston score, heart rate and rhythm, artifacts), procedural (valve type) and technical variables (isocentricity) were related with the image quality assessment. Image quality was good in 128 (72 %) and poor in 51 (28 %) patients. By univariable analysis only valve type (BSL) and the presence of an artefact negatively affected image quality. By multivariate analysis (in which BMI was forced into the model) BSL valve (Odds 3.5, 95 % CI [1.3-9.6], p = 0.02), presence of an artifact (Odds 2.5, 95 % CI [1.2-5.4], p = 0.02) and BMI (Odds 1.1, 95 % CI [1.0-1.2], p = 0.04) were independent predictors of poor image quality. Rotational angiography with motion compensation 3D image reconstruction using a dedicated research prototype software offers good image quality for the evaluation of frame geometry after TAVI in the majority of patients. Valve type, presence of artifacts and higher BMI negatively affect image quality. PMID:27139459

  5. Determinants of image quality of rotational angiography for on-line assessment of frame geometry after transcatheter aortic valve implantation.

    Science.gov (United States)

    Rodríguez-Olivares, Ramón; El Faquir, Nahid; Rahhab, Zouhair; Maugenest, Anne-Marie; Van Mieghem, Nicolas M; Schultz, Carl; Lauritsch, Guenter; de Jaegere, Peter P T

    2016-07-01

    To study the determinants of image quality of rotational angiography using dedicated research prototype software for motion compensation without rapid ventricular pacing after the implantation of four commercially available catheter-based valves. Prospective observational study including 179 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with either the Medtronic CoreValve (MCS), Edward-SAPIEN Valve (ESV), Boston Sadra Lotus (BSL) or Saint-Jude Portico Valve (SJP) in whom rotational angiography (R-angio) with motion compensation 3D image reconstruction was performed. Image quality was evaluated from grade 1 (excellent image quality) to grade 5 (strongly degraded). Distinction was made between good (grades 1, 2) and poor image quality (grades 3-5). Clinical (gender, body mass index, Agatston score, heart rate and rhythm, artifacts), procedural (valve type) and technical variables (isocentricity) were related with the image quality assessment. Image quality was good in 128 (72 %) and poor in 51 (28 %) patients. By univariable analysis only valve type (BSL) and the presence of an artefact negatively affected image quality. By multivariate analysis (in which BMI was forced into the model) BSL valve (Odds 3.5, 95 % CI [1.3-9.6], p = 0.02), presence of an artifact (Odds 2.5, 95 % CI [1.2-5.4], p = 0.02) and BMI (Odds 1.1, 95 % CI [1.0-1.2], p = 0.04) were independent predictors of poor image quality. Rotational angiography with motion compensation 3D image reconstruction using a dedicated research prototype software offers good image quality for the evaluation of frame geometry after TAVI in the majority of patients. Valve type, presence of artifacts and higher BMI negatively affect image quality.

  6. Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review.

    Science.gov (United States)

    Glavis-Bloom, Justin; Vasher, Scott; Marmor, Meghan; Fine, Antonella B; Chan, Philip A; Tashima, Karen T; Lonks, John R; Kojic, Erna M

    2015-11-01

    Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis. PMID:26403965

  7. Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation

    DEFF Research Database (Denmark)

    De Backer, Ole; Arnous, Samer; Sandholt, Benjamin;

    2015-01-01

    Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI......-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48...... stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency...

  8. Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review.

    Science.gov (United States)

    Glavis-Bloom, Justin; Vasher, Scott; Marmor, Meghan; Fine, Antonella B; Chan, Philip A; Tashima, Karen T; Lonks, John R; Kojic, Erna M

    2015-11-01

    Use of cardiovascular implantable electronic devices (CIED), including permanent pacemakers (PPM) and implantable cardioverter defibrillators (ICD), has increased dramatically over the past two decades. Most CIED infections are caused by staphylococci. Fungal causes are rare and their prognosis is poor. To our knowledge, there has not been a previously reported case of multifocal Candida endocarditis involving both a native left-sided heart valve and a CIED lead. Here, we report the case of a 70-year-old patient who presented with nausea, vomiting, and generalised fatigue, and was found to have Candida glabrata endocarditis involving both a native aortic valve and right atrial ICD lead. We review the literature and summarise four additional cases of CIED-associated Candida endocarditis published from 2009 to 2014, updating a previously published review of cases prior to 2009. We additionally review treatment guidelines and discuss management of CIED-associated Candida endocarditis.

  9. 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

    BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an option in certain high-risk surgical patients with severe aortic valve stenosis. It is unknown whether TAVR can be safely introduced to lower-risk patients. OBJECTIVES: The NOTION (Nordic Aortic Valve Intervention Trial) randomized...... clinical trial compared TAVR with surgical aortic valve replacement (SAVR) in an all-comers patient cohort. METHODS: Patients ≥ 70 years old with severe aortic valve stenosis and no significant coronary artery disease were randomized 1:1 to TAVR using a self-expanding bioprosthesis versus SAVR. The primary...... 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...

  10. Comparison of outcomes in patients ≤85 versus >85 years of age undergoing transcatheter aortic-valve implantation.

    Science.gov (United States)

    Havakuk, Ofer; Finkelstein, Ariel; Steinvil, Arie; Halkin, Amir; Arbel, Yaron; Abramowitz, Yigal; Ben Assa, Eyal; Konigstein, Maayan; Keren, Gad; Banai, Shmuel

    2014-01-01

    The impact of age on baseline characteristics and outcomes in patients with severe aortic stenosis who undergo transcatheter aortic valve implantation (TAVI) has not been thoroughly investigated. To describe the baseline clinical profile of TAVI patients aged >85 and ≤85 years and to evaluate the influence of age differences on outcomes, we evaluated a consecutive cohort of 293 patients who underwent transfemoral TAVI at the Tel Aviv Medical Center. The cohort was divided into 2 groups: patients aged >85 years (n = 93) and patients aged ≤85 years (n = 200). Mean age was 83 ± 5.3 years (range 63 to 98) for the entire cohort. Women comprised 70% of the older group and 57.5% of the younger age group (p = 0.043). Baseline clinical profile, including EuroSCORE index and preprocedural aortic valve area were similar in both age groups. Thirty-day mortality, major vascular complications, need for permanent pacemaker implantation, length of hospital stay, and improvement in functional class after the procedure showed no differences between the 2 groups. Adjustment for baseline clinical differences between groups did not change the results. In conclusion, among patients who underwent transfemoral TAVI, older patients (>85 years) experience similar benefits and outcomes regarding functional status, complication rates, and 30-day mortality. PMID:24210675

  11. Contrast-induced acute kidney injury after computed tomography prior to transcatheter aortic valve implantation

    International Nuclear Information System (INIS)

    Aim: To identify independent predictors of contrast medium-induced acute kidney injury (CI-AKI) after enhanced multidetector-row computed tomography (MDCT) prior to transcatheter aortic valve implantation (TAVI) in high-risk patients. Materials and methods: The present single-centre study analysed retrospectively 361 patients who were assessed using MDCT prior to TAVI. CI-AKI was defined as an increase in serum creatinine (SCr) of ≥25% or ≥0.5 mg/dl in at least one sample over baseline (24 h before MDCT) and at 24, 48, and 72 h after MDCT. Results: A total of 38 patients (10.5%) experienced CI-AKI. As compared to patients without CI-AKI, they presented more frequently with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2, (81.6% versus 64.4%, p = 0.045) and tended to receive higher volumes of iodinated contrast media (ICM; 55.3% versus 39%, p = 0.057). There was a significant interaction between baseline eGFR and the amount of intravenous ICM administered (pfor interaction = <0.001) identifying the amount of ICM >90 ml as independent predictive factor of CI-AKI only in patients with baseline eGFR <60 ml/min/1.73m2 (OR 2.615; 95% CI: 1.21–5.64). Conclusion: One in ten elderly patients with aortic stenosis undergoing MDCT to plan a TAVI procedure experienced CI-AKI after intravenous ICM injection. Intravenous administration of <90 ml of ICM reduces this risk in patients with or without pre-existing impaired renal function. However, in the majority of patients renal function recovers before the TAVI procedure. - Highlights: • We analyzed retrospectively 361 patients who were assessed by MDCT prior to TAVI. • Overall incidence of CI-AKI after intravenous ICM injection was 10.5%. • Interaction between baseline eGFR*amount of ICM injected predicts the risk of CI-AKI. • ICM <90 ml reduces the risk in patients with or without impaired renal function. • In the majority of patients renal function recovers before TAVI procedure

  12. Comparison of accuracy of aortic root annulus assessment with cardiac magnetic resonance versus echocardiography and multidetector computed tomography in patients referred for transcatheter aortic valve implantation.

    Science.gov (United States)

    Pontone, Gianluca; Andreini, Daniele; Bartorelli, Antonio L; Bertella, Erika; Mushtaq, Saima; Gripari, Paola; Loguercio, Monica; Cortinovis, Sarah; Baggiano, Andrea; Conte, Edoardo; Beltrama, Virginia; Annoni, Andrea; Formenti, Alberto; Tamborini, Gloria; Muratori, Manuela; Guaricci, Andrea; Alamanni, Francesco; Ballerini, Giovanni; Pepi, Mauro

    2013-12-01

    The evaluation of the aortic root in patients referred for transcatheter aortic valve implantation is crucial. The aim of the present study was to compare the accuracy of cardiac magnetic resonance (CMR) evaluation of the aortic annulus (AoA) with transthoracic and transesophageal echocardiography and multidetector computed tomography (MDCT) in patients referred for transcatheter aortic valve implantation. In 50 patients, maximum diameter, minimum diameter and AoA, length of the left coronary, right coronary, and noncoronary aortic leaflets, degree (grades 1 to 4) of aortic leaflet calcification, and distance between AoA and coronary artery ostia were assessed. AoA maximum diameter, minimum diameter, and area by CMR were 26.4 ± 2.8 mm, 20.6 ± 2.3 mm, 449.8 ± 86.2 mm(2), respectively. The length of left coronary, right coronary, and noncoronary leaflets by CMR were 13.9 ± 2.2, 13.3 ± 2.1, and 13.4 ± 1.8 mm, respectively, whereas the score of aortic leaflet calcifications was 2.9 ± 0.8. Finally, the distances between AoA and left main and right coronary artery ostia were 16.1 ± 2.8 and 16.1 ± 4.4 mm, respectively. Regarding AoA area, transthoracic and transesophageal echocardiography showed an underestimation (p <0.01), with a moderate agreement (r: 0.5 and 0.6, respectively, p <0.01) compared with CMR. No differences and excellent correlation were observed between CMR and MDCT for all parameters (r: 0.9, p <0.01), except for aortic leaflet calcifications that were underestimated by CMR. In conclusion, aortic root assessment with CMR including AoA size, aortic leaflet length, and coronary artery ostia height is accurate compared with MDCT. CMR may be a valid imaging alternative in patients unsuitable for MDCT. PMID:24045059

  13. Transcatheter aortic valve implantation with the new-generation Evolut R™

    Directory of Open Access Journals (Sweden)

    Eberhard Schulz

    2016-09-01

    Conclusions: These initial single-center experience data on the short-term outcomes after EVR valve implantation show a substantially reduced rate of more-than-mild paravalvular regurgitation and higher device success, while 30-day safety outcomes were similar to the CV system. Clinical outcome data from long-term follow-up and larger scale multicenter experience are now necessary.

  14. Percutaneous transcatheter aortic valve implantation for degenerated surgical bioprostheses: the first case series in Asia with one-year follow-up

    Science.gov (United States)

    Chiam, Paul Toon Lim; Ewe, See Hooi; Soon, Jia Lin; Ho, Kay Woon; Sin, Yong Koong; Tan, Swee Yaw; Lim, Soo Teik; Koh, Tian Hai; Chua, Yeow Leng

    2016-01-01

    INTRODUCTION Percutaneous transcatheter aortic valve implantation (TAVI) has become an established therapy for inoperable and high-surgical-risk patients with severe aortic stenosis. Although TAVI in patients with degenerated surgical aortic bioprostheses (i.e. valve-in-valve TAVI) is increasingly reported in Western studies, such data is lacking in Asian patients. We describe the initial experience of valve-in-valve TAVI in Asia. METHODS Eight patients who underwent valve-in-valve TAVI due to degenerated aortic bioprostheses were enrolled. The mechanism of bioprosthetic valve failure was stenotic, regurgitation or mixed. All procedures were performed via transfemoral arterial access, using the self-expanding CoreValve prosthesis or balloon-expandable SAPIEN XT prosthesis. RESULTS The mean age of the patients was 71.6 ± 13.2 years and five were male. Mean duration to surgical bioprosthesis degeneration was 10.2 ± 4.1 years. Valve-in-valve TAVI was successfully performed in all patients. CoreValve and SAPIEN XT prostheses were used in six and two patients, respectively. There were no deaths, strokes or permanent pacemaker requirement at 30 days, with one noncardiac mortality at one year. All patients experienced New York Heart Association functional class improvement. Post-procedure mean pressure gradients were 20 ± 11 mmHg and 22 ± 8 mmHg at 30 days and one year, respectively. Residual aortic regurgitation (AR) of more than mild severity occurred in one patient at 30 days. At one year, only one patient had mild residual AR. CONCLUSION In our experience of valve-in-valve TAVI, procedural success was achieved in all patients without adverse events at 30 days. Good clinical and haemodynamic outcomes were sustained at one year. PMID:27193081

  15. 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...

  16. Gamma radiation and its role in bio prosthetic aortic valves implanted in rat hearts

    International Nuclear Information System (INIS)

    Porcine heart valves glutaraldehyde fixed are implanted in patients with valvular deterioration. Mineralization may be the major factor in the long-term failure of tissue bio prosthesis. Gamma radiation randomly breaks some glutaraldehyde cross-links. As a consequence of irradiation, the polymeric fibers belonging to the valvular tissue are broken too, leading to sites of collagen fiber disorganisation. It is well known that the collagen fibers may act as a passive nucleator of salts where the calcium phosphate salts precipitate. This salt concentration has been described in association with disintegrated sites of protein fiber, which may favour new sites where the calcium salts would be deposit. The irradiation process is a technique used for sterilization of porcine heart valve. The main objective of this work was to study the effect of different doses of gamma radiation on the calcification process of subcutaneously implanted valves in rats. Small pieces from glutaraldehyde fixed valves, irradiated to different doses with a 60Co sources were implanted subcutaneously in rats. The calcium was measured by X-ray and atomic absorption spectrophotometry. In our experimental conditions and at the radiation doses used in these tests, the calcium measurements on control and irradiated material were not significantly different. We conclude that, at the employed doses, the gamma radiation does not alter the process. (author)

  17. 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.

  18. 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

  19. 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 ...

  20. 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 ...

  1. Effect of B-type natriuretic peptides on long-term outcomes after transcatheter aortic valve implantation.

    Science.gov (United States)

    Koskinas, Konstantinos C; O'Sullivan, Crochan J; Heg, Dik; Praz, Fabien; Stortecky, Stefan; Pilgrim, Thomas; Buellesfeld, Lutz; Jüni, Peter; Windecker, Stephan; Wenaweser, Peter

    2015-11-15

    B-type natriuretic peptide (BNP) levels are elevated in patients with aortic stenosis (AS) and decrease acutely after replacement of the stenotic valve. The long-term prognostic value of BNP after transcatheter aortic valve implantation (TAVI) and the relative prognostic utility of single versus serial peri-interventional measurements of BNP and N-terminal prohormone BNP (NT-pro-BNP) are unknown. This study sought to determine the impact of BNP levels on long-term outcomes after TAVI and to compare the utility of BNP versus NT-pro-BNP measured before and after intervention. We analyzed 340 patients with severe AS and baseline pre-TAVI assessment of BNP. In 219 patients, BNP and NT-pro-BNP were measured serially before and after intervention. Clinical outcomes over 2 years were recorded. Patients with high baseline BNP (higher tertile ≥591 pg/ml) had increased risk of all-cause mortality (adjusted hazard ratio 3.16, 95% confidence interval 1.84 to 5.42; p curve 0.75; p <0.01). Baseline-to-discharge reduction, but not baseline levels of BNP, was related to New York Heart Association functional improvement. In conclusion, high preintervention BNP independently predicts 2-year outcomes after TAVI, particularly when elevated levels persist after the intervention. BNP and NT-pro-BNP and their serial periprocedural changes provide complementary prognostic information for symptomatic improvement and survival. PMID:26428025

  2. Transcatheter Aortic Heart Valve Thrombosis

    DEFF Research Database (Denmark)

    Hansson, Nicolaj C; Grove, Erik L; Andersen, Henning R;

    2016-01-01

    BACKGROUND: There is increasing focus on transcatheter heart valve (THV) thrombosis. However, there are limited data on incidence, clinical implications and predisposing factors of THV thrombosis following transcatheter aortic valve replacement (TAVR). OBJECTIVES: We assessed the incidence...

  3. 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

  4. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    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 valve replacement...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  5. Valve-in-valve implantation with a 23-mm balloon-expandable transcatheter heart valve for the treatment of a 19-mm stentless bioprosthesis severe aortic regurgitation using a strategy of "extreme" underfilling.

    Science.gov (United States)

    Chevalier, Florent; Leipsic, Jonathon; Généreux, Philippe

    2014-09-01

    We report a case of valve-in-valve (ViV) implantation by transfemoral approach with a 23-mm balloon-expandable prosthesis inside a stentless 19-mm acutely degenerated bioprosthesis, using a strategy of "extreme" underfilling. A 74-year-old patient presented to our institution in cardiogenic shock. An initial transesophageal echocardiography (TEE) showed severe central aortic regurgitation (AR) due to a torn leaflet. She was deemed inoperable and considered for urgent transcatheter aortic valve replacement. Given the fairly small true internal diameter, a strategy of 3-cc underfilling of a 23-mm transcatheter heart valve (THV) was planned. However, the final implantation was performed with 5-cc underfilling due to the incapacity to deliver the entire amount of fluid contained in the inflation syringe. TEE guidance confirmed the successful positioning and deployment of the prosthesis, with no AR and a mean gradient of 25 mm Hg. While implantation of a smaller prosthesis (20 mm) was debated during the Heart Team discussion, the risk of valve embolization due to inadequate anchoring inside the stentless prosthesis led to the selection of a 23-mm THV. At 6-month follow-up, the patient was in NYHA class I, with no AR and a mean gradient of 28 mm Hg. We report for the first time the use of in vivo THV with 5-cc underfilling with no acute or short-term structural failure, and the first ViV implantation by transfemoral approach with a 23-mm balloon-expandable prosthesis inside a stentless 19-mm bioprosthesis. The current report presents the challenges related to ViV implantation inside a small stentless bioprosthesis and offers practical ways to overcome them. © 2014 Wiley Periodicals, Inc.

  6. 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...

  7. 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

  8. Implante transapical de valva aórtica: resultados de uma nova prótese brasileira Transapical aortic valve implantation: results of a brazilian prosthesis

    Directory of Open Access Journals (Sweden)

    Diego Felipe Gaia

    2010-09-01

    procedimento alternativo.OBJECTIVE: The aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such a risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for the aortic position implant. METHODS: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median Logistic EuroSCORE was 43.7%. Four patients presented with dysfunctional bioprosthesis, remaining ones presented calcified aortic stenosis. All patients presented symptoms. Procedures were performed in a hybrid OR under fluoroscopic and echocardiography guidance. Using a left minithoracotomy the prosthesis was implanted through the ventricular apex under ventricular pacing or hemorrhagic shock, after aortic valvoplasty. Echocardiograph and angiograph controls were performed, and the patients were referred to ICU. RESULTS: Implant was feasible in 13 cases. There were no intra-operative deaths. Median peak transvalvular aortic gradient reduced to 25.0 mmHg, and left ventricular function improved in the first seven post-operative days. Paravalvular aortic regurgitation was mild and present in 71%. No definitive pacemaker was needed. There was no peripheral vascular complication. Overall mortality was 42%. CONCLUSION: The transapical implantation of cathetermounted bioprosthesis was a feasible procedure. Long term follow-up is mandatory in order to access efficacy and indications.

  9. Safety and efficacy of using the Viabahn endoprosthesis for percutaneous treatment of vascular access complications after transfemoral aortic valve implantation.

    Science.gov (United States)

    De Backer, Ole; Arnous, Samer; Sandholt, Benjamin; Brooks, Matthew; Biasco, Luigi; Franzen, Olaf; Lönn, Lars; Bech, Bo; Søndergaard, Lars

    2015-04-15

    Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI-induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients. PMID:25728645

  10. Introducing transapical aortic valve implantation (part 1): Effect of a structured training program on clinical outcome in a series of 500 procedures

    OpenAIRE

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

    2013-01-01

    OBJECTIVES: The purpose of the present study was to test whether the cumulative knowledge from the field of transapical transcatheter aortic valve implantation, when incorporated into a structured training and then gradually dispersed by internal proctoring, might eliminate the negative effect of the learning curve on the clinical outcomes. METHODS: The present study was a retrospective, single-center, observational cohort study of prospectively collected data from all 500 consecutive high-ri...

  11. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... see we've used the cautery to achieve access to the sternum. On the left hand side ... wound, which allows us to get more ready access to the aorta and the aortic valve. The ...

  12. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... for patients who would not tolerate well a traditional open operation or a less invasive operation, as ... physical reserve. So Barbara Bush recently had a traditional aortic valve replacement surgery. What makes a patient ...

  13. CONGENITAL QUADRICUSPID AORTIC-VALVE

    NARCIS (Netherlands)

    BROUWER, MHJ; DEGRAAF, JJ; EBELS, T

    1993-01-01

    Two patients with a quadricuspid aortic valve are described, one of them with concomitant juxtaposed coronary orifices facing the right hand facing sinus. The etiology and incidence of this congenital anomaly will be discussed.

  14. [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

  15. Maximizing prosthetic valve size with the Top Hat supra-annular aortic valve

    DEFF Research Database (Denmark)

    Aagaard, Jan; Geha, Alexander S.

    2007-01-01

    BACKGROUND AND AIM OF THE STUDY: The CarboMedics Top Hat supra-annular aortic valve allows a one-size (and often two-size) increase over the standard intra-annular valve. This advantage should minimize the risk of patient-prosthesis mismatch, where the effective prosthetic valve orifice area...... is less than that of a normal valve. It is suggested that the ability to implant Top Hat valves having greater size, relative to standard intra-annular valves, may currently be under-utilized. Further, there has been some concern that Top Hat implantation can cause obstruction of the coronary ostia....... This study evaluates the authors' clinical experience with Top Hat supra-annular aortic valve size selection, and the technical aspects of implantation. METHODS: Between January 1999 and October 2005, a total of 251 consecutive patients underwent 252 aortic valve replacements with Top Hat supra...

  16. Remote actuated valve implant

    Science.gov (United States)

    McKnight, Timothy E; Johnson, Anthony; Moise, Jr., Kenneth J; Ericson, Milton Nance; Baba, Justin S; Wilgen, John B; Evans, III, Boyd McCutchen

    2014-02-25

    Valve implant systems positionable within a flow passage, the systems having an inlet, an outlet, and a remotely activatable valve between the inlet and outlet, with the valves being operable to provide intermittent occlusion of the flow path. A remote field is applied to provide thermal or magnetic activation of the valves.

  17. Remote actuated valve implant

    Energy Technology Data Exchange (ETDEWEB)

    McKnight, Timothy E.; Johnson, Anthony; Moise, Kenneth J.; Ericson, Milton Nance; Baba, Justin S.; Wilgen, John B.; Evans, Boyd Mccutchen

    2016-05-10

    Valve implant systems positionable within a flow passage, the systems having an inlet, an outlet, and a remotely activatable valve between the inlet and outlet, with the valves being operable to provide intermittent occlusion of the flow path. A remote field is applied to provide thermal or magnetic activation of the valves.

  18. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease

    DEFF Research Database (Denmark)

    Mylotte, Darren; Lefevre, Thierry; Søndergaard, Lars;

    2014-01-01

    BACKGROUND: Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV). OBJECTIVES: This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV. METHODS......: We retrospectively collected baseline characteristics, procedural data, and clinical follow-up findings from 12 centers in Europe and Canada that had performed TAV-in-BAV. RESULTS: A total of 139 patients underwent TAV-in-BAV with the balloon-expandable transcatheter heart valve (THV) (n = 48...

  19. General anaesthesia vs. conscious sedation for transfemoral aortic valve implantation: a single UK centre before-and-after study.

    Science.gov (United States)

    Miles, L F; Joshi, K R; Ogilvie, E H; Densem, C G; Klein, A A; O'Sullivan, M; Martinez, G; Sudarshan, C D; Abu-Omar, Y; Irons, J F

    2016-08-01

    Reported data suggest that 99% of transfemoral, transcatheter aortic valve implantations in the UK are performed under general anaesthesia. This before-and-after study is the first UK comparison of conscious sedation vs. general anaesthesia for this procedure. Patients who underwent general anaesthesia received tracheal intubation, positive pressure ventilation, radial arterial and central venous access and urinary catheterisation. Anaesthesia was maintained with propofol or sevoflurane. Patients who received conscious sedation had a fascia iliaca and ilioinguinal nerve block and low-dose remifentanil infusion, without invasive monitoring or urinary catheterisation. Recruitment took place between August 2012 and July 2015, with a 6-month crossover period between November 2013 and June 2014. A total of 88 patients were analysed, evenly divided between the two groups. Patients receiving conscious sedation had a shorter anaesthetic time (mean (SD) 121 (28) min vs. 145 (41) min; p < 0.001) and recovery room time (110 (50) min vs. 155 (48) min; p = 0.001), lower requirement for inotropes (4.6% vs 81.8%; OR (95% CI) 0.1 (0.002-0.050); p < 0.001) and a lower incidence of malignant dysrhythmia (0% vs 11.4%; p = 0.020). Conscious sedation appears a feasible alternative to general anaesthesia for this procedure and is associated with a reduced requirement for inotropic support and improved efficiency. PMID:27353456

  20. Treatment of aortic stenosis with a self-expanding transcatheter valve

    DEFF Research Database (Denmark)

    Linke, Axel; Wenaweser, Peter; Gerckens, Ulrich;

    2014-01-01

    AIM: Transcatheter aortic valve implantation has become an alternative to surgery in higher risk patients with symptomatic aortic stenosis. The aim of the ADVANCE study was to evaluate outcomes following implantation of a self-expanding transcatheter aortic valve system in a fully monitored, mult...

  1. When a Mechanical Valve Goes Freestyle: A Patient Tailored Valve-In-Valve Implantation.

    Science.gov (United States)

    François, J; Cathenis, K; Hamerlijnck, R

    2015-01-01

    In case of a redo operation after a full root replacement there are two possible options: replacing the entire root or performing a more conservative valve-in-valve implantation. Regarding the relatively high morbidity and mortality of a redo root replacement, the valve-in-valve implantation is the preferred choice if technically feasible. We present the case of a valve-in-valve implantation with a St. Jude mechanical valve in a Medtronic bioprosthesis in a 57-year old man. Follow-up echocardiography after 1 month showed a mean gradient of 17 mmHg and no paravalvular leakage. The combination of a St. Jude bileaflet mechanical valve implanted in a Freestyle root prosthesis has not been described. This case shows that patient tailored treatment with a St. Jude bileaflet mechanical valve in a Freestyle aortic root valve can be safely performed and might be the preferred choice for younger patients, if technically feasible. PMID:26560005

  2. Prognostic value of the ratio between prosthesis area and indexed annulus area measured by MultiSlice-CT for transcatheter aortic valve implantation procedures

    Science.gov (United States)

    Debry, Nicolas; Sudre, Arnaud; Elquodeimat, Ibrahim; Delhaye, Cédric; Schurtz, Guillaume; Bical, Antoine; Koussa, Mohamad; Fattouch, Khalil; Modine, Thomas

    2016-01-01

    Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation (TAVI) procedures remain an issue. Benefit of oversizing strategies to prevent them isn't well established. We compared different level of oversizing in our cohort of consecutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT (MSCT) and the procedures were achieved using Edwards Sapien® or Corevalve devices®. Retrospectively, according to pre-procedural MSCT and the valve size, patients were classified into three groups: normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium (VARC-2) endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve®. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker (PM) implantation rate was significantly higher in the severe oversizing group (P = 0.03), while we observed more in-hospital congestive heart-failure (P = 0.02) in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation (AR) in the normal sizing group (P = 0.07). Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival. PMID:27582762

  3. [Heart valves after 22 years - good long-term function of aortic homograft, advanced impairment in function of atrioventricular valves].

    Science.gov (United States)

    Michalski, Błazej; Chrzanowski, Lukasz; Krzemińska-Pakula, Maria; Kasprzak, Jarosław D

    2010-03-01

    We report a case of a 61-year-old female patient with a history of aortic valve replacement, who was admitted to our hospital with symptoms and signs of decompensated heart failure (NYHA class III). Transthoracic echocardiogram revealed mitral valve and tricuspid valve regurgitation (III grade) with normal function of aortic valve homograft implanted 22 years ago. The patient underwent cardiosurgical mitral valve replacement and tricuspid valve annuloplasty with very good result. An aortic valve homograft may be the best alternative to a mechanical valves for a young female patients. PMID:20411462

  4. Aortic Valve Disease

    Science.gov (United States)

    ... valve opens when the left ventricle squeezes to pump out blood, and closes in between heart beats to keep ... the left ventricle has to work harder to pump blood out through the valve. To do this extra ...

  5. Reoperative transapical transcatheter aortic valve replacement for central aortic regurgitation.

    Science.gov (United States)

    Zhu, Yuanjia; Kapadia, Samir; Krishnaswamy, Amar; Svensson, Lars G; Mick, Stephanie

    2016-09-01

    Paravalvular leak-related aortic regurgitation after transcatheter aortic valve replacement (TAVR) is a common complication and is associated with increased short- and long-term mortality. However, the impact of isolated central aortic regurgitation is unknown. We report a case of transapical (TA) TAVR with postprocedural central aortic regurgitation, who returned after two years with progression of regurgitation. A reoperative valve-in-valve TA-TAVR was performed. PMID:27405799

  6. Implante de bioprótese aórtica "stentless" em pacientes com alterações do anel aórtico Aortic valve replacement with a stentless bioprosthesis in patients with weakened aortic annulus

    Directory of Open Access Journals (Sweden)

    Bayard Gontijo Filho

    1993-06-01

    Full Text Available Dezessete pacientes portadores de doença da valva aórtica associada a alterações estruturais do anel aórtico foram submetidos a implante de bioprótese aórtica "stentless" (Biocór: 8 pacientes eram portadores de endocardite bacteriana, sendo 3 em valva aórtica e 5 em próteses. Os demais pacientes eram portadores de próteses aórticas disfuncionantes. A técnica de implante foi basicamente a mesma, utilizandose dois níveis de sutura, sendo o primeiro ao nível do anel aórtico e o outro na parede aórtica. Em 11 pacientes a aorta ascendente foi ampliada com remendo de pericárdio bovino e 3 pacientes foram submetidos, também, a substituição valvar mitral. Houve 1 óbito hospitalar no 23º dia de pós-operatório por falência de múltiplos órgãos em 1 paciente portador de endocardite bacteriana e quadro de AVC pré-operatório. Dois pacientes necessitaram implante de marcapasso definitivo. Na evolução tardia houve apenas 1 óbito no 6º mês, de forma súbita, em uma criança portadora de marcapasso. Um paciente desenvolveu deiscência parcial da bioprótese na sutura inferior, o que gerou um gradiente na via de saída do ventrículo esquerdo, sendo reoperado com sucesso de 18º mês de pós-operatório. Todos os pacientes encontram-se em controle ambulatorial, com estudos ecocardiográficos seriados, que demonstram excelente desempenho da bioprótese "stentless" sem gradientes transvalvares importantes e ausência de regurgitação aórtica significativa.An aortic stentless bioprosthesis (Biocor Ind. was implanted in 17 patients with difficult aortic annulus due either to endocarditis orto a previous aortic valve replacement. Native valve endocarditis was present in 3 patients and prosthetic valve endocarditis in 5; 9 patients had one or more previous aortic valve replacements showing a wheakened aortic rim. The stentless bioprosthesis was implanted with a two layers suture technique similar to a homograft implant. The

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

    OpenAIRE

    Cai, Jianzhi; Huang, Haitao; Zhou, Yongxin; Mei, YunQing; Shao, Jie; Wang, Yongwu

    2013-01-01

    Background To evaluated the feasibility and safety of new aortic valved stents in transcatheter aortic valve implantation (TAVI) using retrograde approach by in vitro testing and animal implantation. Materials and Methods The fluid passing test, expanding and releasing tests, static and releasing tests in tube were performed for new valved stents. Transvalvular pressure gradient, effective orifice area, pre-implantation and post-implantation regurgitant volume for the new stents were detected...

  8. Giant Thoracic Aneurysm Following Valve Replacement for Bicuspid Aortic Valve.

    Science.gov (United States)

    Tran, Cao; Ul Haq, Ehtesham; Nguyen, Ngoc; Omar, Bassam

    2015-01-01

    Bicuspid aortic valve is a common congenital anomaly associated with aortopathy, which can cause aortic root dilatation, necessitating regular screening if the aortic root is > 4.0 cm. Despite the low absolute incidence of aortic complications associated with bicuspid aortic valve in the general population, the consequences of such complications for an individual patient can be devastating. Herein we propose a balanced algorithm that incorporates recommendations from the three major guidelines for follow-up imaging of the aortic root and ascending thoracic aorta in patients with a bicuspid aortic valve, maintaining the current recommendations with regard to surgical thresholds. PMID:26827748

  9. Pharmacodynamic Effect of Clopidogrel in Patients Undergoing Transcatheter Aortic Valve Implantation

    Directory of Open Access Journals (Sweden)

    Petr Tousek

    2013-01-01

    Full Text Available The aim of this study was to analyze periprocedural and mid-term effect of clopidogrel on platelet function using the VerifyNow P2Y12 point-of-care assay in patients undergoing TAVI. Platelet reactivity was measured at the beginning of the procedure after 300 mg clopidogrel bolus administration and during the follow-up (at 1 month after the procedure in 52 patients undergoing TAVI using the Medtronic CoreValve prosthesis (Medtronic CoreValve. A cutoff value of 240 PRU was used to identify nonresponders to clopidogrel treatment with high residual platelet reactivity (HRPR. Baseline HRPR was identified in 80% of patients and in 72% of patients during 6-month follow-up. There was no significant difference in the pharmacodynamic effects of clopidogrel on platelet reactivity from baseline to 6-months follow-up (297±57 vs. 275±62; P=0.058. Ischemic event occurred only in 3 patients (5.8% from the study group. In conclusion, majority of patients undergoing TAVI had high residual platelet reactivity after pretreatment with 300 mg of clopidogrel and during the 6-month follow-up at dual antiplatelet treatment. The noneffectiveness of clopidogrel in the TAVI population raises the question of the routine use of dual antiplatelet treatment in this setting.

  10. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    Science.gov (United States)

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR. PMID:27295772

  11. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    Science.gov (United States)

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR.

  12. Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices

    Directory of Open Access Journals (Sweden)

    Ladd Mark E

    2010-10-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve® including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve® prosthesis as an initial step towards real-time CMR-guided TAVI. Methods The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T1-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding. Results CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences. Conclusions The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement

  13. New St. Jude Medical Portico™ transcatheter aortic valve: features and early results.

    Science.gov (United States)

    Spence, M S; Lyons, K; McVerry, F; Smith, B; Manoharan, G B; Maguire, C; Doherty, R; Anderson, L; Morton, A; Hughes, S; Hoeritzauer, I; Manoharan, G

    2013-06-01

    Patients with symptomatic aortic valve disease who are inoperable or have high surgery-related risks may be treated with transcatheter aortic valve implantation devices. With this method increasingly applied, device innovations are aimed at achieving improved procedural results and therapeutic outcome. This paper describes the innovations implemented in the St. Jude Medical Portico™ system for transcatheter aortic valve implantation, the application of this system and initial clinical experience. PMID:23681129

  14. Comparison of Outcomes of Transfemoral Transcatheter Aortic Valve Implantation Using a Minimally Invasive Versus Conventional Strategy.

    Science.gov (United States)

    Attizzani, Guilherme F; Alkhalil, Ahmad; Padaliya, Bimal; Tam, Chor-Cheung; Lopes, Joao Pedro; Fares, Anas; Bezerra, Hiram G; Medallion, Benjamin; Park, Soon; Deo, Salil; Sareyyupoglu, Basar; Parikh, Sahil; Zidar, David; Elgudin, Yakov; Popovich, Kehllee; Davis, Angela; Staunton, Elizabeth; Tomic, Ana; Mazzurco, Stacey; Avery, Edward; Markowitz, Alan; Simon, Daniel I; Costa, Marco A

    2015-12-01

    Some centers, mostly in Europe, have demonstrated the feasibility of a minimally invasive strategy (MIS; i.e., local anesthesia and conscious sedation, performed in the cath laboratory without transesophageal echocardiography guidance). Nonetheless, the experience of MIS for TAVI using both commercially available valves is lacking in the United States. We, therefore, retrospectively studied all transfemoral TAVI cases performed at our institution between March 2011 and November 2014 to assess the safety and efficacy of MIS. Patients were dichotomized according to the strategy (MIS vs conventional strategy [CS]) used for the procedure. One hundred sixteen patients were included in the MIS group and 91 patients were included in the CS group. Baseline characteristics were similar, and procedural success was comparable (99.1% in MIS and 98.9% in CS, p = 1). One intraprocedural death occurred in each group, whereas conversion rates to general anesthesia were low (3.4%). Comparable device success was obtained. Rates of complications and >mild paravalvular leak before discharge were low and comparable. Length of hospital stay was significantly reduced in the MIS (median, 3.0 [2.0 to 5.0] days) compared with than that in CS group (median 6.0 days [3.5, 8.0]). At a median follow-up of 230 days, no significant difference in survival rate was detected (89% vs 88%, p = 0.9). On average, MIS was associated with remarkable cost saving compared with CS ($16,000/case). In conclusion, TAVI through MIS was associated with a shorter postprocedural hospital stay, lower costs, and similar safety profile while keeping procedural efficacy compared with CS. PMID:26433275

  15. 新型带瓣膜主动脉瓣球囊扩张支架的研制及测试%A novel balloon-expandable valved stents for transcatheter aortic valve implantation: preparation and testing

    Institute of Scientific and Technical Information of China (English)

    陈翔; 谭洪文; 张志钢; 朱玉峰; 赵仙先; 秦永文; 马丽萍

    2013-01-01

    Objective To evaluate the functions of a new balloon-expandable valved stent for transcatheter aortic valve implantation and the delivery system,so as to provide evidence for future animal study.Methods A new tube-like balloonexpandable valved stent was designed and made of cobalt-base alloys.Bovine pericardium was sutured by hand into the stent to prepare valved aortic stent,which was placed on the instrument to test the pulsating flow and fatigue property of prosthetic valve.The valved stent,which was compressed on a balloon catheter and pulled into a delivery sheath,was placed in the native aortic valve of isolated goat heart via the ascending aorta,and water was injected into the ascending aorta by a silicon tube to evaluate the competence of the prosthetic heart valves.Results Plusating flow examination showed that the artificial valve opened and closed well,without noticeable reflow,and accorded with human physiology.The prosthetic heart valves also performed well in the testing of fatigue property.The valved stent could be stably placed in the native valves of goat heart by delivery sheath,and the prosthetic heart valves showed satisfactory function.Conclusion The aortic valved stent is welldesigned and has satisfactory function.It can be used for animal study of transcathetcr aortic valve implantation.%目的 通过体外测试评价新型带瓣膜主动脉瓣球囊扩张支架及输送装置的各项性能,为下一步动物体内实验提供依据.方法 支架材料采用钴基合金,设计成圆柱形网状结构.人工瓣膜取材于经处理的新鲜牛心包,将人工瓣膜缝合在支架上制成带瓣膜主动脉支架.使用人工心脏瓣膜脉动流测试仪和人工心脏瓣膜加速疲劳测试仪,分别对带瓣膜支架瓣叶材料脉动流和人工瓣膜耐疲劳情况进行测试.将带瓣膜支架压缩至自行研制的输送装置的球囊上,取离体羊心脏标本,经升主动脉将支架直视下置入

  16. Implante transcateter de valva aórtica: resultados atuais do desenvolvimento e implante de um nova prótese brasileira Transcatheter aortic valve implantation: results of the current development and implantation of a new Brazilian prosthesis

    Directory of Open Access Journals (Sweden)

    Diego Felipe Gaia

    2011-09-01

    Full Text Available OBJETIVO: A troca valvar aórtica é procedimento rotineiro com risco aceitável. Em alguns casos, a mortalidade é elevada, contraindicando o procedimento. O implante minimamente invasivo transcateter de valva aórtica parece ser alternativa, reduzindo a morbimortalidade. A avaliação dos resultados clínicos, segurança e eficácia do procedimento são o objetivo desse estudo. MÉTODOS: Uma prótese transcateter, balão expansível foi utilizada em 33 casos de alto risco. EuroScore médio foi de 39,30% e STS score de 30,28%. Oito pacientes apresentavam disfunção de bioprótese e o restante, estenose aórtica calcificada. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Através de minitoracotomia esquerda, as próteses foram implantadas pelo ápice ventricular, sob estimulação de alta frequência ou choque hemorrágico. Foram realizados controles clínicos e ecocardiográficos. RESULTADOS: A correta liberação da prótese foi possível em 30 casos. Três conversões ocorreram. A mortalidade operatória foi de um caso e a mortalidade em 30 dias, 18,18%. O gradiente médio reduziu de 43,58 para 10,54 mmHg. A fração de ejeção apresentou aumento significativo após o 7º pós-operatório. Insuficiência aórtica residual esteve presente em 30,30% dos pacientes. Ocorreu uma complicação vascular periférica e um caso de bloqueio atrioventricular total. Um paciente apresentou acidente vascular cerebral. A mortalidade em 30 dias foi de 18,18%. CONCLUSÃO: O implante transapical de valva aórtica transcateter é procedimento seguro e com resultados de médio prazo satisfatórios. São necessários estudos de longo prazo com maior poder amostral no intuito de determinar resultado hemodinâmico, qualidade de vida e sobrevida em longo prazoOBJECTIVE: Aortic valve replacement is a routine procedure with acceptable risk, but in some cases, such risk can justify contraindication

  17. Balloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis.

    Science.gov (United States)

    Nwaejike, Nnamdi; Mills, Keith; Stables, Rod; Field, Mark

    2015-03-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with severe aortic stenosis, can balloon valvuloplasty be used as a bridge to aortic valve replacement? Altogether 463 papers were found using the reported search, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that balloon aortic valvuloplasty is recommended as a bridge to aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic aortic stenosis. Institutional practices, local and logistic factors can affect patient selection and management approaches to severe aortic stenosis, but having the facility to offer balloon aortic valvuloplasty (especially in the TAVI era) provides another management option for patients who would otherwise have been considered unacceptably high risk for aortic valve surgery. The increased incidence of balloon aortic valvuloplasty mirrors the increase in the use of TAVI with a sharp increase in activity from 2006. Success rates for bridging from balloon aortic valvuloplasty to definite surgical intervention are in the range 26.3-74%, with AVR or TAVI occurring within 8 weeks to 7 months. Complications from balloon aortic valvuloplasty such as aortic regurgitation (AR) can be managed successfully. Up to 40% of patients selected by balloon aortic valvuloplasty to have TAVI or AVR do not have these procedures within 2 years. While most of these patients are excluded for objective clinical reasons such as terminal disease/malignancy or other persistent contraindication, some patients refuse definitive treatment and others die while on the waiting list. Outcomes in patients bridged to AVR/TAVI are better than in patients treated with balloon aortic valvuloplasty

  18. Valve-in-Valve Replacement Using a Sutureless Aortic Valve

    Science.gov (United States)

    Dohmen, Pascal M.; Lehmkuhl, Lukas; Borger, Michael A.; Misfeld, Martin; Mohr, Friedrich W.

    2016-01-01

    Patient: Female, 61 Final Diagnosis: Tissue degeneration Symptoms: Dyspnea Medication: — Clinical Procedure: Redo valve replacement Specialty: Surgery Objective: Rare disease Background: We present a unique case of a 61-year-old female patient with homograft deterioration after redo surgery for prosthetic valve endocarditis with root abscess. Case Report: The first operation was performed for type A dissection with root, arch, and elephant trunk replacement of the thoracic aorta. The present re-redo surgery was performed as valve-in-valve with a sutureless aortic biopros-thesis. The postoperative course was uneventful and the patient was discharged on day 6. Conclusions: The current case report demonstrates that sutureless bioprostheses are an attractive option for surgical valve-in-valve procedures, which can reduce morbidity and mortality. PMID:27694795

  19. Percutaneous aortic valve replacement using a W-model valved stent: a preliminary feasibility study in sheep

    Institute of Scientific and Technical Information of China (English)

    BAI Yuan; ZONG Gang-jun; WANG Yan-yan; JIANG Hai-bin; LI Wei-ping; WU Hong; ZHAO Xian-xian; QIN Yong-wen

    2009-01-01

    Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common lilac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic intima, or of obstruction of the coronary orifice.Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period.

  20. Acute aortic valve prolapse in Marfan's syndrome.

    OpenAIRE

    Carr, N J; Cullen, S. A.

    1991-01-01

    A 22 year old man with Marfan's syndrome died suddenly following acute aortic valve prolapse. Although aortic root involvement in Marfan's syndrome is common, we have found no previous description of this particular complication in the literature.

  1. MARFAN SYNDROME AND QUADRICUSPID AORTIC VALVE

    OpenAIRE

    Sürücü, Hüseyin; ÇİMEN, Sadi

    2013-01-01

    ABSTRACTWhile the major cardiovascular manifestation in Marfan syndrome is a progressive dilatation of the ascending aorta, leading to aortic aneurysm formation and eventually to fatal aortic rupture or dissection, mitral valve prolapse and calcification of the mitral valve annulus, dilatation of the main pulmonary artery may be seen. There was no knowledge about the association of Marfan syndrome and quadricuspid aortic valve. In this case report, we aimed to declare this association between...

  2. Technical aspects of implanting the St. Jude Toronto stentless porcine valve.

    OpenAIRE

    Reardon, M J; Conklin, L D; Estrera, A L

    1999-01-01

    Stentless xenograft aortic valves were designed to provide superior hemodynamic characteristics and durability, in comparison with stented tissue valves. The senior author (MJR) has implanted 46 St. Jude Toronto stentless porcine valves--with excellent hemodynamic results and no aortic insufficiency--since this valve was released by the Food and Drug Administration in November 1997. Because the implantation technique is significantly different from that of implanting a stented valve, and beca...

  3. Impact on Left Ventricular Function and Remodeling and on 1-Year Outcome in Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Carrabba, Nazario; Valenti, Renato; Migliorini, Angela; Marrani, Marco; Cantini, Giulia; Parodi, Guido; Dovellini, Emilio Vincenzo; Antoniucci, David

    2015-07-01

    Conflicting results have been reported about the prognostic impact of left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the impact of LBBB after TAVI on left ventricular (LV) function and remodeling and on 1-year outcomes. Of 101 TAVI patients, 9 were excluded. All complications were evaluated according to the Valve Academic Research Consortium 2 definition. Of 92 patients, 34 developed LBBB without more advanced myocardial damage or inflammation biomarkers in comparison with patients without LBBB. The only predictor of new LBBB was larger baseline LV end-diastolic volume. LBBB plus advanced atrioventricular block was strongly correlated with permanent pacemaker implantation (p reverse remodeling at 1 year. The development of acute kidney injury and the logistic European System for Cardiac Operative Risk Evaluation score were associated with poor outcomes (all-cause mortality and heart failure) (hazard ratio 6.86, 95% confidence interval 2.51 to 18.74, p <0.0001, and hazard ratio 1.04, 95% confidence interval 1.01 to 1.08, p = 0.021, respectively), but not LBBB. In conclusion, after TAVI, 37% of patients developed new LBBB without more advanced myocardial damage or inflammation biomarkers. LBBB was associated with a higher rate of permanent pacemaker implantation, which negatively affected the recovery of LV systolic function. The development of acute kidney injury, rather than LBBB, increases the 1-year risk for mortality and hospitalization for heart failure. PMID:25937352

  4. 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.

  5. Value of the "TAVI2-SCORe" versus surgical risk scores for prediction of one year mortality in 511 patients who underwent transcatheter aortic valve implantation.

    Science.gov (United States)

    Debonnaire, Philippe; Fusini, Laura; Wolterbeek, Ron; Kamperidis, Vasileios; van Rosendael, Philippe; van der Kley, Frank; Katsanos, Spyridon; Joyce, Emer; Tamborini, Gloria; Muratori, Manuela; Gripari, Paola; Bax, Jeroen J; Marsan, Nina Ajmone; Pepi, Mauro; Delgado, Victoria

    2015-01-15

    A bedside-available transcatheter aortic valve implantation (TAVI)-dedicated prognostic risk score is an unmet clinical need. We aimed to develop such a risk score predicting 1-year mortality post-TAVI and to compare it with the performance of the logistic EuroSCORE (LES) I and LES-II and the Society of Thoracic Surgeons' (STS) score. Baseline variables of 511 consecutive patients who underwent TAVI that were independently associated with 1-year mortality post-TAVI were included in the "TAVI2-SCORe." Discrimination and calibration abilities of the novel score were assessed and compared with surgical risk scores. One-year mortality was 17.0% (n = 80 of 471). Porcelain thoracic aorta (hazard ratio [HR] 2.56), anemia (HR 2.03), left ventricular dysfunction (HR 1.98), recent myocardial infarction (HR 3.78), male sex (HR 1.81), critical aortic valve stenosis (HR 2.46), old age (HR 1.68), and renal dysfunction (HR 1.76) formed the TAVI2-SCORe (all p 0.05, Hosmer-Lemeshow statistic 0.304), suggesting superior calibration performance. In conclusion, the TAVI2-SCORe is an accurate, simple, and bedside-available score predicting 1-year mortality post-TAVI, outperforming conventional surgical risk scores for this end point. PMID:25432413

  6. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Ming Li

    2012-01-01

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

  7. Using Clinical Decision Support and Dashboard Technology to Improve Heart Team Efficiency and Accuracy in a Transcatheter Aortic Valve Implantation (TAVI) Program.

    Science.gov (United States)

    Clarke, Sarah; Wilson, Marisa L; Terhaar, Mary

    2016-01-01

    Heart Team meetings are becoming the model of care for patients undergoing transcatheter aortic valve implantations (TAVI) worldwide. While Heart Teams have potential to improve the quality of patient care, the volume of patient data processed during the meeting is large, variable, and comes from different sources. Thus, consolidation is difficult. Also, meetings impose substantial time constraints on the members and financial pressure on the institution. We describe a clinical decision support system (CDSS) designed to assist the experts in treatment selection decisions in the Heart Team. Development of the algorithms and visualization strategy required a multifaceted approach and end-user involvement. An innovative feature is its ability to utilize algorithms to consolidate data and provide clinically useful information to inform the treatment decision. The data are integrated using algorithms and rule-based alert systems to improve efficiency, accuracy, and usability. Future research should focus on determining if this CDSS improves patient selection and patient outcomes. PMID:27332170

  8. Impact of Mean Platelet Volume on Combined Safety Endpoint and Vascular and Bleeding Complications following Percutaneous Transfemoral Transcatheter Aortic Valve Implantation

    Science.gov (United States)

    Magri, Caroline J.; Chieffo, Alaide; Durante, Alessandro; Latib, Azeem; Maisano, Francesco; Cioni, Michela; Agricola, Eustachio; Covello, Remo Daniel; Gerli, Chiara; Franco, Annalisa; Spagnolo, Pietro; Alfieri, Ottavio; Colombo, Antonio

    2013-01-01

    Background. Vascular and bleeding complications remain important complications in patients undergoing percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI). Platelets play an important role in bleeding events. Mean platelet volume (MPV) is an indicator of platelet activation. The objective of this study was to assess whether low MPV is an indicator of major vascular and bleeding complications following TF-TAVI. Methods. A retrospective cohort study of 330 subjects undergoing TF-TAVI implantation was performed. The primary study endpoint was the occurrence of combined safety endpoint (CSEP); secondary endpoints included major vascular complications and life-threatening bleeding. Endpoints were defined according to Valve Academic Research Consortium 2. Results. The CSEP at 30 days was reached in 30.9%; major vascular complications were observed in 14.9% while life-threatening bleeding occurred in 20.6%. Logistic Euroscore and MPV were independent predictors of CSEP. Predictors of vascular complications were female sex, previous myocardial infarction, red blood cell distribution width (RDW), and MPV while predictors of life-threatening bleeding were peripheral arterial disease, RDW, and MPV. Conclusion. A low baseline MPV was shown for the first time to be a significant predictor of CSEP, major vascular complications, and life-threatening bleeding following TF-TAVI. PMID:24455712

  9. Impact of Mean Platelet Volume on Combined Safety Endpoint and Vascular and Bleeding Complications following Percutaneous Transfemoral Transcatheter Aortic Valve Implantation

    Directory of Open Access Journals (Sweden)

    Caroline J. Magri

    2013-01-01

    Full Text Available Background. Vascular and bleeding complications remain important complications in patients undergoing percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI. Platelets play an important role in bleeding events. Mean platelet volume (MPV is an indicator of platelet activation. The objective of this study was to assess whether low MPV is an indicator of major vascular and bleeding complications following TF-TAVI. Methods. A retrospective cohort study of 330 subjects undergoing TF-TAVI implantation was performed. The primary study endpoint was the occurrence of combined safety endpoint (CSEP; secondary endpoints included major vascular complications and life-threatening bleeding. Endpoints were defined according to Valve Academic Research Consortium 2. Results. The CSEP at 30 days was reached in 30.9%; major vascular complications were observed in 14.9% while life-threatening bleeding occurred in 20.6%. Logistic Euroscore and MPV were independent predictors of CSEP. Predictors of vascular complications were female sex, previous myocardial infarction, red blood cell distribution width (RDW, and MPV while predictors of life-threatening bleeding were peripheral arterial disease, RDW, and MPV. Conclusion. A low baseline MPV was shown for the first time to be a significant predictor of CSEP, major vascular complications, and life-threatening bleeding following TF-TAVI.

  10. Transcatheter Aortic Valve Replacement in Europe

    DEFF Research Database (Denmark)

    Mylotte, Darren; Osnabrugge, Ruben L J; Windecker, Stephan;

    2013-01-01

    The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy.......The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy....

  11. Recently patented transcatheter aortic valves in clinical trials.

    Science.gov (United States)

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

    2013-12-01

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

  12. 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

  13. 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...

  14. Aortic valve surgery: what is the future?

    Science.gov (United States)

    Hudorović, Narcis

    2008-04-01

    Modern surgical treatment for aortic valve disease has undergone significant improvements in all areas of this procedure. Successful treatment strategies for cardiovascular diseases have often been initiated and driven by surgeons. Radical excision of diseased tissue, repair and replacement strategies lead to long-term successful treatment of the underlying diseases and clearly improved patient outcome. In highly developed nations, valve surgery will be increasing applied in older people, with more co-morbidities and a higher incidence of concomitant coronary artery disease. Cardiovascular surgeons will be facing increased competition from the catheter-based procedures; these are already applied clinically, and their numbers will rise in near future. Right now interventional cardiologists supported by some cardiac surgeons are on their way to transform some conventional open surgical procedures into catheter-based less invasive interventions, such as valve repair and replacement. Cardiovascular surgery is undergoing a rapid transformation; socio-economic factors and recent advances in medical technology contribute to these changes. Further developments will come, and surgeons with all their expertise in the treatment of valvular heart disease need to be part of it. Cardiovascular surgeons have to adapt the exciting new approaches of transapical and transfemoral transcatheter valve implantation techniques. PMID:17573248

  15. Quadricuspid aortic valve with ruptured sinus of Valsalva.

    Science.gov (United States)

    Akerem Khan, Shamruz Khan; Tamin, Syahidah Syed; Burkhart, Harold M; Araoz, Philip A; Young, Phillip M

    2013-02-01

    We present a case of a 24-year-old woman who was diagnosed with quadricuspid aortic valve with ruptured sinus of Valsalva. Quadricuspid aortic valve is a rare congenital cardiac anomaly. The recognition of quadricuspid aortic valve has clinical significance as it causes aortic valve dysfunction, and is often associated with other congenital cardiac abnormalities. We showed the important role of multimodality imaging in diagnosing a quadricuspid aortic valve associated with ruptured sinus of Valsalva. PMID:22874066

  16. Radiotherapy-induced aortic valve disease associated with porcelain aorta

    International Nuclear Information System (INIS)

    Mediastinal irradiation has been reported to induce cardiac disease such as pericarditis, valvular dysfunction, conduction abnormalities, accelerated arteriosclerosis of the coronary arteries, and also calcifications of the ascending aorta. We herein describe a case of radiotherapy-induced porcelain aorta and aortic valve disease and their surgical treatment. The patient was diagnosed with myasthenia gravis (MG) in 1965 (Osserman's type II), and mediastinal irradiation was performed in 1970 for treatment of thymic tumor associated with MG. Thirty years after radiation therapy, complete atrioventricular block and aortic valve disease with severe calcification of the ascending aorta and aortic arch (porcelain aorta) were detected on echo cardiogram and cardiac catheterization. A permanent pacemaker was implanted via the left subclavian vein and aortic valve replacement was performed under extracorporeal circulation established by selective cerebral perfusion and balloon occlusion instead of aortic cross-clamping. As no risk factors of arteriosclerosis such as hypercholesterolemia, hyperglycemia and hypertension were apparent, we concluded that the aortic valve disease and porcelain aorta were primarily induced by radiotherapy. (author)

  17. Properties of stentless porcine aortic valve for single-layer suture and implantation%适宜单层缝合置入的无支架猪主动脉瓣膜性能评价

    Institute of Scientific and Technical Information of China (English)

    徐殊; 韩宏光; 王辉山

    2013-01-01

    BACKGROUND:The artificial heart valve used in clinical application can be divided into stented and stentless. Stented valve is convenient for operations, with a low possibility of incompetency after transplantation. However stented valve cannot stimulate natural valve. OBJECTIVE:To reduce valve implantation time and improve valve properties, this study was designed to develop a new stentless porcine aortic valve for single-layer suture and implantation based on the design of valve in pig aortic root geometry optimization, and to further evaluate its performance by in vitro test. METHODS:(1) Stentless porcine aortic valve for single-layer suture was prepared. (2) The in vitro valve implantation experiment was performed with monolayer suture method. (3) The valve was detected by in vitro fluid mechanics test and fatigue test. RESULTS AND CONCLUSION:Stentless valve for single-layer suture has removed the valve hard, which contributes to reduce the damaged caused by blood flow on the valve leaflet, at the same time removal of the hard valve ring can widen the diameter of implanted valve and improve hemodynamics, even the implantation time of valve is shorter than traditional double-layer suture. The in vitro fluid mechanics test and fatigue test results are satisfactory. The future research lies in a complete elucidation of long operation time, postoperative long-term clinical efficacy and durability of stentless valve implantation.%背景:现有的生物瓣膜主要分为有支架和无支架两种。有支架瓣膜方便了手术操作,容易植入,植入后发生关闭不全的可能性小,但这种瓣膜并没有很好的模拟天然瓣膜。目的:为缩短瓣膜植入时间,进一步改善瓣膜性能,在参考猪主动脉根构型优化瓣膜设计的基础上,开发一种新型的适合单层缝合置入的无支架猪主动脉瓣膜,体外测试评估其性能。方法:①制备适合单层缝合的无支架猪主动脉瓣。②采用自

  18. Global Strain in Severe Aortic Valve Stenosis

    DEFF Research Database (Denmark)

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

    2012-01-01

    BACKGROUND: -Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement (AVR) is unknown. METHODS AND RESULTS: -A total of 125 patients with severe...

  19. Quadricuspid aortic valve complicated with infective endocarditis: report of a case.

    Science.gov (United States)

    Mizoguchi, Hiroki; Sakaki, Masayuki; Inoue, Kazushige; Kobayashi, Yasuhiko; Iwata, Takashi; Suehiro, Yasuo; Miura, Takuya

    2014-12-01

    Congenital quadricuspid aortic valve is a rare cardiac malformation with an unknown risk of infective endocarditis. We report a case of quadricuspid aortic valve complicated with infective endocarditis. A 53-year-old Japanese woman was hospitalized with leg edema and a fever of unknown origin. Corynebacterium striatum was detected in the blood culture. Echocardiography demonstrated a quadricuspid aortic valve with vegetation and severe functional regurgitation. The condition was diagnosed as a quadricuspid aortic valve with infective endocarditis, for which surgery was performed. The quadricuspid aortic valve had three equal-sized cusps and one smaller cusp (type B according to Hurwitz classification). We dissected the vegetation and infectious focus and implanted a mechanical valve. Following the case report, we review the literature.

  20. The Risk of Acute Kidney Injury and Its Impact on 30-Day and Long-Term Mortality after Transcatheter Aortic Valve Implantation

    Directory of Open Access Journals (Sweden)

    Katrin Gebauer

    2012-01-01

    Full Text Available Background. Transcatheter aortic valve implantation (TAVI is widely used in high risk patients (pts with aortic stenosis. Underlying chronic kidney disease implicates a high risk of postprocedural acute kidney injury (AKI. We analyzed its occurrence, impact on hospital stay, and mortality. Methods. 150 consecutive pts underwent TAVI in our institution (mean age 81 ± 7 years; logistic EuroSCORE 24 ± 15%. AKI definition was a creatinine rise of 26.5 μmol/L or more within 48 hours postprocedural. Ten patients on chronic hemodialysis were excluded. Results. AKI occurred in 28 pts (20%. Baseline creatinine was higher in AKI pts (126.4 ± 59.2 μmol/L versus 108.7 ± 45.1 μmol/L, P=0.09. Contrast media use was distributed evenly. Both, 30-day mortality (29% versus 7%, P<0.0001 and long-term mortality (43% versus 18%, P<0.0001 were higher; hospital stay was longer in AKI pts (20 ± 12 versus 15 ± 10 days, P=0.03. Predicted renal failure calculated STS Score was similar (8.0 ± 5.0% [AKI] versus 7.1 ± 4.0% [non-AKI], P=0.32 and estimated lower renal failure rates than observed. Conclusion. AKI remains a frequent complication with increased mortality in TAVI pts. Careful identification of risk factors and development of more suitable risk scores are essential.

  1. 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 successfully...

  2. Prognostic Value of Fat Mass and Skeletal Muscle Mass Determined by Computed Tomography in Patients Who Underwent Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Mok, Michael; Allende, Ricardo; Leipsic, Jonathon; Altisent, Omar Abdul-Jawad; Del Trigo, Maria; Campelo-Parada, Francisco; DeLarochellière, Robert; Dumont, Eric; Doyle, Daniel; Côté, Mélanie; Freeman, Melanie; Webb, John; Rodés-Cabau, Josep

    2016-03-01

    Body composition (fat mass [FM] and skeletal muscle mass [SMM]) predicts clinical outcomes. In particular, loss of SMM (sarcopenia) is associated with frailty and mortality. There are no data on the prevalence and impact of FM and SMM in patients undergoing transcatheter aortic valve implantation (TAVI). The objective of this study is to determine body composition from pre-TAVI computed tomography (CT) and evaluate its association with clinical outcomes in patients who underwent TAVI. A total of 460 patients (mean age 81 ± 8 years, men: 51%) were included. Pre-TAVI CTs of the aorto-ilio-femoral axis were analyzed for FM and SMM cross-sectional area at the level of the third lumbar vertebrae (L3). Regression equations correlating cross-sectional area at L3 to total body FM and SMM were used to determine prevalence of sarcopenia, obesity, and sarcopenic obesity in patients (64%, 65%, and 46%, respectively). Most TAVI procedures were performed through a transfemoral approach (59%) using a balloon-expandable valve (94%). The 30-day and mid-term (median 12 months [interquartile range 6 to 27]) mortality rates were 6.1% and 29.6%, respectively. FM had no association with clinical outcomes, but sarcopenia predicted cumulative mortality (hazard ratio 1.55, 95% confidence interval 1.02 to 2.36, p = 0.04). In conclusion, body composition analysis from pre-TAVI CT is feasible. Sarcopenia, obesity, and sarcopenic obesity are prevalent in the TAVI population, with sarcopenia predictive of cumulative mortality. PMID:26754122

  3. 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

  4. Valve-sparing aortic root replacement and aortic valve repair in a patient with acromegaly and aortic root dilatation

    Directory of Open Access Journals (Sweden)

    Karel Van Praet

    2015-07-01

    Full Text Available Aortic regurgitation and dilatation of the aortic root and ascending aorta are severe complications of acromegaly. The current trend for management of an aortic root aneurysm is valve-sparing root replacement as well as restoring the diameter of the aortic sinotubular junction (STJ and annulus. Our case report supports the recommendation that in patients with acromegaly, severe aortic root involvement may indicate the need for surgery.

  5. Medtronic Freestyle Aortic Root Bioprosthesis Implantation for the Infective Endocarditis on Aortic Root

    Directory of Open Access Journals (Sweden)

    Zekeriya Arslan

    2013-10-01

    Full Text Available    Infective endocarditis and periannular abscess formation are serious problems in cardiac valve surgery, requiring extensive surgical debridement and reconstruction of the aortic annulus. We aimed to report two cases which were successfully treated with bioprosthetic valve implantation for infective endocarditis. Transosephageal echocardiography were performed for the diagnosis of one prosthetic and one native destructive aortic valve endocarditis in association with congestive heart failure (NYHA class-VI and abscess formation. Medtronic Freestyle stentless aortic root bioprosthesis was implanted into the left ventricular outflow tract after surgical radical aortic root debridement for each patient followed with medical treatment, which was extended to six weeks. Neither early nor late mortality was detected. One patient required prolonged ventilatory support (two days and permanent DDD-R pacing. Echocardiography showed no signs of valve dysfunction or recurrent endocarditis for both patients in 10 months follow up.Medtronic Freestyle stentless aortic root bioprosthesis may be a good alternative way of treatment to aortic valve and root endocarditis instead of homograft.

  6. 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 ...

  7. Reconstructive surgery of the aortic valve

    Directory of Open Access Journals (Sweden)

    Mendonça José Teles de

    2003-01-01

    Full Text Available OBJECTIVE: Lacking an ideal valve substitute and motivated by the good results of mitral valve repair since 1990, we faced with determination aortic valve reconstruction surgery. The objective of this paper is to show our experience with this procedure. METHOD: Between January of 1990 and December of 2001; 136 aortic valve repair surgeries were performed. Seventy-five (55.1% of the patients were female and the ages ranged from 4 to 70 years (mean 23.3 ± 1.2 years. Every patient had rheumatic valve disease and insufficiency was the most prevalent type (108 patients - 79.4%, followed by double aortic lesion in 16 (11.7% patients and stenosis in 12 (8.8%. The surgical techniques used were: subcommissural annuloplasty in 74 (54.4% patients, commissurotomy in 38 (27.9%, cusp extension with pericardium in 17 (12.5%, substitution of one cusp in 2 (1.4%, cusp suspension by annuloplasty in 37 (27.2% and Valsalva sinus remodeling in 27 (19.8%. The surgery exclusively involved the aortic valve in 57 (41.9% patients and was associated in 79 (mitral valve replacement in 12, mitral repair in 65, coronary artery bypass grafting in 1 and pulmonary commissurotomy in 1. RESULTS: Hospital mortality was 2.2% and 22 (16.2% patients underwent a new surgery during the follow-up period (57.7 ± 3.5 months. CONCLUSIONS: Aortic valve repair is a safe surgical procedure that can be used in an increasing number of patients with promising results.

  8. 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

  9. Aortic valve replacement in octogenarians

    Directory of Open Access Journals (Sweden)

    Dark John H

    2007-07-01

    Full Text Available Abstract Background and Aims As our population ages and life expectancy increases the number of people aged over 80 and more referred for cardiac surgery is growing. This study sought to identify the outcome of aortic valve replacement (AVR in octogenarians. Methods 68 patients aged 80 years or more underwent AVR at the Freeman Hospital, between April 2001 and April 2004. A retrospective review of the notes and outcomes from the patients' GP and the NHS strategic tracking service was performed. 54% (37 underwent isolated AVR whilst 46% (31 underwent combined AVR and CABG. Results Follow up was 100% complete. The mean age was 83.1 ± s.d. 2.9 years, a mean gradient of 83 ± s.d. 31 mmHg and mean AVA of 0.56 cm2. The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the logistic EuroSCORE mean 12.0 ± s.d. 5.9. In hospital 30 day mortality was 13 %. Survival was 80% at 1 year and 78% at 2 years. Median follow up was for 712 days. Stepwise logistic regression identified chronic obstructive airways disease as an independent predictor of mortality (p Conclusion Our study demonstrates that the operative mortality for AVR in the over eighties is good, whilst the mid to long term outcome is excellent There is a very low attrition rate with those undergoing the procedure living as long than their age matched population. This study confirms AVR is a safe, acceptable treatment for octogenarians with excellent mid term outcomes.

  10. 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

  11. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... a significant number of mitral valve repairs utilizing robotic techniques as well, which is really outside the ... no significant bleeding. Terry asks if you do robotic valve replacement surgeries. I do not. It's a ...

  12. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... which is made out of pyrolitic carbon, basically metal and plastic. Again, blood flows through this valve. ... has a prosthetic valve should let all their treating physicians, dentists, et cetera, know that so that ...

  13. Application of Regent mechanical valve in patients with small aortic annulus: 3-year follow-up

    OpenAIRE

    Zhao Dong; Wang Chunsheng; Hong Tao; Pan Cuizhen; Guo Changfa

    2012-01-01

    Abstract Background Aortic valve replacement (AVR) with a small aortic annulus is always challenging for the cardiac surgeon. In this study, we sought to evaluate the midterm performance of implantation with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve in retrospective consecutive cohort of patients with small aortic annulus (diameter ≤ 19 mm). Methods From January 2008 to April 2011, 40 patients (31 female, mean age = 47.2 ± 5.8 years) with small aortic annulus (≤19...

  14. Minimally Invasive Aortic Valve Replacement

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    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, ...

  15. Minimally Invasive Aortic Valve Replacement

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    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 ...

  16. Minimally Invasive Aortic Valve Replacement

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    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 ...

  17. Minimally Invasive Aortic Valve Replacement

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    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 ...

  18. 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...

  19. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... a rare problem where the patient's own immune system will attack cardiac valve structures, causing them to ... it be heart, lung et cetera, the immune system recognizes those living issues as not being from ...

  20. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... as represented by the red and the blue color. Typically, blood flowing through a valve should be ... and smooth. We shouldn't see very much color such as we're seeing here. To the ...

  1. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... heart valve which is made out of pyrolitic carbon, basically metal and plastic. Again, blood flows through ... heart surgery here, we actually insufflate, or instill carbon dioxide gas into the field, which we think ...

  2. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... Winkley nor myself have any financial or professional relationships with the manufacturers or the devices used in ... John, just to interrupt for moment, Charles, Charles V., asks can the mitral valve also be replaced ...

  3. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... Jim. Those are coming. There are several valve companies in this country and in Europe that have ... that we've had customized by an instrument company for this approach that really works nicely for ...

  4. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... surgery. I think as physicians we owe a responsibility to our patients to try to make procedures ... patients back annually, which we feel is our responsibility any time we do valve replacement or repair ...

  5. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... patients in the sixth and seventh decades of life. Again, some areas of the valve appear normal ... have been proven to slow that disease path life. Again, it's a progressive disease from sclerosis, or ...

  6. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... to prevent such a problem. Is there a higher risk in someone with a biological valve for ... there but in my experience they're no higher than in someone who's had a full sternotomy. ...

  7. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... back in World War II to look for things in the water. Basically, you use sound waves ... valve replacements a year. So one of the things I 10 would counsel anybody is before they ...

  8. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... Dr. Jim Winkley, who's a cardiac anesthesiologist that works here with us. Before we begin, viewers need ... the valve itself has narrowed, that puts more work on the heart when a patient's at rest. ...

  9. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... or the devices used in this continuing medical educational activity. Thanks, John, we want to remind the ... a rare problem where the patient's own immune system will attack cardiac valve structures, causing them to ...

  10. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... valve, it's just 1 sort of a normal aging process that we see in a certain segment ... this country is primarily a disease of the aging population. And, of course, we are a country ...

  11. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... at the body's surface area. We, in the operating room, have a set of sizers which allow ... proves a nice replacement. However, that's sort of operating on two valves to fix one valvular problem. ...

  12. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... a patient less post-operative pain, blood loss, lung dysfunction. Certainly we can get these patients up ... thorocotomy is an incision we generally use for lung operations and for some valve operations in which ...

  13. Minimally Invasive Aortic Valve Replacement

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    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. ...

  14. 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 ...

  15. Incidental necropsy finding of a quadricuspid aortic valve

    NARCIS (Netherlands)

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

    2015-01-01

    Quadricuspid aortic valve is a rare congenital cardiac malformation often associated with abnormal valve function. In this article, we present a case of quadricuspid aortic valve only diagnosed at the time of post-mortem examination. (C) 2015 Elsevier Inc. All rights reserved.

  16. 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.

  17. 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...

  18. 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

  19. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... polyester material that's used for -- it's basically a medical grade fabric. And again, I want to underscore that these tissue valves are hand-made in factories and undergo quite a bit of testing and tolerance before they ever reach our shelf. ...

  20. Minimally Invasive Aortic Valve Replacement

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    Full Text Available ... to know the human dynamic or blood pressure effects of a valvular problem and is also important with regards to determining coronary artery anatomy, as some patients may need coronary bypass surgery in addition to valve surgery. Exercise testing, as I mentioned previously, is a nice ...

  1. Animal Models of Calcific Aortic Valve Disease

    OpenAIRE

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

    2011-01-01

    Calcific aortic valve disease (CAVD), once thought to be a degenerative disease, is now recognized to be an active pathobiological process, with chronic inflammation emerging as a predominant, and possibly driving, factor. However, many details of the pathobiological mechanisms of CAVD remain to be described, and new approaches to treat CAVD need to be identified. Animal models are emerging as vital tools to this end, facilitated by the advent of new models and improved understanding of the u...

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

    Directory of Open Access Journals (Sweden)

    Sarika Katiyar

    2015-01-01

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

  3. Congenital quadricuspid aortic valve: analysis of 11 surgical cases

    Institute of Scientific and Technical Information of China (English)

    TANG Yang-feng; XU Ji-bin; HAN Lin; LU Fang-lin; LANG Xi-long; SONG Zhi-gang; XU Zhi-yun

    2011-01-01

    Background Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR).The diagnosis and treatment of the disease were reported in 11 cases.Methods Eleven patients (nine men and two women,mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated.Medical records,echocardiograms and surgical treatment were reviewed.Results In accordance with the Hurwitz and Roberts classification,the patients were classified as type A (n=2),type B (n=7),type F (n=1) and type G (n=1).Three patients were associated with other heart diseases,including infective endocarditis and mitral prolaps,left superior vena cava,aortic aneurysm.All had aortic regurgitation (AR) except two with aortic stenosis (AS),detected by color-flow Doppler echocardiography.The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography.All patients underwent successful aortic valve replacement.Conclusion Quadricuspid aortic valve is a rare cause of aortic insufficiency,while echocardiography plays an important role in diagnosing the disease.Aortic valve replacement is the major therapy for the disease.

  4. Aortopathy in patients with a bicuspid aortic valve : determining susceptibility for aortic complications

    NARCIS (Netherlands)

    Grewal, Nimrat

    2015-01-01

    The prevalence of aortic dilation and related complications as rupture and dissection is higher in patients with a bicuspid aortic valve (BAV) as compared to patients with a tricuspid aortic valve (TAV), although not every individual carries this increased risk. It is therefore essential to identify

  5. Cellular regulation of the structure and function of aortic valves

    Directory of Open Access Journals (Sweden)

    Ismail El-Hamamsy

    2010-01-01

    Full Text Available The aortic valve was long considered a passive structure that opens and closes in response to changes in transvalvular pressure. Recent evidence suggests that the aortic valve performs highly sophisticated functions as a result of its unique microscopic structure. These functions allow it to adapt to its hemodynamic and mechanical environment. Understanding the cellular and molecular mechanisms involved in normal valve physiology is essential to elucidate the mechanisms behind valve disease. We here review the structure and developmental biology of aortic valves; we examine the role of its cellular parts in regulating its function and describe potential pathophysiological and clinical implications.

  6. Bicuspid aortic valves: Diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT

    International Nuclear Information System (INIS)

    Objectives: To assess the diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT for bicuspid aortic valves. Materials and methods: The standard axial chest CT scans of 20 patients with known bicuspid aortic valves were blindly, randomly analyzed for (i) the appearance of the valve cusps, (ii) the largest aortic sinus area, (iii) the longest aortic cusp length, (iv) the thickest aortic valve cusp and (v) valve calcification. A second blinded reader independently analyzed the appearance of the valve cusps. Forty-two age- and sex-matched patients with known tricuspid aortic valves were used as controls. Retrospectively ECG-gated cardiac CT multiphase reconstructions of the aortic valve were used as the gold-standard. Results: Fourteen (21%) scans were scored as unevaluable (7 bicuspid, 7 tricuspid). Of the remainder, there were 13 evaluable bicuspid valves, ten of which showed an aortic valve line sign, while the remaining three showed a normal Mercedes-Benz appearance owing to fused valve cusps. The 35 evaluable tricuspid aortic valves all showed a normal Mercedes-Benz appearance (P = 0.001). Kappa analysis = 0.62 indicating good interobserver agreement for the aortic valve cusp appearance. Aortic sinus areas, aortic cusp lengths and aortic cusp thicknesses of ≥3.8 cm2, 3.2 cm and 1.6 mm respectively on standard axial chest CT best distinguished bicuspid from tricuspid aortic valves (P < 0.0001 for all). Of evaluable scans, the sensitivity, specificity, positive and negative predictive values of standard axial chest CT in diagnosing bicuspid aortic valves was 77% (CI 0.54–1.0), 100%, 100% and 70% respectively. Conclusion: The aortic valve is evaluable in approximately 80% of standard chest 64-slice CT scans. Bicuspid aortic valves may be diagnosed on evaluable scans with good diagnostic accuracy. An aortic valve line sign, enlarged aortic sinuses and elongated, thickened valve cusps are specific CT

  7. Infective endocarditis in bicuspid aortic valve: atrioventricular block as sign of perivalvular abscess.

    Science.gov (United States)

    Bacchion, Francesco; Cukon, Sonja; Rizzoli, Giulio; Gerosa, Gino; Daliento, Luciano; Thiene, Gaetano; Basso, Cristina

    2007-01-01

    A 46-year-old man presenting with fever, peripheral edema, and chest pain was admitted to the emergency department. Electrocardiogram showed sinus tachycardia and first-degree atrioventricular block. Transesophageal echocardiogram showed infective endocarditis in bicuspid aortic valve, complicated with severe aortic regurgitation, ring abscess, and sinus-of-Valsalva aneurysm extending to mitroaortic fibrous continuity. The patient, who was unaware of his bicuspid aortic valve condition, reported having undergone an orthodontic procedure complicated with dental abscess 1 month prior, which was treated with combined clavulanate-amoxicillin antibiotic therapy. Blood cultures were positive for Bacteroides fragilis resistant to metronidazole. Intravenous antibiotic therapy was undertaken, with rapid resolution of fever. He eventually underwent successful aortic homograft implantation and mitral valve repair with residual first-degree atrioventricular block. PMID:17637435

  8. 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......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...

  9. Congenital aortic regurgitation in a child with a tricuspid non-stenotic aortic valve.

    OpenAIRE

    Hashimoto, R; Miyamura, H; Eguchi, S

    1984-01-01

    After follow up for seven years a 10 year old boy with congenital aortic regurgitation was found to have a tricuspid non-stenotic aortic valve at operation. The right coronary cusp was dysplastic, thickened, and contracted; the gap between its free margin and aortic wall was bridged with two fibrous bands; and the left coronary and non-coronary cusps were almost normal. The aortic valve was replaced with a prosthesis (St Jude Medical No 23), and the postoperative course was uneventful.

  10. Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves

    DEFF Research Database (Denmark)

    Makkar, Raj R; Fontana, Gregory; Jilaihawi, Hasan;

    2015-01-01

    BACKGROUND: A finding of reduced aortic-valve leaflet motion was noted on computed tomography (CT) in a patient who had a stroke after transcatheter aortic-valve replacement (TAVR) during an ongoing clinical trial. This finding raised a concern about possible subclinical leaflet thrombosis...

  11. Small aortic valve annulus in children with fixed subaortic stenosis.

    Science.gov (United States)

    Thilenius, O G; Campbell, D; Bharati, S; Lev, M; Arcilla, R A

    1989-01-01

    Twenty-one hearts with fixed subaortic stenosis (FSAS) were examined pathologically. Thirty children with no hemodynamically significant heart disease, 31 children with valvar aortic stenosis, and 25 children with FSAS were studied by echo- and angiocardiography. The following conclusions were drawn: (1) Patients with FSAS often have abnormal aortic valve leaflets as well as small aortic valve annulus. (2) A small aortic annulus/descending aorta ratio is probably present at birth, and may decrease with increasing age. (3) In some patients with FSAS the aortic valve annulus is too small for simple resection of the fibroelastic tissue. A Konno operation is needed for these patients. (4) M-mode echocardiography has not been useful in identifying abnormally small aortic valve annulus in FSAS patients.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-06-01

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

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

    International Nuclear Information System (INIS)

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

  14. Simulation for transthoracic echocardiography of aortic valve

    Science.gov (United States)

    Nanda, Navin C.; Kapur, K. K.; Kapoor, Poonam Malhotra

    2016-01-01

    Simulation allows interactive transthoracic echocardiography (TTE) learning using a virtual three-dimensional model of the heart and may aid in the acquisition of the cognitive and technical skills needed to perform TTE. The ability to link probe manipulation, cardiac anatomy, and echocardiographic images using a simulator has been shown to be an effective model for training anesthesiology residents in transesophageal echocardiography. A proposed alternative to real-time reality patient-based learning is simulation-based training that allows anesthesiologists to learn complex concepts and procedures, especially for specific structures such as aortic valve. PMID:27397455

  15. Acute aortic and mitral valve regurgitation following blunt chest trauma.

    Science.gov (United States)

    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  16. 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.

  17. Case report of Streptomyces endocarditis of a prosthetic aortic valve.

    Science.gov (United States)

    Mossad, S B; Tomford, J W; Stewart, R; Ratliff, N B; Hall, G S

    1995-01-01

    We describe the first case of prosthetic valve endocarditis due to a Streptomyces sp. The patient presented with fever, cutaneous embolic lesions, and bacteremia 3 months after aortic valve replacement. Treatment required valve replacement and a long course of parenteral imipenem. PMID:8586732

  18. Case report of Streptomyces endocarditis of a prosthetic aortic valve.

    OpenAIRE

    Mossad, S B; Tomford, J W; Stewart, R; Ratliff, N B; Hall, G. S.

    1995-01-01

    We describe the first case of prosthetic valve endocarditis due to a Streptomyces sp. The patient presented with fever, cutaneous embolic lesions, and bacteremia 3 months after aortic valve replacement. Treatment required valve replacement and a long course of parenteral imipenem.

  19. 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.

  20. 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

  1. Results of surgery for aortic regurgitation due to aortic valve prolapse.

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1988-12-01

    Full Text Available The clinical, hemodynamic and pathological findings of 13 patients with aortic regurgitation due to aortic valve prolapse caused by advanced myxomatous degeneration were evaluated. Eleven patients showed a favorable outcome with no complications resulting from surgery. One patient died from aortic dissection, and another died suddenly from an unknown cause. Five patients had mitral valve prolapse as a complication. Ten patients (77% had a long-standing history of hypertension. Twelve patients (92% were male. None of the patients had the stigmata of Marfan's syndrome. All patients had marked myxomatous degeneration of the aortic valves without any inflammatory changes. Two patients showed microcalcification; 7 demonstrated moderate fibrosis. Five patients showed severe fragility of the cusps which appeared redundant, gelatinous and softened by degenerative changes. Myxomatous degeneration of the aortic valve is not rare, and, in fact, it may be one of the most common pathologic and clinical entities associated with pure aortic insufficiency.

  2. Twenty-Two-Year Experience with Aortic Valve Replacement: Starr-Edwards Ball Valves versus Disc Valves

    OpenAIRE

    Pilegaard, Hans K.; Lund, Ole; Nielsen, Torsten T; Magnussen, Karin; Knudsen, Mary A; Albrechtsen, Ole K.

    1991-01-01

    From 1965 through 1986, 817 patients underwent aortic valve replacement at our institution. Six hundred forty-five patients received Starr-Edwards ball valves, including 286 Silastic ball valves (Models 1200/1260), 165 cloth-covered caged-ball prostheses (Models 2300/2310/2320), and 194 track-valve prostheses (Model 2400). In contrast, 172 patients received disc-valve prostheses, including 126 St. Jude Medical aortic bi-leaflet disc valves, 32 Lillehei-Kaster pivoting disc valves, and 14 Björ...

  3. Acute regional improvement of myocardial function after interventional transfemoral aortic valve replacement in aortic stenosis: A speckle tracking echocardiography study

    Directory of Open Access Journals (Sweden)

    Schattke Sebastian

    2012-03-01

    Full Text Available Abstract Background Transcatheter aortic valve implantation (TAVI is a promising therapy for patients with severe aortic stenosis (AS and high perioperative risk. New echocardiographic methods, including 2D Strain analysis, allow the more accurate measurement of left ventricular (LV systolic function. The goal of this study was to describe the course of LV reverse remodelling immediately after TAVI in a broad spectrum of patients with symptomatic severe aortic valve stenosis. Methods Thirty consecutive patients with symptomatic aortic valve stenosis and preserved LVEF underwent transfemoral aortic valve implantation. We performed echocardiography at baseline and one week after TAVI. Echocardiography included standard 2D and Doppler analysis of global systolic and diastolic function as well as 2D Strain measurements of longitudinal, radial and circumferential LV motion and Tissue Doppler echocardiography. Results The baseline biplane LVEF was 57 ± 8.2%, the mean pressure gradient was 46.8 ± 17.2 mmHg and the mean valve area was 0.73 ± 0.27 cm2. The average global longitudinal 2D strain of the left ventricle improved significantly from -15.1 (± 3.0 to -17.5 (± 2.4 % (p Conclusion There is an acute improvement of myocardial longitudinal systolic function of the basal and medial segments measured by 2D Strain analysis immediately after TAVI. The radial, circumferential strain and LVEF does not change significantly in all patients acutely after TAVI. These data suggest that sensitive new echo methods can reliably detect early regional changes of myocardial function after TAVI before benefits in LVEF are detectable.

  4. 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

  5. 经导管植入式主动脉人工心脏瓣膜临床试验初步建议%Considerations on Clinical Study of Transcatheter Aortic Valve Implantation

    Institute of Scientific and Technical Information of China (English)

    程茂波; 史新立; 苗晶晶; 刘威; 聂飞龙

    2014-01-01

    Transcatheter aortic valve implantation for the patients suffering from severe aortic stenosis has emerged as a promising technique alternative to conventional surgical aortic valve replacement, the guidances of clinical study to evaluate the safety and efficacy of the products have not been drafted as so far. The recommendations which were drafted according to the existing clinical data and guideline for valvular heart disease and expert advice were intro duced in the article in order to provide a guidance to manufacturers. Feasibility study to see if a larger pivotal study is practical and to refine the study protocol for the pivotal study was recommended firstly, the hypothesis of pivotal study was built in accordance with benefit-risk analysis, the aortic stenosis patients who cannot undergo surgery was preferen-tially treated in clinical trial.%用于治疗有症状的重度主动脉瓣狭窄的经导管植入式主动脉人工心脏瓣膜的研发日益增多,但并未有规范性临床试验指导意见,缺少安全性和有效性评价的统一原则,为了更好地引导研究者完成上市前临床试验研究,通过结合该类产品已完成的临床试验研究情况、心脏病治疗指南及国内心血管内科、心血管外科和临床统计学专家的意见,总结了目前对于该类产品临床试验的初步建议。在中国境内开展临床试验时,建议首先完成可行性研究;确证性研究按照产品应用人群风险收益分析,分别对开展安全性和有效性评价,建议优先选择不适合常规外科手术有症状的重度主动脉瓣狭窄患者作为受试人群。

  6. 经导管主动脉瓣置入术后急性肾损伤研究进展%Progress in Acute Kidney Injury after Transcatheter Aortic Valve Implantation

    Institute of Scientific and Technical Information of China (English)

    裴汉军

    2013-01-01

    经导管主动脉瓣置换术已经成为外科手术高危或存在手术禁忌证的重度主动脉瓣狭窄患者的一种新的治疗手段.心脏外科术后急性肾损伤与病死率增加显著相关,而需要肾脏替代治疗者预后更差.既往研究显示经导管主动脉瓣置换术术后急性肾损伤发生率约为1.1%~28%.近来,瓣膜学术研究协会在RIFLE分类的基础上提出了新的急性肾损伤定义标准.根据新标准,一些研究报道了经导管主动脉瓣置换术术后急性肾损伤发病率、预测因素以及临床预后并与之前的研究进行了比较.%Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option for non -operable or very high surgical higtuisk patients with severe aortic stenosis . Acute kidney injury ( AKI) after cardiac surgery is associated with increased mortality and necessity for renal replacement therapy even more so . Similarly AKI after TAVI is not infrequent affecting 1.1% ~ 28% of patients in previous series. Recently, a consensus report from the Valve Academic Research Consortium (VARC) suggested the new criteria for postproce - dural AKI based on modified RIFLE classification. Thus, according to the VARC criteria some studies have showed the probable incidence , predictors, and clinical outcome of AKI after TAVI and compare these outcomes with other previously used definitions .

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

    Science.gov (United States)

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

    2010-02-01

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

  8. 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.)

  9. [Acute Leaflet Arrest in St. Jude Medical Regent Mechanical Aortic Valve;Report of a Case].

    Science.gov (United States)

    Morishima, Yuji; Arakaki, Katsuya

    2015-06-01

    A 61-year-old woman was diagnosed with combined valvular disease and atrial fibrillation, and was admitted for surgery. We performed double valve replacement, tricuspid annuloplasty and maze operation. At the operation, a 19 mm St. Jude Medical Regent valve was implanted with non-everting mattress sutures at the aortic supra-annular position after mitral valve replacement. Although pulling down of the prosthesis into the aortic annulus was easy, the leaflets were unable to open at all in a movability test. After removing several stitches on the mitral side of the hinges, the subvalvular tissue was seen bulging into the hinge, hindering the free movement. The prosthesis was removed and replaced with a 17 mm Regent valve by the same technique. The patient's postoperative course was uneventful. We suggest it is necessary to pay special attention to the structural characteristics of the prosthesis. PMID:26066878

  10. Haemostasis monitoring during sequential aortic valve replacement and liver transplantation

    NARCIS (Netherlands)

    Sieders, E.; De Somer, F.; Bouchez, S.; Szegedi, L.; Van Belleghem, Y.; Colle, I.; Troisi, R.

    2010-01-01

    Despite advances in anaesthesiological and surgical techniques, cardiac surgery in cirrhotic patients remains hazardous. This report outlines our experience with haemostasis monitoring in two consecutive cases of sequential aortic valve replacement and liver transplantation. Clotting disturbances pr

  11. Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Hong Ju [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Cardiovascular Surgery, Seoul (Korea, Republic of); Yonsei University College of Medicine, Department of Cardiovascular Surgery, Seoul (Korea, Republic of); Shin, Je Kyoun; Chee, Hyun Kun; Kim, Jun Suk [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Cardiovascular Surgery, Seoul (Korea, Republic of); Ko, Sung Min [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Radiology, Seoul (Korea, Republic of)

    2015-07-15

    To characterize aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve (BAV) morphology using computed tomography (CT) and surgical findings. We retrospectively enrolled 209 patients with BAVs who underwent transthoracic echocardiography (TTE) and CT. BAVs were classified as anterior-posterior (BAV-AP) or lateral (BAV-LA) orientation of the cusps and divided according to the presence (raphe+) or absence (raphe-) of a raphe. Ascending aortic dimensions were measured by CT at four levels. BAV-AP was present in 129 patients (61.7 %) and raphe+ in 120 (57.4 %). Sixty-nine patients (33.0 %) had aortic regurgitation (AR), 70 (33.5 %) had aortic stenosis (AS), and 58 (27.8 %) had combined AS and AR. AR was more common in patients with BAV-AP and raphe+; AS was more common with BAV-LA and raphe-.Annulus/body surface area and tubular portion/body surface area diameters in patients with BAV-AP (17.1 ± 2.3 mm/m{sup 2} and 24.2 ± 5.3 mm/m{sup 2}, respectively) and raphe+ (17.3 ± 2.2 mm/m{sup 2} and 24.2 ± 5.5 mm/m{sup 2}, respectively) were significantly different from those with BAV-LA (15.8 ± 1.9 mm/m{sup 2} and 26.4 ± 5.5 mm/m{sup 2}, respectively) and raphe- (15.7 ± 1.9 mm/m{sup 2} and 26.2 ± 5.4 mm/m{sup 2}, respectively). The morphological characteristics of BAV might be associated with the type of valvular dysfunction, and degree and location of an ascending aorta dilatation. (orig.)

  12. 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...

  13. The pathology and pathobiology of bicuspid aortic valve: State of the art and novel research perspectives.

    Science.gov (United States)

    Mathieu, Patrick; Bossé, Yohan; Huggins, Gordon S; Corte, Alessandro Della; Pibarot, Philippe; Michelena, Hector I; Limongelli, Giuseppe; Boulanger, Marie-Chloé; Evangelista, Arturo; Bédard, Elisabeth; Citro, Rodolfo; Body, Simon C; Nemer, Mona; Schoen, Frederick J

    2015-10-01

    Bicuspid aortic valve is the most prevalent cardiac valvular malformation. It is associated with a high rate of long-term morbidity including development of calcific aortic valve disease, aortic regurgitation and concomitant thoracic aortic aneurysm and dissection. Recently, basic and translational studies have identified some key processes involved in the development of bicuspid aortic valve and its morbidity. The development of aortic valve disease and thoracic aortic aneurysm and dissection is the result of complex interactions between genotypes, environmental risk factors and specific haemodynamic conditions created by bicuspid aortic valve anatomy. Herein, we review the pathobiology of bicuspid aortic valve with a special emphasis on translational aspects of these basic findings. Important but unresolved problems in the pathology of bicuspid aortic valve and thoracic aortic aneurysm and dissection are discussed, along with the molecular processes involved. PMID:27499904

  14. Shape-based diagnosis of the aortic valve

    Science.gov (United States)

    Ionasec, Razvan Ioan; Tsymbal, Alexey; Vitanovski, Dime; Georgescu, Bogdan; Zhou, S. Kevin; Navab, Nassir; Comaniciu, Dorin

    2009-02-01

    Disorders of the aortic valve represent a common cardiovascular disease and an important public-health problem worldwide. Pathological valves are currently determined from 2D images through elaborate qualitative evalu- ations and complex measurements, potentially inaccurate and tedious to acquire. This paper presents a novel diagnostic method, which identies diseased valves based on 3D geometrical models constructed from volumetric data. A parametric model, which includes relevant anatomic landmarks as well as the aortic root and lea ets, represents the morphology of the aortic valve. Recently developed robust segmentation methods are applied to estimate the patient specic model parameters from end-diastolic cardiac CT volumes. A discriminative distance function, learned from equivalence constraints in the product space of shape coordinates, determines the corresponding pathology class based on the shape information encoded by the model. Experiments on a heterogeneous set of 63 patients aected by various diseases demonstrated the performance of our method with 94% correctly classied valves.

  15. A computerized system for video analysis of the aortic valve.

    Science.gov (United States)

    Vesely, I; Menkis, A; Campbell, G

    1990-10-01

    A novel technique was developed to study the dynamic behavior of the porcine aortic valve in an isolated heart preparation. Under the control of a personal computer, a video frame grabber board continuously acquired and digitized images of the aortic valve, and an analog-to-digital (A/D) converter read four channels of physiological data (flow rate, aortic and ventricular pressure, and aortic root diameter). The valve was illuminated with a strobe light synchronized to fire at the field acquisition rate of the CCD video camera. Using the overlay bits in the video board, the measured parameters were super-imposed over the live video as graphical tracing, and the resultant composite images were recorded on-line to video tape. The overlaying of the valve images with the graphical tracings of acquired data enabled the data tracings to be precisely synchronized with the video images of the aortic valve. This technique enabled us to observe the relationship between aortic root expansion and valve function.

  16. Manejo anestésico e complicações no implante percutâneo de válvula aórtica Manejo anestésico y complicaciones en el implante percutáneo de válvula aórtica Anesthetic management and complications of percutaneous aortic valve implantation

    Directory of Open Access Journals (Sweden)

    Tailur Alberto Grando

    2013-06-01

    monitorizada con una presión arterial promedio (PAP, electrocardiograma (ECG, oximetría, capnografía, ecocardiograma transesofágico, termometría y marcapaso transvenoso. RESULTADOS: Fueron sometidos con éxito al implante valvular 28 pacientes, con una edad promedio de 82,46 años, EuroScore medio de 20,98%, clase funcional III/IV. Nueve pacientes necesitaron implante de marcapaso definitivo. En el seguimiento de los pacientes hubo dos decesos, uno en el transoperatorio por perforación del VI y uno al tercer día por causa desconocida. En 24 meses un paciente falleció con diagnóstico de mieloma múltiple. La técnica anestésica fue segura. CONCLUSIONES: La experiencia inicial con implante valvular aórtico percutáneo bajo anestesia general ha sido segura y eficaz sin complicaciones anestésicas importantes para ese procedimiento.BACKGROUND AND OBJECTIVE: Aortic stenosis is a highly prevalent and life-threatening disease. In elderly patients with comorbidities, percutaneous valve implantation is an option. The aim of the study was to describe the anesthetic management and complications of general anesthesia. METHOD: Case series with 30-day and 24-month follow-ups after implantation of the CoreValve device performed at the Institute of Cardiology/University Foundation of Cardiology between December 2008 and January 2012. The patients underwent general anesthesia monitored with mean arterial pressure (PAM, electrocardiogram (ECG, pulse oximetry, capnography, transesophageal echocardiography, thermometry, and transvenous pacemaker. RESULTS: Twenty-eight patients, mean age 82.46 years, 20.98% mean EuroSCORE, functional class III/IV, successfully underwent valve implantation. Nine patients required permanent pacemaker implantation. During follow-up, two patients died: one during surgery due to LV perforation and the other on the third day of unknown causes. At 24 months, one patient diagnosed with multiple myeloma died. This anesthetic technique proved to be safe

  17. Aortic Valve Repair: A Systematic Review and Meta-analysis of Published Literature

    OpenAIRE

    Fok, Matthew; Shaw, Matthew; Sancho, Elena; Abello, David; Bashir, Mohamad

    2014-01-01

    Background: It is widely accepted that aortic valve disease is surgically managed with aortic valve replacement (AVR) using different available prostheses. The long-term survival, durability of the valve, and freedom from reoperation after AVR are well established in published literature. Over the past two decades, aortic valve repair (AVr) has evolved into an accepted surgical option for patients with aortic valve disease. We review and analyze the published literature on AVr. Methods: A sys...

  18. An Adult Case of Unicommissural Unicuspid Aortic Valve Diagnosed Based on the Intraoperative Findings.

    Science.gov (United States)

    Yamanaka, Tetsuo; Fukatsu, Toru; Ichinohe, Yoshimaro; Komatsu, Hirotaka; Seki, Masahiro; Sasaki, Kenichi; Takai, Hideaki; Kunihara, Takashi; Hirata, Yasunobu

    2016-01-01

    We herein report an adult case of unicommissural unicuspid aortic valve (UAV). A 59-year-old man, who was noted to have a cardiac murmur at 31 years of age, was admitted to our hospital due to acute heart failure. Severe calcification in the aortic valve with severe low-flow/low-gradient aortic stenosis and moderate aortic regurgitation was observed and thought to be the cause of heart failure, however, the etiology of aortic valve dysfunction was not clear. Aortic valve replacement was subsequently performed, and unicommissural UAV was diagnosed according to the intraoperative findings. UAV is very rare congenital aortic valve disease which is rarely diagnosed preoperatively.

  19. Bicuspid aortic valves: Diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, David J., E-mail: david.murphy@st-vincents.ie [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland); McEvoy, Sinead H., E-mail: s.mcevoy@st-vincents.ie [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland); Iyengar, Sri, E-mail: sri.iyengar@nhs.net [Department of Radiology, Plymouth Hospitals NHS Trust, Plymouth Devon PL6 8DH (United Kingdom); Feuchtner, Gudrun, E-mail: Gudrun.Feuchtner@i-med.ac.at [Department of Radiology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck (Austria); Cury, Ricardo C., E-mail: r.cury@baptisthealth.net [Department of Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176 (United States); Roobottom, Carl, E-mail: carl.roobottom@nhs.net [Department of Radiology, Plymouth Hospitals NHS Trust, Plymouth Devon PL6 8DH (United Kingdom); Plymouth University Peninsula Schools of Medicine and Dentistry (United Kingdom); Baumueller, Stephan, E-mail: Hatem.Alkadhi@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich (Switzerland); Alkadhi, Hatem, E-mail: stephan.baumueller@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich (Switzerland); Dodd, Jonathan D., E-mail: jonniedodd@gmail.com [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland)

    2014-08-15

    Objectives: To assess the diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT for bicuspid aortic valves. Materials and methods: The standard axial chest CT scans of 20 patients with known bicuspid aortic valves were blindly, randomly analyzed for (i) the appearance of the valve cusps, (ii) the largest aortic sinus area, (iii) the longest aortic cusp length, (iv) the thickest aortic valve cusp and (v) valve calcification. A second blinded reader independently analyzed the appearance of the valve cusps. Forty-two age- and sex-matched patients with known tricuspid aortic valves were used as controls. Retrospectively ECG-gated cardiac CT multiphase reconstructions of the aortic valve were used as the gold-standard. Results: Fourteen (21%) scans were scored as unevaluable (7 bicuspid, 7 tricuspid). Of the remainder, there were 13 evaluable bicuspid valves, ten of which showed an aortic valve line sign, while the remaining three showed a normal Mercedes-Benz appearance owing to fused valve cusps. The 35 evaluable tricuspid aortic valves all showed a normal Mercedes-Benz appearance (P = 0.001). Kappa analysis = 0.62 indicating good interobserver agreement for the aortic valve cusp appearance. Aortic sinus areas, aortic cusp lengths and aortic cusp thicknesses of ≥3.8 cm{sup 2}, 3.2 cm and 1.6 mm respectively on standard axial chest CT best distinguished bicuspid from tricuspid aortic valves (P < 0.0001 for all). Of evaluable scans, the sensitivity, specificity, positive and negative predictive values of standard axial chest CT in diagnosing bicuspid aortic valves was 77% (CI 0.54–1.0), 100%, 100% and 70% respectively. Conclusion: The aortic valve is evaluable in approximately 80% of standard chest 64-slice CT scans. Bicuspid aortic valves may be diagnosed on evaluable scans with good diagnostic accuracy. An aortic valve line sign, enlarged aortic sinuses and elongated, thickened valve cusps are specific CT

  20. The application value of real-time 3-dimensional transesophageal echocardiography in aortic valve implantation%三维经食管超声心动图在经导管主动脉瓣植入术中的应用研究

    Institute of Scientific and Technical Information of China (English)

    赵维鹏; 潘翠珍; 魏来; 潘文志; 周达新; 舒先红

    2016-01-01

    目的:探讨三维经食管超声心动图在经导管主动脉瓣植入术中的应用价值。方法对16例严重主动脉瓣病变患者分别经由两种不同手术入径行经导管主动脉瓣植入术( transcatheter aortic valve implantation,TAVI ),其中7例重度主动脉瓣狭窄(主动脉瓣狭窄面积<1.0 cm2,主动脉瓣口最大流速≥4 m/s,平均跨瓣压差≥40 mmHg)和1例人工生物主动脉瓣中重度反流患者行经股动脉TAVI,另外4例重度主动脉瓣狭窄和4例重度主动脉瓣反流患者行经心尖TAVI,术前均行常规经胸超声心动图检查及三维经食管超声心动图检查,术中三维经食管超声心动图监测,术后常规经胸超声心动图随访。结果经股动脉TAVI组:所有患者均成功经导管植入人工生物主动脉瓣,其中1例患者术中发现心包填塞合并升主动脉夹层分离。经心尖TAVI组:所有患者均成功植入人工生物主动脉瓣,无并发症发生。 CT和经食管三维超声心动图测量主动脉瓣环最大径、最小径、瓣环面积及狭窄瓣口数据的比较,二者相关性良好,r值分别为0.99(瓣环最大径)、0.97(瓣环最小径)、0.98(瓣环面积)、0.99(狭窄瓣口面积);术前连续性方程测量的狭窄瓣口面积与CT及3D-TEE比较,二者相关性良好,r值均为0.99。结论三维经食管超声心动图能快速、准确地测量主动脉瓣环的大小及评价主动脉的解剖结构,并且能实时引导、监测经导管人工生物主动脉瓣的植入。%Objective To investigate the application value of 3-dimensional transesophageal echocardiography in aortic valve implantation.Methods We performed transcathet aortic valve implantations ( TAVI) to 16 patients with severe aortic stenosis through two different surgical accesses.Of these patients, 7 severe aortic stenosis (AVA<1.0 cm2, peak aortic valve velocity≥4.0m/s, and mean aortic

  1. Cardiovascular magnetic resonance of quinticuspid aortic valve with aortic regurgitation and dilated ascending aorta

    OpenAIRE

    Zhang Zhaoqi; Zhang Lijun; Meng Yanfeng; Wang Yongmei; Yang Xiaoming

    2009-01-01

    Abstract We report a rare case of a quinticuspid aortic valve associated with regurgitation and dilation of the ascending aorta, which was diagnosed and post-surgically followed up by cardiovascular magnetic resonance and dual source computed tomography.

  2. 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

  3. Transcatheter mitral valve implantation via transapical approach

    DEFF Research Database (Denmark)

    Sondergaard, Lars; Brooks, Matthew; Ihlemann, Nikolaj;

    2015-01-01

    OBJECTIVES: As many as 50% of patients with severe symptomatic mitral valve regurgitation are denied surgical valve replacement or repair due to high operative risk. We describe an early series of cases of transcatheter implantation with a CardiAQ™ mitral valve via a transapical approach. METHODS......: Three consecutive patients with an Society of Thoracic Surgeons (STS) mortality score of >22% were selected for transcatheter mitral valve implantation (TMVI) on compassionate grounds. All patients were elderly, had severe mitral regurgitation (MR), were in Class IV heart failure and deemed unsuitable...... bypass surgery (n = 2), severe pulmonary hypertension (n = 1) and moderate to severe chronic renal failure (n = 3). A CardiAQ mitral valve was implanted using fluoroscopy and transoesophageal (TEE) guidance via a standard transapical approach. RESULTS: Accurate prosthesis positioning and deployment...

  4. Implante transapical de endoprótese valvada balão-expansível em posição aórtica sem circulação extracorpórea Off-pump transapical balloon-expandable aortic valve endoprosthesis implantation

    Directory of Open Access Journals (Sweden)

    Diego Felipe Gaia

    2009-06-01

    ão.OBJECTIVE: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation without cardiopulmonary bypass (CPB has been shown to be viable, with lower morbidity and mortality. The aim of this study was to develop a catheter-mounted aortic bioprosthesis for implantation without CPB. METHODS: After developing in animals, three patients with high EuroSCORE underwent implantation. Case 1: patients with bioprosthesis dysfunction; Case 2: severe aortic stenosis; Case 3: dysfunction of aortic bioprosthesis. After minithoracotomy and under echocardiographic and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiographic and angiographic controls were performed and the patients were referred to ICU. RESULTS: In the first case, implantation without CPB was possible with appropriate results. The patient evolved with improvement of ventricular function. After, this patient developed bronchopneumonia, tracheoesophageal fistula and died due to mediastinitis. Autopsy confirmed proper valve positioning and leaflets preservation. The second case showed the device migration after inflation of the balloon, with the need for urgent median sternotomy, CPB and conventional valve replacement. This patient evolved well and was discharged from the ICU on the 14th postoperative day without complications. This patient developed respiratory infection, septic shock and died on the 60th postoperative day. The patient from the third case underwent successful implantation. CONCLUSION: The off-pump transapical implantation of catheter-mounted bioprosthesis was shown to be a feasible procedure. Technical details and learning

  5. Association between aortic valve calcification measured on non-contrast computed tomography and aortic valve stenosis in the general population

    DEFF Research Database (Denmark)

    Paulsen, Niels Herluf; Carlsen, Bjarke Bønløkke; Dahl, Jordi Sanchez;

    2016-01-01

    BACKGROUND: Aortic valve calcification (AVC) measured on non-contrast computed tomography (CT) has shown correlation to severity of aortic valve stenosis (AS) and mortality in patients with known AS. The aim of this study was to determine the association of CT verified AVC and subclinical...... group were invited for a supplementary echocardiography. AS was graded by indexed aortic valve area (AVAi) on echocardiography as moderate 0.6-0.85 cm(2)/m(2) and severe valve surgery, and artifacts from...

  6. 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

    BACKGROUND: Adjustment of cardiac dimensions by measures of body size appears intuitively convincing and in patients with aortic stenosis, aortic valve area (AVA) is commonly adjusted by body surface area (BSA). However, there is little evidence to support such an approach. OBJECTIVE: To identify...... the adequate measure of body size for the adjustment of aortic stenosis severity. METHODS: Parameters of aortic stenosis severity (jet velocity, mean pressure gradient (MPG) and AVA) and measures of body size (height, weight, BSA and body mass index (BMI)) were analysed in 2843 consecutive patients with aortic...... stenosis (jet velocity ≥2.5 m/s) and related to outcomes in a second cohort of 1525 patients from the Simvastatin/Ezetimibe in Aortic Stenosis (SEAS) study. RESULTS: Whereas jet velocity and MPG were independent of body size, AVA was significantly correlated with height, weight, BSA and BMI (Pearson...

  7. Percutaneous pulmonary and tricuspid valve implantations: An update

    Institute of Scientific and Technical Information of China (English)

    Robert; Wagner; Ingo; Daehnert; Philipp; Lurz

    2015-01-01

    The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.

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

    Directory of Open Access Journals (Sweden)

    Keymel S

    2015-09-01

    Full Text Available Stefanie Keymel,1 Katharina Hellhammer,1 Tobias Zeus,1 Marc Merx,2 Malte Kelm,1 Stephan Steiner3 1Department of Cardiology, Pneumology, and Vascular Diseases, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, 2Department of Cardiology, Vascular Diseases and Intensive Care Medicine, KRHKlinikum Robert Koch Gehrden, Gehrden, 3Department of Cardiology, Pneumology and Intensive Care Medicine, St Vincenz Hospital, Limburg, Germany Background: Aortic valve stenosis is common in the elderly, with a prevalence of nearly 3% in patients aged 75 years or older. Despite the fact that sleep-related breathing disorders (SRBD are thought to be associated with cardiac disease, little is known about their prevalence in this patient cohort. The purpose of this study was to evaluate the prevalence of SRBD in older patients with aortic valve stenosis admitted for transcatheter aortic valve implantation.Methods: Forty-eight consecutive patients (mean age 81±6 years; 37.5% male with symptomatic aortic valve stenosis and considered for transcatheter aortic valve replacement were screened for SRBD. Sleep studies were performed by in-hospital unattended cardiorespiratory polygraphy measuring nasal air flow, chest and abdominal efforts, as well as oxygen saturation and body position. The patients were divided in subgroups dependent on the documented apnea–hypopnea index (AHI; no SRBD was defined as an AHI of <5 events/hour; mild SRBD as AHI 5–15 events/hour, and moderate to severe SRBD as AHI ≥15 events/hour.Results: Thirty-seven patients (77% had SRBD defined as an AHI of ≥5 events/hour. Eleven patients had an unremarkable investigation, with AHI <5 events/hour (mean 3.0±1.3 events/hour. Among patients with sleep apnea, 19 patients had mild SRBD, with an AHI of 5–15 events/hour (mean 9.9±3.4 events/hour and 18 patients had moderate to severe SRBD (mean 26.6±11.3 events/hour. Mainly, obstructive apneas were found. Subgroups were not

  9. Crystalline Ultrastructures, Inflammatory Elements, and Neoangiogenesis Are Present in Inconspicuous Aortic Valve Tissue

    OpenAIRE

    2010-01-01

    Morbidity from calcific aortic valve disease (CAVD) is increasing. Recent studies suggest early reversible changes involving inflammation and neoangiogenesis. We hypothesized that microcalcifications, chemokines, and growth factors are present in unaffected regions of calcific aortic valves. We studied aortic valves from 4 patients with CAVD and from 1 control, using immunohistochemistry, scanning electron microscopy, and infrared spectrography. We revealed clusters of capillary neovessels in...

  10. Crystalline Ultrastructures, Inflammatory Elements, and Neoangiogenesis Are Present in Inconspicuous Aortic Valve Tissue

    OpenAIRE

    P. Dorfmüller; Bazin, D.(National Superconducting Cyclotron Laboratory, Department of Physics and Astronomy, Michigan State University, East Lansing, MI, 48824, USA); Aubert, S; Weil, R.; Brisset, F.; Daudon, M.; Capron, F; Brochériou, I

    2010-01-01

    Morbidity from calcific aortic valve disease (CAVD) is increasing. Recent studies suggest early reversible changes involving inflammation and neoangiogenesis. We hypothesized that microcalcifications, chemokines, and growth factors are present in unaffected regions of calcific aortic valves. We studied aortic valves from 4 patients with CAVD and from 1 control, using immunohistochemistry, scanning electron microscopy, and infrared spectrography. We revealed clusters of capillary neovessel...

  11. 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;

    2015-01-01

    BACKGROUND: The underlying pathology in aortic stenosis (AS) and coronary artery stenosis (CAS) is similar including atherosclerosis and calcification. We hypothesize that coronary artery calcification (CAC) is likely to correlate with aortic root calcification (ARC) rather than with aortic valve...... 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...... even after adjusting for age (p = 0.01). AVC score was associated with BAV after adjusting for age (p = 0.03) but ARC was not. Of the total cohort, 82 patients (39%) had significant coronary stenosis (>50%), but these were not different in the pattern of calcification from those without CAS. CAC...

  12. 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

    endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic......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. Thoracic...

  13. Viscoelastic Properties of the Aortic Valve Interstitial Cell

    OpenAIRE

    Merryman, W. David; Bieniek, Paul D.; Guilak, Farshid; Michael S Sacks

    2009-01-01

    There has been growing interest in the mechanobiological function of the aortic valve interstitial cell (AVIC), due to its role in valve tissue homeostasis and remodeling. In a recent study we determined the relation between diastolic loading of the AV leaflet and the resulting AVIC deformation, which was found to be substantial. However, due to the rapid loading time of the AV leaflets during closure (~0.05 s), time-dependent effects may play a role in AVIC deformation during physiological f...

  14. Lactococcus garvieae Endocarditis on a Prosthetic Biological Aortic Valve.

    Science.gov (United States)

    Tsur, A; Slutzki, T; Flusser, D

    2015-09-01

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

  15. Lactococcus garvieae Endocarditis on a Prosthetic Biological Aortic Valve.

    Science.gov (United States)

    Tsur, A; Slutzki, T; Flusser, D

    2015-09-01

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

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

    Science.gov (United States)

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

    2009-08-01

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

  18. Coronary artery dissection with rupture of aortic valve commissure following type A aortic dissection: the role of 64-slice MDCT.

    Science.gov (United States)

    Das, K M; Abdou, Sayed M; El-Menyar, Ayman; Ayman, El Menyar; Khulaifi, A A; Nabti, A L

    2008-01-01

    A rare case of bilateral coronary artery dissection with rupture of aortic valve commissure following type A aortic dissection is described. 64-slice multidetector computed tomography (MDCT) was able to demonstrate both this findings along with involvement of other neck vessels. TEE demonstrated the severity and mechanisms of aortic valve damage and assisted the surgeon in valve repair. MDCT has played an invaluable role in the diagnosis of the abnormal details of such life-threatening vascular complications. PMID:18384568

  19. Sudden death in infancy due to bicuspid aortic valve.

    Science.gov (United States)

    Karayel, Ferah; Ozaslan, Abdi; Turan, Arzu Akcay; Pakis, Isil; Ketenci, Cetin; Eroglu, Ayse Guler

    2006-09-01

    Symptoms of bicuspid aortic valve usually occur in the age group of 50-70 years, but rarely, it can also lead to sudden unexpected death in infancy and early childhood. The autopsy of a 2-month-old baby boy, found dead in his cot, revealed the heart weight as 25 g, and the macroscopic examination showed the circumference of the aortic valve consisting of two leaflets as 8 mm. The thickness of the left ventricle, right ventricle, and septum was measured as 8, 7, and 10 mm, respectively. Microscopically, the heart revealed hypertrophic changes of myocytes. Subendocardial areas displayed necrosis of myocytes, and severe and diffuse ischemic changes characterized by loss of myofibers and vacuolization. Interstitial pneumonia was identified in the lungs. Death occurred as a result of a congenital bicuspid aortic valve obstructing the left ventricular outflow tract complicated by lung infection. As there are only a few reported cases in infancy, and congenital bicuspid aortic valve can lead to sudden unexpected death, this case is presented to the forensic community.

  20. Heart failure after aortic valve substitution due to severe hypothyroidism

    DEFF Research Database (Denmark)

    Munk, Kim; Sørensen, Stine Heidenheim; Andersen, Niels Holmark;

    2008-01-01

    We report a case of a 70-year-old female with considerable co-morbidities (Type 2 diabetes, Leiden factor V mutation, mild to moderate chronic obstructive pulmonary disease) and a recent biological aortic valve substitution, who was admitted due to circulatory collapse caused by severe heart fail...

  1. 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.

  2. SERUM MAGNESIUM LEVELS IN AORTIC AND MITRAL VALVE REPLACEMENT SURGERIES

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-08-01

    Full Text Available BACKGROUND : The purpose of the study was to analyze serum magnesium concentration in patients undergoing Aortic and Mitral Valve replacement surgeries. METHODS: This prospective study was conducted in 60 patients who underwent elective Aortic and Mitral va lve replacement surgeries. Blood samples from radial artery were collected just before induction of anesthesia and three days post - operatively for estimation of serum magnesium. RESULTS: Magnesium level was 2.02mg/dl at baseline, 2.28mg/dl, 2.08mg/dl and 1 .90mg/dl respectively on three consecutive days post - operatively. CONCLUSION: The lowering of serum magnesium in Aortic and Mitral valve replacement surgeries postoperatively recommends the use of routine serum magnesium determination and administration to prevent post - operative arrhythmias.

  3. Annular management during aortic valve repair: a systematic review.

    Science.gov (United States)

    Kunihara, Takashi

    2016-02-01

    Annuloplasty is considered to play a key role to control aortic valve regurgitation (AR) and prevent recurrence of AR after aortic valve repair, because aortic root dilatation has emerged as a risk factor for recurrence of AR. Various modifications of annuloplasty have been advocated, however, none of them has become standardized. Thus in this review they are outlined and classified (internal/external, with/without ring, rigid/flexible ring), and their advantages and disadvantages are clarified. Their clinical outcomes seem currently acceptable in general, and external flexible annuloplasty has been performed more frequently with favorable outcomes. However, they are still performed for a minority of patients by special experienced teams with limited follow-up periods. Therefore, it seems too early to determine the superiority or inferiority of each approach. We must carefully conduct evaluation to clarify which approach will become reproducible, effective, and standardized.

  4. 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

  5. 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.

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

    Directory of Open Access Journals (Sweden)

    Taylan Adademir

    2014-03-01

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

  7. Preliminary MRI study on hemodynamics after prosthetic cardiac valve implantation

    International Nuclear Information System (INIS)

    Objective: To assess the function of prosthetic valve by magnetic resonance imaging (MRI), and to measure the blood velocity downstream of prosthetic valve and three-dimensional surface profiles so as to provide the original materials for appearance and development of thrombi-embolic complications in the long time follow-up. Methods: Twenty-seven cases with prosthetic aortic valve were examined and the blood velocity was measured by using MRI. The diseased heart valves were replaced with two prosthetic valves in 20 cases, and replaced with single prosthetic valve in 7 cases. The axial velocity components were measured at three positions near the valve including half, one, and two diameter downstream in the ascending aorta. Two and three-dimensional surface profile reconstruction were analyzed by using flow analysis software and Matlab 6.5 software. Results: In 16 cases with prosthetic aortic valve replacement with two leaflets prosthetic valves, the velocity profiles downstream of the valve prosthetic reflecting the valve design was nearly three velocity, jets of the two major orifices and the central slit between the two leaflets. In 4 cases with prosthetic aortic valve replace with Sorin two leaflets prosthetic valve, the velocity profiles downstream was nearly two velocity jets of the two major orifices. In 20 cases replaced with two leaflets prosthetic valves, blood velocity profiles were skewed with highest velocities. Seven cases with single leaflet showed single velocity jets of the major orifices at peak systole. Retrograde velocities occurred in part of the lateral orifice regions in 26 cases. Three-dimensional surface profiles downstream of the prosthetic aortic valve reflected the valve design. The blood velocity profiles with prosthetic aortic valve in the one diameter downstream in the ascending aorta clearly showed the valve design. Conclusion: MRI is a non-invasive, direct, and in-vivo method of choice to assess the valvular function and is the

  8. 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.

  9. 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

  10. Cadaveric aorta implantation for aortic graft infection.

    Science.gov (United States)

    Ali, Asad; Bahia, Sandeep S S; Ali, Tahir

    2016-01-01

    This case report describes a 73-year-old gentleman who underwent explantation of an infected prosthetic aorto-iliac graft and replacement with a cryopreserved thoracic and aorto-iliac allograft. The patient has been followed up a for more than a year after surgery and remains well. After elective tube graft repair of his abdominal aortic aneurysm (AAA) in 2003, he presented to our unit in 2012 in cardiac arrest as a result of a rupture of the distal graft suture line due to infection. After resuscitation he underwent aorto-bifemoral grafting using a cuff of the original aortic graft proximally. Distally the new graft was anastomosed to his common femoral arteries, with gentamicin beads left in situ. Post discharge the patient was kept under close surveillance with serial investigations including nuclear scanning, however it became apparent that his new graft was infected and that he would require aortic graft replacement, an operation with a mortality of at least 50%. The patient underwent the operation and findings confirmed a synthetic graft infection. This tube graft was explanted and a cryopreserved aorta was used to the refashion the abdominal aorta and its bifurcation. The operation required a return to theatre day one post operatively for a bleeding side branch, which was repaired. The patient went on to make a full recovery stepping down from the intensive therapy unit day 6 post operatively and went on to be discharged 32 days after his cryopreserved aorta implantation. PMID:27351624

  11. 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...

  12. Commissural detachment and Valsalva sinus dilatation after implantation of Prima Plus stentless valve with full root technique.

    Science.gov (United States)

    Ohira, Suguru; Doi, Kiyoshi; Okawa, Kazunari; Yaku, Hitoshi

    2016-06-01

    The stentless aortic bioprosthesis has been used because of its excellent hemodynamics and few valve-related complications. We report a case of redo aortic root replacement for severe aortic regurgitation and dilatation of the Valsalva sinus 7 years after the implantation of a Prima Plus aortic root bioprosthesis (Edwards LifeScience, Irvine, CA, USA) using a full root technique. Intraoperative findings showed the complete detachment of the commissure between the left and non-coronary cusps, and Valsalva sinus dilatation of the porcine aortic root bioprosthesis. Redo aortic root replacement with a 23-mm porcine bioprosthesis and 28-mm straight graft was performed. There were no findings of intimal tear, suture dehiscence, degeneration, and perforation of the bioprosthesis. Such complications associated with the Edwards Prima Plus aortic root bioprosthesis were rarely reported. Commissural detachment of a porcine stentless aortic bioprosthesis can occur; thus, careful follow-up involving echocardiography and computed tomography is necessary. PMID:25341962

  13. Application of Regent mechanical valve in patients with small aortic annulus: 3-year follow-up

    Directory of Open Access Journals (Sweden)

    Zhao Dong

    2012-09-01

    Full Text Available Abstract Background Aortic valve replacement (AVR with a small aortic annulus is always challenging for the cardiac surgeon. In this study, we sought to evaluate the midterm performance of implantation with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent mechanical valve in retrospective consecutive cohort of patients with small aortic annulus (diameter ≤ 19 mm. Methods From January 2008 to April 2011, 40 patients (31 female, mean age = 47.2 ± 5.8 years with small aortic annulus (≤19 mm in diameter underwent aortic valve replacement with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent mechanical valve. Preoperative mean body surface area, New York Heart Association class, and mean aortic annulus were 1.61 ± 0.26 m2, 3.2 ± 0.4, and 18 ± 1.4 mm respectively. Patients were divided into two groups, according to the implantation of 17 mm SJM Regent mechanical valve (group 1, n = 18 or 19 mm SJM Regent valve (group 2, n = 22. All patients underwent echocardiography examination preoperatively and at one year post-operation. Results There were no early deaths in either group. Follow-up time averaged 36 ± 17.6 months. The mean postoperative New York Heart Association class was 1.3 ± 0.6 (p 2/m2 to 69.8 ± 9.3%, 41.4 ± 8.3%, and 0.92 ± 0.10 cm2/m2 respectively (P 2, 46.1 ± 8.5 mmHg to 86.7 ± 18.2 g/m2 , 13.7 ± 5.2 mmHg respectively. In group 2, the LVEF, LVFS and EOAI increased from 45.9% ± 9.7%, 30.7% ± 8.0%, and 0.81 ± 0.09 cm2/m2 to 77.4% ± 9.7%, 44.5% ± 9.6%, and 1.27 ± 0.11 cm2/m2 respectively, while the LVMI, and the aortic transvalvular pressure gradient decreased from 118.3 ± 27.6 g/m2, 44.0 ± 6.7 mmHg to 80.1 ± 19.7 g/m2, 10.8 ± 4.1 mmHg as well. The prevalence of PPM was documented in 2 patients in Group 1. Conclusions Patients with small aortic annulus and body surface

  14. Aortic Valve Replacement in Young Adults

    NARCIS (Netherlands)

    L.M.A. Klieverik (Loes Maria Anne)

    2007-01-01

    textabstractWorldwide the incidence and burden of heart valve disease is increasing due to aging of the world population and the problem of rheumatic cardiac disease in developing countries and in parts of the population in the developed world.1 Between 2007 and 2050 the world population will increa

  15. Minimal-access median sternotomy for aortic valve replacement

    OpenAIRE

    Luciani, Giovanni Battista; Lucchese, Gianluca

    2013-01-01

    A variety of minimally-invasive approaches for aortic valve replacement (AVR) have been developed and are increasingly being utilized. The different approaches described, such as partial upper sternotomy, right parasternal thoracotomy or transverse sternotomy have the aim to decrease invasiveness and reduce surgical trauma. Whereas port access surgery with remote cannulation has the attendant risks inherent with peripheral cardiopulmonary bypass and limitations in terms of myocardial protecti...

  16. Long-Term Outcomes of Homografts in the Aortic Valve and Root Position: A 20-Year Experience

    Science.gov (United States)

    Kim, Joo Yeon; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2016-01-01

    Background The advantages of using a homograft in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection. The aim of this study was to evaluate the long-term outcomes of homograft implantation in the aortic valve position. Methods This is a retrospective study of 33 patients (>20 years old) who underwent aortic valve replacement or root replacement with homografts between April 1995 and May 2015. Valves were collected within 24 hours from explanted hearts of heart transplant recipients (heart transplantation. The median follow-up duration was 35.6 months (range, 0 to 168 months). Results Aortic homografts were used in all patients. The 30-day mortality rate was 9.1%. The 1- and 5-year survival rates were 80.0%±7.3% and 60.8%±10.1%, respectively. The 1-, 5-, and 10-year freedom from reoperation rates were 92.3%±5.2%, 68.9%±10.2%, and 50.3%±13.6%, respectively. The 1-, 5-, and 10-year freedom from significant aortic dysfunction rates were 91.7%±8.0%, 41.7%±14.2%, and 25.0%±12.5%, respectively. Conclusion Homografts had the advantages of a good hemodynamic profile and low risk of thromboembolic events, and with good outcomes in cases of aortitis. PMID:27525234

  17. Intermittent acute aortic valve regurgitation: A case report of a prosthetic valve dysfunction

    NARCIS (Netherlands)

    S.E. Karagiannis (Stefanos); G. Karatasakis (George); K. Spargias (Konstantinos); L. Louka; D. Poldermans (Don); D.V. Cokkinos (Dennis)

    2008-01-01

    textabstractComplications of any mechanical prosthesis include thrombus or pannus formation. In our case report we demonstrate that prosthetic aortic valve regurgitation due to pannus formation may be intermittent and non-cyclic in pattern and therefore not obvious at the time of original clinical e

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

    DEFF Research Database (Denmark)

    Larsen, Linnea Hornbech; Kofoed, Klaus Fuglsang; Carstensen, Helle Gervig;

    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......(MDCT)) and by the continuity equation with TTE (AVA(TTE)). To generate a reference AVA (AVA(REF)) we used the stroke volume from MDCT divided by the velocity time integral from CW Doppler by TTE (according to the continuity equation: stroke volume in LVOT = stroke volume passing the aortic valve). AVA(REF) was used...... as the reference to compare both measures against, since it bypasses the assumption of LVOT being circular in the continuity equation and the potential placement error of PW Doppler in the LVOT. The mean (±SD) age of the patients was 71 (±9) years, 113 (67%) were males. Mean AVA(TTE) was 0.93 (±0.33) cm(2), mean...

  19. [Minimally invasive cardiac surgery for aortic valve disease].

    Science.gov (United States)

    Fujimura, Y; Katoh, T; Hamano, K; Gohra, H; Tsuboi, H; Esato, K

    1998-12-01

    Recent surgical advances leading to good operative results have contributed to the trend to useminimally invasive approaches, even in cardiac surgery. Smaller incisions are clearly more cosmetically acceptable to patients. When using a minimally invasive approach, it is most important to maintain surgical quality without jeopardizing patients. A good operative visual field leads to good surgical results. In the parasternal approach, we use a retractor to harvest an internal thoracic artery in coronary artery bypass surgery. Retracting the sternum upward allows for a good surgical view and permits the use of an arch cannula rather than femoral cannulation. When reoperating for aortic valve repair, the j-sternotomy approach requires less adhesiolysis compared with the traditional full sternotomy. No special technique is necessary to perform aortic valve surgery using the j-sternotomy approach. However, meticulous attention must be paid to avoiding left ventricular air embolisms to prevent postoperative stroke or neurocognitive deficits, especially when utilizing a minimally invasive approach. Transesophageal echo is useful not only for monitoring cardiac function but also for monitoring the persence of air in the left ventricle and atrium. This paper compare as the degree of invasion of minimally invasive cardiac surgery and the traditional full sternotomy. No differences were found in the occurrence of systemic inflammatory response syndrome between patients undergoing minimally invasive cardiac surgery and the traditional technique. Therefore it is concluded that minimally invasive surgery for patients with aortic valve disease may become the standard approach in the near future.

  20. Case Report: Calcific Aortic Valve Stenosis Due to Central Retinal Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Ender Sener

    2013-10-01

    Full Text Available In this case, it was reported that a 48 year old male patient with spontaneous central retinal artery occlusion (CRAO due to calcific aortic valve stenosis. He had no other systemic disease. CRAO usually occurs in elder patients with systemic risk factors. CRAO results in sudden, painless and severe vision loss. Altough, CRAO is seen rarely under 50 year old, it may appear in younger patient with aortic valve disease and calcific aortic valve stenosis caused cardiac disease.

  1. Transcatheter aortic valve replacement: current application and future directions.

    Science.gov (United States)

    Fassa, Amir-Ali; Himbert, Dominique; Vahanian, Alec

    2013-04-01

    During the last decade, the rapid evolution of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis. Since the PARTNER A and B trials, this technique has become the treatment of reference for inoperable patients, and an attractive alternative to surgical aortic valve replacement in those at high risk for surgery. Large multicenter registries conducted since 2007, mainly in Europe, confirmed the excellent hemodynamic performances of the 2 percutaneous valves currently available on the market, the Edwards SAPIEN, and the Medtronic CoreValve, as well as their benefits in terms of symptom relief and survival. The whole process of TAVR, from patient selection to post-procedural care and result evaluation, should be conducted by a dedicated multidisciplinary "heart team," within centers with expertise in valve disease. Though currently limited to those deemed at high risk for surgery or inoperable, indications for TAVR will likely be extended to a broader spectrum of patients, in particular those with surgical bioprosthetic failure or at intermediate risk for surgery. Beforehand, it will be essential to obtain more extensive data on the durability of percutaneous prostheses, since the available follow-up is seldom longer than 5 years, and in order to further decrease the rate of complications, mainly stroke, paravalvular regurgitation, and access site complications. Furthermore, the use of the transfemoral route will undoubtedly increase because of the miniaturization of the devices, at the expense of other approaches. Above all, multidisciplinary approach, excellent imaging, and careful evaluation will remain key to the success of this technique. PMID:23420448

  2. Left ventricular outflow tract pseudoaneurysm formation following three aortic valve replacement surgeries

    Directory of Open Access Journals (Sweden)

    Nasrien E Ibrahim

    2015-01-01

    Full Text Available We present a case of a pseudoaneurysm arising from the left ventricular outflow tract/aortic root as a complication of aortic valve surgery. A 45-year-old Nigerian female presented to our institution′s emergency department with chest discomfort. She had three bioprosthetic aortic valve replacements in the preceding year at an outside institution for aortic regurgitation and wanted a second opinion on remaining surgical options. The learning points relevant to this case are as follows: (1 Recognizing potential complications postmultiple valve surgeries, (2 screening patients for chronic infections and rheumatologic conditions that can contribute to failed valve surgeries.

  3. Prosthetic valve endocarditis with valvular obstruction after transcatheter aortic valve replacement.

    Science.gov (United States)

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

    2015-04-01

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

  4. Effects of preemptive enoximone on left ventricular diastolic function after valve replacement for aortic stenosis

    NARCIS (Netherlands)

    van der Maaten, Joost M. A. A.; de Vries, Adrianus J.; Rietman, Gerrit W.; Gallandat Huet, Rolf C. G.; De Hert, Stefan G.

    2007-01-01

    Objective: Left ventricular (LV) hypertrophy is associated with increased diastolic chamber stiffness early after aortic valve replacement for valve stenosis. Enoximone, a phosphodiesterase III inhibitor, has been shown to improve myocardial contractility and relaxation when administered as a single

  5. Transfemoral Transcatheter Aortic Valve Replacement for Mixed Aortic Valve Disease in Child's Class C Liver Disease Prior to Orthotopic Liver Transplantation: A Case Report.

    Science.gov (United States)

    Wilkey, Barbara J; Hanson, Ross; Reece, T Brett; Forman, Lisa; Burton, James R; Messenger, John C; Kim, Michael S; Cleveland, Joseph C; Fiegel, Matt J; Nydam, Trevor L; Mandell, M Susan

    2016-06-01

    The American Association for the Study of Liver Diseases practice guidelines list severe cardiac disease as a contraindication to liver transplantation. Transcatheter aortic valve replacement has been shown to decrease all-cause mortality in patients with severe aortic stenosis who are not considered candidates for surgical aortic valve replacement. We report our experience of liver transplantation in a patient with severe aortic stenosis and moderate aortic insufficiency who underwent transcatheter aortic valve replacement with Child-Pugh Class C disease at a Model For End-Stage Liver Disease score of 29. The patient had a difficult post procedure course that was successfully medically managed. After liver transplantation the patient was discharged to home on postoperative day 11. The combination of cardiac disease and end stage liver disease is challenging but these patients can have a successful outcome despite very severe illness.

  6. Mini-sternotomy for the treatment of aortic valve lesions

    Directory of Open Access Journals (Sweden)

    Dias Altamiro Ribeiro

    2001-01-01

    Full Text Available OBJECTIVE: To compare inverted-L mini-sternotomy performed above the sternal furcula with conventional sternotomy in patients with aortic valve diseases who undergo surgical treatment. METHODS: We operated upon 30 patients who had aortic valve lesions that had clinical and hemodynamic findings. All patients underwent inverted-L sternotomy, which extended from above the manubrium of the sternum to the 3rd right intercostal space, without opening the pleural cavity. Their ages ranged from 32 to 76 years, and 18 were males and 12 were females. We used negative pressure in a venous ¼-inch cannula, and the patients were maintained in Trendelemburg's position. Twenty-seven patients received bioprostheses with diameters ranging from 23 to 29mm. Three patients underwent only removal of the calcifications of the aortic valve leaflets and aortic commissurotomy. RESULTS: The mean duration of anoxic cardiac arrest was 63.11min. Access was considered good in all patients. One death was due to pulmonary and renal problems not related to the incision. All patients had a better recovery in the intensive care unit, got out of bed sooner, coughed more easily, and performed prophylactic physiotherapeutic maneuvers for respiratory problems more easily and with less pain in the incision. Early ambulation was more easily carried out by all patients. CONCLUSION: Mini-sternotomy proved to be better than the conventional sternotomy because it provided morecomfort for the patients in the early postoperative period, with less pain and greater desire for early ambulation and all its inherent advantages.

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

    Directory of Open Access Journals (Sweden)

    Gabor Erdoes

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

  8. 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.)

  9. 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...

  10. Aorta measurements are heritable and influenced by bicuspid aortic valve

    Directory of Open Access Journals (Sweden)

    Lisa J Martin

    2011-09-01

    Full Text Available Abstract: Word Count 266, 1609 charactersObjectives: To determine whether the contributions of genetics and bicuspid aortic valve (BAV independently influence aortic (Ao dimensions.Background: Ao dilation is a risk factor for aneurysm, dissection, and sudden cardiac death. Frequent association of BAV with Ao dilation implicates a common underlying defect possibly due to genetic factors. Methods: Families enriched for BAV underwent standardized transthoracic echocardiography. In addition to BAV status, echocardiographic measures of Ao (annulus to descending Ao, pulmonary artery and mitral valve annulus diameters were obtained. Using variance components analysis, heritability was estimated with and without BAV status. Additionally, bivariate genetic analyses between Ao dimensions and BAV were performed.Results: Our cohort was obtained from 209 families enriched for BAV. After adjusting for age, body surface area and sex, individuals with BAV had a statistically significant increase in all echocardiographic measurements (p < 0.006 except descending Ao and mitral valve annulus. Individuals with BAV were at greater odds of having Ao dilation (OR = 4.44, 95% CI 2.93 – 6.72 than family members without BAV. All echocardiographic measurements exhibited moderate to strong heritability (0.25 to 0.53, and these estimates were not influenced by inclusion of BAV as a covariate. Bivariate genetic analyses supported that the genetic correlation between BAV and echo measures were not significantly different from zero.Conclusions: We show for the first time that echocardiographic measurements of Ao, pulmonary artery and mitral valve annulus diameters are quantitative traits that exhibit significant heritability. In addition, our results suggest the presence of BAV independently influences the proximal Ao and pulmonary artery measures but not those in the descending Ao or mitral valve annulus.

  11. Including aortic valve morphology in computational fluid dynamics simulations: initial findings and application to aortic coarctation.

    Science.gov (United States)

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

    2013-06-01

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

  12. Histopathology of aortic complications in bicuspid aortic valve versus Marfan syndrome: relevance for therapy?

    Science.gov (United States)

    Grewal, Nimrat; Franken, Romy; Mulder, Barbara J M; Goumans, Marie-José; Lindeman, Johannes H N; Jongbloed, Monique R M; DeRuiter, Marco C; Klautz, Robert J M; Bogers, Ad J J C; Poelmann, Robert E; Groot, Adriana C Gittenberger-de

    2016-05-01

    Patients with bicuspid aortic valve (BAV) and patients with Marfan syndrome (MFS) are more prone to develop aortic dilation and dissection compared to persons with a tricuspid aortic valve (TAV). To elucidate potential common and distinct pathways of clinical relevance, we compared the histopathological substrates of aortopathy. Ascending aortic wall biopsies were divided in five groups: BAV (n = 36) and TAV (n = 23) without and with dilation and non-dilated MFS (n = 8). General histologic features, apoptosis, the expression of markers for vascular smooth muscle cell (VSMC) maturation, markers predictive for ascending aortic dilation in BAV, and expression of fibrillin-1 were investigated. Both MFS and BAV showed an altered distribution and decreased fibrillin-1 expression in the aorta and a significantly lower level of differentiated VSMC markers. Interestingly, markers predictive for aortic dilation in BAV were not expressed in the MFS aorta. The aorta in MFS was similar to the aorta in dilated TAV with regard to the presence of medial degeneration and apoptosis, while other markers for degeneration and aging like inflammation and progerin expression were low in MFS, comparable to BAV. Both MFS and BAV aortas have immature VSMCs, while MFS and TAV patients have a similar increased rate of medial degeneration. However, the mechanism leading to apoptosis is expected to be different, being fibrillin-1 mutation induced increased angiotensin-receptor-pathway signaling in MFS and cardiovascular aging and increased progerin in TAV. Our findings could explain why angiotensin inhibition is successful in MFS and less effective in TAV and BAV patients. PMID:26129868

  13. Double Valve Replacement (Mitral and Aortic for Rheumatic Heart Disease: A 20-year experience with 300 patients.

    Directory of Open Access Journals (Sweden)

    Prashant Mishra

    2016-09-01

    Full Text Available Introduction: Rheumatic heart disease still remains one of the leading causes of congestive heart failure and death owing to valvular pathologies, in developing countries. Valve replacement still remains the treatment of choice in such patients.The aim of this study wasto analyze the postoperative outcome of  double valve replacement (Mitral and Aortic in patients of rheumatic heart disease. Materials and Methods: Between 1988 and 2008, 300 patients of rheumatic heart disease underwent double (Mitral and Aortic valve replacement with Starr Edwards valve or St Jude mechanical valve prosthesis were implanted. These patients were studied retrospectively for preoperative data and postoperative outcome including causes of early and late deaths and the data was analyzed statistically. Results: The 30-day hospital death rate was 11.3% andlate death occurred in 11.6%. Anticoagulant regimen was followed to maintain the target pro-thrombin time at 1.5 times the control value. The actuarial survival (exclusive of hospital mortality was 92.4%, 84.6%, and 84.4%, per year at 5, 10, and 20 years, respectively Conclusions: In view of the acknowledged advantageof superior durability, increased thromboresistance in our patient population, and its cost effectiveness the Starr-Edwards ball valve or St. Jude valve is the mechanical prosthesis of choice for advanced combined valvular disease. The low-intensity anticoagulant regimen has offered suffcient protection against thromboembolism as well as hemorrhage.

  14. Deficient signaling via Alk2 (Acvr1 leads to bicuspid aortic valve development.

    Directory of Open Access Journals (Sweden)

    Penny S Thomas

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

  15. Aortic Valve Replacement for Infective Endocarditis in a Renal Transplant Recipient

    OpenAIRE

    Masmoudi Sayda; Frikha Imed; Trigui Walid; Karoui Abdelhamid; Daoud Moncef; Sahnoun Youssef

    2000-01-01

    Renal transplant recipients are more prone to developing infections. We report a 37-year old renal transplant recipient who developed infective endocarditis of the aortic valve, heart failure and renal allograft dysfunction. He underwent aortic valve replacement which was followed by improvement in cardiac as well as allograft function.

  16. Endograft failure in an adult patient with coarctation and bicuspid aortic valve.

    Science.gov (United States)

    Dimarakis, Ioannis; Grant, Stuart; Kadir, Isaac

    2013-06-01

    A 25-year-old man presented with associated bicuspid aortic valve and coarctation of the aorta. Following aortic valve replacement, he underwent endovascular stenting of his native coarctation. We describe early failure of the latter procedure that necessitated definitive surgical correction.

  17. Aortic Valve Replacement for Infective Endocarditis in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Masmoudi Sayda

    2000-01-01

    Full Text Available Renal transplant recipients are more prone to developing infections. We report a 37-year old renal transplant recipient who developed infective endocarditis of the aortic valve, heart failure and renal allograft dysfunction. He underwent aortic valve replacement which was followed by improvement in cardiac as well as allograft function.

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  10. Multimodality Imaging of a Giant Aortic Valve Papillary Fibroelastoma

    Directory of Open Access Journals (Sweden)

    Nowell M. Fine

    2013-01-01

    Full Text Available Papillary fibroelastomas (PFEs are benign cardiac tumors arising from endocardium. They are commonly found on valvular surfaces and average 1.0–1.5 cm in size. Though often asymptomatic, PFEs can lead to potentially severe complications, primarily due to their embolic potential. Surgical resection is recommended for all symptomatic or large PFEs. We report the case of a patient presenting with cardiovascular symptoms who was found to have a very large aortic valve PFE, as diagnosed by histopathologic examination following surgical resection. Multimodality cardiovascular imaging demonstrates the classic morphologic findings, including a pedunculated appearance and oscillating “frond-like” surface projections.

  11. Aortic valve endocarditis complicated by ST-elevation myocardial infarction.

    Science.gov (United States)

    Jenny, Benjamin E; Almanaseer, Yassar

    2014-12-01

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

  12. Hemolytic Anemia after Aortic Valve Replacement: a Case Report

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-10-01

    Full Text Available Hemolytic anemia is exceedingly rare and an underestimated complication after aortic valve replacement (AVR.The mechanism responsible for hemolysis most commonly involves a regurgitated flow or jet that related to paravalvar leak or turbulence of subvalvar stenosis. It appears to be independent of its severity as assessed by echocardiography. We present a case of a 24-year-old man with a history of AVR in 10 year ago that developed severe hemolytic anemia due to a mild subvalvar stenosis caused by pannus formation and mild hypertrophic septum. After exclusion of other causes of hemolytic anemia and the lack of clinical and laboratory improvement, the patient underwent redo valve surgery with pannus and subvalvar hypertrophic septum resection. Anemia and heart failure symptoms gradually resolved after surgery

  13. 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

  14. High-risk pregnancy in a woman with Marfan syndrome, a bicuspid aortic valve, and a dilated aortic sinus

    DEFF Research Database (Denmark)

    Groth, Kristian Ambjørn; Greisen, Jacob Raben; Nielsen, Birgitte Bruun;

    2015-01-01

    A 29-year-old woman with Marfan syndrome, a bicuspid aortic valve, and a dilated aortic sinus (5.2 cm) presented herself in clinic 14 weeks pregnant. She was advised to discontinue the pregnancy due to risk of dissection; however, she decided to continue. She was treated with labetalol (300 mg...

  15. Quadricuspid aortic valve by cardiac magnetic resonance imaging: a case report and review of the literature.

    Science.gov (United States)

    Khan, Shamruz Khan Akerem; Tamin, Syahidah Syed; Araoz, Philip A

    2011-01-01

    Quadricuspid aortic valve (QAV) is a rare congenital cardiac entity. The recognition of QAV has clinical significance as it causes aortic valve dysfunction, commonly aortic regurgitation, and is often associated with other congenital cardiac abnormalities. We showed the important role played by cardiac magnetic resonance imaging in detecting QAV and review the available literature to explain its incidence, diagnosis, classifications, embryology, correlation between morphology of the QAV and its function, associated conditions, and management. PMID:21926862

  16. Clinical comparison of St. Jude and porcine aortic valve prostheses.

    Science.gov (United States)

    Douglas, P S; Hirshfeld, J W; Edie, R N; Harken, A H; Stephenson, L W; Edmunds, L H

    1985-09-01

    One hundred eighty-seven consecutive patients who had aortic valve replacement with either a St. Jude or porcine heterograft prosthesis were studied prospectively. The two groups were similar with respect to 67 clinical and operative factors, which allowed comparison of valve performance as an independent variable. Total follow-up was 6162 patient-months (mean 32 months, range 23 to 62, 99% complete). There were no statistical differences in symptomatic improvement or mortality by life-table analysis. Valve-related complications expressed as percent per patient-year included: reoperation, 0.6 St. Jude and 1.2 porcine; endocarditis, 1.1 and 0.9; regurgitant murmur, 3.4 and 2.7; hemolysis, 2.8 and 0.0; thromboembolism, 2.8 and 1.5 (all not significant); and hemorrhage, 7.9 and 2.4 (p less than .005). Anticoagulant-related bleeding was the only significant difference between the two valves in morbidity and mortality 32 to 34 months after operation. PMID:4028357

  17. MDCT evaluation of aortic root and aortic valve prior to TAVI. What is the optimal imaging time point in the cardiac cycle?

    Energy Technology Data Exchange (ETDEWEB)

    Jurencak, Tomas; Turek, Jakub; Nijssen, Estelle C. [Maastricht University Medical Center, Department of Radiology, P. Debyelaan 25, P.O. Box 5800, AZ, Maastricht (Netherlands); Kietselaer, Bastiaan L.J.H. [Maastricht University Medical Center, Department of Radiology, P. Debyelaan 25, P.O. Box 5800, AZ, Maastricht (Netherlands); Maastricht University Medical Center, CARIM School for Cardiovascular Diseases, Maastricht (Netherlands); Maastricht University Medical Center, Department of Cardiology, Maastricht (Netherlands); Mihl, Casper; Kok, Madeleine; Wildberger, Joachim E.; Das, Marco [Maastricht University Medical Center, Department of Radiology, P. Debyelaan 25, P.O. Box 5800, AZ, Maastricht (Netherlands); Maastricht University Medical Center, CARIM School for Cardiovascular Diseases, Maastricht (Netherlands); Ommen, Vincent G.V.A. van [Maastricht University Medical Center, Department of Cardiology, Maastricht (Netherlands); Garsse, Leen A.F.M. van [Maastricht University Medical Center, Department of Cardiothoracic Surgery, Maastricht (Netherlands)

    2015-07-15

    To determine the optimal imaging time point for transcatheter aortic valve implantation (TAVI) therapy planning by comprehensive evaluation of the aortic root. Multidetector-row CT (MDCT) examination with retrospective ECG gating was retrospectively performed in 64 consecutive patients referred for pre-TAVI assessment. Eighteen different parameters of the aortic root were evaluated at 11 different time points in the cardiac cycle. Time points at which maximal (or minimal) sizes were determined, and dimension differences to other time points were evaluated. Theoretical prosthesis sizing based on different measurements was compared. Largest dimensions were found between 10 and 20 % of the cardiac cycle for annular short diameter (10 %); mean diameter (10 %); effective diameter and circumference-derived diameter (20 %); distance from the annulus to right coronary artery ostium (10 %); aortic root at the left coronary artery level (20 %); aortic root at the widest portion of coronary sinuses (20 %); and right leaflet length (20 %). Prosthesis size selection differed depending on the chosen measurements in 25-75 % of cases. Significant changes in anatomical structures of the aortic root during the cardiac cycle are crucial for TAVI planning. Imaging in systole is mandatory to obtain maximal dimensions. (orig.)

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

    Science.gov (United States)

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

    2015-03-01

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

  19. Initial Surgical Experience with Aortic Valve Repair: Clinical and Echocardiographic Results

    Science.gov (United States)

    da Costa, Francisco Diniz Affonso; Colatusso, Daniele de Fátima Fornazari; da Costa, Ana Claudia Brenner Affonso; Balbi Filho, Eduardo Mendel; Cavicchioli, Vinicius Nesi; Lopes, Sergio Augusto Veiga; Ferreira, Andrea Dumsch de Aragon; Collatusso, Claudinei

    2016-01-01

    Introduction Due to late complications associated with the use of conventional prosthetic heart valves, several centers have advocated aortic valve repair and/or valve sparing aortic root replacement for patients with aortic valve insufficiency, in order to enhance late survival and minimize adverse postoperative events. Methods From March/2012 thru March 2015, 37 patients consecutively underwent conservative operations of the aortic valve and/or aortic root. Mean age was 48±16 years and 81% were males. The aortic valve was bicuspid in 54% and tricuspid in the remaining. All were operated with the aid of intraoperative transesophageal echocardiography. Surgical techniques consisted of replacing the aortic root with a Dacron graft whenever it was dilated or aneurysmatic, using either the remodeling or the reimplantation technique, besides correcting leaflet prolapse when present. Patients were sequentially evaluated with clinical and echocardiographic studies and mean follow-up time was 16±5 months. Results Thirty-day mortality was 2.7%. In addition there were two late deaths, with late survival being 85% (CI 95% - 68%-95%) at two years. Two patients were reoperated due to primary structural valve failure. Freedom from reoperation or from primary structural valve failure was 90% (CI 95% - 66%-97%) and 91% (CI 95% - 69%-97%) at 2 years, respectively. During clinical follow-up up to 3 years, there were no cases of thromboembolism, hemorrhage or endocarditis. Conclusions Although this represents an initial series, these data demonstrates that aortic valve repair and/or valve sparing aortic root surgery can be performed with satisfactory immediate and short-term results. PMID:27556321

  20. Assessment of the influence of the compliant aortic root on aortic valve mechanics by means of a geometrical model.

    Science.gov (United States)

    Redaelli, A; Di Martino, E; Gamba, A; Procopio, A M; Fumero, R

    1997-12-01

    In recent years several researchers have suggested that the changes in the geometry and angular dimensions of the aortic root which occur during the cardiac cycle are functional to the optimisation of aortic valve function, both in terms of diminishing leaflet stresses and of fluid-dynamic behaviour. The paper presents an analytical parametric model of the aortic valve which includes the aortic root movement. The indexes used to evaluate the valve behaviour are the circumferential membrane stress and the stress at the free edge of the leaflet, the index of bending strain, the bending of the leaflet at the line attachment in the radial and circumferential directions and the shape of the conduit formed by the leaflets during systole. In order to evaluate the role of geometric changes in valve performance, two control cases were considered, with different reference geometric configuration, where the movement of the aortic root was ignored. The results obtained appear consistent with physiological data, especially with regard to the late diastolic phase and the early ejection phase, and put in evidence the role of the aortic root movement in the improvement of valve behaviour. PMID:9450254

  1. Effect of candesartan treatment on left ventricular remodeling after aortic valve replacement for aortic stenosis

    DEFF Research Database (Denmark)

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

    2010-01-01

    group had greater improvement in longitudinal LV systolic function assessed by tissue Doppler S' wave (0.6 +/- 0.1-cm/s increase in control group vs 1.4 +/- 0.1 cm/s in candesartan group, p = 0.01, p for trend = 0.02) and a decrease in LA volume (p for trend = 0.01). Treatment had no effect on diastolic......In hypertension, angiotensin receptor blockers can augment regression of left ventricular (LV) hypertrophy. It is not known whether this also is the case after aortic valve replacement (AVR) for severe aortic stenosis (AS). To test the hypothesis that treatment with candesartan in addition...... to conventional treatment is able to augment LV and left atrial (LA) reverse remodeling in patients with AS undergoing AVR, we studied 114 patients scheduled for AVR. Patients were randomized to treatment with candesartan 32 mg 1 time/day or conventional therapy immediately after AVR. Patients were followed...

  2. Comparative Transcriptome Analysis Reveals Substantial Tissue Specificity in Human Aortic Valve

    Science.gov (United States)

    Wang, Jun; Wang, Ying; Gu, Weidong; Ni, Buqing; Sun, Haoliang; Yu, Tong; Gu, Wanjun; Chen, Liang; Shao, Yongfeng

    2016-01-01

    RNA sequencing (RNA-seq) has revolutionary roles in transcriptome identification and quantification of different types of tissues and cells in many organisms. Although numerous RNA-seq data derived from many types of human tissues and cell lines, little is known on the transcriptome repertoire of human aortic valve. In this study, we sequenced the total RNA prepared from two calcified human aortic valves and reported the whole transcriptome of human aortic valve. Integrating RNA-seq data of 13 human tissues from Human Body Map 2 Project, we constructed a transcriptome repertoire of human tissues, including 19,505 protein-coding genes and 4,948 long intergenic noncoding RNAs (lincRNAs). Among them, 263 lincRNAs were identified as novel noncoding transcripts in our data. By comparing transcriptome data among different human tissues, we observed substantial tissue specificity of RNA transcripts, both protein-coding genes and lincRNAs, in human aortic valve. Further analysis revealed that aortic valve-specific lincRNAs were more likely to be recently derived from repetitive elements in the primate lineage, but were less likely to be conserved at the nucleotide level. Expression profiling analysis showed significant lower expression levels of aortic valve-specific protein-coding genes and lincRNA genes, when compared with genes that were universally expressed in various tissues. Isoform-level expression analysis also showed that a majority of mRNA genes had a major isoform expressed in the human aortic valve. To our knowledge, this is the first comparative transcriptome analysis between human aortic valve and other human tissues. Our results are helpful to understand the transcriptome diversity of human tissues and the underlying mechanisms that drive tissue specificity of protein-coding genes and lincRNAs in human aortic valve. PMID:27493474

  3. Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway: Minimalist Approach, Standardized Care, and Discharge Criteria to Reduce Length of Stay.

    Science.gov (United States)

    Lauck, Sandra B; Wood, David A; Baumbusch, Jennifer; Kwon, Jae-Yung; Stub, Dion; Achtem, Leslie; Blanke, Philipp; Boone, Robert H; Cheung, Anson; Dvir, Danny; Gibson, Jennifer A; Lee, Bobby; Leipsic, Jonathan; Moss, Robert; Perlman, Gidon; Polderman, Jopie; Ramanathan, Krishnan; Ye, Jian; Webb, John G

    2016-05-01

    We describe the development, implementation, and evaluation of a standardized clinical pathway to facilitate safe discharge home at the earliest time after transfemoral transcatheter aortic valve replacement. Between May 2012 and October 2014, the Heart Team developed a clinical pathway suited to the unique requirements of transfemoral transcatheter aortic valve replacement in contemporary practice. The components included risk-stratified minimalist periprocedure approach, standardized postprocedure care with early mobilization and reconditioning, and criteria-driven discharge home. Our aim was to reduce variation in care, identify a subgroup of patients suitable for early discharge (≤48 hours), and decrease length of stay for all patients. We addressed barriers related to historical practices, complex multidisciplinary stakeholder engagement, and adoption of length of stay as a quality indicator. We retrospectively reviewed the experiences of 393 consecutive patients; 150 (38.2%) were discharged early. At baseline, early discharge patients had experienced less previous balloon aortic valvuloplasty, had higher left ventricular ejection fraction, better cognitive function, and were less frail than the standard discharge group (>48 hours). Early discharge was associated with the use of local anesthesia, implantation of balloon expandable device, avoidance of urinary catheter, and early removal of temporary pacemaker. Median length of stay was 1 day for early discharge and 3 days for other patients; 97.7% were discharged home. There were no differences in 30-day mortality (1.3%), disabling stroke (0.8%), or readmission (10.7%). The implementation of a transcatheter aortic valve replacement clinical pathway shifted the program's approach to combine standardized processes and individual risk stratification. The Vancouver transcatheter aortic valve replacement clinical pathway requires a rigorous assessment to determine its efficacy, safety, and reproducibility. PMID

  4. A fibrous band associated with the non-coronary aortic valve cusp in a dog.

    Science.gov (United States)

    Ajithdoss, Dharani K; Arenas-Gamboa, Angela M; Edwards, John F

    2011-06-01

    A fibrous band connecting the middle of the free edge (nodulus Arantii) of the non-coronary aortic valve cusp to the ascending aorta just above the level of the non-coronary sinus of Valsalva was observed in an asymptomatic, 11-year-old, male Border Collie. The fibrous band was unrelated to the cause of the death in this dog. Such fibrous bands are usually reported in humans with congenital bicuspid aortic valves. To our knowledge, this is the first report of a fibrous band in the aortic valve in a domestic animal. PMID:21641896

  5. [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

  6. Type F Congenital Quadricuspid Aortic Valve: A Very Rare Case Diagnosed by 3-dimenional Transoesophageal Echocardiography

    Science.gov (United States)

    Garg, Pankaj; Kamaruddin, Hazlyna; Orme, Rachel; Watt, Victoria

    2014-01-01

    Congenital quadricuspid aortic valve (QAV) is a rare cardiac anomaly. Several different anatomical variations of a quadricuspid aortic valve have been described. Aortic regurgitation is the predominant valvular dysfunction associated with QAV and patients tend to present in their 5th or 6th decade of life. This anomaly is rarely picked up by transthoracic echocardiogram (TTE). A comprehensive transoesophageal echocardiography (TOE) study is more likely to diagnose it. We describe a very rare type of QAV – Type F in a 52-year-old lady who presented with symptoms of shortness of breath and pre-syncope. We include TOE images and intra-operative valve images. PMID:24707324

  7. A new ultrasonic process for a renewal of aortic valve decalcification

    Directory of Open Access Journals (Sweden)

    Farhat Fadi

    2006-01-01

    Full Text Available Abstract Background Aortic valve decalcification by ultrasound was given up. We evaluated a new ultrasound microhandpiece (Dissectron Penstyle® to rehabilitate this alternative treatment. Methods We used under magnifying lenses the ultrasound microhandpiece to decalcify 30 explanted aortic valves. In the cases with embedded calcifications the thin top of the probe could be introduced into the thickness of the leaflet preserving covering layers. Results The leaflets were totally decalcified and flexible, and surrounding structures were preserved as assessed by histological examination. Conclusion This new approach of ultrasonic aortic valve decalcification gives good in vitro results which allow to consider a clinical evaluation of this procedure.

  8. Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: A cross-sectional study

    NARCIS (Netherlands)

    P. Zacek (Pavel); T. Holubec; M. Vobornik; J. Dominik; J.J.M. Takkenberg (Hanneke); J. Harrer; J. Vojacek

    2016-01-01

    textabstractBackground: In patients after aortic valve surgery, the quality of life is hypothesized to be influenced by the type of the valve procedure. A cross-sectional study on the postoperative quality of life was carried out in patients after aortic valve-sparing surgery (with regards to the ag

  9. Lowering plasma cholesterol levels halts progression of aortic valve disease in mice

    Science.gov (United States)

    Miller, Jordan D.; Weiss, Robert M.; Serrano, Kristine M.; Brooks, Robert M.; Berry, Christopher J.; Zimmerman, Kathy; Young, Stephen G.; Heistad, Donald D.

    2009-01-01

    Background Treatment of hyperlipidemia produces functional and structural improvements in atherosclerotic vessels. However, the effects of treating hyperlipidemia on the structure and function of the aortic valve has been controversial, and any effects could be confounded by pleiotropic effects of hypolipidemic treatment. The goal of this study was to determine whether reducing elevated plasma lipid levels with a “genetic switch” in Reversa mice (Ldlr−/−/Apob100/100/Mttpfl/fl/Mx1Cre+/+) reduces oxidative stress, reduces proosteogenic signaling, and retards the progression of aortic valve disease. Methods and Results After 6 months of hypercholesterolemia, Reversa mice exhibited increases in superoxide, lipid deposition, myofibroblast activation, calcium deposition, and pro-osteogenic protein expression in the aortic valve. Maximum aortic valve cusp separation, as judged by echocardiography, was not altered. During an additional 6 months of hypercholesterolemia, superoxide levels, valvular lipid deposition, and myofibroblast activation remained elevated. Furthermore, calcium deposition and pro-osteogenic gene expression became more pronounced and the aortic cusp separation decreased from 0.85 ± 0.04 to 0.70 ± 0.04 mm (mean ± SE; p < 0.05). Rapid normalization of cholesterol levels at 6 months of age (by inducing expression of Cre recombinase) normalized aortic valve superoxide levels, decreased myofibroblast activation, reduced valvular calcium burden, suppressed pro-osteogenic signaling cascades, and prevented the reductions in aortic valve cusp separation. Conclusions Collectively, these data indicate that reducing plasma lipid levels by genetic inactivation of the mttp gene in hypercholesterolemic mice with early aortic valve disease normalizes oxidative stress, reduces pro-osteogenic signaling, and halts the progression of aortic valve stenosis. PMID:19433756

  10. 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...... with the general population in a nationwide cohort. METHODS: The study comprised the entire Danish population aged ≥18 years followed from 1 January 1997 until diagnosis of AS, 31 December 2011, or death. Information on comorbidity, concomitant medication, and socioeconomic status was identified by individual......-level linkage of administrative registers. Incidence rates for AS were calculated and incidence rate ratios (IRRs) adjusted for age, gender, calendar year, comorbidity, medications, and socioeconomic status, were estimated in Poisson regression models. RESULTS: A total of 5 107 624 subjects were eligible...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1991-09-01

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

  12. Sutureless replacement of aortic valves with St Jude Medical mechanical valve prostheses and Nitinol attachment rings: feasibility in long-term (90-day) pig experiments

    OpenAIRE

    Berreklouw, Eric; Koene, Bart; De Somer, Filip; Bouchez, Stefaan; Chiers, Koen; Taeymans, Yvo; Van Nooten, Guido

    2011-01-01

    Objective: Nitinol attachment rings (devices) used to attach mechanical aortic valve prostheses suturelessly were studied in long-term (90 days) pig experiments. Methods: The aortic valve was removed and replaced by a device around a St Jude Medical mechanical valve prosthesis in 10 surviving pigs. Supravalvular angiography was done at the end of the operation. No coumarin derivates were given. Results: No or minimal aortic regurgitation was confirmed in all surviving pigs at the end ...

  13. Patient-prosthesis mismatch and reduction in left ventricular mass after aortic valve replacement

    DEFF Research Database (Denmark)

    Kandler, Kristian; Møller, Christian H; Hassager, Christian;

    2013-01-01

    The presence of patient-prosthesis mismatch (PPM) after aortic valve replacement may influence patient survival. We examined the relationship between PPM and changes in left ventricular mass index at 3 months follow-up and also overall survival....

  14. 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...

  15. Low‐gradient aortic valve stenosis: value and limitations of dobutamine stress testing

    OpenAIRE

    J. Bermejo; Yotti, R.

    2006-01-01

    Aortic valve stenosis has already reached endemic proportions in Western countries. As the prognosis of low‐flow aortic valve stenosis under medical treatment is dismal, surgery is recommended in most patients. Preoperative dobutamine stress testing may help to assess surgical risk, but there is no strong scientific evidence to deny surgery based exclusively on the results of this test. The problems associated with clinical decision making in this condition are reviewed.

  16. St. Jude Medical Trifecta aortic valve: results from a prospective regional multicentre registry

    OpenAIRE

    Mariscalco, Giovanni; Mariani, Silvia; Bichi, Samuele; Biondi, Andrea; Blasio, Andrea De; Borsani, Paolo; Corti, Fabrizio; Chiara, Benedetta De; Gherli, Riccardo; Leva, Cristian; Russo, Claudio Francesco; Tasca, Giordano; Vanelli, Paolo; Alfieri, Ottavio; Antona, Carlo

    2015-01-01

    Background The Trifecta aortic bioprosthesis (St. Jude Medical, Inc., St. Paul, MN, USA) is a stented pericardial heart valve with excellent preliminary results. Aim of the study was to evaluate its early clinical and hemodynamic performances in a multicenter regional registry. Methods Between January 2011 and June 2012, 178 consecutive patients undergoing aortic valve replacement with the Trifecta bioprosthesis were prospectively enrolled at 9 Italian centers. Clinical and echocardiographic ...

  17. Right Minithoracotomy Approach for Replacement of the Ascending Aorta, Hemiarch, and Aortic Valve.

    Science.gov (United States)

    Lamelas, Joseph; LaPietra, Angelo

    2016-01-01

    A minimally invasive right anterior thoracotomy approach is the preferred technique used at our institution for isolated aortic valve pathology. We have recently introduced more complex concomitant minimally invasive procedures through this access site. Here, we describe how we perform a replacement of the ascending aorta and aortic valve with and without the use of circulatory arrest through a 6-cm right minimally invasive thoracotomy incision.

  18. Baseline MDCT findings after prosthetic heart valve implantation provide important complementary information to echocardiography for follow-up purposes

    Energy Technology Data Exchange (ETDEWEB)

    Sucha, Dominika; Mali, Willem P.T.M.; Habets, Jesse [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Chamuleau, Steven A.J. [University Medical Center Utrecht, Department of Cardiology, Utrecht (Netherlands); Symersky, Petr [VU Medical Center, Department of Cardiothoracic Surgery, Amsterdam (Netherlands); Meijs, Matthijs F.L. [Thoraxcentrum Twente, Medisch Spectrum Twente, Department of Cardiology, Enschede (Netherlands); Brink, Renee B.A. van den [Academic Medical Center, Department of Cardiology, Amsterdam (Netherlands); Mol, Bas A.J.M. de [Academic Medical Center, Department of Cardiothoracic Surgery, Amsterdam (Netherlands); Herwerden, Lex A. van [University Medical Center Utrecht, Department of Cardiothoracic Surgery, Utrecht (Netherlands); Budde, Ricardo P.J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands)

    2016-04-15

    Recent studies have proposed additional multidetector-row CT (MDCT) for prosthetic heart valve (PHV) dysfunction. References to discriminate physiological from pathological conditions early after implantation are lacking. We present baseline MDCT findings of PHVs 6 weeks post implantation. Patients were prospectively enrolled and TTE was performed according to clinical guidelines. 256-MDCT images were systematically assessed for leaflet excursions, image quality, valve-related artefacts, and pathological and additional findings. Forty-six patients were included comprising 33 mechanical and 16 biological PHVs. Overall, MDCT image quality was good and relevant regions remained reliably assessable despite mild-moderate PHV-artefacts. MDCT detected three unexpected valve-related pathology cases: (1) prominent subprosthetic tissue, (2) pseudoaneurysm and (3) extensive pseudoaneurysms and valve dehiscence. The latter patient required valve surgery to be redone. TTE only showed trace periprosthetic regurgitation, and no abnormalities in the other cases. Additional findings were: tilted aortic PHV position (n = 3), pericardial haematoma (n = 3) and pericardial effusion (n = 3). Periaortic induration was present in 33/40 (83 %) aortic valve patients. MDCT allowed evaluation of relevant PHV regions in all valves, revealed baseline postsurgical findings and, despite normal TTE findings, detected three cases of unexpected, clinically relevant pathology. (orig.)

  19. Baseline MDCT findings after prosthetic heart valve implantation provide important complementary information to echocardiography for follow-up purposes

    International Nuclear Information System (INIS)

    Recent studies have proposed additional multidetector-row CT (MDCT) for prosthetic heart valve (PHV) dysfunction. References to discriminate physiological from pathological conditions early after implantation are lacking. We present baseline MDCT findings of PHVs 6 weeks post implantation. Patients were prospectively enrolled and TTE was performed according to clinical guidelines. 256-MDCT images were systematically assessed for leaflet excursions, image quality, valve-related artefacts, and pathological and additional findings. Forty-six patients were included comprising 33 mechanical and 16 biological PHVs. Overall, MDCT image quality was good and relevant regions remained reliably assessable despite mild-moderate PHV-artefacts. MDCT detected three unexpected valve-related pathology cases: (1) prominent subprosthetic tissue, (2) pseudoaneurysm and (3) extensive pseudoaneurysms and valve dehiscence. The latter patient required valve surgery to be redone. TTE only showed trace periprosthetic regurgitation, and no abnormalities in the other cases. Additional findings were: tilted aortic PHV position (n = 3), pericardial haematoma (n = 3) and pericardial effusion (n = 3). Periaortic induration was present in 33/40 (83 %) aortic valve patients. MDCT allowed evaluation of relevant PHV regions in all valves, revealed baseline postsurgical findings and, despite normal TTE findings, detected three cases of unexpected, clinically relevant pathology. (orig.)

  20. Factors affecting computed tomography image quality for assessment of mechanical aortic valves.

    Science.gov (United States)

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

    2016-06-01

    Evaluating mechanical valves with computed tomography (CT) can be problematic because artifacts from the metallic components of valves can hamper image quality. The purpose of this study was to determine factors affecting the image quality of cardiac CT to improve assessment of mechanical aortic valves. A total of 144 patients who underwent aortic valve replacement with mechanical valves (ten different types) and who underwent cardiac CT were included. Using a four-point grading system, the image quality of the CT scans was assessed for visibility of the valve leaflets and the subvalvular regions. Data regarding the type of mechanical valve, tube voltage, average heart rate (HR), and HR variability during CT scanning were compared between the non-diagnostic (overall image quality score ≤2) and diagnostic (overall image quality score >2) image quality groups. Logistic regression analyses were performed to identify predictors of non-diagnostic image quality. The percentage of valve types that incorporated a cobalt-chrome component (two types in total) and HR variability were significantly higher in the non-diagnostic image group than in the diagnostic group (P  0.05). Valve type was the only independent predictor of non-diagnostic quality. The CT image quality for patients with mechanical aortic valves differed significantly depending on the type of mechanical valve used and on the degree of HR variability.

  1. 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

  2. Improving Hemostasis during Replacement of the Ascending Aorta and Aortic Valve with a Composite Graft

    OpenAIRE

    Pratali, Stefano; Milano, Aldo; Codecasa, Riccardo; Carlo, Marco De; Borzoni, Giancarlo; Bortolotti, Uberto

    2000-01-01

    The use of a composite graft is an established treatment for patients with aortic valve disease and ascending aortic aneurysms. Since bleeding from suture lines is a potential complication of this procedure, we modified the technique and evaluated the effect on hemostasis.

  3. 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...

  4. Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review

    Science.gov (United States)

    Lytvyn, Lyubov; Guyatt, Gordon H; Manja, Veena; Siemieniuk, Reed A; Zhang, Yuan; Agoritsas, Thomas; Vandvik, Per O

    2016-01-01

    Objective To investigate patients' values and preferences regarding aortic valve replacement therapy for aortic stenosis. Setting Studies published after transcatheter aortic valve insertion (TAVI) became available (2002). Participants Adults with aortic stenosis who are considering or have had valve replacement, either TAVI or via surgery (surgical aortic valve replacement, SAVR). Outcome measures We sought quantitative measurements, or qualitative descriptions, of values and preferences. When reported, we examined correlations between preferences and objective (eg, ejection fraction) or subjective (eg, health-related quality of life) measures of health. Results We reviewed 1348 unique citations, of which 2 studies proved eligible. One study of patients with severe aortic stenosis used a standard gamble study to ascertain that the median hypothetical mortality risk patients were willing to tolerate to achieve full health was 25% (IQR 25–50%). However, there was considerable variability; for mortality risk levels defined by current guidelines, 130 participants (30%) were willing to accept low-to-intermediate risk (≤8%), 224 (51%) high risk (>8–50%) and 85 (19%) a risk that guidelines would consider prohibitive (>50%). Study authors did not, however, assess participants' understanding of the exercise, resulting in a potential risk of bias. A second qualitative study of 15 patients identified the following factors that influence patients to undergo assessment for TAVI: symptom burden; expectations; information support; logistical barriers; facilitators; obligations and responsibilities. The study was limited by serious risk of bias due to authors' conflict of interest (5/9 authors industry-funded). Conclusions Current evidence on patient values and preferences of adults with aortic stenosis is very limited, and no studies have enrolled patients deciding between TAVI and SAVR. On the basis of the data available, there is evidence of variability in individual

  5. 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...

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hallowell Gayle D

    2013-01-01

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

  8. Valve-related complications after mechanical heart valve implantation.

    Science.gov (United States)

    Misawa, Yoshio

    2015-10-01

    The number of heart valve surgeries is increasing, and 19,164 patients underwent heart valve surgery in Japan in 2011. The early mortality rate has remained stable for more than 10 years. Many patients now survive for many years, with a reported 10-year survival rate of at least 60 %. However, unfavorable complications can occur after valve surgery. Valve-related complications include thromboembolisms, bleeding complications and prosthetic valve endocarditis, followed by structural and nonstructural prosthetic valve dysfunctions. Our review of studies published after 2000 revealed that the rate of all valve-related complications was 0.7-3.5 % per patient-year. Thromboembolisms occur at a rate of approximately 1 % per patient-year, and bleeding complications occur at almost 0.5 % per patient-year. Thromboembolic and hemorrhagic events related to anticoagulant therapy should be considered during life-long follow-up. The occurrence rate of endocarditis reaches 0.5 % per patient-year, with a poor postoperative survival. Structural dysfunctions have been largely overcome, and the nonstructural dysfunction rate is 0.4-1.2 % per patient-year. The nonstructural dysfunctions induced by paravalvular leaks and pannus ingrowth are also issues that need to be resolved.

  9. Hemodynamic function of the standard St. Jude bileaflet disc valve has no clinical impact 10 years after aortic valve replacement

    DEFF Research Database (Denmark)

    Lund, Ole; Dorup, Inge; Emmertsen, Kristian;

    2005-01-01

    OBJECTIVES: Size mismatch and impaired left ventricular function have been shown to determine the hemodynamic function of the standard St. Jude bileaflet disc valve early after aortic valve replacement (AVR). We aimed to analyse St. Jude valve hemodynamic function and its clinical impact in the...... regurgitation were excluded from further analysis: they had significantly lower St. Jude valve gradient and left ventricular ejection fraction (LVEF) and larger mass index (LVMi) than 37 without. RESULTS: In the 37 patients without left sided valve regurgitation peak and mean gradients were inversely related to...... St. Jude valve geometric orifice area (GOA) indexed for either body surface area or left ventricular end-diastolic dimension (LVEDD). The gradients correlated directly with LVEDD but not with LVEF or LVMi. Eleven patients with hypertension had higher peak gradients (31+/-13 versus 22+/-8 mmHg, p<0...

  10. St Jude Medical Portico valve.

    Science.gov (United States)

    Manoharan, Ganesh; Spence, Mark S; Rodés-Cabau, Joseph; Webb, John G

    2012-09-01

    Transcatheter aortic valve implantation is increasingly being used to treat high-risk patients with symptomatic aortic valve disease. However, challenges still remain with current devices, both in terms of the procedure and the outcome. The St Jude Medical Portico transcatheter valve system is designed to mitigate some of these difficulties. We describe the device characteristics and how the device may impact on a TAVI procedure. An overview of the clinical experiences with the Portico valve system is also described. PMID:22995122

  11. A comparison of echocardiographic and electron beam computed tomographic assessment of aortic valve area in patients with valvular aortic stenosis

    NARCIS (Netherlands)

    Piers, Lieuwe H.; Dikkers, Riksta; Tio, Rene A.; van den Berg, Maarten P.; Willems, Tineke P.; Zijlstra, Felix; Oudkerk, Matthijs

    2007-01-01

    The purpose of this study was to compare electron beam computed tomography (EBT) with transthoracic echocardiography (TTE) in determining aortic valve area (AVA). Thirty patients (9 females, 21 males) underwent a contrast-enhanced EBT scan (e-Speed, GE, San Francisco, CA, USA) and TTE within 17 +/-

  12. Microparticle-Induced Coagulation Relates to Coronary Artery Atherosclerosis in Severe Aortic Valve Stenosis.

    Directory of Open Access Journals (Sweden)

    Patrick Horn

    Full Text Available Circulating microparticles (MPs derived from endothelial cells and blood cells bear procoagulant activity and promote thrombin generation. Thrombin exerts proinflammatory effects mediating the progression of atherosclerosis. Aortic valve stenosis may represent an atherosclerosis-like process involving both the aortic valve and the vascular system. The aim of this study was to investigate whether MP-induced thrombin generation is related to coronary atherosclerosis and aortic valve calcification.In a cross-sectional study of 55 patients with severe aortic valve stenosis, we assessed the coronary calcification score (CAC as indicator of total coronary atherosclerosis burden, and aortic valve calcification (AVC by computed tomography. Thrombin-antithrombin complex (TATc levels were measured as a marker for thrombin formation. Circulating MPs were characterized by flow cytometry according to the expression of established surface antigens and by measuring MP-induced thrombin generation.Patients with CAC score below the median were classified as patients with low CAC, patients with CAC Score above the median as high CAC. In patients with high CAC compared to patients with low CAC we detected higher levels of TATc, platelet-derived MPs (PMPs, endothelial-derived MPs (EMPs and MP-induced thrombin generation. Increased level of PMPs and MP-induced thrombin generation were independent predictors for the severity of CAC. In contrast, AVC Score did not differ between patients with high and low CAC and did neither correlate with MPs levels nor with MP-induced thrombin generation.In patients with severe aortic valve stenosis MP-induced thrombin generation was independently associated with the severity of CAC but not AVC indicating different pathomechanisms involved in coronary artery and aortic valve calcification.

  13. 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.

  14. Detecting Aortic Valve Opening and Closing from Distal Body Vibrations

    CERN Document Server

    Wiens, Andrew D; Inan, Omer T

    2016-01-01

    Objective: Proximal and whole-body vibrations are well studied in seismocardiography and ballistocardiography, yet distal vibrations are still poorly understood. In this paper we develop two methods to measure aortic valve opening (AVO) and closing (AVC) from distal vibrations. Methods: AVO and AVC were detected for each heartbeat with accelerometers on the upper arm (A), wrist (W), and knee (K) of 22 consenting adults following isometric exercise. Exercise-induced changes were recorded with impedance cardiography, and nine-beat ensemble averaging was applied. Our first method, FilterBCG, detects peaks in distal vibrations after filtering with individually-tuned bandpass filters while RidgeBCG uses ridge regression to estimate AVO and AVC without peaks. Pseudocode is provided. Results: In agreement with recent studies, we did not find peaks at AVO and AVC in distal vibrations, and the conventional R-J interval method from the literature also correlated poorly with AVO (r2 = 0.22 A, 0.14 W, 0.12 K). Interestin...

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2014-02-01

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

  17. Myocardial hypertrophy after pulmonary regurgitation and valve implantation in pigs

    DEFF Research Database (Denmark)

    Smith, Julie; Goetze, Jens Peter; Søndergaard, Lars;

    2012-01-01

    BACKGROUND: Patients may suffer from right ventricular (RV) failure and malignant cardiac arrhythmias after late pulmonary valve replacement correcting pulmonary regurgitation (PR). But the underlying mechanisms of the refractory arrhythmias are not well understood. METHODS: The aim of present...... study was to characterize the RV myocardium after percutaneous pulmonary valve implantation (PPVI) in a porcine model after severe PR for 3months. RV histology was evaluated with morphometric methods and RV function was assessed with electrophysiology, echocardiography, and biochemical measures...

  18. St. Jude Medical and CarboMedics Mechanical Heart Valves in the Aortic Position: Comparison of Long-Term Results

    OpenAIRE

    Kandemir, Ozer; Tokmakoglu, Hilmi; Yildiz, Ulku; TEZCANER, Tevfik; Yorgancioglu, A. Cem; Gunay, Ilhan; Suzer, Kaya; Zorlutuna, Yaman

    2006-01-01

    We designed this study to compare long-term results of St. Jude Medical and CarboMedics mechanical heart valves in the aortic position. We retrospectively analyzed the results of 174 consecutive patients who received either a St. Jude (n=80) or a CarboMedics (n=94) mechanical aortic valve from March 1992 through October 2004.

  19. Left Atrial Volume as Predictor of Valve Replacement and Cardiovascular Events in Patients with Asymptomatic Mild to Moderate Aortic Stenosis

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Egstrup, Kenneth; Wachtell, Kristian;

    2013-01-01

    Left atrial (LA) size is known to increase with chronically increased left ventricular (LV) filling pressure. We hypothesized that LA volume was predictive of aortic valve replacement (AVR) and cardiovascular events in a large cohort of patients with asymptomatic mild to moderate aortic valve ste...

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

    DEFF Research Database (Denmark)

    Sivertsen, Jacob; Køber, Lars Valeur; Abdulla, Jawdat;

    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 ...

  1. 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.

  2. Capnocytophaga canimorsus endocarditis with root abscess in a patient with a bicuspid aortic valve

    OpenAIRE

    Guillaume Coutance; Olivier Lepage; Christophe Bachelet; Michèle Hamon; Damien Legallois; Arnaud Pellissier; Fabien Labombarda

    2009-01-01

    Infective endocarditis caused by a zoonotic micro organism is a rare clinical condition. Capnocytophaga canimorsus is a commensal bacterium living in the saliva of dogs and cats which produces rarely reported endocarditis whose incidence may be underestimated, considering its failure to grow on standard media. We reported the case of a 65-year-old man with bicuspid aortic valve endocarditis and multiple abscesses of the aortic wall caused by the canine bacteria C. canimorsus.

  3. Capnocytophaga canimorsus endocarditis with root abscess in a patient with a bicuspid aortic valve

    Directory of Open Access Journals (Sweden)

    Michèle Hamon

    2009-04-01

    Full Text Available Infective endocarditis caused by a zoonotic micro organism is a rare clinical condition. Capnocytophaga canimorsus is a commensal bacterium living in the saliva of dogs and cats which produces rarely reported endocarditis whose incidence may be underestimated, considering its failure to grow on standard media. We reported the case of a 65-year-old man with bicuspid aortic valve endocarditis and multiple abscesses of the aortic wall caused by the canine bacteria C. canimorsus.

  4. 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 ...

  5. 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...

  6. Acute myocardial ischemia after aortic valve replacement: A comprehensive diagnostic evaluation using dynamic multislice spiral computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lembcke, Alexander [Department of Radiology, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany)]. E-mail: alexander.lembcke@gmx.de; Hein, Patrick A. [Department of Radiology, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany); Enzweiler, Christian N.H. [Department of Radiology, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany); Hoffmann, Udo [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA (United States); Klessen, Christian [Department of Radiology, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany); Dohmen, Pascal M. [Department of Cardiovascular Surgery, Charite-Universitaetsmedizin Berlin, Freie Universitaet Berlin and Humboldt-Universitaet zu Berlin, Berlin (Germany)

    2006-03-15

    We describe the case of a 72-year-old man presenting with endocarditis and clinical signs of acute myocardial ischemia after biological aortic valve replacement. A comprehensive cardiac dynamic multislice spiral computed tomography demonstrated: (1) an endocarditic vegetation of the aortic valve; (2) a subvalvular leakage feeding a paravalvular pseudoaneurysm based on an aortic root abscess with subsequent compromise of the systolic blood flow in the left main coronary artery and the resulting myocardial perfusion deficit.

  7. Octogenarian with an untreated femoral neck fracture: upright position during the postoperative course after aortic valve replacement

    Directory of Open Access Journals (Sweden)

    M. Polastri

    2015-06-01

    Full Text Available We describe a patient with a femoral neck fracture undergoing an aortic valve replacement. The study design was a case report. An 82-year-old female with an untreated right femoral neck fracture, and a severe aortic valve stenosis was admitted to a cardiac surgery department for surgical treatment of the valve disease. She underwent aortic valve replacement with a sutureless biological valve prosthesis through a partial sternotomy. At an early stage, the patient was instructed to make postural changes in the standing position. As a result, she was able to perform body movements associated with either a sitting or standing position. This case shows that appropriate early mobilization of a patient with a femoral neck fracture is feasible after aortic valve replacement, even though this does not necessarily mean that the patient needs to walk.

  8. Mechanical aortic valve without anticoagulation for 33 years in a Yemeni man: a case report

    OpenAIRE

    Aman, Khadija

    2016-01-01

    Background Mechanical prosthetic heart valves have been used for many decades to replace damaged native valves. Guidelines mandate the use of anticoagulant therapy in patients with mechanical prosthetic valves of any type, irrespective of the position in the heart. The rationale for this is to prevent valve thrombosis and thromboembolic complications without increasing the risk of excess bleeding. We report a case involving a patient with a functioning aortic mechanical valve without any anti...

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

    OpenAIRE

    K. Ghandehari Z. Izadimoud

    2005-01-01

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

  10. In vitro flow dynamics of four prosthetic aortic valves: a comparative analysis.

    Science.gov (United States)

    Hanle, D D; Harrison, E C; Yoganathan, A P; Allen, D T; Corcoran, W H

    1989-01-01

    The velocity fields downstream of four prosthetic heart valves were mapped in vitro over the entire cross-section of a model aortic root using laser Doppler anemometry. THe Björk-Shiley 60 degrees convexo-concave tilting disc valve, the Smeloff-Cutter caged ball valve, the St. Jude Medical bileaflet valve, and the Ionescu-Shiley standard bioprosthesis were examined under both steady and pulsatile flows. Velocity profiles under steady flow conditions were a good approximation for pulsatile profiles only during midsystole. The pulsatile flow characteristics of the four valves showed variation in large scale flow structures. Comparison of the valves according to pressure drop, shear stress and maximum velocities are also provided. PMID:2808443

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

    Science.gov (United States)

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

    2012-12-01

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

  12. Initial hydrodynamic study on a new intraaortic axial flow pump: Dynamic aortic valve

    Institute of Scientific and Technical Information of China (English)

    LI; Guorong

    2001-01-01

    [1]Portner, P. M., Oyer, P. E., Pennington, D. G. et al., Implantable electrical left ventricular assist system: bridge to trans-plantation and the future, Ann. Thorac. Surg., 1989, 47: 142.[2]Pennington, D. G., McBride, L. R. et al., Bridging to heart transplantation with circulatory support devices, J. Heart Transplant, 1989, 8: 116.[3]Westaby, S., Katsumata, T., Evans, R. et al., The Jarvik 2000 Oxford system: increasing the scope of mechanical circulatory support, J. Thorac. Cardiovasc. Surg., 1997, 114: 467.[4]Thomas, D. C., Butler, K. C., Taylor, L. P. et al., Progress on development of the Nimbus-University of Pittsburgh axial flow left ventricular assist system, ASAIO J., 1998, 44: M521.[5]Levin, H. R., Oz, M. C., Paker, M. et al., Reversal of chronic ventricular dilation in patients with end stage cardiomyopathy by prolonged mechanical unloading, Circulation, 1995, 91: 2717.[6]Frazier, O. H., Benedict, C. R., Radovancevic, B. et al., Improved left ventricular function after chronic left ventricular offloading, Ann. Thorac. Surg., 1996, 62: 675.[7]Li, G. R., Zhu, X. D., Wang, J. H. et al., China Patent, Publication Number: 1168263, 1997.[8]Li, G. R., Zhu, X. D., Hu, S. S. et al., Preliminary study of a new concept for left ventricular assistance Dynamic Aortic Valve, J. Biomed. Eng. (in Chinese), 1999, 16(1): 116.[9]Lee, W. H. Jr., Krumbhaar, D., Fonkalstrud, E. W. et al., Denaturation of plasma proteins as a cause of morbidity and death after intracardiac operations, Surgery, 1961, 50: 29.[10] Kalter, R. D., Saul, C. M., Wetstein, L. et al., Cardiopulmonary bypass associated hemostalic abnormalities, J. Thorac. Cardiovasc. Surg., 1979, 77: 427.[11] Ross, J. Jr., Braunwald, E., The study of left ventricular function in man by increasing resistance to ventricular ejection with angiotensin, Circulation, 1964, 29: 739.[12] Mitamura, Y., Yozu, R., Tanka, T. Y. et al., Toward an implantable axial intracardiac blood

  13. 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...

  14. 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 a...... echocardiography. CONCLUSIONS: Haemodynamic performance and early clinical results of Medtronic advantage in the aortic position were satisfactory and comparable with those of other bileaflet valves in current clinical use.......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...

  15. Semiautomatic, Quantitative Measurement of Aortic Valve Area Using CTA : Validation and Comparison with Transthoracic Echocardiography

    NARCIS (Netherlands)

    Tuncay, V.; Prakken, N.; van Ooijen, P. M. A.; Budde, R. P. J.; Leiner, T.; Oudkerk, M.

    2015-01-01

    Objective. The aim of this work was to develop a fast and robust (semi) automatic segmentation technique of the aortic valve area (AVA) MDCT datasets. Methods. The algorithm starts with detection and cropping of Sinus of Valsalva on MPR image. The cropped image is then binarized and seed points are

  16. Intima-media thickness of the descending aorta in patients with bicuspid aortic valve

    Directory of Open Access Journals (Sweden)

    Johan Petrini

    2016-06-01

    Conclusions: Intima-media thickness of the descending aorta is not affected by aortic valve morphology (BAV/TAV; age is the main determinant of AoIMT. Genetic markers (SNPs known to influence IMT in the carotid artery seem to correlate to IMT in the descending aorta only in patients with TAV.

  17. Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement

    NARCIS (Netherlands)

    Koene, Bart M.; Hamad, Mohamed A. Soliman; Bouma, Wobbe; Mariani, Massimo A.; Peels, Kathinka C.; van Dantzig, Jan-Melle; van Straten, Albert H.

    2013-01-01

    Background: The influence of prosthesis-patient mismatch (PPM) on survival after aortic valve replacement (AVR) remains controversial. In this study, we sought to determine the effect of PPM on early (30 days) after AVR or AVR combined with coronary artery bypass grafting (AVR with CABG). Methods: B

  18. Cross Talk between NOTCH Signaling and Biomechanics in Human Aortic Valve Disease Pathogenesis

    Directory of Open Access Journals (Sweden)

    Richard C. Godby

    2014-12-01

    Full Text Available Aortic valve disease is a burgeoning public health problem associated with significant mortality. Loss of function mutations in NOTCH1 cause bicuspid aortic valve (BAV and calcific aortic valve disease. Because calcific nodules manifest on the fibrosa side of the cusp in low fluidic oscillatory shear stress (OSS, elucidating pathogenesis requires approaches that consider both molecular and mechanical factors. Therefore, we examined the relationship between NOTCH loss of function (LOF and biomechanical indices in healthy and diseased human aortic valve interstitial cells (AVICs. An orbital shaker system was used to apply cyclic OSS, which mimics the cardiac cycle and hemodynamics experienced by AVICs in vivo. NOTCH LOF blocked OSS-induced cell alignment in human umbilical vein endothelial cells (HUVECs, whereas AVICs did not align when subjected to OSS under any conditions. In healthy AVICs, OSS resulted in decreased elastin (ELN and α-SMA (ACTA2. NOTCH LOF was associated with similar changes, but in diseased AVICs, NOTCH LOF combined with OSS was associated with increased α-SMA expression. Interestingly, AVICs showed relatively higher expression of NOTCH2 compared to NOTCH1. Biomechanical interactions between endothelial and interstitial cells involve complex NOTCH signaling that contributes to matrix homeostasis in health and disorganization in disease.

  19. Video densitometric determinations of relative regurgitation volumes in aortic valve insufficiency

    International Nuclear Information System (INIS)

    A simple video densitometric method based on the indicator distribution principle in the region of interes permits the determination of the relative amount of regurgitation between the ascending aorta and the left ventricle in cases of aortic valve insufficiency. The experimental basis and early clinical measurements are described and are compared with the more conventional methods of cine angiography and radionuclide ventriculography. (orig.)

  20. Patient-specific simulation of a trileaflet aortic heart valve in a realistic left ventricle and aorta

    Science.gov (United States)

    Gilmanov, Anvar; Le, Trung; Stolarski, Henryk; Sotiropoulos, Fotis

    2013-11-01

    We develop a patient-specific model of the left ventricle consisting of: (1) magnetic-resonance images (MRI) data for wall geometry and kinematics reconstruction of the left ventricle during one cardiac cycle and (2) an elastic trileaflet aortic heart valve implanted in (3) a realistic aorta interacting with blood flow driven by the pulsating left ventricle. Blood flow is simulated via a new fluid-structure interaction (FSI) method, which couples the sharp-interface CURVIB [L. Ge, F. Sotiropoulos, JCP, (2007)] for handling complex moving boundaries with a new, rotation-free finite-element (FE) formulation for simulating large tissue deformations [H. Stolarski, A. Gilmanov, F. Sotiropoulos, IJNME, (2013)] The new FE shell formulation has been extensively tested and validated for a range of relevant problems showing good agreements. Validation of the coupled FSI-FE-CURVIB model is carried out for a thin plate undergoing flow-induced vibrations in the wake of a square cylinder and the computed results are in good agreement with published data. The new approach has been applied to simulate dynamic interaction of a trileaflet aortic heart valve with pulsating blood flow at physiological conditions and realistic artery and left ventricle geometry.

  1. Approaches for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Vinayak Nagaraja

    2014-02-01

    Full Text Available Introduction: Retrograde transfemoral and antegrade transapical approaches are mostly used for transcatheter aortic valve replacement. This meta-analysis is designed to assess the performance of the transfemoral and transapical approach. Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. Original data was abstracted from each study and used to calculate a pooled odd ratio (OR and 95% confidence interval (95% CI. Results: Only 14 studies comprising of 6965 patients met full criteria for analysis. The mean duration of hospitalisation and procedure duration were similar among the 2 cohorts. The 30 days mortality (OR: 0.70, 95% CI: 0.531-0.921, the need for haemodialysis (OR: 0.29, 95% CI: 0.157-0.525 and one year mortality (OR: 0.72, 95% CI: 0.564-0.927 were lower in the transfemoral cohort. The frequency of stroke at 30 days and new pacemaker insertion were comparable. However, the prevalence of vascular complication (OR: 2.88, 95% CI: 1.821-4.563 was higher in the transfemoral group. The incidence of aortic regurgitation (OR: 1.25, 95% CI: 0.844-1.855, valve embolization (OR: 2.00, 95% CI: 0.622-6.448, major bleeding incidence rates (OR:0.77, 95% CI: 0.488-1.225, coronary obstruction (OR:0.74, 95% CI:0.234-2.311, myocardial infarction (OR: 0.75, 95% CI: 0.28-2.00, conversion to open cardiac surgery (OR: 0.29, 95% CI: 0.062-1.343 and successful implantation (OR: 0.67, 95% CI: 0.394-1.149 were comparable in the two cohorts. Conclusions: In the absence of a randomized controlled study, the ability to discriminate true differences is challenging. Even though the complications rate was much lower in transfemoral group as compared to transapical group, the current literature does not support a clear superiority of one approach to TAVR over the other.

  2. Ahmed glaucoma valve implant: Experience in East Africa

    Directory of Open Access Journals (Sweden)

    Kiage D

    2009-01-01

    Full Text Available Purpose : To describe short term outcomes of Ahmed Glaucoma Valve [AGV] implantation in East African patients. Materials and Methods : In this multi-center retrospective case series we reviewed eyes of Black African patients with refractory glaucoma, treated consecutively with Ahmed Glaucoma Valve implantation, in two centers in Kenya between January 2006 and October 2007. Results : About 25 cases including 18 [72%] pediatric eyes and seven [28%] adult eyes were identified. Results have been presented with a median follow-up of two months with inter-quartile range [IQR] of one to 12 months. intraocular pressure [IOP] was reduced from a mean of 36.4 mmHg preoperatively to 16.7 mmHg and glaucoma medications were lowered from a mean of 1.32 before surgery to 0.2 after surgery. The success rate during short term follow-up was 79%. The mean visual acuity dropped slightly from 6/18 pre-operatively to 6/24. There was only one major complication of an extruded, infected valve in a child. Conclusions : The Ahmed Valve Implant is safe and effective in lowering IOP for the short term in pediatric and adult East African patients with refractory glaucoma. Further studies with more patients and longer term follow-up are needed in this population.

  3. Structural and Histochemical Alterations in the Aortic Valves of Elderly Patients: A Comparative Study of Aortic Stenosis, Aortic Regurgitation, and Normal Valves

    Science.gov (United States)

    Katoh, Hideki

    2016-01-01

    The aim of this study was to reveal the pathogenesis of aortic stenosis (AS) and regurgitation (AR) by comparing differences in mechanical and biochemical alterations. We applied scanning acoustic microscopy (SAM) to measure the speed of sound (SOS) through valves to estimate the elasticity and monitor sensitivity to protease treatment, as the SOS is correlated with the stiffness of materials, which is reduced after digestion by proteases. The fibrosa of both the AS and AR groups were stiffer than the fibrosa of the normal group. The AR group displayed significantly stiffer fibrosa than the AS group, with the exception of calcified areas. The AS group showed significantly decreased SOS values following protease digestion, whereas the AR showed little reduction. The AS group presented type III collagen in the fibrosa and the ventricularis. In the AR group, both type I collagen and type III collagen coexisted in the fibrosa and the ventricularis. Upon immunostaining for advanced glycation end-products, the AS group showed sparse, weak staining, whereas the AR group presented a strong, band-like positive reaction in the fibrosa. In conclusion, tissue remodelling associated with damage and repair is associated with AS pathogenesis, whereas static chemical alterations with slow collagen turnover induce AR. PMID:27747234

  4. Percutaneous pulmonary valve implantation in a single artery branch: A preliminary experience

    Institute of Scientific and Technical Information of China (English)

    Massimo; Chessa; Gianfranco; Butera; Luca; Giugno; Angelo; Micheletti; Diana; G; Negura; Mario; Carminati

    2015-01-01

    To describe preliminary experience of percutaneous pulmonary valve implantation, in a single pulmonary branch position. Two procedures in 2 patients from a single center are described, where implantation of percutaneous valves within a single pulmonary artery branch was technically successful. The procedural indication was pulmonary valve regurgitation and/or residual stenosis. The 2 patients were symptomatic. An Edwards Sapien? valve(Patient 1), and a Medtronic Melody? valve(Patient 2) were implanted. Both pts were discharged with an excellent valve function. In this report it is underlined that this modality is technically feasible and may be considered an option in patients with congenital heart defect under special circumstances.

  5. Thoracic aortopathy in Turner syndrome and the influence of bicuspid aortic valves and blood pressure: a CMR study

    Directory of Open Access Journals (Sweden)

    Hager Alfred

    2010-03-01

    Full Text Available Abstract Background To investigate aortic dimensions in women with Turner syndrome (TS in relation to aortic valve morphology, blood pressure, karyotype, and clinical characteristics. Methods and results A cross sectional study of 102 women with TS (mean age 37.7; 18-62 years examined by cardiovascular magnetic resonance (CMR- successful in 95, echocardiography, and 24-hour ambulatory blood pressure. Aortic diameters were measured by CMR at 8 positions along the thoracic aorta. Twenty-four healthy females were recruited as controls. In TS, aortic dilatation was present at one or more positions in 22 (23%. Aortic diameter in women with TS and bicuspid aortic valve was significantly larger than in TS with tricuspid valves in both the ascending (32.4 ± 6.7 vs. 26.0 ± 4.4 mm; p Conclusions Aortic dilatation was present in 23% of adult TS women, where aortic valve morphology, age and blood pressure were major determinants of the aortic diameter.

  6. Técnica simplificada de implante de bioprótese aórtica sem suporte ("stentless" Simplified implantation technique of stentless aortic bioprosthesis

    Directory of Open Access Journals (Sweden)

    Bruno Botelho PINHEIRO

    2000-03-01

    Full Text Available OBJETIVO: A maior complexidade técnica de implante é provavelmente o mais importante fator limitante do uso mais amplo das biopróteses aórticas "stentless". CASUÍSTICA E MÉTODOS: Quinze pacientes foram submetidos a troca valvar aórtica por bioprótese porcina "stentless", tipo Labcor, com técnica simplificada de implante - um plano de sutura com pontos separados ao nível do anel aórtico e suspensão dos pilares com sutura contínua. Doze pacientes eram do sexo masculino e 3 do feminino, com idade variando de 9 a 56 anos. As indicações cirúrgicas foram a estenose valvar aórtica em 8 (53,3% casos, a dupla lesão em 4 (26,7% e a insuficiência aórtica em 3 (20%. Dez (66,7% pacientes apresentavam-se em classe funcional (CF III da NYHA e 5 (33,3% em CF IV. RESULTADOS: Não ocorreram complicações na fase hospitalar. Em 2 (13,3% pacientes constatou-se, antes da alta hospitalar, presença de insuficiência central discreta da prótese, sem repercussão hemodinâmica. Um paciente apresentou endocardite bacteriana 14 meses após o implante, necessitando de reoperacão, evoluindo com choque séptico e óbito. A curva atuarial de sobrevida é de 93,3% em seguimento médio de 23,5 meses, variando de 17 a 29 meses. Doze (85,7% pacientes apresentam-se em CF I (NYHA e 2 (14,3% pacientes em CF II, sem a ocorrência de complicações tromboembólicas, escape paravalvular ou hemólise, no período avaliado. CONCLUSÃO: A técnica em questão é de fácil execução, reprodutível e com baixo índice de complicações, podendo constituir-se em mais uma opção nas operações de troca valvar aórtica.OBJECTIVE: Probably the major drawback to a stentless porcine xenograft is the complexity of the technical demands required for inserting a competent aortic valve (usually two suture rows. MATERIAL AND METHODS: Fifteen patients underwent aortic valve replacement with the Labcor stentless porcine heterograft using a simplified technique for implantation

  7. Estimation of the shear stress on the surface of an aortic valve leaflet.

    Science.gov (United States)

    Weston, M W; LaBorde, D V; Yoganathan, A P

    1999-01-01

    The limited durability of xenograft heart valves and the limited supply of allografts have sparked interest in tissue engineered replacement valves. A bioreactor for tissue engineered valves must operate at conditions that optimize the biosynthetic abilities of seeded cells while promoting their adherence to the leaflet matrix. An important parameter is shear stress, which is known to influence cellular behavior and may thus be crucial in bioreactor optimization. Therefore, an accurate estimate of the shear stress on the leaflet surface would not only improve our understanding of the mechanical environment of aortic valve leaflets, but it would also aid in bioreactor design. To estimate the shear stress on the leaflet surface, two-component laser-Doppler velocimetry measurements have been conducted inside a transparent polyurethane valve with a trileaflet structure similar to the native aortic valve. Steady flow rates of 7.5, 15.0, and 22.5 L/min were examined to cover the complete range possible during the cardiac cycle. The laminar shear stresses were calculated by linear regression of four axial velocity measurements near the surface of the leaflet. The maximum shear stress recorded was 79 dyne/cm2, in agreement with boundary layer theory and previous experimental and computational studies. This study has provided a range of shear stresses to be explored in bioreactor design and has defined a maximum shear stress at which cells must remain adherent upon a tissue engineered construct.

  8. Externalization of a stiff guide wire via the radial artery: a new technique to facilitate advancement of an Inoue balloon across the aortic valve in patients with aortic stenosis undergoing antegrade balloon aortic valvuloplasty.

    Science.gov (United States)

    Kato, Hiroshi; Kubota, Shoichi; Goto, Takuya; Haba, Toshihiro; Yamamoto, Makoto

    2016-04-01

    An 84-year-old woman with aortic stenosis underwent antegrade balloon aortic valvuloplasty (BAV). After transseptal puncture, we introduced a 7-Fr wedge catheter into the left ventricle and across the aortic valve. We then inserted a 0.032-inch soft guide wire, and the tip of the guide wire was advanced into the brachial artery and exchanged for a stiff guide wire. We externalized the tip of the stiff guide wire from the radial artery. Finally, we advanced an Inoue balloon (Toray, Tokyo, Japan) across the aortic valve and inflated the balloon. Transradial externalization makes antegrade BAV an even less invasive procedure. PMID:25862651

  9. Transcatheter Aortic Valve Replacement in Lower Surgical Risk Patients: Review of Major Trials and Future Perspectives.

    Science.gov (United States)

    Saji, Mike; Lim, D Scott

    2016-10-01

    Following the first successful transcatheter aortic valve replacement (TAVR) in 2002, TAVR has globally evolved to become a standard procedure in high-risk patients. Surgical aortic valve replacement in non-high-risk patients remains the gold standard for treatment of severe aortic stenosis. However, a paradigm shift appears to be occurring in the direction of treating lower-risk patients, and several studies have suggested its impact on clinical outcomes. In this review, we highlight the current status of TAVR in intermediate-risk patients and review major trials including Placement of AoRTic TraNscathetER (PARTNER) 2A randomized intermediate-risk trial using SAPIEN XT (Edwards Lifesciences Corp, Irvine, CA) recently presented with excellent outcomes and the lowest major complications rate at the American College of Cardiology's 65th Annual Scientific Session in Chicago. Clinical trials in low-risk patients using SAPIEN 3 and CoreValve Evolut R have just been launched, and they are going to be important milestones in the TAVR field.

  10. 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

  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. Mechanism and Correlated Factors of SAM Phenomenon after Aortic Valve Replacement

    Institute of Scientific and Technical Information of China (English)

    XU Jing; WEN Jianguo; SHU Liliang; LIU Chao; ZHANG Jingchao; ZHAO Wenzeng

    2007-01-01

    To investigate the mechanism and correlated factors of systolic anterior motion (SAM) phenomenon after aortic valve replacement, 48 patients with severe aortic valvular stenosis were studied. Tested by echo-Doppler one week after aortic valve replacement, the patients were divided into two groups: SAM group and non-SAM group. The data of the left ventricular end-diastolic diameters, the left ventricular end-systolic diameters, the left ventricular outflow diameters, the thickness of the interventricular septum, the posterior wall of left ventricle, the blood velocities of left ventricular outflow and intra-cavitary gradients were recorded and compared. The results showed that no patients died during or after the operation. The blood velocities of left ventricular outflow was increased significantly in 9 patients (>2.5 m/s), and 6 of them developed SAM phenomenon. There was significant difference in all indexes (P<0.05 or P<0.01) except the posterior wall of left ventricle (P>0.05) between two groups. These indicated that the present of SAM phenomenon after aortic valve replacement may be directly related to the increase of blood velocities of left ventricular outflow and intra-cavitary gradients. It is also suggested that smaller left ventricular diastolic diameters, left ventricular systolic diameters, left ventricular outflow diameters and hypertrophy of interventricular septum may be the anatomy basis of SAM phenomenon.

  13. Methodological inaccuracies in clinical aortic valve severity assessment: insights from computational fluid dynamic modeling of CT-derived aortic valve anatomy

    Science.gov (United States)

    Traeger, Brad; Srivatsa, Sanjay S.; Beussman, Kevin M.; Wang, Yechun; Suzen, Yildirim B.; Rybicki, Frank J.; Mazur, Wojciech; Miszalski-Jamka, Tomasz

    2016-04-01

    Aortic stenosis is the most common valvular heart disease. Assessing the contribution of the valve as a portion to total ventricular load is essential for the aging population. A CT scan for one patient was used to create one in vivo tricuspid aortic valve geometry and assessed with computational fluid dynamics (CFD). CFD simulated the pressure, velocity, and flow rate, which were used to assess the Gorlin formula and continuity equation, current clinical diagnostic standards. The results demonstrate an underestimation of the anatomic orifice area (AOA) by Gorlin formula and overestimation of AOA by the continuity equation, using peak velocities, as would be measured clinically by Doppler echocardiography. As a result, we suggest that the Gorlin formula is unable to achieve the intended estimation of AOA and largely underestimates AOA at the critical low-flow states present in heart failure. The disparity in the use of echocardiography with the continuity equation is due to the variation in velocity profile between the outflow tract and the valve orifice. Comparison of time-averaged orifice areas by Gorlin and continuity with instantaneous orifice areas by planimetry can mask the errors of these methods, which is a result of the assumption that the blood flow is inviscid.

  14. Análise do comportamento hemodinâmico de conduto valvado de pericárdio bovino, implantado em posição aórtica de ovinos Analysis of hemodynamic performance of the bovine pericardium valved conduit, implanted in the aortic position in ovines

    Directory of Open Access Journals (Sweden)

    Josalmir José Melo do Amaral

    2010-12-01

    Full Text Available OBJETIVOS: A necessidade de substituição da valva, aorta ascendente e reimplante coronariano em pacientes onde a anticoagulação é indesejável, é crescente. Avaliamos em animais o comportamento hemodinâmico de um conduto valvado aórtico feito com pericárdio bovino tratado pelo glutaraldeído (CVAP. MÉTODOS: Para isto, implantamos CVAPs em oito ovinos e os explantamos após 150 dias de pós-operatório. Realizouse estudo angiográfico e hemodinâmico no pré-operatório e antes do explante. EcoDopplercardiogramas foram realizados nos dias 30 e 150 de pós-operatório (teste e também em cinco ovinos não operados. Após explantados, submetemos os CVAPs à avaliação macroscópica, radiológica e histológica por microscopia óptica. RESULTADOS: Na análise hemodinâmica, as pressões arterial e capilar pulmonar aumentaram (POBJECTIVE: The necessity for replacement of the valve, ascending aorta and aortic with coronary reimplantation in patients where anti-coagulation is undesirable, is increasing. We evaluated the hemodynamic performance of an aortic valved conduit made with glutaraldehyde treated bovine pericardium (AVCP in animals. METHODS: Therefore, AVCPs were implanted in eight young ovine and explanted after 150 days. Angiographic and hemodynamic study was performed at pre-operative and prior the explant. EchoDopplercardiograms were performed at day 30 and 150 of post-operative (test and also in five nonoperated ovines. After explanted, AVCPs were submitted to a macroscopical, radiological and histological evaluation by optic microscopy. RESULTS: In the hemodynamic analysis the arterial and pulmonary capillary pressure increased (P<0.05 between day 0 and 150. In the echoDoppercardiographic analysis, the test group presented higher values in the diastolic and systolic diameters of the left ventricle (P<0.05. In the test group, between day 30 and 150, occurred an increase of weight, thickness of the left ventricle walls, maximum

  15. Estimation of aortic valve leaflets from 3D CT images using local shape dictionaries and linear coding

    Science.gov (United States)

    Liang, Liang; Martin, Caitlin; Wang, Qian; Sun, Wei; Duncan, James

    2016-03-01

    Aortic valve (AV) disease is a significant cause of morbidity and mortality. The preferred treatment modality for severe AV disease is surgical resection and replacement of the native valve with either a mechanical or tissue prosthetic. In order to develop effective and long-lasting treatment methods, computational analyses, e.g., structural finite element (FE) and computational fluid dynamic simulations, are very effective for studying valve biomechanics. These computational analyses are based on mesh models of the aortic valve, which are usually constructed from 3D CT images though many hours of manual annotation, and therefore an automatic valve shape reconstruction method is desired. In this paper, we present a method for estimating the aortic valve shape from 3D cardiac CT images, which is represented by triangle meshes. We propose a pipeline for aortic valve shape estimation which includes novel algorithms for building local shape dictionaries and for building landmark detectors and curve detectors using local shape dictionaries. The method is evaluated on real patient image dataset using a leave-one-out approach and achieves an average accuracy of 0.69 mm. The work will facilitate automatic patient-specific computational modeling of the aortic valve.

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

    Directory of Open Access Journals (Sweden)

    Yongle Chen

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

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

    Science.gov (United States)

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

    2014-01-01

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

  18. 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.

  19. In vitro characterization of bicuspid aortic valve hemodynamics using particle image velocimetry.

    Science.gov (United States)

    Saikrishnan, Neelakantan; Yap, Choon-Hwai; Milligan, Nicole C; Vasilyev, Nikolay V; Yoganathan, Ajit P

    2012-08-01

    The congenital bicuspid aortic valve (BAV) is associated with increased leaflet calcification, ascending aortic dilatation, aortic stenosis (AS) and regurgitation (AR). Although underlying genetic factors have been primarily implicated for these complications, the altered mechanical environment of BAVs could potentially accelerate these pathologies. The objective of the current study is to characterize BAV hemodynamics in an in vitro system. Two BAV models of varying stenosis and jet eccentricity and a trileaflet AV (TAV) were constructed from excised porcine AVs. Particle Image Velocimetry (PIV) experiments were conducted at physiological flow and pressure conditions to characterize fluid velocity fields in the aorta and sinus regions, and ensemble averaged Reynolds shear stress and 2D turbulent kinetic energy were calculated for all models. The dynamics of the BAV and TAV models matched the characteristics of these valves which are observed clinically. The eccentric and stenotic BAV showed the strongest systolic jet (V = 4.2 m/s), which impinged on the aortic wall on the non-fused leaflet side, causing a strong vortex in the non-fused leaflet sinus. The magnitudes of TKE and Reynolds stresses in both BAV models were almost twice as large as comparable values for TAV, and these maximum values were primarily concentrated around the central jet through the valve orifice. The in vitro model described here enables detailed characterization of BAV flow characteristics, which is currently challenging in clinical practice. This model can prove to be useful in studying the effects of altered BAV geometry on fluid dynamics in the valve and ascending aorta. These altered flows can be potentially linked to increased calcific responses from the valve endothelium in stenotic and eccentric BAVs, independent of concomitant genetic factors.

  20. Percutaneous Edwards SAPIEN valve implantation in the tricuspid position : case report and review of literature

    NARCIS (Netherlands)

    Hoendermis, Elke S.; Douglas, Yvonne L.; van den Heuvel, Ad F. M.

    2012-01-01

    Aims: Experience with transcatheter valve-in-valve implantation in a failing bioprosthetic tricuspid valve is very limited. Fewer than 30 cases have been reported, and in most of them the Melody valve (Medtronic, Inc., Minneapolis, MN, USA) was used. With this case report and review of literature we

  1. Bicuspid aortic valve and aortic coarctation are linked to deletion of the X chromosome short arm in Turner syndrome

    Science.gov (United States)

    Bondy, Carolyn; Bakalov, Vladimir K; Cheng, Clara; Olivieri, Laura; Rosing, Douglas R; Arai, Andrew E

    2013-01-01

    Background Congenital heart disease (CHD) is a cardinal feature of X chromosome monosomy, or Turner syndrome (TS). Haploinsufficiency for gene(s) located on Xp have been implicated in the short stature characteristic of the syndrome, but the chromosomal region related to the CHD phenotype has not been established. Design We used cardiac MRI to diagnose cardiovascular abnormalities in four non-mosaic karyotype groups based on 50-metaphase analyses: 45,X (n=152); 46,X,del(Xp) (n=15); 46,X,del(Xq) (n=4); and 46,X,i(Xq) (n=14) from peripheral blood cells. Results Bicuspid aortic valves (BAV) were found in 52/152 (34%) 45,X study subjects and aortic coarctation (COA) in 19/152 (12.5%). Isolated anomalous pulmonary veins (APV) were detected in 15/152 (10%) for the 45,X study group, and this defect was not correlated with the presence of BAV or COA. BAVs were present in 28.6% of subjects with Xp deletions and COA in 6.7%. APV were not found in subjects with Xp deletions. The most distal break associated with the BAV/COA trait was at cytologic band Xp11.4 and ChrX:41,500 000. One of 14 subjects (7%) with the 46,X,i(Xq) karyotype had a BAV and no cases of COA or APV were found in this group. No cardiovascular defects were found among four patients with Xq deletions. Conclusions The high prevalence of BAV and COA in subjects missing only the X chromosome short arm indicates that haploinsufficiency for Xp genes contributes to abnormal aortic valve and aortic arch development in TS. PMID:23825392

  2. Access Options for Transcatheter Aortic Valve Replacement in Patients with Unfavorable Aortoiliofemoral Anatomy.

    Science.gov (United States)

    Patel, Jayendrakumar S; Krishnaswamy, Amar; Svensson, Lars G; Tuzcu, E Murat; Mick, Stephanie; Kapadia, Samir R

    2016-11-01

    In the current era, 10-15 % of transcatheter aortic valve replacement (TAVR)-eligible high and prohibitive risk patients with severe symptomatic aortic stenosis are not candidates for transfemoral arterial access. Knowledge of the various alternative access options can enable TAVR teams to provide improved quality of life and potentially life-saving treatment for a group of patients who otherwise have no viable options. In this article, we review approach to patients with unfavorable femoral arterial anatomy and provide an in-depth discussion on the various alternative routes for TAVR. PMID:27650782

  3. Impact of Endografting on the Thoracic Aortic Anatomy: Comparative Analysis of the Aortic Geometry before and after the Endograft Implantation

    Energy Technology Data Exchange (ETDEWEB)

    Midulla, Marco, E-mail: marco.midulla@chru-lille.fr [University Hospital of Lille, Cardiovascular and Interventional Radiology (France); Moreno, Ramiro, E-mail: ramoroa@gmail.com [Rangueil University Hospital, Department of Radiology (France); Negre-Salvayre, Anne, E-mail: anne.negre-salvayre@inserm.fr [INSERM, UMR 1048, I2MC (France); Nicoud, Franc, E-mail: franck.nicoud@univ-montp2.fr [CNRS, UMR 5149 I3M, CC 051, University Montpellier II (France); Pruvo, Jean Pierre, E-mail: jean-pierre.pruvo@chru-lille.fr [University Hospital of Lille, Cardiovascular and Interventional Radiology (France); Haulon, Stephan, E-mail: stephan.haulon@chru-lille.fr [University Hospital of Lille, Department of Vascular Surgery (France); Rousseau, Hervé, E-mail: rousseau.h@chu-toulouse.fr [Rangueil University Hospital, Department of Radiology (France)

    2013-03-13

    PurposeAlthough the widespread acceptance of thoracic endovascular aortic repair (TEVAR) as a first-line treatment option for a multitude of thoracic aortic diseases, little is known about the consequences of the device implantation on the native aortic anatomy. We propose a comparative analysis of the pre- and postoperative geometry on a clinical series of patients and discuss the potential clinical implicationsMethodsCT pre- and postoperative acquisitions of 30 consecutive patients treated by TEVAR for different pathologies (20 thoracic aortic aneurysms, 6 false aneurysms, 3 penetrating ulcers, 1 traumatic rupture) were used to model the vascular geometry. Pre- and postoperative geometries were compared for each patient by pairing and matching the 3D models. An implantation site was identified, and focal differences were detected and described.ResultsSegmentation of the data sets was successfully performed for all 30 subjects. Geometry differences between the pre- and postoperative meshes were depicted in 23 patients (76 %). Modifications at the upper implantation site were detected in 14 patients (47 %), and among them, the implantation site involved the arch (Z0–3) in 11 (78 %).ConclusionModeling the vascular geometry on the basis of imaging data offers an effective tool to perform patient-specific analysis of the vascular geometry before and after the treatment. Future studies will evaluate the consequences of these changes on the aortic function.

  4. [Isolated Pulmonary Valve Endocarditis in a Patient with Aortic Regurgitation and Patent Foramen Ovale;Report of a Case].

    Science.gov (United States)

    Doi, Toshio; Gyoten, Takayuki; Sakata, Kimimasa; Nagura, Saori; Yamashita, Akio; Fukahara, Kazuaki; Kotoh, Keiju; Yoshimura, Naoki

    2016-07-01

    Isolated pulmonary valve endocarditis is an extremely rare clinical condition. Here, we report a case of pulmonary valve endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA). An 84-year-old man with a history of aortic regurgitation and patent foramen ovale was admitted to our hospital due to fever of unknown origin for 4 weeks' duration. MRSA was detected in his blood cultures. Transthoracic echocardiography demonstrated a mobile vegetation attached to the pulmonary valve, moderate to severe aortic regurgitation, and patent foramen ovale with left-to-right shunt. After 30-days' treatment with vancomycin, gentamicin and rifampicin, he defervesced and blood cultures became negative. At surgery, a large vegetation was still attached to the pulmonary valve, but the leaflets remained with minimum damage. Aortic valve replacement, direct closure of the patent foramen ovale, and simple resection of the vegetation were performed. The postoperative course was uneventful. PMID:27365067

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

    Directory of Open Access Journals (Sweden)

    Mony Shuvy

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

  6. Sudden cardiac death and mitral and aortic valve disease

    Directory of Open Access Journals (Sweden)

    Bockeria O.L.

    2013-09-01

    Independent determinants of sudden death were left ventricular ejection fraction and atrial fibrillation. The main cause of death in patients with mitral valve stenosis is a thromboembolism from the left heart chambers to systemic circulation, and the risk of the latter increases with atrial fibrillation. There is no sudden cardiac death in mitral valve stenosis. The absence of left ventricular remodeling in mitral valve stenosis probably explains this finding. Onset of symptoms and signs of left ventricular dysfunction are the main predictors of sudden death and are indications for surgery. It should be emphasized that the database of sudden cardiac death in patients with valvular heart disease is very limited compared to patients with coronary heart disease and cardiomyopathies. Some issues related to predictors and mechanisms of SCD are currently poorly understood, therefore prevention of sudden cardiac death is difficult, especially in asymptomatic patients.

  7. The influence of the aortic valve angle on the hemodynamic features of the thoracic aorta

    Science.gov (United States)

    Ha, Hojin; Kim, Guk Bae; Kweon, Jihoon; Lee, Sang Joon; Kim, Young-Hak; Kim, Namkug; Yang, Dong Hyun

    2016-08-01

    Since the first observation of a helical flow pattern in aortic blood flow, the existence of helical blood flow has been found to be associated with various pathological conditions such as bicuspid aortic valve, aortic stenosis, and aortic dilatation. However, an understanding of the development of helical blood flow and its clinical implications are still lacking. In our present study, we hypothesized that the direction and angle of aortic inflow can influence helical flow patterns and related hemodynamic features in the thoracic aorta. Therefore, we investigated the hemodynamic features in the thoracic aorta and various aortic inflow angles using patient-specific vascular phantoms that were generated using a 3D printer and time-resolved, 3D, phase-contrast magnetic resonance imaging (PC-MRI). The results show that the rotational direction and strength of helical blood flow in the thoracic aorta largely vary according to the inflow direction of the aorta, and a higher helical velocity results in higher wall shear stress distributions. In addition, right-handed rotational flow conditions with higher rotational velocities imply a larger total kinetic energy than left-handed rotational flow conditions with lower rotational velocities.

  8. Patient prosthesis mismatch after aortic valve replacement: An Indian perspective

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2016-01-01

    Full Text Available Context: Perioperative period. Aims: Occurrence of PPM after AVR, factors associated with PPM, impact on mortality. Settings and Design: Teritary Care Referral Cardiac Centre. Materials and Methods: A retrospective analysis of AVR procedures at a single centre over 4 years was conducted. Demographic, echocardiographic and outcome data were collected from institute database. Rahimtoola criteria of indexed effective orifice area (iEOA were used to stratify patients into PPM categories. Patients with and without PPM were compared for associated factors. Statistical Analysis Used: Independent t-test, chi-square test, logistic regression analysis, ROC-AUC, Youden index. Results: 606 patients with complete data were analysed for PPM. The incidence of mild, moderate and severe PPM was 6.1% (37, 2.5% (15 and 0.5% (3 respectively. There was no impact of PPM on all-cause in-hospital mortality. PPM was observed more with Aortic Stenosis (AS compared to Aortic Regurgitation (AR as etiology. Aortic annulus indexed to BSA (iAA had a very good predictive ability for PPM at <16mm/m 2 BSA. Conclusions: PPM has lower incidence after AVR in this Indian population and does not increase early mortality. Patients with AS and iAA<16mm/m2BSA should be cautiously dealt with to prevent PPM.

  9. Prognostic value of multi-detector computed tomography in asymptomatic aortic valve stenosis

    DEFF Research Database (Denmark)

    Larsen, Linnea Hornbech; Kofoed, Klaus Fuglsang; Carstensen, Helle Gervig;

    2016-01-01

    was defined as indication for aortic valve replacement (AVR) determined by the treating physician or sudden cardiac death. RESULTS: The mean age was 72 (8) years, 27% were women, mean AVA by TTE was 1.01 (0.30) cm(2). Median follow up time was 27 (IQR 19-44) months. Forty seven patients (41%) developed...... indication for AVR. No patients suffered a sudden cardiac death. AVA and aortic valve calcification were significant univariable predictors of AVR when measured by both TTE and MDCT, whereas left ventricular mass was only significant measured by MDCT. Significant coronary artery disease by MDCT tended...... to predict future indication for AVR, but this did not reach statistical significance (HR: 1.79 (95% CI 0.96-3.44), p=0.08). CONCLUSION: MDCT derived AVA can be of use as an alternative to TTE derived AVA in patients with asymptomatic AS to predict future clinical indication for AVR....

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

    Science.gov (United States)

    Nigam, Vishal

    2011-11-01

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

  11. Identification of a novel flow-mediated gene expression signature in patients with bicuspid aortic valve.

    Science.gov (United States)

    Maleki, Shohreh; Björck, Hanna M; Folkersen, Lasse; Nilsson, Roland; Renner, Johan; Caidahl, Kenneth; Franco-Cereceda, Anders; Länne, Toste; Eriksson, Per

    2013-01-01

    Individuals with bicuspid aortic valve (BAV) are at significantly higher risk of developing serious aortic complications than individuals with tricuspid aortic valves (TAV). Studies have indicated an altered aortic blood flow in patients with BAV; however, the extent to which altered flow influences the pathological state of BAV aorta is unclear. In the present study, we dissected flow-mediated aortic gene expression in patients undergoing elective open heart surgery. A large collection of public microarray data sets were firstly screened for consistent co-expression with five well-characterized flow-regulated genes (query genes). Genes with co-expression probability of >0.5 were selected and further analysed in expression profiles (127 arrays) from ascending aorta of BAV and TAV patients. Forty-four genes satisfied two filtering criteria: a significant correlation with one or more of the query genes (R > 0.40) and differential expression between patients with BAV and TAV. No gene fulfilled the criteria in mammary artery (88 arrays), an artery not in direct contact with the valve. Fifty-five percent of the genes significantly altered between BAV and TAV patients showed differential expression between two identified flow regions in the rat aorta. A large proportion of the identified genes were related to angiogenesis and/or wound healing, with pro-angiogenesis genes downregulated and inhibitory genes upregulated in patients with BAV. Moreover, differential expression of ZFP36, GRP116 and PKD2 was confirmed using immunohistochemistry. Implementing a new strategy, we have demonstrated an angiostatic gene expression signature in patients with BAV, indicating impaired wound healing in these patients, potentially involved in BAV-associated aortopathy. PMID:22903503

  12. Dynamic left ventricular outflow tract obstruction complicating aortic valve replacement: A hidden malefactor revisited

    Directory of Open Access Journals (Sweden)

    Panduranga Prashanth

    2010-01-01

    Full Text Available It is known that a dynamic left ventricular outflow tract (LVOT obstruction exists in patients, following aortic valve replacement (AVR and is usually considered to be benign. We present a patient with dynamic LVOT obstruction following AVR, who developed refractory cardiogenic shock and expired inspite of various treatment strategies. This phenomenon must be diagnosed early and should be considered as a serious and potentially fatal complication following AVR. The possible mechanisms and treatment options are reviewed.

  13. Iliac branched device implantation in tortuous iliac anatomy after previous open ruptured aortic aneurysm repair

    NARCIS (Netherlands)

    Vourliotakis, G.; Bracale, U. M.; Sondakh, A.; Tielliu, I. F. J.; Prins, T. R.; Verhoeven, E. L. G.

    2012-01-01

    The aim of this paper was to present iliac branched device (IBD) implantation in a fit 67-year-old man with tortuous iliac anatomy after previous emergent open abdominal aortic aneurysm (AAA) repair. The patient underwent open treatment for a ruptured abdominal aortic aneurysm in another hospital. T

  14. Crystalline Ultrastructures, Inflammatory Elements, and Neoangiogenesis Are Present in Inconspicuous Aortic Valve Tissue

    Directory of Open Access Journals (Sweden)

    P. Dorfmüller

    2010-01-01

    Full Text Available Morbidity from calcific aortic valve disease (CAVD is increasing. Recent studies suggest early reversible changes involving inflammation and neoangiogenesis. We hypothesized that microcalcifications, chemokines, and growth factors are present in unaffected regions of calcific aortic valves. We studied aortic valves from 4 patients with CAVD and from 1 control, using immunohistochemistry, scanning electron microscopy, and infrared spectrography. We revealed clusters of capillary neovessels in calcified (ECC, to a lesser extent in noncalcified (ECN areas. Endothelial cells proved constant expression of SDF-1 in ECC, ECN, and endothelial cells from valvular surface (ECS. Its receptor CXCR4 was expressed in ECC. IL-6 expression correlated with CXCR4 staining and presence of lymphocytes. VEGF was expressed by ECS, its receptor by ECC and ECN. Crystalline ultrastructures were found on the surface of histologically noncalcified areas (HNCAs, spectrography revealed calcium hydroxylapatite. Our results demonstrate that crystalline ultrastructures are present in HNCAs, undergoing neoangiogenesis in an inflammatory context. These alterations could be an early witness of disease and an opening to therapy.

  15. The impact of coronary artery disease on early outcome of aortic valve replacement in elderly patients

    Directory of Open Access Journals (Sweden)

    Seyed Yaser Hariri

    2015-03-01

    Full Text Available Background: The operative risk of aortic valve replacement (AVR depends on several factors such as underlying coronary artery disease (CAD. Objective: The aim of this study was to determine postoperative complications and early outcome for elderly patients with CAD undergoing isolated aortic valve replacement and compare them with patients without CAD. Methods: Preoperative characteristics, postoperative in-hospital complications, 30-day mortality rate, and length of stay in hospital (LOS in 79 patients at least 65 years old that underwent isolated AVR (53 patients with CAD and 25 patients without CAD were studied and compared. Results: All studied in-hospital complications were similar between the two groups. No signi cant di erence in 30-day mortality rate between the two groups was found (CAD group 8.1%, non CAD group 10.0%, P=0.781, whereas the mean of ICU stay in patients with CAD was higher than other patients (75.9 versus 47.6 hours, P=0.006. Female gender, obesity, hypertension, prolonged ventilation, and postoperative heart block in patients with CAD and only obesity in other group were signi cant predictors of 30-day mortality. Conclusion: Early outcome of patients with and without CAD undergoing aortic valve replacement was similar.

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

    Science.gov (United States)

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

    2012-07-01

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

  17. Postoperative Migration of an Edwards-SAPIEN XT Mitral Valve-in-Valve Treated With Direct Vision Implantation During Beating-Heart Bypass.

    Science.gov (United States)

    Mick, Stephanie L; Roselli, Eric E; Kapadia, Samir; Tuzcu, E Murat; Krishnaswamy, Amar; Svensson, Lars G

    2016-03-01

    Transcatheter valve-in-valve mitral valve replacement provides treatment options to high-risk patients but is subject to its own complications. We present the migration of a transcatheter balloon-expandable Edwards-SAPIEN XT valve (Edwards Lifesciences, Irvine, CA) within a previously implanted surgical Carpentier-Edwards valve (Edwards Lifesciences) and our novel approach to its treatment. PMID:26897205

  18. Infective Endocarditis and Aortic Valve Abscess in an Infant.

    Science.gov (United States)

    Williamson, Kristy A; Gmuca, Sabrina; Rosman, Eliyahu C; Thomas, Philomena

    2015-09-01

    Infective endocarditis is relatively uncommon in the pediatric population, but when it does occur, results in substantial morbidity and mortality. Children at risk for endocarditis are typically those with an underlying congenital heart condition. Furthermore, an endocardial abscess is a very rare yet serious complication of infective endocarditis. We describe a case of a 23-month-old previously healthy male infant with no known congenital heart disease who returned to the emergency department after a recent hospitalization for pneumococcal bacteremia, presenting acutely ill but without fever. He was found to be in congestive heart failure due to endocarditis and an aortic root abscess.

  19. Myocardial Infarction and Aortic Root Mycotic Aneurysm Complicating Aortic Valve Endocarditis: Utility of Cardiac CT.

    Science.gov (United States)

    Moores, Aimee E; Cahill, Michael S; Villines, Todd C

    2016-01-01

    Aortic mycotic aneurysms are a rare but life-threatening potential complication of infective endocarditis. Rapid deterioration of the vascular wall in highly focal areas makes these pseudoaneurysms particularly prone to rupture, resulting in uncontrolled aortic hemorrhage. While computed tomography angiography (CTA) is the imaging modality of choice for the evaluation of mycotic aneurysms, it is not routinely performed in patients with known or suspected infective endocarditis (IE). However, current valvular heart disease guidelines support the use of cardiac CTA in cases of IE and suspected perivalvular extension when there is inadequate or ambiguous visualization on echocardiography. Here, we describe a case of IE in which cardiac CTA was used for two purposes: to assess perivalvular complications and to define coronary anatomy in a patient with a suspected embolic myocardial infarction. Subsequent detection of an aortic root mycotic aneurysm not previously demonstrated on transthoracic or transesophageal echocardiography allowed for timely and uncomplicated surgical intervention, while avoiding invasive coronary angiography. PMID:27642299

  20. Aortic valve replacement in a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Bhuvnesh Kansara

    2013-01-01

    Full Text Available Valvular heart disease in systemic lupus erythematosus (SLE is associated with substantial morbidity and mortality. Current therapy includes symptomatic measures and valve replacement. SLE can present major challenges because of accrued organ damage, coagulation defects and complex management regimes. The peri-operative goals are to maintain strict asepsis, avoid use of nephrotoxic drugs and thereby renal insult, and to promote early ambulation post-operatively.

  1. Myocardial hypertrophy after pulmonary regurgitation and valve implantation in pigs

    DEFF Research Database (Denmark)

    Smith, Julie; Goetze, Jens Peter; Søndergaard, Lars;

    2012-01-01

    BACKGROUND: Patients may suffer from right ventricular (RV) failure and malignant cardiac arrhythmias after late pulmonary valve replacement correcting pulmonary regurgitation (PR). But the underlying mechanisms of the refractory arrhythmias are not well understood. METHODS: The aim of present...... study was to characterize the RV myocardium after percutaneous pulmonary valve implantation (PPVI) in a porcine model after severe PR for 3months. RV histology was evaluated with morphometric methods and RV function was assessed with electrophysiology, echocardiography, and biochemical measures...... and plasma natriuretic peptides were unchanged. CONCLUSIONS: The RV does not completely recover after three months of PR with persistent myocardial hypertrophy one month after PPVI. Future studies should address whether RV chamber and cellular hypertrophy, without fibrosis or interventional scar tissue, may...

  2. Aortic Valve Replacement With the Stentless Freedom SOLO Bioprosthesis: A Systematic Review.

    Science.gov (United States)

    Wollersheim, Laurens W; Li, Wilson W; Bouma, Berto J; Repossini, Alberto; van der Meulen, Jan; de Mol, Bas A

    2015-10-01

    This systematic review examined the clinical and hemodynamic performance of the stentless Freedom SOLO (Sorin Group, Milan, Italy) aortic bioprosthesis. The occurrence of postoperative thrombocytopenia was also analyzed. The Freedom SOLO is safe to use in everyday practice, with short cross-clamp times, and postoperative pacemaker implantation is notably lower. Valvular gradients are low and remain stable during short-term follow-up. Thrombocytopenia is more severe than in other aortic prostheses; however, this is without clinical consequences. Within a few years, the 15-year follow-up of this bioprosthesis will be known, which will be key to evaluating its long-term durability. PMID:26324106

  3. Recurrent Rare Genomic Copy Number Variants and Bicuspid Aortic Valve Are Enriched in Early Onset Thoracic Aortic Aneurysms and Dissections

    Science.gov (United States)

    Prakash, Siddharth; Kuang, Shao-Qing; Regalado, Ellen; Guo, Dongchuan; Milewicz, Dianna

    2016-01-01

    Thoracic Aortic Aneurysms and Dissections (TAAD) are a major cause of death in the United States. The spectrum of TAAD ranges from genetic disorders, such as Marfan syndrome, to sporadic isolated disease of unknown cause. We hypothesized that genomic copy number variants (CNVs) contribute causally to early onset TAAD (ETAAD). We conducted a genome-wide SNP array analysis of ETAAD patients of European descent who were enrolled in the National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC). Genotyping was performed on the Illumina Omni-Express platform, using PennCNV, Nexus and CNVPartition for CNV detection. ETAAD patients (n = 108, 100% European American, 28% female, average age 20 years, 55% with bicuspid aortic valves) were compared to 7013 dbGAP controls without a history of vascular disease using downsampled Omni 2.5 data. For comparison, 805 sporadic TAAD patients with late onset aortic disease (STAAD cohort) and 192 affected probands from families with at least two affected relatives (FTAAD cohort) from our institution were screened for additional CNVs at these loci with SNP arrays. We identified 47 recurrent CNV regions in the ETAAD, FTAAD and STAAD groups that were absent or extremely rare in controls. Nine rare CNVs that were either very large (>1 Mb) or shared by ETAAD and STAAD or FTAAD patients were also identified. Four rare CNVs involved genes that cause arterial aneurysms when mutated. The largest and most prevalent of the recurrent CNVs were at Xq28 (two duplications and two deletions) and 17q25.1 (three duplications). The percentage of individuals harboring rare CNVs was significantly greater in the ETAAD cohort (32%) than in the FTAAD (23%) or STAAD (17%) cohorts. We identified multiple loci affected by rare CNVs in one-third of ETAAD patients, confirming the genetic heterogeneity of TAAD. Alterations of candidate genes at these loci may contribute to the pathogenesis of TAAD. PMID:27092555

  4. Low radiation dose non-contrast cardiac CT: is it of value in the evaluation of mechanical aortic valve

    Energy Technology Data Exchange (ETDEWEB)

    Bazeed, Mohamed Fayez (Dept. of Diagnostic Radiology, Faculty of Medicine, Mansoura Univ. (Egypt)), email: m_bazeed@yahoo.com; Moselhy, Mohamed Saleh (Cardiology Dept. Faculty of Medicine, Suez Canal Univ. (Egypt)); Rezk, Ahmad Ibrahim (Dept. of Cardiac Surgery, Faculty of Medicine, Aim Shams Univ. (Egypt)); Al-Murayeh, Mushabab Ayedh (Dept. of Cardiac Services, Armed Forces Hospitals Southern Region (Saudi Arabia))

    2012-05-15

    Background: Prosthetic bileaflet mechanical valve function has been traditionally evaluated using echocardiography and fluoroscopy. Multidetector computed tomography (MDCT) is a novel technique for cardiac evaluation. Purpose: To evaluate bileaflet mechanical aortic valves using a low-milliampere (mA), non-contrast MDCT protocol with a limited scan range. Material and Methods: Forty patients with a bileaflet mechanical aortic valve were evaluated using a non-contrast, low-mA, ECG-gated 64 MDCT protocol with a limited scan range. MDCT findings of opening and closing valve angles were correlated to fluoroscopy and echocardiography. Also, the valve visibility was evaluated on MDCT and fluoroscopy according to a 3-point grading scale. Results: The visualization score with the MDCT was significantly superior to the fluoroscopy (3 vs. 2.7). A strong correlation was noted between the opening (r = 0.82) and closing (r = 0.96) valve angles with MDCT and fluoroscopy without a statistically significant difference (P = 0.31 and 0.16, respectively). The mean effective radiation dose of the suggested protocol was 4 +- 0.5 mSv. Five valves were evaluated using transesophageal echocardiography because the valves were difficult to evaluate with transthoracic echocardiography, and all of these valves were evaluated optimally with MDCT. A high-pressure gradient was noted in nine valves, and the MDCT showed that seven of these valves inadequately opened, and two valves opened well, which resulted in patient valve mismatch. Incomplete valve closure was noted in five valves, and the echocardiography showed significant transvalvular regurgitation in all five valves. Conclusion: MDCT can provide a precise measurement of valve function and can potentially evaluate high-pressure gradients and transvalvular regurgitation

  5. 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: ...

  6. Transapical JenaValve in a patient with mechanical mitral valve prosthesis.

    LENUS (Irish Health Repository)

    O' Sullivan, Katie E

    2014-01-29

    We report the first case of transcatheter aortic valve replacement implantation using JenaValve™ in a patient with mechanical mitral valve prosthesis. We believe that the design features of this valve may be particularly suited for use in this setting. © 2014 Wiley Periodicals, Inc.

  7. Case study of relevant pressures for an implanted hydrocephalus valve in everyday life.

    Science.gov (United States)

    Elixmann, Inga Margrit; Goffin, Christine; Krueger, Rolf; Meier, Ullrich; Lemcke, Johannes; Kiefer, Michael; Antes, Sebastian; Leonhardt, Steffen

    2012-01-01

    Hydrocephalus patients with increased intracranial pressure are generally treated by draining cerebrospinal fluid (CSF) into the abdomen through an implanted shunt with a passive differential pressure valve. To perfectly adapt the valve's opening pressure to the patient's need, more information on the acutal pressure across the valve in everyday life actions like walking, eating, sleeping etc. is necessary.

  8. 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 myo......: In 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....

  9. Isolated spontaneous dissection of the celiac trunk in a patient with bicuspid aortic valve

    Directory of Open Access Journals (Sweden)

    Abdel-Rauf Zeina

    2010-05-01

    Full Text Available Abdel-Rauf Zeina1, Alicia Nachtigal1, Anton Troitsa2, Gil Admon2, Nina Avshovich31Department of Radiology, 2Department of Surgery A, 3Department of Internal Medicine C, Hillel Yaffe Medical Center, Hadera, Israel. Hillel Yaffe Medical Center is affiliated with the Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, IsraelAbstract: Isolated spontaneous dissection of celiac trunk is a rare entity. The spontaneous dissection of the visceral artery occurs without aortic dissection. The most consistent presenting symptom is acute onset abdominal pain. Complications consist of ischemia, aneurysm formation, and rupture. We report an exceptional case of an isolated spontaneous dissection of the celiac trunk which occurred in a 49 year old male with a previously undiagnosed bicuspid aortic valve (BAV. We also describe the classical appearance in different imaging modalities with a particular emphasis on multidetector computed tomography, and discuss the clinical manifestation and its relationship to BAV.Keywords: celiac trunk dissection, isolated spontaneous dissection, CT angiography, bicuspid aortic valve, MRA

  10. Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

    Directory of Open Access Journals (Sweden)

    Fernando de Azevedo Lamana

    2015-09-01

    Full Text Available AbstractObjective:To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graftvalve replacement.Methods:From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling. Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%, with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.Results:In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns. During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns. Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001 and lower bleeding complications (P=0.006. There was no difference for thromboembolism, endocarditis, and need of reoperation.Conclusion:The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

  11. Effect of surgeon on transprosthetic gradients after aortic valve replacement with Freestyle® stentless bioprosthesis and its consequences: A follow-up study in 587 patients

    Directory of Open Access Journals (Sweden)

    Bauer Stefan

    2007-10-01

    Full Text Available Abstract Background The implantation of stentless valves is technically demanding and the outcome may depend on the performance of surgeons. We studied systematically the role of surgeons and other possible determinants for mid-term survival, postoperative gradients and Quality of Life (QoL after aortic valve replacement (AVR with Freestyle® stentless bioprostheses. Methods Between 1996 and 2003, 587 patients (mean 75 years underwent AVR with stentless Medtronic Freestyle® bioprostheses. Follow-up was 99% complete. Determinants of morbidity, mortality, survival time and QoL were evaluated by multiple, time-related, regression analysis. Risk models were built for all sections of the Nottingham Health Profile (NHP: energy, pain, emotional reaction, sleep, social isolation and physical mobility Results Actuarial freedom from aortic valve re-operation, structural valve deterioration, non-structural valve dysfunction, prosthetic valve endocarditis and thromboembolic events at 6 years were 95.9 ± 2.1%, 100%, 98.7 ± 0.5%, 97.0 ± 1.5%, 79.6 ± 4.3%, respectively. The actuarial freedom from bleeding events at 6 years was 93.1 ± 1.9%. Estimated survival at 6 years was similar to the age-matched German population (61.4 ± 3.8 %. Predictors of survival time were: diabetes mellitus, atrial fibrillation, peripheral vascular disease, renal dysfunction, female gender > 80 years and patients 0.7 for each of the 6 QoL sections. Early transvalvular gradients were identified as independent risk factors for impaired physical mobility (c-index 0.77, p Conclusion In addition to the valve size (in relation to body size, subcoronary technique (versus total root and various patient-related factors the risk of elevated gradients after stentless valve implantation depends, considerably on the individual surgeon. Although there was no effect on survival time and most aspects of QoL, higher postoperative transvalvular gradients affect physical mobility after AVR.

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

    Science.gov (United States)

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

    2015-12-01

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

  13. Transcorneal tube erosion of an Ahmed valve implant in an adult

    Directory of Open Access Journals (Sweden)

    Al-Shahwan Sami

    2010-01-01

    Full Text Available Ahmed valve implants are currently used to manage high-risk complicated adults and pediatric glaucoma when standard filtration surgery is unsuccessful. Despite its success, the Ahmed valve shunt has significant complications particularly in the anterior segment. We report an unusual case of transcorneal tube erosion of an Ahmed valve implant in an adult that resulted from long-standing tube-corneal touch. Periodic observation of tube position is recommended.

  14. Complications associated with the implantation of peritoneo-venous valves and possibilities of prevention.

    Science.gov (United States)

    Vincze, K

    1994-01-01

    The author describes the complications associated with the implantation of peritoneo-venous valves in the therapy of refractory ascites. They survey the various complications (disorders in the healing of the wound, valve occlusion, ascites induced coagulation disorders) observed during the treatment of 71 patients and give full account of their work performed while observing these complications, their prevention and avoidance. They stress the importance of haematologic examinations and postoperative haemostasis parameters of patients having undergone valve implantation. PMID:7618386

  15. 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....

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

    Science.gov (United States)

    Aoki, Takuma; Sunahara, Hiroshi; Sugimoto, Keisuke; Ito, Tetsuro; Kanai, Eiichi; Fujii, Yoko

    2015-03-01

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

  17. Acquired Aorto-Right Ventricular Fistula following Transcatheter Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Muhammad Tariq Shakoor

    2015-01-01

    Full Text Available Transcatheter aortic valve replacement (TAVR techniques are rapidly evolving, and results of published trials suggest that TAVR is emerging as the standard of care in certain patient subsets and a viable alternative to surgery in others. As TAVR is a relatively new procedure and continues to gain its acceptance, rare procedural complications will continue to appear. Our case is about an 89-year-old male with extensive past medical history who presented with progressive exertional dyspnea and angina secondary to severe aortic stenosis. Patient got TAVR and his postoperative course was complicated by complete heart block, aorto-RV fistula, and ventricular septal defect (VSD formation as a complication of TAVR. To the best of our knowledge, this is the third reported case of aorto-RV fistula following TAVR as a procedural complication but the first one to show three complications all together in one patient.

  18. Pacing to treat low cardiac output syndrome following elective aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Muhammad Ishaq

    2012-01-01

    Full Text Available We report a case of low cardiac output syndrome caused by dynamic left ventricular (LV outflow obstruction after aortic valve replacement (AVR. This recognized phenomenon probably occurs more frequently than appreciated, and the author suggests that this should be considered when managing patients with severe hemodynamic instability after AVR. In addition, we also focus on the fact that invasive pacemaker systems have significant effects on cardiac output augmentation postoperatively and in long-term management of patients with LV outflow tract (LVOT obstruction following AVR. The possible mechanisms and subsequent treatments are discussed.

  19. 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

    %), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09-1.26; p coronary artery bypass surgery (OR = 385, 79-2738; p obesity (OR = 4.69, 1.......51-13.77; p disease (COPD) (OR = 3.66, 1.21-10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease...

  20. Multi-embolic ST-elevation myocardial infarction secondary to aortic valve endocarditis.

    Science.gov (United States)

    Rischin, Adam P; Carrillo, Philip; Layland, Jamie

    2015-01-01

    We present the case of a 42 year-old woman admitted to hospital with ST-elevation myocardial infarction involving two separate coronary territories. Angiography revealed multi-embolic occlusions of her left anterior descending (LAD) and first obtuse marginal (OM1) coronary arteries. Transoesophageal echocardiogram (TOE) showed a lesion attached to the left cusp of the aortic valve and she was treated for infective endocarditis. We discuss the management issues raised from this unique patient, including reperfusion strategies in endocarditis-associated myocardial infarction.

  1. Intra-operative Vector Flow Imaging Using Ultrasound of the Ascending Aorta among 40 Patients with Normal, Stenotic and Replaced Aortic Valves

    DEFF Research Database (Denmark)

    Hansen, Kristoffer Lindskov; Møller-Sørensen, Hasse; Kjaergaard, Jesper;

    2016-01-01

    Stenosis of the aortic valve gives rise to more complex blood flows with increased velocities. The angleindependent vector flow ultrasound technique transverse oscillation was employed intra-operatively on the ascending aorta of (I) 20 patients with a healthy aortic valve and 20 patients...... with aortic stenosis before (IIa) and after (IIb) valve replacement. The results indicate that aortic stenosis increased flow complexity (p , 0.0001), induced systolic backflow (p , 0.003) and reduced systolic jet width (p , 0.0001). After valve replacement, the systolic backflow and jet width were normalized...... (p , 0.52 and p , 0.22), but flow complexity was not (p , 0.0001). Flow complexity (p , 0.0001), systolic jet width (p , 0.0001) and systolic backflow (p , 0.001) were associated with peak systolic velocity. The study found that aortic stenosis changes blood flow in the ascending aorta and valve...

  2. Evaluation of 17-mm St. Jude Medical Regent prosthetic aortic heart valves by rest and dobutamine stress echocardiography

    OpenAIRE

    Minardi Giovanni; Manzara Carla; Creazzo Vittorio; Maselli Daniele; Casali Giovanni; Pulignano Giovanni; Musumeci Francesco

    2006-01-01

    Abstract Background The prosthesis used for aortic valve replacement in patients with small aortic root can be too small in relation to body size, thus showing high transvalvular gradients at rest and/or under stress conditions. This study was carried out to evaluate rest and Dobutamine stress echocardiography (DSE) hemodynamic response of 17-mm St. Jude Medical Regent (SJMR-17 mm) in relatively aged patients at mean 24 months follow-up. Methods and results The study population consisted of 1...

  3. Papillary fibroelastoma of aortic valve: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Cheng Wei; Xiao Yingbin; Zhong Qianjin

    2008-01-01

    Papillary fibroelastoma, a rare primary benign tumor, can be found anywhere in the heart, but most commonly involves the cardiac valves. Most papillary fibroelastomas do not cause symptoms and are usually incidental found by routine eehocardiography or at autopsy. However, with the advent of echocardiography, more and more patients are diagnosed in life. Early diagnosis of this condition becomes very important since it represents a surgically correctable cause for systemic emboli, stroke, myocardial infarction, and sudden cardiac death. The echocardiographic findings should be confirmed by histology because the clinical differential diagnoses includes myxoma, vegetation, thrombi, lipoma, and pseudopapillary fibroelastoma. We reported a ease of papillary fibroelastoma of the aortic valve and presented a comprehensive review of the literature.

  4. 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...

  5. Imaging analysis of collagen fiber networks in cusps of porcine aortic valves: effect of their local distribution and alignment on valve functionality.

    Science.gov (United States)

    Mega, Mor; Marom, Gil; Halevi, Rotem; Hamdan, Ashraf; Bluestein, Danny; Haj-Ali, Rami

    2016-07-01

    The cusps of native aortic valve (AV) are composed of collagen bundles embedded in soft tissue, creating a heterogenic tissue with asymmetric alignment in each cusp. This study compares native collagen fiber networks (CFNs) with a goal to better understand their influence on stress distribution and valve kinematics. Images of CFNs from five porcine tricuspid AVs are analyzed and fluid-structure interaction models are generated based on them. Although the valves had similar overall kinematics, the CFNs had distinctive influence on local mechanics. The regions with dilute CFN are more prone to damage since they are subjected to higher stress magnitudes. PMID:26406926

  6. Medially constrained deformable modeling for segmentation of branching medial structures: Application to aortic valve segmentation and morphometry.

    Science.gov (United States)

    Pouch, Alison M; Tian, Sijie; Takebe, Manabu; Yuan, Jiefu; Gorman, Robert; Cheung, Albert T; Wang, Hongzhi; Jackson, Benjamin M; Gorman, Joseph H; Gorman, Robert C; Yushkevich, Paul A

    2015-12-01

    Deformable modeling with medial axis representation is a useful means of segmenting and parametrically describing the shape of anatomical structures in medical images. Continuous medial representation (cm-rep) is a "skeleton-first" approach to deformable medial modeling that explicitly parameterizes an object's medial axis and derives the object's boundary algorithmically. Although cm-rep has effectively been used to segment and model a number of anatomical structures with non-branching medial topologies, the framework is challenging to apply to objects with branching medial geometries since branch curves in the medial axis are difficult to parameterize. In this work, we demonstrate the first clinical application of a new "boundary-first" deformable medial modeling paradigm, wherein an object's boundary is explicitly described and constraints are imposed on boundary geometry to preserve the branching configuration of the medial axis during model deformation. This "boundary-first" framework is leveraged to segment and morphologically analyze the aortic valve apparatus in 3D echocardiographic images. Relative to manual tracing, segmentation with deformable medial modeling achieves a mean boundary error of 0.41 ± 0.10 mm (approximately one voxel) in 22 3DE images of normal aortic valves at systole. Deformable medial modeling is additionally demonstrated on pathological cases, including aortic stenosis, Marfan syndrome, and bicuspid aortic valve disease. This study demonstrates a promising approach for quantitative 3DE analysis of aortic valve morphology.

  7. Health status after transcatheter aortic valve replacement in patients at extreme surgical risk: Results from the CoreValve U.S. Trial

    NARCIS (Netherlands)

    R.L.J. Osnabrugge (Ruben); S.V. Arnold (Suzanne); M.R. Reynolds (Matthew R.); E.A. Magnuson (Elizabeth); K.K. Wang (Kenneth); V.A. Gaudiani (Vincent A.); R. Stoler (Robert); T.A. Burdon (Thomas A.); N.S. Kleiman (Neal); M.J. Reardon (Michael); D.H. Adams (David H.); J.J. Popma (Jeffrey J.); D.J. Cohen (David J.)

    2015-01-01

    textabstractObjectives The purpose of this study was to characterize health status outcomes after transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis among patients at extreme surgical risk and to identify pre-procedural patient characteristics associated with a poor ou

  8. [Neuroendovascular Treatment for Cerebral Embolism in a Patient just after Aortic Valve Replacement;Report of a Case].

    Science.gov (United States)

    Kumagai, Motoyuki; Nishizawa, Junichiro; Heima, Daisuke; Takatoku, Kazuhiro; Watanabe, Yoshihiko; Matsui, Yasuzumi; Miyake, Hidenori

    2015-12-01

    A 67-year-old woman suffered from severe aortic stenosis and atrial fibrillation, and underwent aortic valve replacement with a St. Jude Medical Regent 23-mm valve and pulmonary vein isolation using an AtriCure Isolator Synergy.At 6 days after the operation, she experienced sudden onset of atrial fibrillation, left side paralysis, and dysarthria. Right internal carotid artery embolism was diagnosed via magnetic resonance imaging, and we promptly performed neuroendovascular therapy with a Solitaire FR. Neuroendovascular treatment succeeded, and her neurological function was restored to near-normal. Her post-treatment course was uneventful, and she is currently well without neurological dysfunction. PMID:26759947

  9. Papillary fibroelastoma of the aortic valve - a case report and literature review

    Directory of Open Access Journals (Sweden)

    Von Canal Friederike

    2010-10-01

    Full Text Available Abstract The prevalence of primary cardiac tumour ranges from 0.0017-0.28% and papillary fibroelastoma is rare but not uncommon benign cardiac neoplasm. Currently, with the advent of higher-resolution imaging technology especially transoesophageal echocardiography such cases being recognized frequently. The clinical presentation of these tumours varies from asymptomatic to severe ischaemic or embolic complications. We herein, present a 50-year-old female patient with a papillary fibroelastoma of the aortic valve arising from the endocardium of the right coronary cusp very close to the commissure between the right and non-coronary cusps. The patient presented with angina-like chest pain and was investigated using echocardiography and CT angiographic modalities in addition to the usual investigations. The differential diagnosis considered was a thrombus, myxoma, Lambl's excrescence and infective vegetation. The surgical management included a prompt resection of the tumour on cardiopulmonary bypass avoiding injury to the aortic valve. The patient recovered well. A review of the literature suggests that the cardiac papillary fibroelastoma is a rare but potentially treatable cause of embolic stroke and other fatal complications, therefore, a strong suspicion; appropriate use of imaging modality, preoperative anticoagulation and urgent surgical resection is warranted. Also, possibility of this diagnosis should be kept in mind while managing cardiac or valvular tumours.

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

    Directory of Open Access Journals (Sweden)

    Filipe Carvalho Marmelo

    2014-11-01

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

  11. Use of cardiovascular magnetic resonance imaging for TAVR assessment in patients with bioprosthetic aortic valves: Comparison with computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Quail, Michael A., E-mail: m.quail@ucl.ac.uk [Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, London (United Kingdom); Nordmeyer, Johannes [Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin (Germany); Schievano, Silvia [Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, London (United Kingdom); Reinthaler, Markus; Mullen, Michael J. [The Heart Hospital, University College Hospital and Institute of Cardiovascular Sciences, UCL, 16-18 Westmoreland Street, London (United Kingdom); Taylor, Andrew M. [Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science and Great Ormond Street Hospital for Children, London (United Kingdom)

    2012-12-15

    Purpose: Transcatheter aortic valve replacement (TAVR) has been successfully used to treat patients with failing aortic bioprostheses. Computed tomography (CT) is the usual method of pre-procedural imaging for TAVR in the native position; however, the optimal modality for valve-in-valve procedures has not been established. CT can assess intracardiac anatomy and is superior to cardiovascular magnetic resonance (CMR) in the assessment of coronary artery disease. However, CMR can provide superior haemodynamic information, does not carry the risk of ionising radiation, and may be performed without contrast in patients with renal insufficiency. In this study, we compared CT and CMR for the evaluation of TAVR in a small cohort of patients with existing aortic bioprostheses. Materials and methods: 21 patients with aortic bioprostheses were prospectively evaluated by CT and CMR, as pre-assessment for TAVR; agreement between measurements of aortic geometries was assessed. Results: 16/21 patients had aortic bioprostheses constructed with a metal ring, and 5/21 patients had a metal strut construction. Patients with metal struts had significant metal-artefact on CMR, which compromised image quality in this region. There was good agreement between CT and CMR measurements of aortic geometry. The mean difference (d) in annulus area-derived diameter was 0.5 mm (95% limits of agreement [L.A] 4.2 mm). There was good agreement between modalities for the cross-sectional area of the sinuses of valsalva (d 0.5 cm{sup 2}, L.A 1.4 cm{sup 2}), sinotubular junction (d 0.9 cm{sup 2}, L.A 1.5 cm{sup 2}), and ascending aorta (d 0.6 cm{sup 2}, L.A 1.4 cm{sup 2}). In patients without metal struts, the left coronary artery height d was 0.7 mm and L.A 2.8 mm. Conclusions: Our analysis shows that CMR and CT measurements of aortic geometry show good agreement, including measurement of annulus size and coronary artery location, and thus provide the necessary anatomical information for valve-in-valve

  12. Use of cardiovascular magnetic resonance imaging for TAVR assessment in patients with bioprosthetic aortic valves: Comparison with computed tomography

    International Nuclear Information System (INIS)

    Purpose: Transcatheter aortic valve replacement (TAVR) has been successfully used to treat patients with failing aortic bioprostheses. Computed tomography (CT) is the usual method of pre-procedural imaging for TAVR in the native position; however, the optimal modality for valve-in-valve procedures has not been established. CT can assess intracardiac anatomy and is superior to cardiovascular magnetic resonance (CMR) in the assessment of coronary artery disease. However, CMR can provide superior haemodynamic information, does not carry the risk of ionising radiation, and may be performed without contrast in patients with renal insufficiency. In this study, we compared CT and CMR for the evaluation of TAVR in a small cohort of patients with existing aortic bioprostheses. Materials and methods: 21 patients with aortic bioprostheses were prospectively evaluated by CT and CMR, as pre-assessment for TAVR; agreement between measurements of aortic geometries was assessed. Results: 16/21 patients had aortic bioprostheses constructed with a metal ring, and 5/21 patients had a metal strut construction. Patients with metal struts had significant metal-artefact on CMR, which compromised image quality in this region. There was good agreement between CT and CMR measurements of aortic geometry. The mean difference (d) in annulus area-derived diameter was 0.5 mm (95% limits of agreement [L.A] 4.2 mm). There was good agreement between modalities for the cross-sectional area of the sinuses of valsalva (d 0.5 cm2, L.A 1.4 cm2), sinotubular junction (d 0.9 cm2, L.A 1.5 cm2), and ascending aorta (d 0.6 cm2, L.A 1.4 cm2). In patients without metal struts, the left coronary artery height d was 0.7 mm and L.A 2.8 mm. Conclusions: Our analysis shows that CMR and CT measurements of aortic geometry show good agreement, including measurement of annulus size and coronary artery location, and thus provide the necessary anatomical information for valve-in-valve TAVR planning. However, in patients

  13. Myocardial protection during aortic valve replacement. Cardiac metabolism and enzyme release following hypothermic cardioplegia.

    Science.gov (United States)

    Bomfim, V; Kaijser, L; Bendz, R; Sylvén, C; Olin, C

    1980-01-01

    Cardiac metabolism following hypothermic potassium cardioplegia was studied in 23 patients undergoing isolated aortic valve replacement. All had normal coronary arteries. Cardioplegia was induced by infusing 700-1 000 ml of cold Ringer's acetate containing 20 mekv K+ selectively into the left coronary artery. Simultaneous blood samples were taken from the radial artery, a central vein and from the coronary sinus before and after cardioplegia. The PO2, O2-saturation and content, PCO2, pH, lactate, glucose, potassium, myoglobin, total creatine kinase (CK), its isoenzyme CK-MB, aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) were assessed. Before bypass lactate was extracted by the heart. During the initial 10 to 20 min after cardioplegia there was a marked release of lactate in the coronary sinus. Myoglobin concentration and CK-MB serum activity peaked during the first 4 hours after the release of the aortic cross-clamping. In order to determine the best indicator of myocardial damage after cardioplegia, duration of extracorporeal circulation (ECC-time), aortic occlusion time (AOT), mean myocardial temperature (MMT) and the product of AOT and MMT, referred to as time-temperature area (TTA), were related to possible indicators of myocardial injury, such as enzyme and myoglobin release. The TTA was the best way of expressing the degree of exposure of the heart to ischaemia. The CK-MB to peak area (CK-MB max area) was the best indicator of the degree of ischaemic injury sustained by the heart during operation. PMID:7375890

  14. Anterior valve of the pulmonary valve transplantation in the treatment of single aortic valve disease%肺动脉瓣前瓣移植治疗主动脉瓣单瓣病变

    Institute of Scientific and Technical Information of China (English)

    李斌; 赵文增

    2015-01-01

    Objective To discuss the partial pulmonary artery with front valve for aortic root transplantation in the treatment of aortic valve of a single valve lesions.Methods Complete animal experiments in vitro pig heart valve model 18 cases.10 cases of aortic valve group:using part of the pulmonary artery with front disc,a single aortic valve replacement for aortic root transplantation.8 cases pulmonary valve group:Taking part of the pulmonary artery with front disc,pericardial patch shape after pulmonary artery.Results Preoperative aortic cross valve differential pressure pulsation flow state of 2.08 kPa,continuous flow condition of 1.70 kPa.Postoperative aortic cross valve differential pressure pulsation flow state of 3.10 kPa,continuous flow condition of 2.46 kPa.Aortic cross valve pressure difference before and after surgery had no significant change (P > 0.05).Preoperative pulmonary valve across valve differential pressure pulsation flow state of 1.00 kPa,continuous flow condition of 0.77 kPa.Postoperative pulmonary valve across valve differential pressure pulsation flow state of 1.29 kPa,continuous flow condition of 1.04 kPa.Across pulmonary valve differential pressure tban before surgery had no significant change (P > 0.05).Aortic valve and pulmonary valve function well after the surgery,no more than mild reflux.Conclusion Part of the pulmonary artery with front disc showed good hemodynamic status.%目的 探讨肺动脉瓣前瓣移植治疗主动脉瓣单瓣病变的手术方法.方法 完成猪心瓣膜模型18例.主动脉瓣组10例:利用肺动脉瓣前瓣作主动脉根部移植、置换单个主动脉瓣.肺动脉瓣组8例:切取肺动脉瓣前瓣、利用心包修补成形肺动脉.结果 主动脉瓣组术前主动脉瓣跨瓣压差脉动流为2.08 kPa、连续流为1.70 kPa,术后主动脉瓣跨瓣压差脉动流为3.10 kPa、连续流为2.46 kPa,手术前后差异无统计学意义(P>0.05).肺动脉瓣组术前肺动脉瓣跨瓣压差脉动流为1

  15. Commercial versus PARTNER study experience with the transfemoral Edwards SAPIEN valve for inoperable patients with severe aortic stenosis.

    Science.gov (United States)

    Pendyala, Lakshmana K; Minha, Sa'ar; Barbash, Israel M; Torguson, Rebecca; Magalhaes, Marco A; Okubagzi, Petros; Loh, Joshua P; Chen, Fang; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2014-01-15

    In patients with aortic stenosis who cannot have surgery, transcatheter aortic valve replacement using the Edwards SAPIEN valve has been shown to improve survival rate and is approved for commercial use in the United States. This study aims to assess the clinical profile, procedural characteristics, and in-hospital complications in patients treated with a commercial SAPIEN valve outside the clinical trial context. We retrospectively analyzed 69 consecutive patients who underwent transcatheter aortic valve replacement with a commercial SAPIEN valve compared with 55 Placement of AoRTic traNscathetER valves (PARTNER) trial patients from cohort B enrolled in the same institution by the same Heart Team. Compared with the commercial group, patients in the PARTNER cohort B had higher mean Society of Thoracic Surgeons score (10 ± 5 vs 9 ± 4, p = 0.04) and a lower rate of peripheral arterial disease (19% vs 44%, p = 0.004). Most patients in the commercial group had the procedure under conscious sedation (83% vs 66%, p = 0.03). Planned surgical cut down for vascular access was rare in the commercial group (1.4% vs 46%, p length of hospitalization (p length of stay (p = 0.01) was shorter in the commercial group. In conclusion, transfemoral commercial use of the Edwards SAPIEN valve for inoperable patients shows similar in-hospital mortality and stroke rates compared with PARTNER cohort B. The refinements in the procedure such as more conscious sedation, experience of the operators, and careful vascular planning in the commercial group led to lesser vascular and bleeding complications and shorter length of stay. PMID:24220281

  16. JenaValve.

    Science.gov (United States)

    Treede, Hendrik; Rastan, Ardawan; Ferrari, Markus; Ensminger, Stephan; Figulla, Hans-Reiner; Mohr, Friedrich-Wilhelm

    2012-09-01

    The JenaValve is a next-generation TAVI device which consists of a well-proven porcine root valve mounted on a low-profile nitinol stent. Feeler guided positioning and clip fixation on the diseased leaflets allow for anatomically correct implantation of the device without rapid pacing. Safety and efficacy of transapical aortic valve implantation using the JenaValve were evaluated in a multicentre prospective study that showed good short and midterm results. The valve was CE-mark released in Europe in September 2011. A post-market registry ensures on-going and prospective data collection in "real-world" patients. The transfemoral JenaValve delivery system will be evaluated in a first-in-man study in the near future. PMID:22995119

  17. 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

  18. Limitations of multimodality imaging in the diagnosis of pannus formation in prosthetic aortic valve and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Juan; Bautista; Soumoulou; Tomás; Francisco; Cianciulli; Andrea; Zappi; Alberto; Cozzarin; María; Cristina; Saccheri; Jorge; Alberto; Lax; Robert; Guidoin; Ze; Zhang

    2015-01-01

    Pannus formation is a rare complication and occurs almost exclusively in mechanical prosthetic valves.It consists of fibrous tissue that covers the surface of the prosthesis either concentrically or eccentrically,resulting in valve dysfunction.The pathophysiology seems to be associated to a chronic inflammatory process that explains the late and insidious clinical presentation.This diagnosis should be considered in patients with high transvalvular gradients on transthoracic echo,and workup should be completed with fluoroscopy and transesophageal echocardiography.Treatment is always surgical and recurrence is rare.We present a case of pannus formation in a prosthetic aortic valve and a review of the literature regarding this disorder.

  19. ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Fagman, Erika; Flinck, Agneta; Lamm, Carl [Sahlgrenska University Hospital, Department of Radiology, Gothenburg (Sweden); Perrotta, Sossio [Sahlgrenska University Hospital, Department of Cardiovascular Surgery and Anaesthesia, Gothenburg (Sweden); Bech-Hanssen, Odd [Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg (Sweden); Sahlgrenska University Hospital, Department of Cardiology, Gothenburg (Sweden); Olaison, Lars [Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg (Sweden); Svensson, Gunnar [Sahlgrenska University Hospital, Department of Cardiovascular Surgery and Anaesthesia, Gothenburg (Sweden); The Sahlgrenska Academy at the University of Gothenburg, Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg (Sweden)

    2012-11-15

    The aim of this prospective study was to investigate the agreement in findings between ECG-gated CT and transoesophageal echocardiography (TEE) in patients with aortic prosthetic valve endocarditis (PVE). Twenty-seven consecutive patients with PVE underwent 64-slice ECG-gated CT and TEE and the results were compared. Imaging was compared with surgical findings (surgery was performed in 16 patients). TEE suggested the presence of PVE in all patients [thickened aortic wall (n = 17), vegetation (n = 13), abscess (n = 16), valvular dehiscence (n = 10)]. ECG-gated CT was positive in 25 patients (93 %) [thickened aortic wall (n = 19), vegetation (n = 7), abscess (n = 18), valvular dehiscence (n = 7)]. The strength of agreement [kappa (95 % CI)] between ECG-gated CT and TEE was very good for thickened wall [0.83 (0.62-1.0)], good for abscess [0.68 (0.40-0.97)] and dehiscence [0.75 (0.48-1.0)], and moderate for vegetation [0.55 (0.26-0.88)]. The agreement was good between surgical findings (abscess, vegetation and dehiscence) and imaging for ECG-gated CT [0.66 (0.49-0.87)] and TEE [0.79 (0.62-0.96)] and very good for the combination of ECG-gated CT and TEE [0.88 (0.74-1.0)]. Our results indicate that ECG-gated CT has comparable diagnostic performance to TEE and may be a valuable complement in the preoperative evaluation of patients with aortic PVE. (orig.)

  20. Clinical and economic outcomes after surgical aortic valve replacement in Medicare patients

    Directory of Open Access Journals (Sweden)

    Clark MA

    2012-10-01

    Full Text Available Mary Ann Clark,1 Francis G Duhay,2 Ann K Thompson,2 Michelle J Keyes,3 Lars G Svensson,4 Robert O Bonow,5 Benjamin T Stockwell,3 David J Cohen61The Neocure Group LLC, Washington, DC, 2Edwards Lifesciences Corporation, Irvine, CA, 3The Burgess Group LLC, Alexandria, VA, 4Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 5Center for Cardiovascular Innovation, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 6Saint Luke's Mid America Heart Institute, Kansas City, MO, USABackground: Aortic valve replacement (AVR is the standard of care for patients with severe, symptomatic aortic stenosis who are suitable surgical candidates, benefiting both non-high-risk and high-risk patients. The purpose of this study was to report long-term medical resource use and costs for patients following AVR and validate our assumption that high-risk patients have worse outcomes and are more costly than non-high-risk patients in this population.Methods: Patients with aortic stenosis who underwent AVR were identified in the 2003 Medicare 5% Standard Analytic Files and tracked over 5 years to measure clinical outcomes, medical resource use, and costs. An approximation to the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation based on administrative data was used to assess surgical risk, with a computed logistic EuroSCORE > 20% considered high-risk.Results: We identified 1474 patients with aortic stenosis who underwent AVR, of whom 1222 (82.9% were non-high-risk and 252 (17.1% were high-risk. Among those who were non-high-risk, the mean age was 73.3 years, 464 (38.2% were women, and the mean logistic EuroSCORE was 7%, whereas in those who were high-risk, the mean age was 77.6 years, 134 (52.8% were women, and the mean logistic EuroSCORE was 37%. All-cause mortality was 33.2% for non-high-risk and 66.7% for high-risk patients at 5 years. Over this time period, non