Imaging techniques in transcatheter aortic valve replacement

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Quaife RA

2013-11-01

Full Text Available Robert A Quaife, Jennifer Dorosz, John C Messenger, Ernesto E Salcedo Division of Cardiology, University of Colorado, Aurora, CO, USA Abstract: Calcific aortic stenosis is now understood as a complex valvular degenerative process sharing many risk factors with atherosclerosis. Once patients develop symptomatic calcific aortic stenosis, the only effective treatment is aortic valve replacement. In the past decade, transcatheter aortic valve replacement (TAVR has been developed as an alternative to surgery to treat severe calcific aortic stenosis. Cardiac imaging plays a pivotal role in the contemporary management of patients with calcific aortic stenosis, and particularly in patients being considered for TAVR, who demand detailed imaging of the aortic valve apparatus. In this review, we highlight the role of cardiac imaging for patient selection, procedural guidance, and evaluation of results of TAVR. Keywords: aortic stenosis, cardiovascular imaging, transcutaneous aortic valve replacement

The Effects of Fetuin-A Levels on Aortic Stenosis

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Ahmet Tutuncu

2016-07-01

Full Text Available Aim: We aimed to investigate the relation between fetuin-A and calcific aortic stenosis in non diabetic patients whose renal function were normal. Material and Method: 26 patients followed for aortic stenosis by our cardiology clinic for outpatients and 25 voluntary healthy subjects were included in the study. The fetuin%u2013A levels were measured from the venous blood samples of the study population. All patients underwent transthorasic echocardiography, the aortic valvular area and left ventricular parameters of the patients were measured. Results: The average age of the patients in degenerative aortic stenosis group was significantly higher than the control group. The parameters related to aortic valve were naturally higher in patients with dejenerative aortic valve. There was no siginificant difference between two groups about fetuin-A levels. Further more there was no significant relation between fetuin-a levels and aortic stenosis severity. Discussion: In conclusion fetuin-A is a multifunctional glycoprotein that plays important role in systemic calcification inhibition and valvular calcification. Finally aortic stenosis is an active process and larger studies that investigate the relation between fetuin-a and the progression and prognosis of aortic stenosis are needed.

Left ventricular hypertrophy in valvular aortic stenosis: mechanisms and clinical implications.

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Rader, Florian; Sachdev, Esha; Arsanjani, Reza; Siegel, Robert J

2015-04-01

Valvular aortic stenosis is the second most prevalent adult valve disease in the United States and causes progressive pressure overload, invariably leading to life-threatening complications. Surgical aortic valve replacement and, more recently, transcatheter aortic valve replacement effectively relieve the hemodynamic burden and improve the symptoms and survival of affected individuals. However, according to current American College of Cardiology/American Heart Association guidelines on the management of valvular heart disease, the indications for aortic valve replacement, including transcatheter aortic valve replacement, are based primarily on the development of clinical symptoms, because their presence indicates a dismal prognosis. Left ventricular hypertrophy develops in a sizeable proportion of patients before the onset of symptoms, and a growing body of literature demonstrates that regression of left ventricular hypertrophy resulting from aortic stenosis is incomplete after aortic valve replacement and associated with adverse early postoperative outcomes and worse long-term outcomes. Thus, reliance on the development of symptoms alone without consideration of structural abnormalities of the myocardium for optimal timing of aortic valve replacement potentially constitutes a missed opportunity to prevent postoperative morbidity and mortality from severe aortic stenosis, especially in the face of the quickly expanding indications of lower-risk transcatheter aortic valve replacement. The purpose of this review is to discuss the mechanisms and clinical implications of left ventricular hypertrophy in severe valvular aortic stenosis, which may eventually move to center stage as an indication for aortic valve replacement in the asymptomatic patient. Copyright © 2015 Elsevier Inc. All rights reserved.

Aortic valve replacement and the stentless Freedom SOLO valve

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Wollersheim, L.W.L.M.

2016-01-01

Aortic valve stenosis has become the most prevalent valvular heart disease in Europe and North America, and is generally caused by age-related calcification of the aortic valve. For most patients, severe symptomatic aortic stenosis needs effective mechanical relief in the form of valve replacement

Pathophysiology of valvular heart disease.

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Zeng, Y I; Sun, Rongrong; Li, Xianchi; Liu, Min; Chen, Shuang; Zhang, Peiying

2016-04-01

Valvular heart disease (VHD) is caused by either damage or defect in one of the four heart valves, aortic, mitral, tricuspid or pulmonary. Defects in these valves can be congenital or acquired. Age, gender, tobacco use, hypercholesterolemia, hypertension, and type II diabetes contribute to the risk of disease. VHD is an escalating health issue with a prevalence of 2.5% in the United States alone. Considering the likely increase of the aging population worldwide, the incidence of acquired VHD is expected to increase. Technological advances are instrumental in identifying congenital heart defects in infants, thereby adding to the growing VHD population. Almost one-third of elderly individuals have echocardiographic or radiological evidence of calcific aortic valve (CAV) sclerosis, an early and subclinical form of CAV disease (CAVD). Of individuals ages >60, ~2% suffer from disease progression to its most severe form, calcific aortic stenosis. Surgical intervention is therefore required in these patients as no effective pharmacotherapies exist. Valvular calcium load and valve biomineralization are orchestrated by the concerted action of diverse cell-dependent mechanisms. Signaling pathways important in skeletal morphogenesis are also involved in the regulation of cardiac valve morphogenesis, CAVD and the pathobiology of cardiovascular calcification. CAVD usually occurs without any obvious symptoms in early stages over a long period of time and symptoms are identified at advanced stages of the disease, leading to a high rate of mortality. Aortic valve replacement is the only primary treatment of choice. Biomarkers such as asymmetric dimethylarginine, fetuin-A, calcium phosphate product, natriuretic peptides and osteopontin have been useful in improving outcomes among various disease states. This review, highlights the current understanding of the biology of VHD, with particular reference to molecular and cellular aspects of its regulation. Current clinical questions

Association of Aortic Calcification on Plain Chest Radiography with Obstructive Coronary Artery Disease

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Kang, Yeong Han; Chang, Jeong Ho [Dept. of Diagnostic Radiology, Daegu Catholic University Hospital, Daegu (Korea, Republic of); Park, Jong Sam [Dept. of Radiologic Tecnology, Daegu Health College, Daegu (Korea, Republic of)

2009-03-15

This study was conducted to determine an association between aortic calcification viewed on plain chest radiography and obstructive coronary artery disease. Retrospective review of all chest radiography obtained from consecutive patients undergoing coronary angiography. Chest PA images were reviewed by technical radiologist and radiologist. Considering the presence of aortic arch calcification, images were compared with the results of coronary angiography. In addition, the size of aortic arch calcification were divided into two groups - the smaller and the larger than 10 mm. Among the total 846 patients, the number of the patients with obstructive coronary artery disease is total 417 (88.3%) in males and 312 (83.4%) in females. Considering the presence of aortic arch calcification, the positive predictive value of relation between aortic arch calcification and obstructive coronary artery disease was 91.4% and the relative risk of the group with aortic arch calcification to the opposite group was 1.10. According to the size of aortic arch calcification and obstructive coronary artery disease, the positive predictive value was 91.9% and the relative risk between two groups was 1.04. This study shows that aortic calcification was closely associated with obstructive coronary artery disease. If the aortic calcification is notified on plain chest radiography, we strongly recommend to consult with doctor.

History of hot flashes and aortic calcification among postmenopausal women.

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Thurston, Rebecca C; Kuller, Lewis H; Edmundowicz, Daniel; Matthews, Karen A

2010-03-01

Menopausal hot flashes are considered largely a quality-of-life issue. However, emerging research also links hot flashes to cardiovascular risk. In some investigations, this risk is particularly apparent among women using hormone therapy. The aim of this study was to determine whether a longer history of reported hot flashes over the study period was associated with greater aortic and coronary artery calcification. Interactions with hormone therapy use were examined in an exploratory fashion. Participants included 302 women participating in the Healthy Women Study, a longitudinal study of cardiovascular risk during perimenopause and postmenopause, which was initiated in 1983. Hot flashes (any/none) were assessed when women were 1, 2, 5, and 8 years postmenopausal. Electron beam tomography measures of coronary artery calcification and aortic calcification were completed in 1997-2004. Associations between the number of visits with report of hot flashes, divided by the number of visits attended, and aortic or coronary artery calcification (transformed) were examined in linear regression models. Interactions by hormone therapy use were evaluated. Among women using hormone therapy, a longer history of reported hot flashes was associated with increased aortic calcification, controlling for traditional cardiovascular risk factors (b = 2.87, SE = 1.21, P history of hot flashes and coronary artery calcification. Among postmenopausal women using hormone therapy, a longer history of reported hot flashes measured prospectively was associated with increased aortic calcification, controlling for traditional cardiovascular risk factors. Hot flashes may signal adverse cardiovascular changes among certain postmenopausal women.

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

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Yamada, M.; Suzuki, G.; Masunari, N.; Kasagi, F.

2003-01-01

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

Molecular and cellular mechanisms of aortic stenosis.

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Yetkin, Ertan; Waltenberger, Johannes

2009-06-12

Calcific aortic stenosis is the most common cause of aortic valve replacement in developed countries, and this condition increases in prevalence with advancing age. The fibrotic thickening and calcification are common eventual endpoint in both non-rheumatic calcific and rheumatic aortic stenoses. New observations in human aortic valves support the hypothesis that degenerative valvular aortic stenosis is the result of active bone formation in the aortic valve, which may be mediated through a process of osteoblast-like differentiation in these tissues. Additionally histopathologic evidence suggests that early lesions in aortic valves are not just a disease process secondary to aging, but an active cellular process that follows the classical "response to injury hypothesis" similar to the situation in atherosclerosis. Although there are similarities with the risk factor and as well as with the process of atherogenesis, not all the patients with coronary artery disease or atherosclerosis have calcific aortic stenosis. This review mainly focuses on the potential vascular and molecular mechanisms involved in the pathogenesis of aortic valve stenosis. Namely extracellular matrix remodeling, angiogenesis, inflammation, and eventually osteoblast-like differentiation resulting in bone formation have been shown to play a role in the pathogenesis of calcific aortic stenosis. Several mediators related to underlying mechanisms, including growth factors especially transforming growth factor-beta1 and vascular endothelial growth factors, angiogenesis, cathepsin enzymes, adhesion molecules, bone regulatory proteins and matrix metalloproteinases have been demonstrated, however the target to be attacked is not defined yet.

Calcific aortic valve damage as a risk factor for cardiovascular events

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Wasilewski, Jarosław; Mirota, Kryspin; Wilczek, Krzysztof; Głowacki, Jan; Poloński, Lech

2012-01-01

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

Calcific Aortic Valve Disease Is Associated with Layer-Specific Alterations in Collagen Architecture.

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Heather N Hutson

Full Text Available Disorganization of the valve extracellular matrix (ECM is a hallmark of calcific aortic valve disease (CAVD. However, while microarchitectural features of the ECM can strongly influence the biological and mechanical behavior of tissues, little is known about the ECM microarchitecture in CAVD. In this work, we apply advanced imaging techniques to quantify spatially heterogeneous changes in collagen microarchitecture in CAVD. Human aortic valves were obtained from individuals between 50 and 75 years old with no evidence of valvular disease (healthy and individuals who underwent valve replacement surgery due to severe stenosis (diseased. Second Harmonic Generation microscopy and subsequent image quantification revealed layer-specific changes in fiber characteristics in healthy and diseased valves. Specifically, the majority of collagen fiber changes in CAVD were found to occur in the spongiosa, where collagen fiber number increased by over 2-fold, and fiber width and density also significantly increased. Relatively few fibrillar changes occurred in the fibrosa in CAVD, where fibers became significantly shorter, but did not otherwise change in terms of number, width, density, or alignment. Immunohistochemical staining for lysyl oxidase showed localized increased expression in the diseased fibrosa. These findings reveal a more complex picture of valvular collagen enrichment and arrangement in CAVD than has previously been described using traditional analysis methods. Changes in fiber architecture may play a role in regulating the pathobiological events and mechanical properties of valves during CAVD. Additionally, characterization of the ECM microarchitecture can inform the design of fibrous scaffolds for heart valve tissue engineering.

Abdominal aortic calcifications predict survival in peritoneal dialysis patients

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Mäkelä, Satu M; Asola, Markku; Hadimeri, Henrik

2018-01-01

BACKGROUND: Peripheral arterial disease and vascular calcifications contribute significantly to the outcome of dialysis patients. The aim of this study was to evaluate the prognostic role of severity of abdominal aortic calcifications and peripheral arterial disease on outcome of peritoneal...... dialysis (PD) patients using methods easily available in everyday clinical practice. METHODS: We enrolled 249 PD patients (mean age 61 years, 67% male) in this prospective, observational, multicenter study from 2009 to 2013. The abdominal aortic calcification score (AACS) was assessed using lateral lumbar.......9) in 17%, and high (> 1.3) in 34% of patients. Altogether 91 patients (37%) died during the median follow-up of 46 months. Only 2 patients (5%) with AACS 0 died compared with 50% of the patients with AACS ≥ 7 (p

Type A aortic dissection: Are there CT signs suggestive of valvular involvement?

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Platon, Alexandra, E-mail: alexandra.platon@hcuge.ch [Department of Radiology, Emergency Radiology Unit, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Bernard, Stephane; Perrin, Nils [Department of Radiology, Emergency Radiology Unit, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Murith, Nicolas [Division of Cardiovascular Surgery, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); John, Gregor [Department of Internal medicine/Geriatrics and Rehabilitation, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Department of Internal Medicine, Hôpital neuchâtelois, 2300 La Chaux-de-Fonds (Switzerland); Perneger, Thomas [Division of Clinical Epidemiology, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Rutschmann, Olivier T. [Division of Emergency Medicine, University Hospitals of Geneva and School of Medicine, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland); Poletti, Pierre-Alexandre [Department of Radiology, Emergency Radiology Unit, University Hospital of Geneva, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva (Switzerland)

2016-11-15

Highlights: • Non-ECG gated CT rarely shows valve involvement in type A aortic dissection. • Diameters of the aortic root in type A aortic dissection were measured on initial CT. • Sinus of Valsalva diameter >45 mm is 100% specific to predict aortic valve involvement. - Abstract: Aim: To identify the predictive signs of aortic valve involvement on the non-electrocardiogram (ECG)-gated admission computed tomography (CT) of patients with Type A aortic dissection (AD) according to the Stanford classification. Materials and methods: We retrospectively analyzed the non-ECG-gated CT examinations of patients admitted to the emergency department who underwent surgery for Type A AD over a period of 4 years. The diameter of the following structures was calculated as the mean of the smallest and largest diameters (mm) measured in two different planes: aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. These parameters were compared against operative reports in order to determine whether they were predictive of aortic valve involvement. Results: In total, 20 patients (13 men and 7 women) of a mean age of 59.5 years (29–80) were included, 55% of patients (11/20) having surgically proven valvular involvement. The mean diameters (in mm) of the aortic annulus, sinus of Valsalva, sinotubular junction and proximal ascending aorta in the group with (and without, respectively) valvular involvement was 27.7 (26.7), 44.3 (38.1), 42.6 (36.6), and 47.8 (45.9). Only the measurement of the mean diameter of the sinuses of Valsalva was significantly predictive (p = 0.02) of aortic valve involvement. Conclusion: Our findings suggest that measuring the diameter of the sinuses of Valsalva on non-ECG-gated admission CT examinations allows for predicting aortic valve involvement in Type A AD patients.

Type A aortic dissection: Are there CT signs suggestive of valvular involvement?

International Nuclear Information System (INIS)

Platon, Alexandra; Bernard, Stephane; Perrin, Nils; Murith, Nicolas; John, Gregor; Perneger, Thomas; Rutschmann, Olivier T.; Poletti, Pierre-Alexandre

2016-01-01

Highlights: • Non-ECG gated CT rarely shows valve involvement in type A aortic dissection. • Diameters of the aortic root in type A aortic dissection were measured on initial CT. • Sinus of Valsalva diameter >45 mm is 100% specific to predict aortic valve involvement. - Abstract: Aim: To identify the predictive signs of aortic valve involvement on the non-electrocardiogram (ECG)-gated admission computed tomography (CT) of patients with Type A aortic dissection (AD) according to the Stanford classification. Materials and methods: We retrospectively analyzed the non-ECG-gated CT examinations of patients admitted to the emergency department who underwent surgery for Type A AD over a period of 4 years. The diameter of the following structures was calculated as the mean of the smallest and largest diameters (mm) measured in two different planes: aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. These parameters were compared against operative reports in order to determine whether they were predictive of aortic valve involvement. Results: In total, 20 patients (13 men and 7 women) of a mean age of 59.5 years (29–80) were included, 55% of patients (11/20) having surgically proven valvular involvement. The mean diameters (in mm) of the aortic annulus, sinus of Valsalva, sinotubular junction and proximal ascending aorta in the group with (and without, respectively) valvular involvement was 27.7 (26.7), 44.3 (38.1), 42.6 (36.6), and 47.8 (45.9). Only the measurement of the mean diameter of the sinuses of Valsalva was significantly predictive (p = 0.02) of aortic valve involvement. Conclusion: Our findings suggest that measuring the diameter of the sinuses of Valsalva on non-ECG-gated admission CT examinations allows for predicting aortic valve involvement in Type A AD patients.

Abdominal aortic calcification in dialysis patients: results of the CORD study

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Honkanen, Eero; Kauppila, Leena; Wikström, Björn

2008-01-01

BACKGROUND: Patients with chronic kidney disease stage 5 have a high prevalence of vascular calcification, but the specific anatomical distribution and severity of abdominal aortic calcification (AAC), in contrast to coronary calcification, is less well documented. AAC may be recorded using plain...

Valvular heart disease

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Carabello, B.; Crawford, F.

1998-01-01

The predicts of the patients with valvular heart disease it has improved substantially in the last 15 years.A better understanding of the appropriate programming of the surgery it is one of the key reasons .In general the surgery for the illness valvular stenosis it can take a long time until the appearance of the symptoms. Probably that in the future it progresses toward a conservation of the native valves in the patient.It will be beneficial because the valves modern prosthetic even have inherent risks .The aortic stenosis acquired it will follow requiring a valve prosthetic substitution .But the valvular disease it will be treated every time but by means of procedures that keep the native valves.They include the lung autograft for the aortic stenosis ,The balloonla commissurectomy with ball for the mitral stenosis ,the aortic valvular repair for aortic inadequacy .This procedures will make that the surgery is but attractive eliminating the risks associated with the prosthetics.The continuous advances in the valuation non invasive of the aortic and mitral valves, the of the appropriate selection moment for the derivation for surgical treatment, the improves of the surgical techniques for the valvular substitution and reconstruction and the very recent advances in less aggressive surgical focuses they should combine to improve the patients' perspectives with cardiopatia valvular [es

Lipoprotein(a Induces Human Aortic Valve Interstitial Cell Calcification

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Bin Yu, PhD

2017-08-01

Full Text Available Lipoprotein(a, or Lp(a, significantly increased alkaline phosphatase activity, release of phosphate, calcium deposition, hydroxyapatite, cell apoptosis, matrix vesicle formation, and phosphorylation of signal transduction proteins; increased expression of chondro-osteogenic mediators; and decreased SOX9 and matrix Gla protein (p < 0.001. Inhibition of MAPK38 and GSK3β significantly reduced Lp(a-induced calcification of human aortic valve interstitial cells (p < 0.001. There was abundant presence of Lp(a and E06 immunoreactivity in diseased human aortic valves. The present study demonstrates a causal effect for Lp(a in aortic valve calcification and suggests that interfering with the Lp(apathway could provide a novel therapeutic approach in the management of this debilitating disease.

Conservative treatment of type B aortic intramural hematoma with no calcification

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Wang Zhiwei; Wang Jiaxiang; Li Zhen; Guan Sheng; Wang Leiyong

2014-01-01

Objective: To investigate the effect of conservative treatment for type B aortic intramural hematoma with no calcification, and to discuss the medium-term follow-up results. Methods: During the period from March 2009 to March 2012, a total of 21 patients with type B aortic intramural hematoma without calcification on the aortic wall were admitted to authors' hospital. The diagnosis was confirmed by CT angiography in all patients. Drug therapy was carried out in all the 21 patients, and all the patients were followed up for one year. At 3, 6 and 12 months after the treatment, CT angiography of the aorta was performed to check the results. Results: Of the 21 patients, one received TEVAR therapy one week after the start of drug therapy and the remaining 20 accomplished the whole medication course. At the time of discharge, all the patients were asymptomatic. All the patients were alive up to the end of the following-up period and no recurrence was observed. Three months after the treatment, complete disappearance of the left pleural effusion was obtained in 11 patients, and complete absorption of the intramural hematoma was seen in 3 patients. Six months after the treatment, complete absorption of the intramural hematoma was found in 13 cases. One year after the treatment, complete absorption of the intramural hematoma was confirmed in 19 patients, and in the remaining two patients both the thickness and extent of the intramural hematoma were markedly improved. Conclusion: It is easy to determine whether there is calcification or not in aortic wall of the diseased segment in patients with Stanford type B aortic intramural hematoma. Strict conservative treatment has satisfactory medium-term therapeutic results for type B aortic intramural hematoma with no calcification on the aortic wall. (authors)

Vitamin K2 regression aortic calcification induced by warfarin via Gas6/Axl survival pathway in rats.

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Jiang, Xiaoyu; Tao, Huiren; Qiu, Cuiting; Ma, Xiaolei; Li, Shan; Guo, Xian; Lv, Anlin; Li, Huan

2016-09-05

The aim of this study was to investigate the effect of vitamin K2 on aortic calcification induced by warfarin via Gas6/Axl survival pathway in rats. A calcification model was established by administering 3mg/g warfarin to rats. Rats were divided into 9 groups: control group (0W, 4W, 6W and 12W groups), 4W calcification group, 6W calcification group, 12W calcification group, 6W calcification+6W normal group and 6W calcification+6W vitamin K2 group. Alizarin red S staining measured aortic calcium depositions; alkaline phosphatase activity in serum was measured by a kit; apoptosis was evaluated by TUNEL assay; protein expression levels of Gas6, Axl, phosphorylated Akt (p-Akt), and Bcl-2 were determined by western blotting. The calcium content, calcium depositions, ALP activity and apoptosis were significantly higher in the calcification groups than control group. Gas6, Axl, p-Akt and Bcl-2 expression was lower in the calcification group than control group. 100μg/g vitamin K2 treatment decreased calcium depositions, ALP activity and apoptosis significantly, but increased Gas6, Axl, p-Akt and Bcl-2 expression. 100μg/g vitamin K2 reversed 44% calcification. Pearson correlation analysis showed a positive correlation between formation calcification and apoptosis (R(2)=0.8853, PK2 can inhibit warfarin-induced aortic calcification and apoptosis. The regression of aortic calcification by vitamin K2 involved the Gas6/Axl axis. This data may provide a theoretical basis for future clinical treatments for aortic calcification. Copyright © 2016 Elsevier B.V. All rights reserved.

Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

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Rai, Divyajeet; Velu, Ramesh; Tosenovsky, Patrik; Quigley, Francis; Wisniowski, Brendan; Walker, Philip J.; Bradshaw, Barbara; Golledge, Jonathan

2014-01-01

Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

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Rai, Divyajeet; Velu, Ramesh; Tosenovsky, Patrik; Quigley, Francis [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); Wisniowski, Brendan; Walker, Philip J. [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia); Bradshaw, Barbara [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); Golledge, Jonathan [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia)

2014-08-15

Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

AN ANALYSIS OF VALVULAR HEART DISEASE BY ECHOCARDIOGRAPHY- A TERTIARY CARE INSTITUTE STUDY

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Perumal Jaisankar

2017-06-01

Full Text Available BACKGROUND Diseases of heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide. In developing countries, Rheumatic Heart Disease (RHD continues to be the predominant form of valvular heart disease. The current study was undertaken at a Tertiary Care Institute with an objective of establishing distribution and different patterns of valvular heart diseases by echocardiography. MATERIALS AND METHODS 17,625 consecutive first time Echocardiograms performed between January 2016 and December 2016 were analysed. Echo was performed by consultant cardiologists using Philips HD11XE and Aloka SSD4000 machine following ASE guidelines. Applying exclusion criteria of trivial and functional regurgitant lesions yielded a total of 632 cases of organic valvular heart diseases. RESULTS In our study 632 patients were diagnosed with valvular heart disease, out of which 428 patients (67.7% were diagnosed with Rheumatic Heart Disease. Mitral valve was the most commonly affected followed by aortic and tricuspid valves. The least commonly affected valve was pulmonary valve. In Rheumatic heart disease, most common isolated lesion reported was MS with MR, most commonly reported in females between 21 - 40 years’ age group. CONCLUSION In non-RHD group, mitral valve prolapse (21.3% was the commonest lesion reported followed by calcific degenerative aortic valve (6.17% and congenital bicuspid aortic valve (3.4%; 118 patients were reported with multivalvular lesion. MS + MR + AR was the commonest multivalvular lesion found in 65 patients (55.08%.

Radiotherapy-induced aortic valve disease associated with porcelain aorta

International Nuclear Information System (INIS)

Daitoku, Kazuyuki; Fukui, Kozo; Ichinoseki, Ikkoh; Munakata, Mamoru; Takahashi, Shoichi; Fukuda Ikuo

2004-01-01

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)

Dietary fatty acids on aortic root calcification in mice with metabolic syndrome.

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Naranjo, Maria C; Bermudez, Beatriz; Garcia, Indara; Lopez, Sergio; Abia, Rocio; Muriana, Francisco J G; Montserrat-de la Paz, Sergio

2017-04-19

Metabolic syndrome (MetS) is associated with obesity, dyslipidemia, type 2 diabetes, and chronic low-grade inflammation. The aim of this study was to determine the role of high-fat low-cholesterol diets (HFLCDs) rich in SFAs (HFLCD-SFAs), MUFAs (HFLCD-MUFAs) or MUFAs plus omega-3 long-chain PUFAs (HFLCD-PUFAs) on vascular calcification by the modulation of the RANKL/RANK/OPG system in the aortic roots of Lep ob/ob LDLR -/- mice. Animals fed with HFLCD-SFAs had increased weight and a greater atheroma plaque size, calcification, and RANKL/CATHK expression in the aortic root than mice on MUFA-enriched diets, with an increasing OPG expression in the aortic roots of the latter. Our study demonstrates that compared to dietary SFAs, MUFAs from olive oil protect against atherosclerosis by interfering with vascular calcification via the RANKL/RANK/OPG system in the setting of MetS. These findings open opportunities for developing novel nutritional strategies with olive oil as the most important dietary source of MUFAs (notably oleic acid) to prevent cardiovascular complications in MetS.

[Mechanism of losartan suppressing vascular calcification in rat aortic artery].

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Shao, Juan; Wu, Panfeng; Wu, Jiliang; Li, Mincai

2016-08-01

Objective To investigate the effect of the angiotensin II receptor 1 (AT1R) blocker losartan on vascular calcification in rat aortic artery and explore the underlying mechanisms. Methods SD rats were divided randomly into control group, vascular calcification model group and treatment group. Vascular calcification models were made by subcutaneous injection of warfarin plus vitamin K1 for two weeks. Rats in the treatment group were subcutaneously injected with losartan (10 mg/kg) at the end of the first week and consecutively for one week. We observed the morphological changes by HE staining and the calcium deposition by Alizarin red staining in the artery vascular wall. The mRNA expressions of bone morphogenetic protein 2 (BMP2) and Runt-related transcription factor 2 (RUNX2) were analyzed by reverse transcription PCR. The BMP2 and RUNX2 protein expressions were determined by Western blotting. The apoptosis of smooth muscle cells (SMCs) were detected by TUNEL. The AT1R expression was tested by fluorescent immunohistochemistry. Results The aortic vascular calcification was induced by warfarin and vitamin K1. Compared with the vascular calcification model group, the mRNA and protein expressions of BMP2 and RUNX2 were significantly downregulated in the aorta in the losartan treatment group. Furthermore, the apoptosis of SMCs and the AT1R expression obviously decreased. Conclusion AT1R blocker losartan inhibits the apoptosis of SMCs and reduces AT1R expression; it downregulates the BMP2 and RUNX2 expressions in the vascular calcification process.

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

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Henein, Michael; Hällgren, Peter; Holmgren, Anders

2015-01-01

calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue. MATERIAL AND METHODS: We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector...... cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve. RESULTS: CAC was present in 92%, AVC in 100% and ARC in 82......% of patients. CAC correlated with ARC (rho = 0.51, p AVC. The number of calcified coronary arteries correlated with ARC (rho = 0.45, p AVC. 29/152 patients had echocardiographic evidence of BAV and 123 TAV, who were older (p

Pregnancy after Prosthetic Aortic Valve Replacement: How Do We Monitor Prosthetic Valvular Function during Pregnancy?

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Nicole Sahasrabudhe

2018-01-01

Full Text Available Background. With modern medicine, many women after structural heart repair are deciding to experience pregnancy. There is a need for further study to identify normal echocardiographic parameters to better assess prosthetic valvular function in pregnancy. In addition, a multidisciplinary approach is essential in managing pregnant patients with complex cardiac conditions. Case. A 22-year-old nulliparous woman with an aortic valve replacement 18 months prior to her pregnancy presented to prenatal care at 20-week gestation. During her prenatal care, serial echocardiography showed a significant increase in the mean gradient across the prosthetic aortic valve. Multidisciplinary management and a serial echocardiography played an integral role in her care that resulted in a successful spontaneous vaginal delivery without complications. Conclusion. Further characterization of the normal echocardiographic parameters in pregnant patients with prosthetic valves is critical to optimize prenatal care for this patient population. This case report is novel in that serial echocardiograms were obtained throughout prenatal care, which showed significant changes across the prosthetic aortic valve. Teaching Points. (1 Further study is needed to identify normal echocardiographic parameters to best assess prosthetic valvular function in pregnancy. (2 Multidisciplinary management is encouraged to optimize prenatal care for women with prosthetic aortic valve replacements.

Procyanidins-crosslinked aortic elastin scaffolds with distinctive anti-calcification and biological properties.

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Wang, Xiaoya; Zhai, Wanyin; Wu, Chengtie; Ma, Bing; Zhang, Jiamin; Zhang, Hongfeng; Zhu, Ziyan; Chang, Jiang

2015-04-01

Elastin, a main component of decellularized extracellular matrices and elastin-containing materials, has been used for tissue engineering applications due to their excellent biocompatibility. However, elastin is easily calcified, leading to the decrease of life span for elastin-based substitutes. How to inhibit the calcification of elastin-based scaffolds, but maintain their good biocompatibility, still remains significantly challenging. Procyanidins (PC) are a type of natural polyphenols with crosslinking ability. To investigate whether pure elastin could be crosslinked by PC with anti-calcification effect, PC was first used to crosslink aortic elastin. Results show that PC can crosslink elastin and effectively inhibit elastin-initiated calcification. Further experiments reveal the possible mechanisms for the anti-calcification of PC crosslinking including (1) inhibiting inflammation cell attachment, and secretion of inflammatory factors such as MMPs and TNF-α, (2) preventing elastin degradation by elastase, and (3) direct inhibition of mineral nucleation in elastin. Moreover, the PC-crosslinked aortic elastin maintains natural structure with high pore volume (1111 μL/g), large pore size (10-300 μm) and high porosity (75.1%) which facilitates recellularization of scaffolds in vivo, and displays excellent hemocompatibility, anti-thrombus and anti-inflammatory potential. The advantages of PC-crosslinked porous aortic elastin suggested that it can serve as a promising scaffold for tissue engineering. Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Valvular heart disease and anaesthesia.

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Paul, Abhijit; Das, Sucharita

2017-09-01

Valvular heart disease presents as mixed spectrum lesion in healthcare settings in the third-world and developing countries. Rheumatic heart disease still forms the bulk of the aetiopathology of valve lesions. Mitral and aortic valve lesions top the list of valvular pathology. A thorough understanding of the pathophysiology of valvular heart disease is essential while planning anaesthesia and perioperative care for such patients. Meticulous use of optimal fluids, close monitoring of the changing haemodynamics and avoidance of situations that can cause major reduction of cardiac output and fluid shifts are mandatory to achieve good clinical outcome. We searched MEDLINE using combinations of the following: anaesthesia, aortic, mitral, regurgitation, stenosis and valvular heart disease. We also hand searched textbooks and articles on valvular heart disease and anaesthesia. This article mainly focuses on the understanding the pathophysiology of valvular heart disease in patients presenting for non-cardiac surgeries in secondary and tertiary care setting.

Impact of valvular heart disease on oral anticoagulant therapy in non-valvular atrial fibrillation: results from the RAMSES study.

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Başaran, Özcan; Dogan, Volkan; Beton, Osman; Tekinalp, Mehmet; Aykan, Ahmet Çağrı; Kalaycıoğlu, Ezgi; Bolat, Ismail; Taşar, Onur; Şafak, Özgen; Kalçık, Macit; Yaman, Mehmet; İnci, Sinan; Altıntaş, Bernas; Kalkan, Sedat; Kırma, Cevat; Biteker, Murat

2017-02-01

The definition of non-valvular atrial fibrillation (NVAF) is controversial. We aimed to assess the impact of valvular heart disease on stroke prevention strategies in NVAF patients. The RAMSES study was a multicenter and cross-sectional study conducted on NVAF patients (ClinicalTrials.gov identifier NCT02344901). The study population was divided into patients with significant valvular disease (SVD) and non-significant valvular disease (NSVD), whether they had at least one moderate valvular disease or not. Patients with a mechanical prosthetic valve and mitral stenosis were excluded. Baseline characteristics and oral anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF, there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant valvular disease was mitral regurgitation (58.1%), followed by aortic regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had higher CHA 2 DS 2 VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0; 5.0), p valvular heart disease with the predominance of mitral regurgitation. Patients with SVD were at greater risk of stroke and bleeding compared to patients with NSVD. Although patients with mitral regurgitation should be given more aggressive anticoagulant therapy due to their higher risk of stroke, they are undertreated compared to patients with aortic valve diseases.

Long-term effect of cinacalcet hydrochloride on abdominal aortic calcification in patients on hemodialysis with secondary hyperparathyroidism

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Nakayama K

2013-12-01

Full Text Available Kazunori Nakayama,1,2 Kazushi Nakao,1,2 Yuji Takatori,1,2 Junko Inoue,1 Shoichirou Kojo,1 Shigeru Akagi,1,2 Masaki Fukushima,2 Jun Wada,1 Hirofumi Makino11Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2Shigei Medical Research Hospital, Okayama, JapanBackground: Secondary hyperparathyroidism (SHPT is one of the common complications in dialysis patients, and is associated with increased risk of vascular calcification. The effects of cinacalcet hydrochloride treatment on bone and mineral metabolism have been previously reported, but the benefit of cinacalcet on vascular calcification remains uncertain. The aim of this study was to evaluate the impact of cinacalcet on abdominal aortic calcification in dialysis patients.Subjects and methods: Patients were on maintenance hemodialysis with insufficiently controlled SHPT (intact parathyroid hormone [PTH] >180 pg/mL by conventional therapies. All subjects were initially administered 25 mg cinacalcet daily, with concomitant use of calcitriol analogs. Abdominal aortic calcification was annually evaluated by calculating aortic calcification area index (ACAI using multidetector computed tomography (MDCT, from 12 months before to 36 months after the initiation of cinacalcet therapy.Results: Twenty-three patients were analyzed in this study. The mean age was 59.0±8.7 years, 34.8% were women, and the mean dialysis duration was 163.0±76.0 months. After administration of cinacalcet, serum levels of intact PTH, phosphorus, and calcium significantly decreased, and mean Ca × P values significantly decreased from 67.4±7.9 mg2/dL2 to 52±7.7 mg2/dL2. Although the ACAI value did not decrease during the observation period, the increase in ACAI between 24 months and 36 months after cinacalcet administration was significantly suppressed.Conclusion: Long-term administration of cinacalcet was associated with reduced progression of

The long non-coding HOTAIR is modulated by cyclic stretch and WNT/β-CATENIN in human aortic valve cells and is a novel repressor of calcification genes.

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Carrion, Katrina; Dyo, Jeffrey; Patel, Vishal; Sasik, Roman; Mohamed, Salah A; Hardiman, Gary; Nigam, Vishal

2014-01-01

Aortic valve calcification is a significant and serious clinical problem for which there are no effective medical treatments. Individuals born with bicuspid aortic valves, 1-2% of the population, are at the highest risk of developing aortic valve calcification. Aortic valve calcification involves increased expression of calcification and inflammatory genes. Bicuspid aortic valve leaflets experience increased biomechanical strain as compared to normal tricuspid aortic valves. The molecular pathogenesis involved in the calcification of BAVs are not well understood, especially the molecular response to mechanical stretch. HOTAIR is a long non-coding RNA (lncRNA) that has been implicated with cancer but has not been studied in cardiac disease. We have found that HOTAIR levels are decreased in BAVs and in human aortic interstitial cells (AVICs) exposed to cyclic stretch. Reducing HOTAIR levels via siRNA in AVICs results in increased expression of calcification genes. Our data suggest that β-catenin is a stretch responsive signaling pathway that represses HOTAIR. This is the first report demonstrating that HOTAIR is mechanoresponsive and repressed by WNT β-catenin signaling. These findings provide novel evidence that HOTAIR is involved in aortic valve calcification.

The long non-coding HOTAIR is modulated by cyclic stretch and WNT/β-CATENIN in human aortic valve cells and is a novel repressor of calcification genes.

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Katrina Carrion

Full Text Available Aortic valve calcification is a significant and serious clinical problem for which there are no effective medical treatments. Individuals born with bicuspid aortic valves, 1-2% of the population, are at the highest risk of developing aortic valve calcification. Aortic valve calcification involves increased expression of calcification and inflammatory genes. Bicuspid aortic valve leaflets experience increased biomechanical strain as compared to normal tricuspid aortic valves. The molecular pathogenesis involved in the calcification of BAVs are not well understood, especially the molecular response to mechanical stretch. HOTAIR is a long non-coding RNA (lncRNA that has been implicated with cancer but has not been studied in cardiac disease. We have found that HOTAIR levels are decreased in BAVs and in human aortic interstitial cells (AVICs exposed to cyclic stretch. Reducing HOTAIR levels via siRNA in AVICs results in increased expression of calcification genes. Our data suggest that β-catenin is a stretch responsive signaling pathway that represses HOTAIR. This is the first report demonstrating that HOTAIR is mechanoresponsive and repressed by WNT β-catenin signaling. These findings provide novel evidence that HOTAIR is involved in aortic valve calcification.

Recent clinical trials in valvular heart disease.

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Kiss, Daniel; Anwaruddin, Saif

2017-07-01

With widespread adoption of transcatheter aortic valve replacement, there has been a change in the approach to management of valvular heart disease. New interest has taken hold in transcatheter therapies for valvular heart disease, as well as research into pathophysiology and progression of disease. Additionally, several key trials have further refined our understanding of surgical management of valvular heart disease. This review will elucidate recent clinical trial data leading to changes in practice. There have been several landmark trials expanding the indications for transcatheter aortic valve replacement. Additionally, although still early, trials are beginning to demonstrate the feasibility and safety of transcatheter mitral valves. Options for transcatheter management of right-sided valvular disease continue to evolve, and these are areas of active investigation. The emergence of novel therapies for valvular heart disease has expanded the management options available, allowing physicians to better individualize treatment of patients with valvular heart disease. This review will focus on the recent (within 2 years) trials in this field of interest.

Low-level overexpression of p53 promotes warfarin-induced calcification of porcine aortic valve interstitial cells by activating Slug gene transcription.

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Gao, Li; Ji, Yue; Lu, Yan; Qiu, Ming; Shen, Yejiao; Wang, Yaqing; Kong, Xiangqing; Shao, Yongfeng; Sheng, Yanhui; Sun, Wei

2018-03-09

The most frequently used oral anti-coagulant warfarin has been implicated in inducing calcification of aortic valve interstitial cells (AVICs), whereas the mechanism is not fully understood. The low-level activation of p53 is found to be involved in osteogenic transdifferentiation and calcification of AVICs. Whether p53 participates in warfarin-induced AVIC calcification remains unknown. In this study, we investigated the role of low-level p53 overexpression in warfarin-induced porcine AVIC (pAVIC) calcification. Immunostaining, quantitative PCR, and Western blotting revealed that p53 was expressed in human and pAVICs and that p53 expression was slightly increased in calcific human aortic valves compared with non-calcific valves. Terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling staining indicated that apoptosis slightly increased in calcific aortic valves than in non-calcific valves. Warfarin treatment led to a low-level increase of p53 mRNA and protein in both pAVICs and mouse aortic valves. Low-level overexpression of p53 in pAVICs via an adenovirus vector did not affect pAVIC apoptosis but promoted warfarin-induced calcium deposition and expression of osteogenic markers. shRNA-mediated p53 knockdown attenuated the pAVIC calcium deposition and osteogenic marker expression. Moreover, ChIP and luciferase assays showed that p53 was recruited to the slug promoter and activated slug expression in calcific pAVICs. Of note, overexpression of Slug increased osteogenic marker Runx2 expression, but not pAVIC calcium deposition, and Slug knockdown attenuated pAVIC calcification and p53-mediated pAVIC calcium deposition and expression of osteogenic markers. In conclusion, we found that p53 plays an important role in warfarin induced pAVIC calcification, and increased slug transcription by p53 is required for p53-mediated pAVIC calcification. © 2018 by The American Society for Biochemistry and Molecular Biology, Inc.

Edema pulmonar refractario secundario a estenosis valvular aórtica severa - valvuloplastia aórtica como terapia puente a cirugía: Presentación de un caso Refractory pulmonary edema secondary to severe aortic valvular stenosis - aortic valvuloplasty as bridge therapy to surgery

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Santiago Salazar

2009-04-01

Full Text Available La estenosis valvular aórtica es una entidad progresiva, que cuando es severa y produce síntomas, tiene un pronóstico sombrío que afecta de forma adversa la sobrevida. En estos casos el tratamiento de elección es la cirugía de cambio valvular, la cual, bajo determinadas circunstancias clínicas, puede ser de muy alto riesgo, y obliga así a considerar alternativas de manejo menos agresivas que permitan solucionar el problema. Se muestra el caso de un hombre de 65 años, con estenosis valvular aórtica severa, quien desarrolló edema pulmonar refractario al manejo médico, que se resolvió mediante valvuloplastia aórtica, como terapia puente a cirugía.Aortic valve stenosis is a progressive disease; when it is severe and symptomatic has a bleak prognosis that affects adversely the patient survival. In these cases, the treatment of choice is valve replacement surgery that under certain circumstances can bear a huge risk that forces the physician to consider less aggressive management alternatives to solve the problem. The case of a 65 years old male with severe aortic valve stenosis is reported. He developed pulmonary edema refractory to medical treatment that was solved by aortic valvuloplasty as bridge therapy to surgery.

Neurotrophin 3 upregulates proliferation and collagen production in human aortic valve interstitial cells: a potential role in aortic valve sclerosis.

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Yao, Qingzhou; Song, Rui; Ao, Lihua; Cleveland, Joseph C; Fullerton, David A; Meng, Xianzhong

2017-06-01

Calcific aortic valve disease (CAVD) is a leading cardiovascular disorder in the elderly. Diseased aortic valves are characterized by sclerosis (fibrosis) and nodular calcification. Sclerosis, an early pathological change, is caused by aortic valve interstitial cell (AVIC) proliferation and overproduction of extracellular matrix (ECM) proteins. However, the mechanism of aortic valve sclerosis remains unclear. Recently, we observed that diseased human aortic valves overexpress growth factor neurotrophin 3 (NT3). In the present study, we tested the hypothesis that NT3 is a profibrogenic factor to human AVICs. AVICs isolated from normal human aortic valves were cultured in M199 growth medium and treated with recombinant human NT3 (0.10 µg/ml). An exposure to NT3 induced AVIC proliferation, upregulated the production of collagen and matrix metalloproteinase (MMP), and augmented collagen deposition. These changes were abolished by inhibition of the Trk receptors. NT3 induced Akt phosphorylation and increased cyclin D1 protein levels in a Trk receptor-dependent fashion. Inhibition of Akt abrogated the effect of NT3 on cyclin D1 production. Furthermore, inhibition of either Akt or cyclin D1 suppressed NT3-induced cellular proliferation and MMP-9 and collagen production, as well as collagen deposition. Thus, NT3 upregulates cellular proliferation, ECM protein production, and collagen deposition in human AVICs. It exerts these effects through the Trk-Akt-cyclin D1 cascade. NT3 is a profibrogenic mediator in human aortic valve, and overproduction of NT3 by aortic valve tissue may contribute to the mechanism of valvular sclerosis. Copyright © 2017 the American Physiological Society.

Exposure to ambient air pollution and calcification of the mitral annulus and aortic valve: the multi-ethnic study of atherosclerosis (MESA).

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Tibuakuu, Martin; Jones, Miranda R; Navas-Acien, Ana; Zhao, Di; Guallar, Eliseo; Gassett, Amanda J; Sheppard, Lianne; Budoff, Matthew J; Kaufman, Joel D; Michos, Erin D

2017-12-21

Long-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD). Calcifications of left-sided heart valves are also markers of CVD risk. We investigated whether air pollution was associated with valvular calcification and its progression. We studied 6253 MESA participants aged 45-84 years who underwent two cardiac CT scans 2.5 years apart to quantify aortic valve calcium (AVC) and mitral annular calcium (MAC). CAC was included for the same timeframe for comparison with AVC/MAC. Ambient particulate matter AVC and MAC at baseline were 13% and 9% respectively, compared to 50% prevalence of CAC. The adjusted prevalence ratios of AVC and MAC for each 5 μg/m 3 higher PM 2.5 was 1.19 (95% CI 0.87, 1.62) and 1.20 (0.81, 1.77) respectively, and for CAC was 1.14 (1.01, 1.27). Over 2.5 years, the mean change in Agatston units/year for each 5 μg/m 3 higher PM 2.5 concentration was 0.29 (-5.05, 5.63) for AVC and 4.38 (-9.13, 17.88) for MAC, compared to 8.66 (0.61, 16.71) for CAC. We found no significant associations of NOx with AVC and MAC. Our findings suggest a trend towards increased 2.5-year progression of MAC with exposure to outdoor PM 2.5 , although this association could not be confirmed. Additional well-powered studies with longer periods of follow-up are needed to further study associations of air pollution with valvular calcium. Although MESA is not a clinical trial, this cohort is registered at ClinicalTrials.gov Identifier: NCT00005487; Date of registration May 25, 2000.

Valvular Heart Disease in Women, Differential Remodeling, and Response to New Therapies.

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Chandrasekhar, Jaya; Dangas, George; Mehran, Roxana

2017-09-11

In the United States, valvular heart disease (VHD) has a prevalence of 2.5%, most commonly presenting as aortic stenosis (AS) or mitral valve regurgitation (MR) and increasingly observed to be of a degenerative etiology. Women frequently have latent symptoms despite significant disease, and it is therefore pertinent to consider both clinical symptoms and imaging findings for decision-making on treatment. Indeed, significant advances have been made in noninvasive imaging allowing for more accurate diagnosis and disease prognostication. While echo remains the standard diagnostic test, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) provide complementary information on aortic valve calcification and left ventricular (LV) function, respectively. For any given calcification load or increase in calcification density of the aortic valve, women have greater increase in aortic valve stenosis severity than men; thus, moderate AS in women warrants closer attention. MRI allows identification of different patterns of hypertrophy and remodeling, extent of LV fibrosis, and insights into differential reverse remodeling and clinical outcomes in men and women. In conjunction with surgical treatment, percutaneous technologies are being increasingly used in the management of VHD. Nearly 50% of patients undergoing transcatheter aortic valve replacement (TAVR) are women. In high- or intermediate-risk subjects with significant symptomatic AS, TAVR has been shown to be noninferior to surgical AVR (SAVR). Notably, whereas both treatment strategies are equally effective in men, transfemoral TAVR has been shown to be superior to SAVR resulting in better survival in women. Analogously, few data have examined sex differences with percutaneous MitraClip devices in the treatment of degenerative MR, and men and women appear to have equivalent composite outcomes. Randomized clinical trial data are presently awaited for outcomes in the percutaneous treatment of

Aortic valve calcifications on chest films: how much calcium do I need?

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Mahnken, Andreas H; Dohmen, Guido; Koos, Ralf

2011-08-01

Aortic valve calcifications (AVC) as seen on conventional chest films or on CT are associated with aortic valve stenosis (AVS). The absence of AVC on chest films does not exclude high grade AVS. The aim of this study was to analyse if there is a threshold for the detection of AVC from conventional chest films in patients suffering from high grade AVS. The explanted aortic valves of 29 patients (16 male, mean age 72.3 +/- 11.5 years) with high grade AVS were examined by dual-source CT. AVC were quantified using the Agatston AVC score. In all patients conventional chest films obtained the day before surgery were evaluated for the presence of AVC. Results were analysed with students t-test, Spearman's rank correlation and ROC analysis. On conventional chest films AVC were visible in 18 patients. On CT all specimen presented with AVC with an Agatston AVC score ranging from 40.7 to 1870 (mean 991.3 +/- 463.1). In patients with AVC visible on chest films the AVC score was significantly higher (1264.0 +/- 318.2) when compared with patients without visible calcifications (544.9 +/- 274.4; P AVC score and the visibility of AVC on chest films (r = 0.781). ROC analysis identified an ideal threshold of 718 for AVC score to separate conventional chest films with and without visible AVC. Unlike in coronary calcifications, there is a threshold for identifying AVC from conventional chest films. This finding may be of diagnostic value, as conventional chest films may be used to semiquantitatively evaluate the extent of AVC.

[The best of valvular heart disease in 2006].

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de Gevigney, G

2007-01-01

In the field of valvular diseases, the year 2006 has been above all marked by the publication of new joint AHA/ACC guidelines. Besides, other publications included severe aortic stenosis, drug therapy in chronic aortic regurgitation, the indications for surgery in asymptomatic mitral regurgitation, as well as valve surgery in the elderly and mismatch severity after aortic valve replacement. In a series of 66 cases of aortic stenosis with poor LV function undergoing stress echocardiography, it has been shown that whether the absence of contractile reserve identifies a high-risk subgroup for aortic valve replacement (33% vs. 6%), this exam does not predict the functional prognosis and the post-operative LV function improvement. Hence, the absence of contractile reserve should not contra-indicate aortic valve replacement surgery, even though the prognosis is severe, since the natural prognosis is extremely severe. The question of aortic valve replacement in case of mild stenosis with the indication of CABG remains difficult. Taking into account the important mortality of redo surgery, a study was in favor of a systematic aortic valve replacement associated to CABG in patients 30 mmHg, a LVH and aortic valve calcifications. Old patients (>80 years) with severe aortic stenosis have a very severe natural prognosis, authorizing wide indications for aortic valve replacement, in the absence of important comorbidities. The use of vasodilators in severe chronic aortic regurgitation remains debated. In a randomized study comparing Nifedipine 40 mg vs. Enalapril 20 mm vs. placebo, it has been shown that the use of a vasodilator does not modify the time of valvular surgery at all. After a mean follow-up of 7 years, the rates of aortic valve replacement were identical in the 3 groups, and there wa no difference regarding the preoperative regurgitation volume, LV dimensions and mass, and LVEF. The timing for huge chronic and asymptomatic mitral regurgitation remains debated, even

Aortic valve calcification - a commonly observed but frequently ignored finding during CT scanning of the chest.

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Raju, Prashanth; Sallomi, David; George, Bindu; Patel, Hitesh; Patel, Nikhil; Lloyd, Guy

2012-06-01

To describe the frequency and severity of Aortic valve calcification (AVC) in an unselected cohort of patients undergoing chest CT scanning and to assess the frequency with which AVC was being reported in the radiology reports. Consecutive CT scan images of the chest and the radiological reports (December 2009 to May 2010) were reviewed at the district general hospital (DGH). AVC on CT scan was visually graded on a scale ranging from 0 to IV (0 = no calcification, IV = severe calcification). Total of 416 (232 male; 184 female) CT chest scans [Contrast enhanced 302 (72%), unenhanced 114 (28%)] were reviewed. Mean age was 70.55 ± 11.48 years. AVC in CT scans was identified in 95 of the 416 patients (22.83%). AVC classification was as follows: Grade I: 60 (63.15%), Grade II: 22 (23.15%), Grade III: 9 (9.47%), Grade IV: 4 (4.21%). Only one CT report mentioned AVC. Only 31 of 95 AVC had Transthoracic echocardiogram (TTE). The interval time between CT scan and TTE was variable.   Aortic valve calcification in CT chest scans is a common finding and studies have shown that it is strongly related to the presence and severity of aortic valve disease. As CT scans are considered as a valuable additional screening tool for detection of aortic stenosis, AVC should always be commented upon in the radiology reports. Furthermore, patients with at least Grade III and IV AVC should be sent for TTE. © 2012 Blackwell Publishing Ltd.

Aortic obstruction: anatomy and echocardiography

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Keirns Candace

2006-09-01

Full Text Available Abstract Echocardiography is a valuable non-invasive technique for identifying the site and type of aortic obstruction. Knowledge of the morphological details of each type of obstruction is the basis for correct interpretation of the diagnostic images and clinical decisions. This study was undertaken to correlate the echocardiographic images with anatomic specimens of equivalent valvular and supravalvular aortic obstruction. Specimens were part of the collection of the Department of Embryology. Fifty six patients were studied, and forty specimens with aortic obstruction were analyzed. Echocardiographic characteristics: Thirty one (55.3% patients were women and twenty five (44.7% men. Valvular aortic obstruction was found in Thirty six patients (64.3 % and supravalvular aortic obstruction in twenty (35.7%. Anatomic characteristics: Of the forty specimens examined, twenty one (52.5% had valvular aortic obstruction and nineteen (47.5% supravalvular aortic obstruction. The anatomoechocardiographic correlation clearly showed that the anatomic findings of the specimen hearts and aortas corresponded to echocardiographic images of valvular and supravalvular aortic obstruction and provided solid corroboration of echocardiographic diagnoses.

Association of the C-Reactive Protein Gene (CRP rs1205 C>T Polymorphism with Aortic Valve Calcification in Patients with Aortic Stenosis

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Ewa Wypasek

2015-10-01

Full Text Available Elevation in C-reactive protein (CRP levels have been shown in patients with aortic valve stenosis (AS. Minor allele of the CRP gene (CRP rs1205 C>T polymorphism has been associated with lower plasma CRP concentrations in cohorts of healthy and atherosclerotic patients. Considering the existing similarities between atherosclerosis and AS, we examined the effect of CRP rs1205 C>T polymorphism on the AS severity. Three hundred consecutive Caucasian patients diagnosed with AS were genotyped for the rs1205 C>T polymorphism using the TaqMan assay. Severity of the AS was assessed using transthoracic echocardiography. The degree of calcification was analyzed semi-quantitatively. Carriers of the rs1205 T allele were characterized by elevated serum CRP levels (2.53 (1.51–3.96 vs. 1.68 (0.98–2.90 mg/L, p < 0.001 and a higher proportion of the severe aortic valve calcification (70.4% vs. 55.1%, p = 0.01 compared with major homozygotes. The effect of CRP rs1205 polymorphism on CRP levels is opposite in AS-affected than in unaffected subjects, suggesting existence of a disease-specific molecular regulatory mechanism. Furthermore, rs1205 variant allele predisposes to larger aortic valve calcification, potentially being a novel genetic risk marker of disease progression.

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

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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.

Statins for progression of aortic valve stenosis and the best evidence for making decisions in health care

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Luciana Thiago

2011-01-01

Full Text Available In the Western world, calcified aortic valve stenosis is the most common form of valvular heart disease, affecting up to 3% of adults over the age of 75 years. It is a gradually progressive disease, characterized by a long asymptomatic phase that may last for several decades, followed by a short symptomatic phase associated with severe restriction of the valve orifice. Investigations on treatments for aortic valve stenosis are still in progress. Thus, it is believed that calcification of aortic valve stenosis is similar to the process of atherosclerosis that occurs in coronary artery disease. Recent studies have suggested that cholesterol lowering through the use of statins may have a salutary effect on the progression of aortic valve stenosis

Aortic insufficiency

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... page, please enable JavaScript. Aortic insufficiency is a heart valve disease in which the aortic valve does not close ... aortic insufficiency Images Aortic insufficiency References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil ...

Effects of dietary calcium on atherosclerosis, aortic calcification, and icterus in rabbits fed a supplemental cholesterol diet

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Culley Nathan C

2006-06-01

Full Text Available Abstract Background Vascular calcification is implicated in myocardial infarction, instability and rigidity of the aortic wall, and bioprosthetic failures. Although an increase in the calcium (Ca content in atherogenic diets has been shown to decrease atherosclerosis in rabbits, whether Ca supplementation and deficiency can affect atherosclerosis-related aortic calcification remains unknown. Results New Zealand White male rabbit littermates were fed an atherogenic diet containing 0.5% cholesterol and 2% peanut oil. The Ca content of the diet, which normally contains 1%, was adjusted to 0.5 or 3%. Segments of thoracic aortas were dissected from rabbits for histological evaluations and Ca and Pi determinations. Rabbits with calcium supplementation were maintained for 4 months, whereas those with calcium deficiency were maintained for 2 1/2 months due to severe icterus beyond this stage. The ratios of intimal to medial areas and calcified to intimal areas were used to semi-quantify lesion accumulation and calcification, respectively. Icterus was estimated from the extent of yellowing of the skin, sclera, and mucous membranes along with gross evidence of hepatic lipidosis and/or biliary obstructions. Statistical analysis of 16 matched littermates shows that Ca supplementation significantly decreased the lesions by 41% (p Conclusion Ca supplementation to an atherogenic diet inhibits atherosclerosis, aortic calcification, and icterus, whereas a Ca deficient-diet promotes them.

Evaluation of valvular heart diseases with computed tomography

International Nuclear Information System (INIS)

Tomoda, Haruo; Hoshiai, Mitsumoto; Matsuyama, Seiya

1982-01-01

Forty-two patients with valvular heart diseases were studied with a third-generation computed tomographic system. The cardiac chambers (the atria and ventricles) were evaluated semiquantitatively, and valvular calcification was easily detected with computed tomography. Computed tomography was most valuable in revealing left atrial thrombi which were not identified by other diagnostic procedures in some cases. (author)

Echocardiographic aortic valve calcification and outcomes in women and men with aortic stenosis.

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Thomassen, Henrik K; Cioffi, Giovanni; Gerdts, Eva; Einarsen, Eigir; Midtbø, Helga Bergljot; Mancusi, Costantino; Cramariuc, Dana

2017-10-01

Sex differences in risk factors of aortic valve calcification (AVC) by echocardiography have not been reported from a large prospective study in aortic stenosis (AS). AVC was assessed using a prognostically validated visual score and grouped into none/mild or moderate/severe AVC in 1725 men and women with asymptomatic AS in the Simvastatin Ezetimibe in Aortic Stenosis study. The severity of AS was assessed by the energy loss index (ELI) taking pressure recovery in the aortic root into account. More men than women had moderate/severe AVC at baseline despite less severe AS by ELI (pAVC at baseline was independently associated with lower aortic compliance and more severe AS in both sexes, and with increased high-sensitive C reactive protein (hs-CRP) only in men (all pAVC at baseline was associated with a 2.5-fold (95% CI 1.64 to 3.80) higher hazard rate of major cardiovascular events in women, and a 2.2-fold higher hazard rate in men (95% CI 1.54 to 3.17) (both pAVC at baseline also predicted a 1.8-fold higher hazard rate of all-cause mortality in men (95% CI 1.04 to 3.06, pAVC scored by echocardiography has sex-specific characteristics in AS. Moderate/severe AVC is associated with higher cardiovascular morbidity in both sexes, and with higher all-cause mortality in men. ClinicalTrials.gov identifier: NCT00092677. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A Radiographic Study on the Associations of Age and Prevalence of Vertebral Fractures with Abdominal Aortic Calcification in Japanese Postmenopausal Women and Men

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Jun Iwamoto

2010-01-01

Full Text Available The purpose of the present study was to determine the associations of age and history of non- and low-traumatic fractures with the severity of abdominal aortic calcification in Japanese postmenopausal women and men. Four hundred and one Japanese persons (24 men and 377 postmenopausal women, mean age: 73.8 years for whom thoracic and lumbar spine radiographs had been obtained to evaluate their posture prior to patient participation in a fall-prevention exercise program were enrolled. The associations of sex, age, history of hip fracture, prevalence of vertebral fracture, and spondylosis grade (the Nathan degree with the severity of abdominal aortic calcification (length of calcification, as evaluated according to the number of vertebral bodies were analyzed. Nine subjects (2.2% had a history of hip fracture, and 221 (55.1% had at least one prevalent vertebral fracture. Two hundred and sixty-seven subjects (66.6% had first-degree spondylosis. Age and the number of prevalent vertebral fractures, but not sex, history of hip fracture, or spondylosis grade, were significantly associated with the severity of abdominal aortic calcification. The present study confirmed that age and the number of vertebral fractures were associated with the severity of abdominal aortic calcification in Japanese postmenopausal women and men.

Toll-Like Receptors, Inflammation, and Calcific Aortic Valve Disease

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Carmen García-Rodríguez

2018-03-01

Full Text Available Inflammation, the primary response of innate immunity, is essential to initiate the calcification process underlying calcific aortic valve disease (CAVD, the most prevalent valvulopathy in Western countries. The pathogenesis of CAVD is multifactorial and includes inflammation, hemodynamic factors, fibrosis, and active calcification. In the development of CAVD, both innate and adaptive immune responses are activated, and accumulating evidences show the central role of inflammation in the initiation and propagation phases of the disease, being the function of Toll-like receptors (TLR particularly relevant. These receptors act as sentinels of the innate immune system by recognizing pattern molecules from both pathogens and host-derived molecules released after tissue damage. TLR mediate inflammation via NF-κB routes within and beyond the immune system, and play a crucial role in the control of infection and the maintenance of tissue homeostasis. This review outlines the current notions about the association between TLR signaling and the ensuing development of inflammation and fibrocalcific remodeling in the pathogenesis of CAVD. Recent data provide new insights into the inflammatory and osteogenic responses underlying the disease and further support the hypothesis that inflammation plays a mechanistic role in the initiation and progression of CAVD. These findings make TLR signaling a potential target for therapeutic intervention in CAVD.

Animal Models of Calcific Aortic Valve Disease

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Krista L. Sider

2011-01-01

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

Association of aortic valve calcification severity with the degree of aortic regurgitation after transcatheter aortic valve implantation.

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Koos, Ralf; Mahnken, Andreas Horst; Dohmen, Guido; Brehmer, Kathrin; Günther, Rolf W; Autschbach, Rüdiger; Marx, Nikolaus; Hoffmann, Rainer

2011-07-15

This study sought to examine a possible relationship between the severity of aortic valve calcification (AVC), the distribution of AVC and the degree of aortic valve regurgitation (AR) after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). 57 patients (22 men, 81 ± 5 years) with symptomatic AS and with a logistic EuroSCORE of 24 ± 12 were included. 38 patients (67%) received a third (18F)-generation CoreValve® aortic valve prosthesis, in 19 patients (33%) an Edwards SAPIEN™ prosthesis was implanted. Prior to TAVI dual-source computed tomography for assessment of AVC was performed. To determine the distribution of AVC the percentage of the calcium load of the most severely calcified cusp was calculated. After TAVI the degree of AR was determined by angiography and echocardiography. The severity of AR after TAVI was related to the severity and distribution of AVC. There was no association between the distribution of AVC and the degree of paravalvular AR after TAVI as assessed by angiography (r = -0.02, p = 0.88). Agatston AVC scores were significantly higher in patients with AR grade ≥ 3 (5055 ± 1753, n = 3) than in patients with AR grade AVC scores > 3000 were associated with a relevant paravalvular AR and showed a trend for increased need for second manoeuvres. There was a significant correlation between the severity of AVC and the degree of AR after AVR (r = 0.50, p AVC have an increased risk for a relevant AR after TAVI as well as a trend for increased need for additional procedures. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation

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Stefania Scarsoglio

2016-07-01

Full Text Available Background: Although atrial fibrillation (AF, a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. Methods: We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of the four heart chambers, together with the systemic and pulmonary circulation. The AF modelling involves: (i irregular, uncorrelated and faster heart rate; (ii atrial contractility dysfunction. Three different grades of severity (mild, moderate, severe were analyzed for each of the four valvulopathies (AS, aortic stenosis, MS, mitral stenosis, AR, aortic regurgitation, MR, mitral regurgitation, by varying–through the valve opening angle–the valve area. Results: Regurgitation was hemodynamically more relevant than stenosis, as the latter led to inefficient cardiac flow, while the former introduced more drastic fluid dynamics variation. Moreover, mitral valvulopathies were more significant than aortic ones. In case of aortic valve diseases, proper mitral functioning damps out changes at atrial and pulmonary levels. In the case of mitral valvulopathy, the mitral valve lost its regulating capability, thus hemodynamic variations almost equally affected regions upstream and downstream of the valve. In particular, the present study revealed that both mitral and aortic regurgitation strongly affect hemodynamics, followed by mitral stenosis, while aortic stenosis has the least impact among the analyzed valvular diseases. Discussion: The proposed approach can provide new mechanistic insights as to which valvular pathologies merit more aggressive

Traditional Cardiovascular Risk Factors and Their Relation to Future Surgery for Valvular Heart Disease or Ascending Aortic Disease: A Case-Referent Study.

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Ljungberg, Johan; Johansson, Bengt; Engström, Karl Gunnar; Albertsson, Elin; Holmer, Paul; Norberg, Margareta; Bergdahl, Ingvar A; Söderberg, Stefan

2017-05-05

Risk factors for developing heart valve and ascending aortic disease are based mainly on retrospective data. To elucidate these factors in a prospective manner, we have performed a nested case-referent study using data from large, population-based surveys. A total of 777 patients operated for heart valve disease or disease of the ascending aorta had previously participated in population-based health surveys in Northern Sweden. Median time (interquartile range) from survey to surgery was 10.5 (9.0) years. Primary indications for surgery were aortic stenosis (41%), aortic regurgitation (12%), mitral regurgitation (23%), and dilatation/dissection of the ascending aorta (17%). For each case, referents were allocated, matched for age, sex, and geographical area. In multivariable models, surgery for aortic stenosis was predicted by hypertension, high cholesterol levels, diabetes mellitus, and active smoking. Surgery for aortic regurgitation was associated with a low cholesterol level, whereas a high cholesterol level predicted surgery for mitral regurgitation. Hypertension, blood pressure, and previous smoking predicted surgery for disease of the ascending aorta whereas diabetes mellitus was associated with reduced risk. After exclusion of cases with coronary atherosclerosis, only the inverse associations between cholesterol and aortic regurgitation and between diabetes mellitus and disease of the ascending aorta remained. This is the first truly prospective study of traditional cardiovascular risk factors and their association with valvular heart disease and disease of the ascending aorta. We confirm the strong association between traditional risk factors and aortic stenosis, but only in patients with concomitant coronary artery disease. In isolated valvular heart disease, the impact of traditional risk factors is varying. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Aortic stenosis

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... Images Aortic stenosis Heart valves References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil ... ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/ ...

Simultaneous rota-stenting and transcatheter aortic valve implantation for patients with heavily calcified coronary stenosis and aortic stenosis

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Yung-Tsai Lee

2016-09-01

Full Text Available Given that coronary artery disease (CAD in octogenarians undergoing transcatheter aortic valve implantation (TAVI often presents with more complex lesions and extensive calcification, rotational atherectomy (RA may be needed in some cases before stenting. However, data regarding the feasibility and safety of simultaneous RA during TAVI using the Medtronic CoreValve (MCV; Medtronic, Minneapolis, MN, USA system are lacking. Three out of 107 (2.8% patients (2 females, average age 85.6 years, mean aortic valve area 0.5 cm2, mean left ventricular ejection fraction 39%, mean Logistic EuroScore 70%, with complex, heavily calcified coronary stenosis, and severe valvular aortic stenosis (AS were treated with TAVI and RA due to high surgical risk. After balloon valvuloplasty, all coronary lesions were successfully treated with RA and stenting, immediately followed by transfemoral TAVI with a self-expandable MCV. Our data suggested that in the very elderly patients with severe and heavily calcified CAD and AS who were turned down for cardiac surgery, RA and stenting followed by TAVI may be performed successfully in a combined, single-stage procedure.

[Offer early attention and intervention to patients with valvular heart disease].

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Jiang, Shengli; Ren, Chonglei

2015-02-01

As a key feature of the updates, early intervention of valvular heart disease is highlighted in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. This article reviewed the new guideline in regards to the issue of early intervention of diseases such as aortic stenosis, aortic insufficiency, mitral stenosis, mitral insufficiency, tricuspid insufficiency, and infective endocarditis, with discussion on the related topics according to the authors' understanding and practical experience in China. We conclude that valvular heart disease should receive early intervention and attention should also be paid on the progress of disease.

Reoperation for non-structural valvular dysfunction caused by pannus ingrowth in aortic valve prosthesis.

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Oh, Se Jin; Park, Samina; Kim, Jun Sung; Kim, Kyung-Hwan; Kim, Ki Bong; Ahn, Hyuk

2013-07-01

The authors' clinical experience is presented of non-structural valvular dysfunction of the prosthetic aortic valve caused by pannus ingrowth during the late postoperative period after previous heart valve surgery. Between January 1999 and April 2012, at the authors' institution, a total of 33 patients underwent reoperation for increased mean pressure gradient of the prosthetic aortic valve. All patients were shown to have pannus ingrowth. The mean interval from the previous operation was 16.7 +/- 4.3 years, and the most common etiology for the previous aortic valve replacement (AVR) was rheumatic valve disease. The mean effective orifice area index (EOAI) of the previous prosthetic valve was 0.97 +/- 0.11 cm2/m2, and the mean pressure gradient on the aortic prosthesis before reoperation was 39.1 +/- 10.7 mmHg. Two patients (6.1%) died in-hospital, and late death occurred in six patients (18.2%). At the first operation, 30 patients underwent mitral or tricuspid valve surgery as a concomitant procedure. Among these operations, mitral valve replacement (MVR) was combined in 24 of all 26 patients with rheumatic valve disease. Four patients underwent pannus removal only while the prosthetic aortic valve was left in place. The mean EOAI after reoperation was significantly increased to 1.16 +/- 0.16 cm2/m2 (p pannus ingrowth was shown in patients with a small EOAI of the prosthetic aortic valve and combined MVR for rheumatic disease. As reoperation for pannus overgrowth showed good clinical outcomes, an aggressive resection of pannus and repeated AVR should be considered in symptomatic patients to avoid the complications of other cardiac diseases.

Prognostic Utility of Neutrophil-to-Lymphocyte Ratio on Adverse Clinical Outcomes in Patients with Severe Calcific Aortic Stenosis.

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Kyoung Im Cho

Full Text Available Inflammation is an important factor in the pathogenesis of calcific aortic stenosis (AS. We aimed to evaluate the association between an inflammatory marker, neutrophil-to-lymphocyte ratio (NLR and major adverse cardiovascular events (MACE in patients with severe calcific AS.A total of 336 patients with isolated severe calcific AS newly diagnosed between 2010 and 2015 were enrolled in this study. Using Cox proportional hazards (PH regression models, we investigated the prognostic value of NLR adjusted for baseline covariates including logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE-I and undergoing aortic valve replacement (AVR. We also evaluated the clinical relevance of NLR risk groups (divided into low, intermediate, high risk as categorized by NLR cutoff values. MACE was defined as a composite of all-cause mortality, cardiac death and non-fatal myocardial infarction during the follow-up period.The inflammatory marker NLR was an independent prognostic factor most significantly associated with MACE [hazard ratio (HR, 1.06; 95% confidence interval (CI, 1.04-1.09; p-value 9, respectively.The findings of the present study demonstrate the potential utility of NLR in risk stratification of patients with severe calcific AS.

Aortic calcification and renal cysts demonstrated by CT in a teenager with Alagille syndrome

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Pombo, F. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Isla, C. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Gayol, A. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Bargiela, A. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain)

1995-06-01

Alagille syndrome, or arteriohepatic dysplasia, is a disorder characterized by paucity of intrahepatic bile ducts, peculiar facies and skeletal anomalies. We report a typical case of this syndrome in an 18-year-old girl, in whom abdominal CT showed bilateral renal cysts and aortic wall calcification, findings unreported in the radiological literature. (orig.)

Cine-MR imaging of valvular heart disease

International Nuclear Information System (INIS)

Park, Jae Hyung; Han, Man Chung; Kim, Chu Wan; Kim, Dae Jin; Kim, Woo Sung; Park, Hyun Wuk; Cho, Zang Hee

1989-01-01

Cine-MR imaging was done in 2 normal persons and 9 patients of valvular heart disease with 2.0 T superconducting MR system (Spectro-2000; GoldStar, Korea). The MRI was undertaken using gradient echo technique with small flip angle. Repetition time (TR) was 34 msec, and echo time (TE), 18 msec. In most cases, 20 to 30 frames could be obtained during one cardiac cycle. With normal heart, high signal intensity was identified in the blood filled cardiac chambers. Transient signal void was observed near tricuspid, mitral and aortic valves due to the turbulences induced by valve opening or closure. In 6 cases of mitral valvular disease, mitral valve was identified in all cases. The valvular motion was limited revealing doming toward cardiac apex during diastole. Signal void was evident in pansystolic phase of left ventricle in all cases. Evidence of combined aortic or tricuspid valve disease were also demonstrated, revealing signal void in the corresponding cardiac chambers. Cine-MRI seemed to be not only a good non-invasive diagnostic modality for the valvular heart disease, but also an accurate modality for cardiac functional evaluation

Cine-MR imaging of valvular heart disease

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Park, Jae Hyung; Han, Man Chung; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Dae Jin; Kim, Woo Sung; Park, Hyun Wuk; Cho, Zang Hee [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

1989-04-15

Cine-MR imaging was done in 2 normal persons and 9 patients of valvular heart disease with 2.0 T superconducting MR system (Spectro-2000; GoldStar, Korea). The MRI was undertaken using gradient echo technique with small flip angle. Repetition time (TR) was 34 msec, and echo time (TE), 18 msec. In most cases, 20 to 30 frames could be obtained during one cardiac cycle. With normal heart, high signal intensity was identified in the blood filled cardiac chambers. Transient signal void was observed near tricuspid, mitral and aortic valves due to the turbulences induced by valve opening or closure. In 6 cases of mitral valvular disease, mitral valve was identified in all cases. The valvular motion was limited revealing doming toward cardiac apex during diastole. Signal void was evident in pansystolic phase of left ventricle in all cases. Evidence of combined aortic or tricuspid valve disease were also demonstrated, revealing signal void in the corresponding cardiac chambers. Cine-MRI seemed to be not only a good non-invasive diagnostic modality for the valvular heart disease, but also an accurate modality for cardiac functional evaluation.

Fate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement.

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Milewski, Rita Karianna; Habertheuer, Andreas; Bavaria, Joseph E; Siki, Mary; Szeto, Wilson Y; Krause, Eric; Korutla, Varun; Desai, Nimesh D; Vallabhajosyula, Prashanth

2017-08-01

In patients presenting with aortic valvulopathy with concomitant ascending aortic aneurysm, surgical management of the sinus of Valsalva segment remains undefined, especially for moderately dilated aortic roots. In patients with this pathology undergoing aortic valve replacement with supracoronary ascending aorta replacement, we assessed the fate of the remnant preserved sinus of Valsalva segment stratified by aortic valve morphology and pathology. From 2002 to 2015, 428 patients underwent elective aortic valve replacement with supracoronary ascending aorta replacement. Patients were stratified on the basis of valvular morphology (bicuspid aortic valve [n = 254] and tricuspid aortic valve [n = 174]), valvular pathology (bicuspid aortic valve with aortic stenosis [n = 178], bicuspid aortic valve with aortic insufficiency [n = 76], tricuspid aortic valve with aortic stenosis [n = 61], tricuspid aortic valve with aortic insufficiency [n = 113]), and preoperative sinus of Valsalva dimensions (45 mm). Kaplan-Meier analysis revealed no significant difference in freedom from reoperation in tricuspid aortic valve versus bicuspid aortic valve (P = .576). Multivariable Cox regression model performed with sinus of Valsalva dimensions at baseline and follow-up as time-varying covariates did not adversely affect survival. A repeated-measure, mixed-effects model constructed to assess longitudinal sinus of Valsalva trends revealed that the retained sinus of Valsalva dimensions remain stable over long-term follow-up (discharge to ≥10 years), irrespective of valvular morphology/pathology (bicuspid aortic valve with aortic insufficiency, tricuspid aortic valve with aortic insufficiency, tricuspid aortic valve with aortic stenosis) and preoperative sinus of Valsalva groups (45 mm). In patients with nonaneurysmal sinuses of Valsalva undergoing aortic valve replacement with supracoronary ascending aorta replacement, the sinus segment can be preserved irrespective of

The effect of aging on aortic atherosclerotic plaque inflammation and molecular calcification: A FDG and NaF PET CT imaging study

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Blomberg, Björn; Thomassen, Anders; Hildebrandt, Malene

2013-01-01

Objectives: Aging is an important independent determinant of plaque biology. This study aimed to investigate the effect of aging on atherosclerotic plaque inflammation and calcification metabolism. Methods: Thirteen healthy volunteers without traditional cardiovascular risk factors were...... and correlation coefficients summarized the data. Results: A quadratic relationship was observed between aging and aortic 18-FDG and aortic Na-18F avidity. A second order polynomial regression established that aging is a predictor of the degree of aortic plaque inflammation (R = 0.524; F statistic = 4.93; P = 0...... data, a quadratic relationship appears to exist between aging and plaque inflammation. Furthermore, a quadratic relationship was observed between aging and plaque calcification metabolism. In line with these observations, a linear relationship was observed between atherosclerotic plaque inflammation...

Prognostic implications of left ventricular asymmetry in patients with asymptomatic aortic valve stenosis

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Sigvardsen, Per Ejlstrup; Larsen, Linnea Hornbech; Carstensen, Helle Gervig

2018-01-01

Aims: Left ventricular (LV) regional hypertrophy in the form of LV asymmetry is a common finding in patients with aortic valve stenosis. The aim of this study was to test the hypothesis that LV asymmetry predicts future symptomatic status and indication for aortic valve replacement (AVR) in patie......Aims: Left ventricular (LV) regional hypertrophy in the form of LV asymmetry is a common finding in patients with aortic valve stenosis. The aim of this study was to test the hypothesis that LV asymmetry predicts future symptomatic status and indication for aortic valve replacement (AVR...... occurred in 46 patients (40%). Patients with LV asymmetry had more than 3 times the risk of AVR (hazard ratio: 3.16; 95% CI: 1.77-5.66; P future need of AVR (hazard ratio: 3.10; 95......% CI: 1.44-6.65; P = 0.004), independent of LV geometry, jet velocity, valvular calcification, and pro-BNP. Conclusions: LV asymmetry is an independent predictor of future need for AVR in patients with asymptomatic aortic valve stenosis. It has incremental prognostic value to LV geometry and may...

Bicuspid aortic valve

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... aortic disease. In: Otto CM, Bonow RO, eds. Valvular Heart Disease: A Companion to Braunwald’s Heart Disease . 4th ed. ... PA: Elsevier Saunders; 2014:chap 13. Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman’s Cecil ...

Valvular heart disease in pregnancy.

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Windram, Jonathan D; Colman, Jack M; Wald, Rachel M; Udell, Jacob A; Siu, Samuel C; Silversides, Candice K

2014-05-01

In women with valvular heart disease, pregnancy-associated cardiovascular changes can contribute to maternal, foetal and neonatal complications. Ideally, a woman with valvular heart disease should receive preconception assessment and counselling from a cardiologist with expertise in pregnancy. For women with moderate- and high-risk valve lesions, appropriate risk stratification and management during pregnancy will optimise outcomes. Pregnancy in women with high-risk lesions, such as severe aortic stenosis, severe mitral stenosis and those with mechanical valves, requires careful planning and coordination of antenatal care by a multidisciplinary team. The purpose of this overview is to describe the expected haemodynamic changes in pregnancy, review pregnancy risks for women with valvular heart disease and discuss strategies for management. Copyright © 2014. Published by Elsevier Ltd.

The effect of aging on aortic atherosclerotic plaque inflammation and molecular calcification: A FDG and NaF PET CT imaging study

DEFF Research Database (Denmark)

Blomberg, Björn; Thomassen, Anders; Hildebrandt, Malene

2013-01-01

prospectively assessed by 18-FDG (inflammation) and Sodium 18-Fluoride (Na-18F) (calcification metabolism) PET CT imaging. Global aortic uptake of 18-FDG and Na-18F was quantified by subtracting the blood pool SUVmean from the aortic SUVmax (cSUV) [maximum SUVaorta - mean SUVblood pool]. Calculating regression...

Serum phosphate is associated with aortic valve calcification in the Multi-ethnic Study of Atherosclerosis (MESA).

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Linefsky, Jason P; O'Brien, Kevin D; Sachs, Michael; Katz, Ronit; Eng, John; Michos, Erin D; Budoff, Matthew J; de Boer, Ian; Kestenbaum, Bryan

2014-04-01

This study sought to investigate associations of phosphate metabolism biomarkers with aortic valve calcification (AVC). Calcific aortic valve disease (CAVD) is a common progressive condition that involves inflammatory and calcification mediators. Currently there are no effective medical treatments, but mineral metabolism pathways may be important in the development and progression of disease. We examined associations of phosphate metabolism biomarkers, including serum phosphate, urine phosphate, parathyroid hormone (PTH) and serum fibroblast growth factor (FGF)-23, with CT-assessed AVC at study baseline and in short-term follow-up in 6814 participants of the Multi-Ethnic Study of Atherosclerosis (MESA). At baseline, AVC prevalence was 13.2%. Higher serum phosphate levels were associated with significantly greater AVC prevalence (relative risk 1.3 per 1 mg/dL increment, 95% confidence incidence: 1.1 to 1.5, pAVC. Average follow-up CT evaluation was 2.4 years (range 0.9-4.9 years) with an AVC incidence of 4.1%. Overall, phosphate metabolism biomarkers were not associated with incident AVC except in the top FGF-23 quartile. Serum phosphate levels are significantly associated with AVC prevalence. Further study of phosphate metabolism as a modifiable risk factor for AVC is warranted. Published by Elsevier Ireland Ltd.

Relation between intracranial artery calcifications and aortic atherosclerosis in ischemic stroke patients.

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Bugnicourt, Jean-Marc; Chillon, Jean-Marc; Tribouilloy, Christophe; Canaple, Sandrine; Lamy, Chantal; Massy, Ziad A; Godefroy, Olivier

2010-08-01

We previously demonstrated a strong relation between carotid atherosclerosis (defined as carotid artery stenosis > or =50%) and intracranial artery calcification (IAC) in ischemic stroke patients. The purpose of this study was to evaluate the relation between aortic atherosclerosis and IAC. Four hundred fifty-four patients with ischemic stroke were included. Complex aortic plaques (CAP) were assessed by transesophageal echocardiography (TEE) and defined as plaques > or =4 mm thick or with mobile components in the proximal aorta. IAC were assessed in the seven major cerebral arteries and a semiquantitative score system was applied, ranging from 0 (no calcification) to 7. Forty-two patients (9.3%) had CAP. Patients with CAP were older compared with patients without CAP (73.6 vs. 63.6 years, p vs. 1.8; p stroke or TIA (OR 3.3; 95%CI 1.5-7.0; p = 0.002), carotid artery stenosis > or =50% (OR 3.7; 95%CI 1.7-8.0; p = 0.001), chronic kidney disease (OR 3.8; 95%CI 1.9-7.8; p stroke patients, the absence of IAC strongly points to the lack of CAP. However, these results warrant confirmation in prospective studies before concluding the non-utility of the use of TEE to exclude CAP as a potential source of cerebral embolism in patients without IAC.

Coronary artery calcification correlates with the presence and severity of valve calcification.

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Koulaouzidis, G; Nicoll, R; MacArthur, T; Jenkins, P J; Henein, M Y

2013-10-15

To investigate the prevalence of coronary artery calcification (CAC) in symptomatic individuals with CT evidence for left heart valve calcification, aortic valve (AVC), mitral valve (MAC) or both. This is a retrospective study of 282 consecutive patients with calcification in either the aortic valve or mitral annulus. Calcium scoring of the coronary artery, aortic and mitral valve was measured using the Agatston score. AVC was more prevalent than MAC (64% vs. 2.5%, p AVC + CAC were observed in 53.5%, MAC and CAC in 2.1%, and combined AVC, MAC and CAC in 31.6%. The median CAC score was higher in individuals with combined AVC+MAC, followed by those with AVC and lowest was in the MAC group. The majority (40%) of individuals with AVC had CAC score >400, and only in 16% had CAC = 0. The same pattern was more evident in individuals with AVC + MAC, where 70% had CAC score >400 and only 6% had CAC score of 0. These results were irrespective of gender. There was no correlation between AVC and MAC but there was modest correlation between CAC score and AVC score (r = 0.28, p = 0.0001), MAC (r = 0.36, p = 0.0001) and with combined AVC + MAC (r = 0.5, p = 0.0001). AVC score of 262 had a sensitivity of 78% and specificity of 92% for the prediction of presence of CAC. The presence and extent of calcification in the aortic valve or/and mitral valves are associated with severe coronary artery calcification. © 2013.

Significant intra-valvular pressure loss across EPIC SUPRA and perimount magna supra-annular designed aortic bioprostheses in patients with normal aortic size

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Jagdish C. Mohan

2017-01-01

Full Text Available Doppler-derived trans-prosthetic gradients are higher and the estimated effective valve area is smaller than the catheter-derived and directly measured hemodynamic values, mostly due to pressure recovery phenomenon. Pressure recovery to a varying extent is common to all prosthetic heart valves including bioprostheses. Pressure recovery-related differences are usually small except in patients with bileaflet metallic prosthesis, wherein high-pressure local jets across central orifice have been documented since long back and also in patients with narrow aortic root. We describe two patients with normally functioning stented aortic bioprostheses with supra-annular design (EPIC SUPRA and PERIMOUNT MAGNA, wherein very high trans-prosthetic gradients and critically reduced estimated effective valve orifice areas in presence of normal aortic size were consistently recorded over long periods of follow-up. The valve leaflets, however had normal excursion, were thin, opened with a triangular or oblong shape and had expected geometric valve area (1.7 and 1.6 cm2 respectively measured by 3D trans-oesophageal echocardiographic planimetry. Pressure recovery upstream the valves accounted for 20% and 12% of total pressure gradients respectively. Dominant site for pressure drop was intra-valvular (75–85%. Such a phenomenon has not been reported in vivo for these two valve designs.

Significant intra-valvular pressure loss across EPIC SUPRA and perimount magna supra-annular designed aortic bioprostheses in patients with normal aortic size.

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Mohan, Jagdish C; Mohan, Vishwas; Shukla, Madhu; Sethi, Arvind

Doppler-derived trans-prosthetic gradients are higher and the estimated effective valve area is smaller than the catheter-derived and directly measured hemodynamic values, mostly due to pressure recovery phenomenon. Pressure recovery to a varying extent is common to all prosthetic heart valves including bioprostheses. Pressure recovery-related differences are usually small except in patients with bileaflet metallic prosthesis, wherein high-pressure local jets across central orifice have been documented since long back and also in patients with narrow aortic root. We describe two patients with normally functioning stented aortic bioprostheses with supra-annular design (EPIC SUPRA and PERIMOUNT MAGNA), wherein very high trans-prosthetic gradients and critically reduced estimated effective valve orifice areas in presence of normal aortic size were consistently recorded over long periods of follow-up. The valve leaflets, however had normal excursion, were thin, opened with a triangular or oblong shape and had expected geometric valve area (1.7 and 1.6cm 2 respectively) measured by 3D trans-oesophageal echocardiographic planimetry. Pressure recovery upstream the valves accounted for 20% and 12% of total pressure gradients respectively. Dominant site for pressure drop was intra-valvular (75-85%). Such a phenomenon has not been reported in vivo for these two valve designs. Copyright © 2016. Published by Elsevier B.V.

Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience.

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Manjunath, C N; Srinivas, P; Ravindranath, K S; Dhanalakshmi, C

2014-01-01

Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo). Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort. In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease. RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: A single center experience

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Manjunath, C.N.; Srinivas, P.; Ravindranath, K.S.; Dhanalakshmi, C.

2014-01-01

Background Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo). Methods Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort. Results In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease. Conclusion RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases. PMID:24973838

Quantification of aortic regurgitation by magnetic resonance velocity mapping

DEFF Research Database (Denmark)

Søndergaard, Lise; Lindvig, K; Hildebrandt, P

1993-01-01

The use of magnetic resonance (MR) velocity mapping in the quantification of aortic valvular blood flow was examined in 10 patients with angiographically verified aortic regurgitation. MR velocity mapping succeeded in identifying and quantifying the regurgitation in all patients, and the regurgit......The use of magnetic resonance (MR) velocity mapping in the quantification of aortic valvular blood flow was examined in 10 patients with angiographically verified aortic regurgitation. MR velocity mapping succeeded in identifying and quantifying the regurgitation in all patients...

Magnesium prevents phosphate-induced vascular calcification via TRPM7 and Pit-1 in an aortic tissue culture model.

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Sonou, Tomohiro; Ohya, Masaki; Yashiro, Mitsuru; Masumoto, Asuka; Nakashima, Yuri; Ito, Teppei; Mima, Toru; Negi, Shigeo; Kimura-Suda, Hiromi; Shigematsu, Takashi

2017-06-01

Previous clinical and experimental studies have indicated that magnesium may prevent vascular calcification (VC), but mechanistic characterization has not been reported. This study investigated the influence of increasing magnesium concentrations on VC in a rat aortic tissue culture model. Aortic segments from male Sprague-Dawley rats were incubated in serum-supplemented high-phosphate medium for 10 days. The magnesium concentration in this medium was increased to demonstrate its role in preventing VC, which was assessed by imaging and spectroscopy. The mineral composition of the calcification was analyzed using Fourier transform infrared (FTIR) spectroscopic imaging, scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) mapping. Magnesium supplementation of high-phosphate medium dose-dependently suppressed VC (quantified as aortic calcium content), and almost ablated it at 2.4 mm magnesium. The FTIR images and SEM-EDX maps indicated that the distribution of phosphate (as hydroxyapatite), phosphorus and Mg corresponded with calcium content in the aortic ring and VC. The inhibitory effect of magnesium supplementation on VC was partially reduced by 2-aminoethoxy-diphenylborate, an inhibitor of TRPM7. Furthermore, phosphate transporter-1 (Pit-1) protein expression was increased in tissues cultured in HP medium and was gradually-and dose dependently-decreased by magnesium. We conclude that a mechanism involving TRPM7 and Pit-1 underpins the magnesium-mediated reversal of high-phosphate-associated VC.

Usefulness of abdominal aortic calcification for screening of peripheral vascular disease

International Nuclear Information System (INIS)

Park, Chul Hi; Kim, Jeong Ho; Choi, Soo Jin; Kim, Hyung Sik; Jin, Wook; Yang, Dal Mo

2006-01-01

We wanted to evaluate the value of abdominal aortic calcification (AAC), as detected on CT, as a predictor of atherosclerotic stenotic disease of the lower extremity arteries. One hundred three patients who had CT angiography performed for the evaluation of peripheral vascular disease were enrolled in this retrospective study. The volume (mm 3 ) of the AAC was measured on CT. Each lower extremity was divided into 8 segments. The extent of stenosis of the lower extremity artery was manifested as the sum of the stenosis scores for 16 segments (total stenosis score: TSS). The significant stenosis scores (SSS-50 and SSS-75) were defined as the sum of scores for the lower extremity artery segments that had significant stenosis of more than 50% and 75%, respectively. AAC was correlated to the TSS, SSS-50 and SSS-75 with using Spearman's correlation coefficient. The diagnostic performance of AAC for stenosis of a lower extremity artery of more than 50% and 75%, respectively, was evaluated by using the receiver operating characteristic (ROC) curve. The Spearman's correlation coefficients were 0.728 (AAC vs. TSS), 0.662 (AAC vs. SSS-50), and 0.602 (AAC vs. SSS-75), respectively. For significant stenosis more than 50% and 75%, the areas under the ROC curve were 0.898 and 0.866, respectively. The cutoff value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 1030 mm 3 , 87%, 88%, 89%. 86% and 87% for stenosis more than 50% and 1030 mm 3 , 87%, 80%, 79%, 88% and 84% for stenosis more than 75%, respectively. Abdominal aortic calcification detected on CT may be a useful predictor of atherosclerotic stenotic disease of lower extremity arteries

Acute peritonitis as the first presentation of valvular cardiomyopathy.

LENUS (Irish Health Repository)

Higgins, Nikki

2012-02-01

Valvular cardiomyopathy can present a diagnostic challenge in the absence of overt cardiac symptoms. This report describes the case of a 46-year-old woman who presented with acute peritonitis associated with vomiting and abdominal distension. Subsequent abdominal computed tomography and ultrasound revealed bibasal pleural effusions, ascites, and normal ovaries. An echocardiogram revealed that all cardiac chambers were dilated with a global decrease in contractility and severe mitral, tricuspid, and aortic regurgitation. A diagnosis of cardiomyopathy with acute heart failure, secondary to valvular heart disease, was secured. Acute peritonitis as the presenting feature of valvular cardiomyopathy is a rare clinical entity.

Serum Osteoprotegerin level and the extent of cardiovascular calcification in haemodialysis patients

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Waleed Ammar

2014-03-01

Conclusion: There is strong positive relationship between osteoprotegerin and both vascular and valvular calcification in hemodialysis patients. This positive correlation may open the gate for routine estimation of this agent as a surrogate marker of cardiovascular calcification in hemodialysis patients.

Cardiovascular calcification. An inflammatory disease

International Nuclear Information System (INIS)

New, S.E.P.; Aikawa, E.

2011-01-01

Cardiovascular calcification is an independent risk factor for cardiovascular morbidity and mortality. This disease of dysregulated metabolism is no longer viewed as a passive degenerative disease, but instead as an active process triggered by pro-inflammatory cues. Furthermore, a positive feedback loop of calcification and inflammation is hypothesized to drive disease progression in arterial calcification. Both calcific aortic valve disease and atherosclerotic arterial calcification may possess similar underlying mechanisms. Early histopathological studies first highlighted the contribution of inflammation to cardiovascular calcification by demonstrating the accumulation of macrophages and T lymphocytes in 'early' lesions within the aortic valves and arteries. A series of in vitro work followed, which gave a mechanistic insight into the stimulation of smooth muscle cells to undergo osteogenic differentiation and mineralization. The emergence of novel technology, in the form of animal models and more recently molecular imaging, has enabled accelerated progression of this field, by providing strong evidence regarding the concept of this disorder as an inflammatory disease. Although there are still gaps in our knowledge of the mechanisms behind this disorder, this review discusses the various studies that have helped form the concept of the inflammation-dependent cardiovascular calcification paradigm. (author)

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

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N. Yu. Karpova

2014-07-01

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

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

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N. Yu. Karpova

2013-01-01

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

Aortic annulus eccentricity before and after transcatheter aortic valve implantation: Comparison of balloon-expandable and self-expanding prostheses

International Nuclear Information System (INIS)

Schuhbaeck, Annika; Weingartner, Christina; Arnold, Martin; Schmid, Jasmin; Pflederer, Tobias; Marwan, Mohamed; Rixe, Johannes; Nef, Holger; Schneider, Christian; Lell, Michael; Uder, Michael; Ensminger, Stephan; Feyrer, Richard; Weyand, Michael; Achenbach, Stephan

2015-01-01

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

Role of echocardiography for catheter-based management of valvular heart disease.

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Shiota, Takahiro

2017-01-01

Catheter-based treatment of valvular heart disease, such as transvalvular aortic valve replacement (TAVR) or mitral clip procedure, has been increasingly accepted as a treatment choice for the past several years. Such new treatment options have been changing the management of patients with valvular heart disease drastically while socio-economic factors regarding their application need to be taken into consideration. The use of echocardiography, including transesophageal echocardiography (TEE), for such catheter-based treatments is essential for the success of the procedures. Severe hypotension after TAVR is a life-threatening emergency. Rapid assessment and diagnosis in the catheterization or hybrid laboratory is essential for safety and a positive outcome. Possible diagnoses in this critical situation would include severe left ventricular dysfunction due to coronary obstruction, cardiac tamponade, aortic rupture, acute severe aortic and/or mitral valve regurgitation, and hypovolemia due to bleeding. Although new types of TAVR valves reduce para-valvular aortic regurgitation (AR) significantly, it is still important to judge the severity of para-valvular AR correctly in the laboratory. As for mitral clip procedure, TEE is vital for guiding and monitoring the entire process. Accurate identification of the location and the geometry of the regurgitant orifice is necessary for proper placement of the clip. Real-time 3D TEE provides helpful en face view of the mitral valve and clip together to this end. Residual mitral regurgitation (MR) after the first clip is not uncommon. Quick and precise imaging of the residual MR (location and severity) with TEE is extremely important for the interventionist to place the second clip and possibly third clip properly. After the completion of the clip procedure, mitral valve stenosis and also iatrogenic atrial septal defect need to be checked by TEE. Echocardiography, especially TEE, is also vital for the success of other newer trans

Epidemiology of acquired valvular heart disease.

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Iung, Bernard; Vahanian, Alec

2014-09-01

Population-based studies including systematic echocardiographic examinations are required to assess the prevalence of valvular heart disease. In industrialized countries, the prevalence of valvular heart disease is estimated at 2.5%. Because of the predominance of degenerative etiologies, the prevalence of valvular disease increases markedly after the age of 65 years, in particular with regard to aortic stenosis and mitral regurgitation, which accounts for 3 in 4 cases of valvular disease. Rheumatic heart disease still represents 22% of valvular heart disease in Europe. The prevalence of secondary mitral regurgitation cannot be assessed reliably but it seems to be a frequent disease. The incidence of infective endocarditis is approximately 30 cases per million individiuals per year. Its stability is associated with marked changes in its presentation. Patients are getting older and staphylococcus is now becoming the microorganism most frequently responsible. Heath care-associated infections are the most likely explanation of changes in the microbiology of infective endocarditis. In developing countries, rheumatic heart disease remains the leading cause of valvular heart disease. Its prevalence is high, between 20 and 30 cases per 1000 subjects when using systematic echocardiographic screening. In conclusion, the temporal and geographical heterogeneity illustrates the effect of socioeconomic status and changes in life expectancy on the frequency and presentation of valvular heart disease. A decreased burden of valvular disease would require the elaboration of preventive strategies in industrialized countries and an improvement in the socioeconomic environment in developing countries. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Systematic review of the cost-effectiveness of transcatheter interventions for valvular heart disease.

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Gialama, Fotini; Prezerakos, Panagiotis; Apostolopoulos, Vasilis; Maniadakis, Nikolaos

2018-04-01

Transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve repair (TMVR) are increasingly used for managing patients with valvular heart disease to whom surgery presents a high-risk. As these are costly procedures, a systematic review of studies concerned with their economic assessment was undertaken. The search was performed in PubMed and the Cochrane Library and followed recommended methodological steps. Studies were screened and their data were retrieved and were synthesized using a narrative approach. Twenty-four, good to high quality, evaluations were identified, representing different viewpoints, modelling techniques and willingness-to-pay thresholds. Studies show that in high-risk patients with symptomatic aortic stenosis, TAVI may be cost-effective compared with medical management (MM) across many health care settings. In contrast, studies of TAVI compared with surgical aortic valve replacement (SAVR) yield conflicting and inconclusive results. The limited data available show that TMVR may also be cost-effective relative to MM in mitral valve disease. Existing evidence indicates that transcatheter techniques may be cost-effective options, relative to MM, in high-risk patients with valvular disease. Nonetheless, more research is needed to establish their economic value further, to investigate the drives of cost-effectiveness, and to evaluate surgical with transcatheter techniques in aortic valvular disease.

Raman spectroscopy imaging reveals interplay between atherosclerosis and medial calcification in the human aorta

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You, Amanda Y. F.; Bergholt, Mads S.; St-Pierre, Jean-Philippe; Kit-Anan, Worrapong; Pence, Isaac J.; Chester, Adrian H.; Yacoub, Magdi H.; Bertazzo, Sergio; Stevens, Molly M.

2017-01-01

Medial calcification in the human aorta accumulates during aging and is known to be aggravated in several diseases. Atherosclerosis, another major cause of cardiovascular calcification, shares some common aggravators. However, the mechanisms of cardiovascular calcification remain poorly understood. To elucidate the relationship between medial aortic calcification and atherosclerosis, we characterized the cross-sectional distributions of the predominant minerals in aortic tissue, apatite and whitlockite, and the associated extracellular matrix. We also compared the cellular changes between atherosclerotic and nonatherosclerotic human aortic tissues. This was achieved through the development of Raman spectroscopy imaging methods that adapted algorithms to distinguish between the major biomolecules present within these tissues. We present a relationship between apatite, cholesterol, and triglyceride in atherosclerosis, with the relative amount of all molecules concurrently increased in the atherosclerotic plaque. Further, the increase in apatite was disproportionately large in relation to whitlockite in the aortic media directly underlying a plaque, indicating that apatite is more pathologically significant in atherosclerosis-aggravated medial calcification. We also discovered a reduction of β-carotene in the whole aortic intima, including a plaque in atherosclerotic aortic tissues compared to nonatherosclerotic tissues. This unprecedented biomolecular characterization of the aortic tissue furthers our understanding of pathological and physiological cardiovascular calcification events in humans. PMID:29226241

Determining the influence of calcification on the failure properties of abdominal aortic aneurysm (AAA) tissue.

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O'Leary, Siobhan A; Mulvihill, John J; Barrett, Hilary E; Kavanagh, Eamon G; Walsh, Michael T; McGloughlin, Tim M; Doyle, Barry J

2015-02-01

Varying degrees of calcification are present in most abdominal aortic aneurysms (AAAs). However, their impact on AAA failure properties and AAA rupture risk is unclear. The aim of this work is evaluate and compare the failure properties of partially calcified and predominantly fibrous AAA tissue and investigate the potential reasons for failure. Uniaxial mechanical testing was performed on AAA samples harvested from 31 patients undergoing open surgical repair. Individual tensile samples were divided into two groups: fibrous (n=31) and partially calcified (n=38). The presence of calcification was confirmed by fourier transform infrared spectroscopy (FTIR). A total of 69 mechanical tests were performed and the failure stretch (λf), failure stress (σf) and failure tension (Tf) were recorded for each test. Following mechanical testing, the failure sites of a subset of both tissue types were examined using scanning electron microscopy (SEM)/energy dispersive X-ray spectroscopy (EDS) to investigate the potential reasons for failure. It has been shown that the failure properties of partially calcified tissue are significantly reduced compared to fibrous tissue and SEM and EDS results suggest that the junction between a calcification deposit and the fibrous matrix is highly susceptible to failure. This study implicates the presence of calcification as a key player in AAA rupture risk and provides further motivation for the development of non-invasive methods of measuring calcification. Copyright © 2014 Elsevier Ltd. All rights reserved.

Fatal postoperative systemic pulmonary hypertension in benfluorex-induced valvular heart disease surgery: A case report.

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Baufreton, Christophe; Bruneval, Patrick; Rousselet, Marie-Christine; Ennezat, Pierre-Vladimir; Fouquet, Olivier; Giraud, Raphael; Banfi, Carlo

2017-01-01

Drug-induced valvular heart disease (DI-VHD) remains an under-recognized entity. This report describes a heart valve replacement which was complicated by intractable systemic pulmonary arterial hypertension in a 61-year-old female with severe restrictive mitral and aortic disease. The diagnosis of valvular disease was preceded by a history of unexplained respiratory distress. The patient had been exposed to benfluorex for 6.5 years. The diagnostic procedure documented specific drug-induced valvular fibrosis. Surgical mitral and aortic valve replacement was performed. Heart valve replacement was postoperatively complicated by unanticipated disproportionate pulmonary hypertension. This issue was fatal despite intensive care including prolonged extracorporeal life support. Benfluorex is a fenfluramine derivative which has been marketed between 1976 and 2009. Although norfenfluramine is the common active and toxic metabolite of all fenfluramine derivatives, the valvular and pulmonary arterial toxicity of benfluorex was much less known than that of fenfluramine and dexfenfluramine. The vast majority of benfluorex-induced valvular heart disease remains misdiagnosed as hypothetical rheumatic fever due to similarities between both etiologies. Better recognition of DI-VHD is likely to improve patient outcome.

Valvular Heart Disease in Heart Failure

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Giuseppe MC Rosano

2017-01-01

Full Text Available Structural valvular heart disease may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure may also develop in patients treated with valve surgery. Patients with heart failure with valvular heart disease are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous all patients should receive appropriate medical and device therapy taking into account that vasodilators must be used with caution in patients with severe aortic stenosis. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of valvular heart disease. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk– benefit ratio of different treatment strategies and should be made by a multidisciplinary ‘heart team’ with a particular expertise in valvular heart disease. The heart team should include heart failure cardiologists, cardiac surgeons/structural valve interventionists, imaging specialists, anaesthetists, geriatricians and intensive care specialists. This article will review recent developments and distill practical guidance in the management of this important heart failure co-morbidity.

Predominance of Abdominal Visceral Adipose Tissue Reflects the Presence of Aortic Valve Calcification.

Science.gov (United States)

Oikawa, Masayoshi; Owada, Takashi; Yamauchi, Hiroyuki; Misaka, Tomofumi; Machii, Hirofumi; Yamaki, Takayoshi; Sugimoto, Koichi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-Ichi; Takeishi, Yasuchika

2016-01-01

Background. Aortic valve calcification (AVC) is a common feature of aging and is related to coronary artery disease. Although abdominal visceral adipose tissue (VAT) plays fundamental roles in coronary artery disease, the relationship between abdominal VAT and AVC is not fully understood. Methods. We investigated 259 patients who underwent cardiac and abdominal computed tomography (CT). AVC was defined as calcified lesion on the aortic valve by CT. %abdominal VAT was calculated as abdominal VAT area/total adipose tissue area. Results. AVC was detected in 75 patients, and these patients showed higher %abdominal VAT (44% versus 38%, p AVC. When the cutoff value of %abdominal VAT was set at 40.9%, the area under the curve to diagnose AVC was 0.626. Multivariable logistic regression analysis showed that age (OR 1.120, 95% CI 1.078-1.168, p AVC. The net reclassification improvement value for detecting AVC was increased when %abdominal VAT was added to the model: 0.5093 (95% CI 0.2489-0.7697, p AVC.

The role of cardiac magnetic resonance in valvular heart disease.

Science.gov (United States)

Lopez-Mattei, Juan C; Shah, Dipan J

2013-01-01

The prevalence of valvular heart disease is increasing as the population ages. In diagnosing individuals with valve disease, echocardiography is the primary imaging modality used by clinicians both for initial assessment and for longitudinal evaluation. However, in some cases cardiovascular magnetic resonance has become a viable alternative in that it can obtain imaging data in any plane prescribed by the scan operator, which makes it ideal for accurate investigation of all cardiac valves: aortic, mitral, pulmonic, and tricuspid. In addition, CMR for valve assessment is noninvasive, free of ionizing radiation, and in most instances does not require contrast administration. The objectives of a comprehensive CMR study for evaluating valvular heart disease are threefold: (1) to provide insight into the mechanism of the valvular lesion (via anatomic assessment), (2) to quantify the severity of the valvular lesion, and (3) to discern the consequences of the valvular lesion.

Application of cine cardiac MR imaging in normal subjects and patients with valvular, coronary artery, and aortic disease

International Nuclear Information System (INIS)

Maddahi, J.; Ostrzega, E.; Crues, J.; Honma, H.; Siegel, R.; Charuzi, Y.; Berman, D.

1987-01-01

Cine MR imaging was performed on 15 normal subjects and 27 patients with cardiac disease. In normal subjects, high signal intensity of flowing blood contrasted with that of the myocardium. In 16 patients with valvular regurgitation, signal void jet due to turbulence was visualized across the diseased valves. In three IHSS patients, thickened LV myocardium, mitral regurgitant jets, and systolic LV outflow jets were noted. Five patients with myocardial infarction (MI) showed thinning and/or hypokinesis of MI regions. In three patients with Marfan syndrome, aortic dilatation, insufficiency, and flap (one pt) were identified. Cine MR imaging is potentially useful for evaluation of a variety of cardiac diseases

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

International Nuclear Information System (INIS)

Nagy, Edit; Caidahl, Kenneth; Franco-Cereceda, Anders; Bäck, Magnus

2012-01-01

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

TRAUMA VALVULAR MITRAL EN UN LACTANTE DURANTE LA VALVULOPLASTIA AÓRTICA Y SU TRATAMIENTO QUIRÚRGICO / Mitral valve trauma in an infant during aortic valvuloplasty and its surgical treatment

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Francisco Díaz Ramírez

2013-04-01

Full Text Available Resumen: La valvuloplastia con globo es ampliamente aceptada como tratamiento de elección de la estenosis aórtica congénita en recién nacidos y lactantes. Las complicaciones por el procedimiento son bien conocidas pero el daño valvular mitral es infrecuente. Se presenta un paciente masculino, de siete meses de edad, con el diagnóstico de coartación de la aorta y estenosis valvular aórtica a quién se le realizó dilatación de ambas lesiones por cateterismo intervencionista. A las 20 horas del procedimiento se diagnosticó insuficiencia cardíaca grave secundaria a lesión de la valva anterior mitral. Se intervino quirúrgicamente de urgencia y se observó un desgarro en forma de hendidura desde el borde libre hasta el anillo, el cual se reparó y se realizó anuloplastia en la comisura lateral. En el postoperatorio inmediato evolucionó sin complicaciones y al año de seguimiento presenta insuficiencia valvular mitral leve sin signos de recoartación ni de estenosis valvular aórticas. / Abstract: Balloon valvuloplasty is widely accepted as the treatment of choice for congenital aortic stenosis in newborns and infants. Complications from the procedure are well known but mitral valve damage is rare. This is the case of a 7-month-old male patient with the diagnosis of coarctation of the aorta and aortic valve stenosis who underwent dilation of both lesions via catheterization. At 20 hours of the procedure a severe heart failure secondary to an injury of the anterior mitral valve was diagnosed. The patient underwent emergency surgery and a slit-like tear from the free edge to the annulus was observed, which was repaired and annuloplasty in the lateral commissure was performed. In the immediate postoperative period the patient progressed without complications and at one year follow up he shows mild valve regurgitation without evidence of recoarctation or aortic valve stenosis.

Supravalvular aortic stenosis with sudden cardiac death

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Pradeep Vaideeswar

2015-01-01

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

Impact of valvular heart disease on activities of daily living of nonagenarians: the Leiden 85-plus study a population based study.

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van Bemmel, Thomas; Delgado, Victoria; Bax, Jeroen J; Gussekloo, Jacobijn; Blauw, Gerard J; Westendorp, Rudi G; Holman, Eduard R

2010-04-01

Data on the prevalence of valvular heart disease in very old individuals are scarce and based mostly on in-hospital series. In addition, the potential detrimental effect of valvular heart disease on the activities of daily living is unknown. The present study evaluated the prevalence of significant valvular heart disease and the impact of valvular heart disease on the activities of daily living in community dwelling nonagenarians. Nested within the Leiden 85-plus study, a population based follow-up study of the oldest old, a sample of 81 nonagenarians was recruited. The left ventricular (LV) dimensions, function and the presence and severity of heart valvular disease were evaluated by echocardiography. Significant valvular heart disease included any mitral or aortic stenosis severity, moderate or severe mitral regurgitation, moderate or severe aortic regurgitation and moderate or severe tricuspid regurgitation. Activities of daily living were assessed using the Groningen Activity Restriction Scale (GARS). LV cavity diameters (end-diastolic diameter 47 +/- 8 mm, end-systolic diameter 30 +/- 8 mm) and systolic LV function (LV ejection fraction 66 +/- 13%) were within normal for the majority of the participants. Significant valvular disease was present in 57 (70%) individuals, with mitral regurgitation and aortic regurgitation as the most frequent valve diseases (49% and 28% respectively). The GARS score between individuals with and without significant valvular heart disease was similar (36.2 +/- 9.2 vs. 34.4 +/- 13.2, p = 0.5). Nonagenarian, outpatient individuals have a high prevalence of significant valvular heart disease. However, no relation was observed between the presence of significant valvular heart disease and the ability to perform activities of daily living.

[Management of valvular heart disease : ESC/EACTS guidelines 2017].

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Haude, M

2017-12-01

After 5 years the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery have released an update on the guidelines for the management of valvular heart diseases. In recent years published results of randomized trials in patients with aortic valve stenosis have resulted in updated recommendations for catheter-based prosthesis implantation (TAVI), which is now extended to patients presenting without a low risk for conventional surgical valve replacement. In mitral or tricuspid valvular disease, the recommendations for catheter-based therapies are less strong because of a lack of supportive scientific data. A special focus of these updated guidelines is on concomitant antithrombotic therapy in valvular heart disease and in the context of a combination with coronary artery disease and/or accompanying arrhythmia. Special emphasis was again put on the multidisciplinary heart team for the diagnostics and treatment of patients with valvular heart disease. In order to support the quality of treatment for patients with valvular heart disease, it is suggested that heart valve centers of excellence should be established, which have to fulfil complex personnel, structural and technological prerequisites.

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; Bønløkke Carlsen, Bjarke; 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...... AS in a general population undergoing CT. METHODS: CT scans from 566 randomly selected male participants (age 65-74) in the Danish cardiovascular screening study (DANCAVAS) were analyzed for AVC. All participants with a moderately or severely increased AVC score (≥300 arbitrary units (AU)) and a matched control...... ICD leads 16 individuals were excluded from the AVC scoring. Moderate or severe increased AVC was observed in 10.7% (95% CI: 8.4-13.7). Echocardiography was performed in 101 individuals; 32.7% (95% CI: 21.8 to 46.0) with moderate or high AVC score had moderate or severe AS, while none with no or low...

Msx2 promotes cardiovascular calcification by activating paracrine Wnt signals

OpenAIRE

Shao, Jian-Su; Cheng, Su-Li; Pingsterhaus, Joyce M.; Charlton-Kachigian, Nichole; Loewy, Arleen P.; Towler, Dwight A.

2005-01-01

In diabetic LDLR–/– mice, an ectopic BMP2-Msx2 gene regulatory program is upregulated in association with vascular calcification. We verified the procalcific actions of aortic Msx2 expression in vivo. CMV-Msx2 transgenic (CMV-Msx2Tg+) mice expressed 3-fold higher levels of aortic Msx2 than nontransgenic littermates. On high-fat diets, CMV-Msx2Tg+ mice exhibited marked cardiovascular calcification involving aortic and coronary tunica media. This corresponded to regions of Msx2 immunoreactivity...

Ochronosis as an unusual cause of valvular defect: a case report

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Steverding Dietmar

2009-11-01

Full Text Available Abstract Introduction Alkaptonuria (also known as ochronosis is a genetic disorder characterised by the accumulation of homogentisic acid deposits in connective tissue. In rare cases, ochronosis can cause valvular heart disease. Case presentation We present the case of a 68-year-old Caucasian man with alkaptonuria-associated degenerative valvular defects with aortic, mitral and tricuspid valve insufficiency. The patient did not have any cardiac complaints and was referred to our clinic for evaluation of a conspicuous new heart murmur. Conclusion This case report shows that early diagnosis of cardiovascular ochronosis gives us the opportunity to use conservative treatment to slow down the progression of valvular dysfunction.

Additive effects of lupin protein and phytic acid on aortic calcification in ApoE deficient mice.

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Schutkowski, Alexandra; Hirche, Frank; Geissler, Stefanie; Radtke, Juliane; Stangl, Gabriele I

2015-03-01

Lupin proteins have repeatedly been shown to exhibit lipid lowering properties and reduce aortic calcification in atherosclerosis models. Despite many efforts on its identification, the component which is responsible for the observed effects is still under debate. Phytic acid which is generally associated with lupin protein isolates has currently been described as bioactive plant compound. The objective of the study was to determine the role of associated phytic acid for the described lupin protein effects. A two-factorial study with ApoE knockout mice was conducted in which mice received lupin protein isolate or casein with or without phytase. Phytic acid was added to the casein diets to a final concentration identical to the lupin protein diets. Here we show that the serum concentrations of cholesterol, lathosterol and desmosterol were lower and the faecal bile acid excretion was higher in the groups fed lupin proteins than in the groups fed casein ( p  < 0.05). Mice that received the lupin protein diet containing phytic acid were characterized by a lower aortic calcification than mice of the other three groups ( p  < 0.05). In conclusion, our results show that the cholesterol lowering properties of lupin protein isolate were not caused by phytic acid. However, the hypocalcific action of lupin proteins appears to depend on the combination of lupin proteins and phytic acid.

Quantitative assessment of valvular regurgitation using radionuclide ventriculography

International Nuclear Information System (INIS)

Shi Rongfang

1992-01-01

Radionuclide ventriculography has been used to assess quantitatively the extent of mitral and aortic regurgitation in 70 patients and compared to echocardiography and the finding of surgery. Two radionuclide parameters were measured: regurgitant index (RI) = left ventricular stroke counts/right ventricular stroke counts; and regurgitant fraction (RF) = left ventricular stroke counts-right ventricular stroke counts/left ventricular stroke counts. In 28 patients without valvular heart disease, the RI was 1.10 ± 0.15 and Rf was 10.3 ± 15.0%, respectively. However, in patients with valvular regurgitation, the RI and RF were 3.41 ± 1.73 and 61.1 ± 21.2%, respectively. A good correlation was found between the results obtained by radionuclide techniques and the findings of surgery and doppler studies. The level of concordance between RI and surgical findings was 91.7%. Follow up studies in 10 patients after valvular replacement surgery showed the RI and RF return to normal. These data suggested that radionuclide ventriculography is very useful for quantitative assessment of valvular regurgitation

Subvalvular Pannus Overgrowth after Mosaic Bioprosthesis Implantation in the Aortic Position.

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Hirota, Masanori; Isomura, Tadashi; Yoshida, Minoru; Katsumata, Chieko; Ito, Fusahiko; Watanabe, Masazumi

2016-01-01

Although pannus overgrowth by itself was not the pathology of structural valve deterioration (SVD), it might be related to reoperation for SVD of the bioprostheses. We retrospectively reviewed patients undergoing reoperation for SVD after implantation of the third-generation Mosaic aortic bioprosthesis and macroscopic appearance of the explanted valves was examined to detect the presence of pannus. There were 10 patients and the age for the initial aortic valve replacement was 72 ± 10 years old. The duration of durability was 9.9 ± 2.0 years. Deteriorated valve presented stenosis (valvular area of 0.96 ± 0.20 cm(2); pressure gradient of 60 ± 23 mmHg). Coexisting regurgitant flow was detected in two cases. Macroscopically, subvalvular pannus overgrowth was detected in 8 cases (80%). The proportion of overgrowth from the annulus was almost even and pannus overgrowth created subvalvular membrane, which restricted the area especially for each commissure. In contrast, opening and mobility of each leaflet was not severely limited and pannus overgrowth would restrict the area, especially for each commissure. In other two cases with regurgitation, tear of the leaflet on the stent strut was detected and mild calcification of each leaflet restricted opening. In patients with the Mosaic aortic bioprosthesis, pannus overgrowth was the major cause for reoperation.

[ESC guidelines on the management of valvular heart disease. What has changed and what is new?].

Science.gov (United States)

Mangner, N; Schuler, G

2013-12-01

In 2012 the new and collaborative "Guidelines on the management of valvular heart disease (version 2012)" were published by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). These guidelines emphasize that decision-making in patients with valvular heart disease should ideally be carried out by a"heart team" with particular expertise in valvular heart disease. In aortic regurgitation pathologies of the aortic root are frequent and in patients with Marfan syndrome, surgery is indicated when the maximal ascending aortic diameter is ≥50 mm, while the threshold for intervention should be lower in patients with risk factors for progression. Regarding aortic stenosis, transcatheter aortic valve implantation (TAVI) should be performed only in hospitals with on-site cardiac surgery and with a"heart team" available to assess patient risks. The TAVI procedure is indicated in patients with severe symptomatic aortic stenosis who are judged by the"heart team" to be unsuitable for surgery but have sufficient life expectancy. It should be considered for high-risk patients with severe symptomatic aortic stenosis based on the individual risk profile assessed by the"heart team". Furthermore, low flow - low gradient aortic stenosis with normal ejection fraction and the difficult topic of asymptomatic severe aortic stenosis and the indications for aortic valve replacement are discussed. With respect to mitral regurgitation, valve repair should be the preferred technique when it is expected to be durable. The topics of asymptomatic mitral regurgitation as well as percutaneous mitral valve repair using the edge to edge technique as an alternative for high risk patients are discussed. Tricuspid disease should not be forgotten and during left-sided valve surgery, tricuspid valve surgery should be considered in the presence of mild to moderate secondary regurgitation if there is significant annular dilatation. Last but not least

Induction of calcification by serum depletion in cell culture: a model for focal calcification in aortas related to atherosclerosis

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Villar Maria T

2008-01-01

Full Text Available Abstract Background Since aortic calcification has been shown to initiate in the lower zone of well-thickened plaques (LZP adjacent to the aortic media of rabbits fed supplemental cholesterol diets, a restricted supply of serum to vascular cells could play a role in vascular calcification. This study was designed to use a cell culture model to support this hypothesis. Results Rabbit aortic smooth muscle cells were grown to confluence in a culture media containing 10 % fetal bovine serum (FBS. The confluent cells were then exposed to the media for 2 hrs with or without serum at a Ca × P ion product range of 4.5–9.4 mM2. In contrast to the cells cultured in the presence of FBS, confluent cells in its absence displayed marked mineral-positive alizarin red staining and infrared absorption of mineral phosphate. A kinetic parameter C1/2 was used to designate the concentration of serum or its protein constituents needed to reduce the deposition of Ca and P by half. The C1/2 for FBS and rabbit serum was 0.04–0.07 % The C1/2 value for rabbit serum proteins was 13.5 μg/ml corresponding to the protein concentration in 0.06 % of serum. This C1/2 was markedly smaller than 86.2 μg/ml for bovine serum albumin present in 0.37 % serum (p Conclusion The aortic smooth muscle cell culture model suggests that serum depletion may play a role in the initiation of aortic calcification. The serum exhibits remarkable ability to inhibit cell-mediated calcification.

[Valvular heart disease: preoperative assessment and postoperative care].

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Nägele, Reto; Kaufmann, Beat A

2013-10-30

Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction.

Resting heart rate and the incidence and progression of valvular calcium: The Multi-Ethnic Study of Atherosclerosis (MESA).

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Amoakwa, Kojo; Fashanu, Oluwaseun E; Tibuakuu, Martin; Zhao, Di; Guallar, Eliseo; Whelton, Seamus P; O'Neal, Wesley T; Post, Wendy S; Budoff, Matthew J; Michos, Erin D

2018-06-01

Left-sided valvular calcification is associated with cardiovascular disease (CVD) morbidity and mortality. Resting heart rate (RHR) may influence valvular calcium progression through shear stress. Whether RHR, an established CVD risk factor, is associated with valvular calcium progression is unknown. We assessed whether RHR predicts incidence and progression of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a community-based cohort free of CVD at baseline. RHR was obtained from baseline electrocardiograms of 5498 MESA participants. MAC and AVC were quantified using Agatston scoring from cardiac computed tomography scans obtained at baseline and at a second examination during follow-up. We examined associations of RHR with incident MAC/AVC and annual change in MAC/AVC scores, after adjusting for demographics, CVD risk factors, physical activity, and atrioventricular nodal blocker use. At baseline, participants had mean age of 62 ± 10 years and mean RHR of 63 ± 10 bpm; 12.3% and 8.9% had prevalent AVC and MAC, respectively. Over a median of 2.3 years, 4.1% and 4.5% developed incident AVC and MAC, respectively. Each 10 bpm higher RHR was significantly associated with incident MAC [Risk Ratio 1.17 (95% CI 1.03-1.34)], but not incident AVC. However, RHR was associated with AVC progression [β = 1.62 (0.45-2.80) Agatston units/year for every 10 bpm increment], but not MAC progression. Higher RHR was associated with MAC incidence and AVC progression, independent of traditional CVD risk factors. Future studies are needed to determine whether modification of RHR through lifestyle or pharmacologic interventions can reduce valvular calcium incidence or progression. Copyright © 2018 Elsevier B.V. All rights reserved.

Aortic calcified particles modulate valvular endothelial and interstitial cells.

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van Engeland, Nicole C A; Bertazzo, Sergio; Sarathchandra, Padmini; McCormack, Ann; Bouten, Carlijn V C; Yacoub, Magdi H; Chester, Adrian H; Latif, Najma

Normal and calcified human valve cusps, coronary arteries, and aortae harbor spherical calcium phosphate microparticles of identical composition and crystallinity, and their role remains unknown. The objective was to examine the direct effects of isolated calcified particles on human valvular cells. Calcified particles were isolated from healthy and diseased aortae, characterized, quantitated, and applied to valvular endothelial cells (VECs) and interstitial cells (VICs). Cell differentiation, viability, and proliferation were analyzed. Particles were heterogeneous, differing in size and shape, and were crystallized as calcium phosphate. Diseased donors had significantly more calcified particles compared to healthy donors (Pinnocent bystanders but induce a phenotypical and pathological change of VECs and VICs characteristic of activated and pathological cells. Therapy tailored to reduce these calcified particles should be investigated. Copyright © 2017 Elsevier Inc. All rights reserved.

Changes in the etiology of valvular heart disease in the rapidly aging Korean population.

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Jang, Shin Yi; Ju, Eun-Young; Seo, Su Ra; Choi, Ji Yeon; Park, Sung-Ji; Kim, Duk-Kyung; Park, Seung Woo

2014-06-15

The aim of this study is to assess the changes in the causes of valvular heart disease between 2006 and 2011 in Korea. Data were collected from the Korean National Health Insurance Service from 2006 through 2011. These data consisted of primary diagnoses related to valvular heart disease regardless of other conditions. Valvular heart disease included non-rheumatic mitral valve disorders, non-rheumatic aortic valve disorders, rheumatic mitral valve disorders, and rheumatic aortic valve disorders. Overall, the age-standardized cumulative prevalence of non-rheumatic valvular heart disease was 70.6 per 100,000 persons in 2006 and 110.3 in 2011. This represented an increase from 42.2 to 65.2 in women and from 28.4 to 45.1 in men. In particular, there was a greater increase in prevalence in patients aged 65 years or older compared with groups aged 20-44 years or 45-64 years for both genders. The age-standardized cumulative prevalence of rheumatic valve disease did not change dramatically between 2006 and 2011. The overall age-standardized cumulative prevalence of non-rheumatic valvular heart diseases increased between 2006 and 2011, especially in individuals older than 65 years. These changes should be considered in future designs of cardiovascular healthcare services in countries with a rapidly aging population. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Quantified degree of eccentricity of aortic valve calcification predicts risk of paravalvular regurgitation and response to balloon post-dilation after self-expandable transcatheter aortic valve replacement.

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Park, Jun-Bean; Hwang, In-Chang; Lee, Whal; Han, Jung-Kyu; Kim, Chi-Hoon; Lee, Seung-Pyo; Yang, Han-Mo; Park, Eun-Ah; Kim, Hyung-Kwan; Chiam, Paul T L; Kim, Yong-Jin; Koo, Bon-Kwon; Sohn, Dae-Won; Ahn, Hyuk; Kang, Joon-Won; Park, Seung-Jung; Kim, Hyo-Soo

2018-05-15

Limited data exist regarding the impact of aortic valve calcification (AVC) eccentricity on the risk of paravalvular regurgitation (PVR) and response to balloon post-dilation (BPD) after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value of AVC eccentricity in predicting the risk of PVR and response to BPD in patients undergoing TAVR. We analyzed 85 patients with severe aortic stenosis who underwent self-expandable TAVR (43 women; 77.2±7.1years). AVC was quantified as the total amount of calcification (total AVC load) and as the eccentricity of calcium (EoC) using calcium volume scoring with contrast computed tomography angiography (CTA). The EoC was defined as the maximum absolute difference in calcium volume scores between 2 adjacent sectors (bi-partition method) or between sectors based on leaflets (leaflet-based method). Total AVC load and bi-partition EoC, but not leaflet-based EoC, were significant predictors for the occurrence of ≥moderate PVR, and bi-partition EoC had a better predictive value than total AVC load (area under the curve [AUC]=0.863 versus 0.760, p for difference=0.006). In multivariate analysis, bi-partition EoC was an independent predictor for the risk of ≥moderate PVR regardless of perimeter oversizing index. The greater bi-partition EoC was the only significant parameter to predict poor response to BPD (AUC=0.775, p=0.004). Pre-procedural assessment of AVC eccentricity using CTA as "bi-partition EoC" provides useful predictive information on the risk of significant PVR and response to BPD in patients undergoing TAVR with self-expandable valves. Copyright © 2017 Elsevier B.V. All rights reserved.

Vitamin K2 can suppress the expression of Toll-like receptor 2 (TLR2) and TLR4, and inhibit calcification of aortic intima in ApoE-/- mice as well as smooth muscle cells.

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Wang, Zhaojun; Wang, Zhongqun; Zhu, Jie; Long, Xinguang; Yan, Jinchuan

2018-02-01

Background and objectives Vascular calcification is a common complication in atherosclerosis. Accumulating evidence showed that Toll-like receptors (TLRs) mediate pro-inflammatory and atherosclerosis. Recent studies demonstrated that vascular calcification is one of the detrimental effects of vitamin K (Vit K) antagonists. However, the effects of Vit K on the expression of TLR2 and 4 and intimal calcification in artery remained unidentified. Methods and results Eighteen ApoE -/- mice were randomly divided into model group, Vit K-treated group, and control group. The mice of model and Vit K-treated group were fed with high-fat diet, while control group mice were fed with normal diet. Mice of Vit K-treated group were administered orally with vitamin K2 (40 mg.kg -1 .day -1 ) for 12 weeks. Twelve weeks later the aortic sections of mice were acquired and stained with hematoxylin and eosin and von Kossa, respectively. Calcium content and activity of alkaline phosphatase (ALP) at aortic tissues were measured. The expression levels of TLR2 and TLR4 in aorta sections were detected by immunohistochemisty and RT-PCR, respectively. The effects of Vit K on cellular calcification were further studied in A7r5 SMCs. Results demonstrated that high-fat diet induced typical atherosclerosis with intimal calcification in ApoE -/- mice, while in Vit K-treated group atherosclerosis and calcium deposits were not serious; Vit K2 also inhibited cellular calcification in A7r5 SMCs. Quantitative analysis showed that calcium and ALP activity at aortic tissues in the Vit K-treated mice were significantly lower than that of the model group ( P < 0.01); Compared to the control group, the expression levels of TLR2 and TLR4 in the model group were significantly higher ( P < 0.05), while in Vit K-treated group the levels of TLR2 and 4 were significantly lower than that in the model group. Furthermore, the content of calcium was positively related to the expression levels of TLR2 and TLR4

Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017 European guidelines for the management of valvular heart disease

Science.gov (United States)

Thonghong, Tasalak; De Backer, Ole; Søndergaard, Lars

2018-01-01

New European guidelines on the management of valvular heart disease—supported by the European Society of Cardiology (ESC) and European Association of CardioThoracic Surgery (EACTS)—were recently published. Although these guidelines are very comprehensive, these typically are not very inviting to read. In this document, we aimed to distil all the information about transcatheter aortic valve replacement (TAVR) in the new 2017 ESC/EACTS guidelines to the essential and give additional comments on the position of TAVR in 2017. PMID:29531767

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.

Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).

Science.gov (United States)

Torres, Armando; Torregrosa, Vicens; Marcen, Roberto; Campistol, Josep María; Arias, Manuel; Hernández, Domingo; Fernández, Constantino; Esforzado, Nuria; Paschoalin, Raphael; Pérez, Nuria; García, Ana Isabel; Del Amo, Montserrat; Pomés, Jaume; González Rinne, Ana; Marrero, Domingo; Pérez, Estefanía; Henríquez, Fernando; Díaz, Juan Manuel; Silva, Irene; López, Verónica; Perello, Manuel; Ramos, David; Beneyto, Isabel; Cruzado, José María; Martínez Castelao, Alberto; Bravo, Juan; Rodríguez, Minerva; Díaz, Carmen; Crespo, Josep; Anaya, Fernando; Rodríguez, María Luisa; Cubero, Juan José; Pascual, Pilar; Romero, Rafael; Andrés Belmonte, Amado; Checa, María Dolores; Jiménez, Carlos; Escuin, Fernando; Crespo, Marta; Mir, Marisa; Gómez, Gonzalo; Bayes, Beatriz; González, María José; Gutiérrez, Alex; Cuberes, Marta; Rodríguez Benoit, Alberto; García, Teresa; Llamas, Francisco; Ortega, Agustín; Conde, José Luis; Gómez Alamillo, Carlos

2016-01-01

The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Anti-fibrin antibody binding in valvular vegetations and kidney lesions during experimental endocarditis.

Science.gov (United States)

Yokota, M; Basi, D L; Herzberg, M C; Meyer, M W

2001-01-01

In Streptococcus sanguinis (sanguis) induced experimental endocarditis, we sought evidence that the development of aortic valvular vegetation depends on the availability of fibrin. Endocarditis was induced in New Zealand white rabbits by catheter placement into the left ventricle and inoculation of the bacteria. Fibrin was localized in the developing vegetation with 99mTechnetium (Tc)-labeled anti-fibrin antibody one or three days later. When rabbit anti-fibrin antibody was given intravenously on day 1, the mass of aortic valvular vegetation was significantly reduced at day 3; infusion of non-specific rabbit IgG showed no effect. The 99mTc-labeled anti-fibrin antibody also labeled kidneys that showed macroscopic subcapsular hemorrhage. To learn if the deposition of fibrin in the kidneys was a consequence of endocarditis required a comparison of farm-bred and specific pathogen-free rabbits before and after the induction of endocarditis. Before induction, the kidneys of farm-bred rabbits were labeled, but specific pathogen-free rabbits were free of labeling and signs of macroscopic hemorrhage. After 3 days of endocarditis, kidneys of 10 of 14 specific pathogen-free rabbits labeled with 99mTc-labeled anti-fibrin antibody and showed hemorrhage. Kidney lesions were suggested to be a frequent sequellae of S. sanguinis infective endocarditis. For the first time, fibrin was shown to be required for the continued development of aortic valvular vegetations.

Severe aortic stenosis: diagnosis, treatment and prognosis

NARCIS (Netherlands)

M.W.A. van Geldorp (Martijn)

2013-01-01

textabstractDegenerative aortic stenosis is the most common valvular heart disease in developed countries. The prevalence of severe aortic stenosis increases with age from 1% in people below 65 years of age to nearly 6% in people over the age of 85. Since the population life expectancy continues to

Valvular heart disease is changing – a challenge for Africa

Directory of Open Access Journals (Sweden)

David A. Tibbutt, DM, FRCP

2015-11-01

Full Text Available The pattern of valvular heart disease is changing in Western populations. There are implications for Africa as healthcare improves and people live longer. Over the last half century in Western countries there has been a change in the incidence of valvular heart disease from a rheumatic cause to one of degeneration. Until the age of 64 years all moderate to severe valve disease affects less than 2%. In the group aged 64 – 75 years the proportion increases to 4 - 8% and after age 75 years it rises to 12 - 13%. Mitral incompetence (regurgitation and aortic stenosis contribute to the majority of cases. Mitral stenosis is much more common in patients who have had rheumatic heart disease. As the population ages the healthcare burden of valvular heart disease will become greater.

A Specific IFIH1 Gain-of-Function Mutation Causes Singleton-Merten Syndrome

NARCIS (Netherlands)

Rutsch, Frank; Macdougall, Mary; Lu, Changming; Buers, Insa; Mamaeva, Olga; Nitschke, Yvonne; Rice, Gillian I.; Erlandsen, Heidi; Kehl, Hans Gerd; Thiele, Holger; Nürnberg, Peter; Höhne, Wolfgang; Crow, Yanick J.; Feigenbaum, Annette; Hennekam, Raoul C.

2015-01-01

Singleton-Merten syndrome (SMS) is an infrequently described autosomal-dominant disorder characterized by early and extreme aortic and valvular calcification, dental anomalies (early-onset periodontitis and root resorption), osteopenia, and acro-osteolysis. To determine the molecular etiology of

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

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

2015-06-01

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

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

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Paulsen, Niels Herluf; Carlsen, Bjarke Bønløkke; Dahl, Jordi Sanchez; Carter-Storch, Rasmus; Christensen, Nicolaj Lyhne; Khurrami, Lida; Møller, Jacob Eifer; Lindholt, Jes Sandal; Diederichsen, Axel Cosmus Pyndt

2016-01-01

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 AS in a general population undergoing CT. CT scans from 566 randomly selected male participants (age 65-74) in the Danish cardiovascular screening study (DANCAVAS) were analyzed for AVC. All participants with a moderately or severely increased AVC score (≥300 arbitrary units (AU)) and a matched control 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 AVC scoring. Moderate or severe increased AVC was observed in 10.7% (95% CI: 8.4-13.7). Echocardiography was performed in 101 individuals; 32.7% (95% CI: 21.8 to 46.0) with moderate or high AVC score had moderate or severe AS, while none with no or low AVC. A ROC analysis defined an AVC score ≥588 AU to be suggestive of moderate or severe AS (AUC 0.89 ± 0.04, sensitivity 83% and specificity 87%). In the univariate analyses, AVC was the only variable significantly associated with AS. This study indicates an association between CT verified AVC and subclinical AS. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Smooth muscle LDL receptor-related protein-1 deletion induces aortic insufficiency and promotes vascular cardiomyopathy in mice.

Directory of Open Access Journals (Sweden)

Joshua E Basford

Full Text Available Valvular disease is common in patients with Marfan syndrome and can lead to cardiomyopathy. However, some patients develop cardiomyopathy in the absence of hemodynamically significant valve dysfunction, suggesting alternative mechanisms of disease progression. Disruption of LDL receptor-related protein-1 (Lrp1 in smooth muscle cells has been shown to cause vascular pathologies similar to Marfan syndrome, with activation of smooth muscle cells, vascular dysfunction and aortic aneurysms. This study used echocardiography and blood pressure monitoring in mouse models to determine whether inactivation of Lrp1 in vascular smooth muscle leads to cardiomyopathy, and if so, whether the mechanism is a consequence of valvular disease. Hemodynamic changes during treatment with captopril were also assessed. Dilation of aortic roots was observed in young Lrp1-knockout mice and progressed as they aged, whereas no significant aortic dilation was detected in wild type littermates. Diastolic blood pressure was lower and pulse pressure higher in Lrp1-knockout mice, which was normalized by treatment with captopril. Aortic dilation was followed by development of aortic insufficiency and subsequent dilated cardiomyopathy due to valvular disease. Thus, smooth muscle cell Lrp1 deficiency results in aortic dilation and insufficiency that causes secondary cardiomyopathy that can be improved by captopril. These findings provide novel insights into mechanisms of cardiomyopathy associated with vascular activation and offer a new model of valvular cardiomyopathy.

Association between aortic valve calcification and myocardial ischemia, especially in asymptomatic patients.

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Yamazato, Ryo; Yamamoto, Hideya; Tadehara, Futoshi; Teragawa, Hiroki; Kurisu, Satoshi; Dohi, Yoshihiro; Ishibashi, Ken; Kunita, Eiji; Utsunomiya, Hiroto; Oka, Toshiharu; Kihara, Yasuki

2012-08-01

Aortic valve calcification (AVC) is recognized as a manifestation of systemic arteriosclerosis. However, it is unclear whether AVC is associated with myocardial ischemia. Stress myocardial perfusion SPECT (MPS) is widely used for the diagnosis of myocardial ischemia. However, routine MPS is not recommended, particularly in asymptomatic patients. Accordingly, we investigated the hypothesis that the presence of AVC is strongly associated with inducible myocardial ischemia, even among asymptomatic patients. We investigated 669 consecutive patients who underwent both adenosine stress (201)Tl MPS and echocardiography. We evaluated the extent and severity of myocardial ischemia by the summed difference score (SDS). We defined the presence of myocardial ischemia as SDS ≥ 3 and moderate to severe ischemia as SDS ≥ 8. We classified the severity of AVC according to the number of affected aortic leaflets. We also compared the mean SDS and the prevalence of SDS ≥ 3 and SDS ≥ 8 among patients stratified by the severity of AVC. The presence of AVC was significantly associated with myocardial ischemia (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.10-2.23; P = 0.013) and moderate to severe ischemia (OR, 2.16; 95% CI, 1.26-3.80; P = 0.0061). In 311 asymptomatic patients, AVC was strongly associated with moderate to severe ischemia (OR, 4.31; 95% CI, 1.67-12.8; P = 0.0043). However, the SDS value and the prevalence of SDS ≥ 3 and SDS ≥ 8 did not increase with increasing number of affected aortic leaflets. The presence of AVC may be associated with the presence of myocardial ischemia, particularly in asymptomatic patients. However, we found no association between the extent of AVC and inducible myocardial ischemia. The presence of AVC may be a useful anatomic marker to help identify patients at high risk of myocardial ischemia, particularly asymptomatic patients.

Gated blood pool scintigraphy in patients with valvular heart disease

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Breuel, H.P.; Heusinger, J.H.; Hanisch, K.

1984-10-01

In 58 patients suffering from either stenosis or insufficiency of a single heart valve, gated blood pool scintigraphy was performed to determine the ejection fraction as well as the peak filling and peak ejection rates. It could be demonstrated that in patients with valvular disorders the ejection fraction was only moderately decreased, generally remaining in the lower reference range. The peak filling and ejection rates showed no pathologic changes with the exception of patients with aortic regurgitation where these rates were significantly decreased. Thus, the estimation of left ventricular peak filling and ejection rates may permit diagnosis of myocardial impairment in patients with valvular disease even under resting conditions.

The Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal.

Science.gov (United States)

Gentry Iii, James L; Phelan, Dermot; Desai, Milind Y; Griffin, Brian P

Stress echocardiography is a widely available, safe, low-cost, versatile imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with native and prosthetic left-sided valvular heart disease. It provides a quantitative assessment to help guide clinical decision-making when discordance exists between symptoms and severity of valve disease. Exercise (treadmill or bicycle) remains the preferred stress modality, but pharmacological augmentation with dobutamine can be used if needed. Low-dose dobutamine stress echocardiography is specifically valuable in patients with low-flow, low-gradient aortic stenosis when attempting to differentiate true severe aortic stenosis from pseudo-severe aortic stenosis. Stress echocardiography not only identifies high-risk features that indicate need for earlier surgery, it also provides useful information for the peri- and postoperative period, including long-term outcome, risk stratification to guide monitoring frequency, and offers guidance for eligibility in competitive sports participation. As research continues to expand the utility of stress echocardiography in the management of patients with valvular heart disease, future research should focus on the recognition of newer parameters identifying high-risk features including subsequent validation in a large population. © 2017 S. Karger AG, Basel.

Magnesium intake is inversely associated with coronary artery calcification: the Framingham Heart Study

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OBJECTIVES: The aim of this study was to examine whether magnesium intake is associated with coronary artery calcification (CAC) and abdominal aortic calcification (AAC). BACKGROUND: Animal and cell studies suggest that magnesium may prevent calcification within atherosclerotic plaques underlying c...

Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries.

Science.gov (United States)

Nel, Karen; Nam, Michael C Y; Anstey, Chris; Boos, Christopher J; Carlton, Edward; Senior, Roxy; Kaski, Juan Carlos; Khattab, Ahmed; Shamley, Delva; Byrne, Christopher D; Stanton, Tony; Greaves, Kim

2017-12-01

Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation. 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay. Mean (±SD) participant age was 59.8 (9.6) years. Mean AVCS was 68 (258) AU, TPL was 15.6 (22.2) mm, and median coronary calcification score was 43.5AU. Mean MBFR was 2.20 (0.52). Mean hs-CRP was 2.52 (3.86) mg/l. Multivariable linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (β=0.05, 95% CI: 0.02, 0.08, P=0.007), hs-CRP (β=0.09, CI: 0.02, 0.16, P=0.010) and diabetes (β=1.03, CI: 0.08, 1.98, P=0.033), were positively associated with AVCS. MBFR (β=-0.87, CI: -1.44, -0.30, P=0.003), BMI (β=-0.11, CI: -0.21, -0.01, P=0.033), and LDL (β=-0.32, CI: -0.61, -0.03, P=0.029) were negatively associated with AVCS. TPL and coronary calcium score were not independently associated with AVCS when included in the regression model. Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation. Copyright © 2017 Elsevier B.V. All rights

Doppler-echocardiographic assessment of valvular regurgitation in healthy young subjects

International Nuclear Information System (INIS)

Filcheva, K.; Gochev, D.; Petrovski, P.; Kotsev, P.

1995-01-01

The study covers 300 clinically healthy, randomly selected young subjects, aged 17 to 21 years. The incidence and characteristic features of the valvular regurgitations are assayed by means of pulsed and continuous transthoracic Doppler echocardiography. Valvular insufficiency is registered in total of 198 cases (66%). Regurgitation of single valve is observed in 122 cases (61%), regurgitation of two valves - in 70 (36%) and three valves - in six (3%). Right-sided regurgitations (tricuspid, pulmonic and a combination of both) are detected in 156 subjects, and left-sided (mitral and/or aortic) in twenty-six of which only one regurgitation of the aortic valve. There is a definite tendency of the first two to prevail at a ratio 6:1. A constellation of various anatomical and physiological factors are considered as a likely underlying cause. Whenever atrio-ventricular valves are examined (the mitral one in particular), it is necessary that the regurgitation jet involves over 50% of systole in order to avoid hyperdiagnostics and the so-called 'Doppler's disease'. 14 refs., 1 tab., 2 figs. (author)

Electrospinning versus knitting: two scaffolds for tisssue engineering of the aortic valve

NARCIS (Netherlands)

Lieshout, van M.I.; Vaz, C.M.; Rutten, M.C.M.; Peters, G.W.M.; Baaijens, F.P.T.

2006-01-01

Two types of scaffolds were developed for tissue engineering of the aortic valve; an electrospun valvular scaffold and a knitted valvular scaffold. These scaffolds were compared in a physiologic flow system and in a tissue-engineering process. In fibrin gel enclosed human myofibroblasts were seeded

Role of modern 3D echocardiography in valvular heart disease

Science.gov (United States)

2014-01-01

Three-dimensional (3D) echocardiography has been conceived as one of the most promising methods for the diagnosis of valvular heart disease, and recently has become an integral clinical tool thanks to the development of high quality real-time transesophageal echocardiography (TEE). In particular, for mitral valve diseases, this new approach has proven to be the most unique, powerful, and convincing method for understanding the complicated anatomy of the mitral valve and its dynamism. The method has been useful for surgical management, including robotic mitral valve repair. Moreover, this method has become indispensable for nonsurgical mitral procedures such as edge to edge mitral repair and transcatheter closure of paravaluvular leaks. In addition, color Doppler 3D echo has been valuable to identify the location of the regurgitant orifice and the severity of the mitral regurgitation. For aortic and tricuspid valve diseases, this method may not be quite as valuable as for the mitral valve. However, the necessity of 3D echo is recognized for certain situations even for these valves, such as for evaluating the aortic annulus for transcatheter aortic valve implantation. It is now clear that this method, especially with the continued development of real-time 3D TEE technology, will enhance the diagnosis and management of patients with these valvular heart diseases. PMID:25378966

A hospital-based survey of patients with severe valvular heart disease in China.

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Hu, Po; Liu, Xian-Bao; Liang, Jie; Zhu, Qi-Feng; Pu, Chao-Xia; Tang, Meng-Yao; Wang, Jian-An

2017-03-15

Due to increasing aging, the epidemiology of VHD may have changed in China. This study aimed to provide contemporary information on the prevalence, distribution patterns, and etiology of severe VHD in China. This was a retrospective survey at Second Affiliated Hospital of Zhejiang University, which included all consecutive patients between 2010 and 2015. In all, 139,496 patients were enrolled. Among severe valve diseases, MR was the most frequent (n=946, 0.68%) followed by MS (n=524, 0.38%), AS (n=392, 0.28%), and AR (n=371, 0.27%). Severe MR and AS prevalence rates increased strikingly with age. Rheumatic heart disease had an prevalence of 1.56% (n=2179), and remained one of the most common causes of severe VHD in patients younger than 65years old (99.5% of MS with rheumatic; 27.6% of MR with rheumatic; 25.7% of AS with rheumatic; 31.6% of AR with rheumatic). Aortic valve calcification was the predominant AS etiology, and its prevalence greatly increased with age. In severe AR, rheumatic fever was the most common etiology in patients below 65; in those above 65, etiology was mostly degenerative. In severe primary MR, mitral valve prolapse was the most common cause. Prevalence of secondary MR increased with age, from 16.4% in 18-44years old to 51.7% in individuals ≥75. Severe valvular diseases are very common; rheumatic fever and degenerative valvular changes remain predominant causes in patients below 65 and older ones, respectively. Young adults present mainly with primary MR, while secondary MR is more common in elderly ones. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Association of body mass index and visceral fat with aortic valve calcification and mortality after transcatheter aortic valve replacement: the obesity paradox in severe aortic stenosis.

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Mancio, Jennifer; Fonseca, Paulo; Figueiredo, Bruno; Ferreira, Wilson; Carvalho, Monica; Ferreira, Nuno; Braga, Pedro; Rodrigues, Alberto; Barros, Antonio; Falcao-Pires, Ines; Leite-Moreira, Adelino; Ribeiro, Vasco Gama; Bettencourt, Nuno

2017-01-01

Previous studies showed that metabolic syndrome is associated with aortic valve calcification (AVC) and poor outcomes in aortic stenosis (AS). However, if these associations change and how body fat impacts the prognosis of patients in late stage of the disease have been not yet explored. To determine the association of body mass index (BMI) and visceral fat with AVC and mortality after transcatheter aortic valve replacement (TAVR). This was a prospective cohort of 170 severe AS patients referred to TAVR. We quantified AVC mass score and fat depots including epicardial adipose tissue, intrathoracic fat, and abdominal visceral (VAF) and subcutaneous fats by computed tomography. Fat depots were indexed to body surface area. All-cause and cardiovascular-related deaths after TAVR were recorded over a median follow-up of 1.2 years. Higher AVC mass was independently associated with low BMI and low VAF. All-cause mortality risk increased with the decrease of BMI and increment of VAF. A stratified analysis by obesity showed that in non-obese, VAF was inversely associated with mortality, whereas in obese, high VAF was associated with higher mortality (p value for interaction < 0.05). At long-term, hazard ratio [HR] with non-obese/low VAF was 2.3 (95% confidence interval [CI] 1.1-4.9; p = 0.021) and HR with obese/high VAF was 2.5 (95% CI 1.1-5.8; p = 0.031) compared with obese/low VAF patients. In AS patients submitted to TAVR, BMI and VAF were inversely associated with AVC. Pre-intervention assessment of VAF by computed tomography may provide a better discrimination of mortality than BMI alone.

Arterial wave reflection and aortic valve calcification in an elderly community-based cohort.

Science.gov (United States)

Sera, Fusako; Russo, Cesare; Iwata, Shinichi; Jin, Zhezhen; Rundek, Tatjana; Elkind, Mitchell S V; Homma, Shunichi; Sacco, Ralph L; Di Tullio, Marco R

2015-04-01

Aortic valve calcification (AVC) without stenosis is common in the elderly, is associated with cardiovascular morbidity and mortality, and may progress to aortic valve stenosis. Arterial stiffness and pulse-wave reflection are important components of proximal aortic hemodynamics, but their relationship with AVC is not established. To investigate the relationship of arterial wave reflection and stiffness with AVC, pulse wave analysis and AVC evaluation by echocardiography were performed in 867 participants from the Cardiovascular Abnormalities and Brain Lesions study. Participants were divided into four categories on the basis of the severity and extent of AVC: (1) none or mild focal AVC, (2) mild diffuse AVC, (3) moderate to severe focal AVC, and (4) moderate to severe diffuse AVC. Central blood pressures and pulse pressure, total arterial compliance, augmentation index, and time to wave reflection were assessed using applanation tonometry. Indicators of arterial stiffness and wave reflection were significantly associated with AVC severity, except for central systolic and diastolic pressures and time to reflection. After adjustment for pertinent covariates (age, sex, race/ethnicity, and estimated glomerular filtration rate), only augmentation pressure (P = .02) and augmentation index (P = .002) were associated with the severity of AVC. Multivariate logistic regression analysis revealed that augmentation pressure (odds ratio per mm Hg, 1.14; 95% confidence interval, 1.02-1.27; P = .02) and augmentation index (odds ratio per percentage point, 1.07; 95% confidence interval, 1.01-1.13; P = .02) were associated with an increased risk for moderate to severe diffuse AVC, even when central blood pressure value was included in the same model. Arterial wave reflection is associated with AVC severity, independent of blood pressure values. Increased contribution of wave reflection to central blood pressure could be involved in the process leading to AVC. Copyright © 2015

Clinical and epidemiological profile of patients with valvular heart disease admitted to the emergency department

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Moraes, Ricardo Casalino Sanches de [Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Katz, Marcelo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Tarasoutchi, Flávio [Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

2014-07-01

To evaluate the clinical and epidemiological profile of patients with valvular heart disease who arrived decompensated at the emergency department of a university hospital in Brazil. A descriptive analysis of clinical and echocardiographic data of 174 patients with severe valvular disease, who were clinically decompensated and went to the emergency department of a tertiary cardiology hospital, in the State of São Paulo, in 2009. The mean age of participants was 56±17 years and 54% were female. The main cause of valve disease was rheumatic in 60%, followed by 15% of degenerative aortic disease and mitral valve prolapse in 13%. Mitral regurgitation (27.5%) was the most common isolated valve disease, followed by aortic stenosis (23%), aortic regurgitation (13%) and mitral stenosis (11%). In echocardiographic data, the mean left atrial diameter was 48±12mm, 38±12mm for the left ventricular systolic diameter, and 54±12mm for the diastolic diameter; the mean ejection fraction was 56±13%, and the mean pulmonary artery pressure was 53±16mmHg. Approximately half of patients (44%) presented atrial fibrillation, and over one third of them (37%) had already undergone another cardiac surgery. Despite increased comorbidities and age-dependent risk factors commonly described in patients with valvular heart disease, the clinical profile of patients arriving at the emergency department represented a cohort of rheumatic patients in more advanced stages of disease. These patients require priority care in high complexity specialized hospitals.

Clinical and epidemiological profile of patients with valvular heart disease admitted to the emergency department

International Nuclear Information System (INIS)

Moraes, Ricardo Casalino Sanches de; Katz, Marcelo; Tarasoutchi, Flávio

2014-01-01

To evaluate the clinical and epidemiological profile of patients with valvular heart disease who arrived decompensated at the emergency department of a university hospital in Brazil. A descriptive analysis of clinical and echocardiographic data of 174 patients with severe valvular disease, who were clinically decompensated and went to the emergency department of a tertiary cardiology hospital, in the State of São Paulo, in 2009. The mean age of participants was 56±17 years and 54% were female. The main cause of valve disease was rheumatic in 60%, followed by 15% of degenerative aortic disease and mitral valve prolapse in 13%. Mitral regurgitation (27.5%) was the most common isolated valve disease, followed by aortic stenosis (23%), aortic regurgitation (13%) and mitral stenosis (11%). In echocardiographic data, the mean left atrial diameter was 48±12mm, 38±12mm for the left ventricular systolic diameter, and 54±12mm for the diastolic diameter; the mean ejection fraction was 56±13%, and the mean pulmonary artery pressure was 53±16mmHg. Approximately half of patients (44%) presented atrial fibrillation, and over one third of them (37%) had already undergone another cardiac surgery. Despite increased comorbidities and age-dependent risk factors commonly described in patients with valvular heart disease, the clinical profile of patients arriving at the emergency department represented a cohort of rheumatic patients in more advanced stages of disease. These patients require priority care in high complexity specialized hospitals

Exercise tolerance in asymptomatic patients with moderate-severe valvular heart disease and preserved ejection fraction.

Science.gov (United States)

Olaf, Schulz; Debora, Brala; Ricarda, Bensch; Gunnar, Berghöfer; Jochen, Krämer; Schimke, Ingolf; Halle, Martin; Jaffe, Allan

2012-12-20

For asymptomatic patients with moderate-severe valvular heart disease, in whom symptoms may be obscured, objective exercise tolerance measures are warranted for decisions concerning physical activities and surgical treatment. We compared 61 patients (39 with aortic stenosis, 22 with aortic or mitral regurgitation) to 23 controls without valvular heart disease but with indications for stress testing. All participants underwent cardiopulmonary function testing and dobutamine stress echocardiography. Blood was drawn before as well as after bicycle stress to assess high-sensitivity cardiac troponin T (hscTnT). Patients who underwent surgery were re-evaluated 1.5 ±0.9 years after the operation. Conventional bicycle test following guideline criteria revealed a pathologic result in 26% of the patients, whereas spiroergometry showed an objectively reduced exercise tolerance in 59%, reaching a prognostically relevant feature in 39%. Stress echocardiography detected a reduced systolic reserve in 33% and elevated filling pressures in 62%. These abnormalities were significantly less present in the control group (4, 17, 9, 9, 4% respectively, p valvular heart disease beyond stress-test criteria recommended in recent guidelines. High-sensitivity cardiac troponin I may be of additional value. Results of these tests presage post-operative function.

Preliminary investigation of orally administered benazepril in horses with left-sided valvular regurgitation.

Science.gov (United States)

Afonso, T; Giguère, S; Brown, S A; Barton, M H; Rapoport, G; Barba, M; Dembek, K A; Toribio, R E; Coleman, A E

2017-10-17

Despite the paucity of data available, orally administered angiotensin-converting enzyme (ACE) inhibitors are empirically used in horses with valvular regurgitation. Evaluate the echocardiographic and hormonal changes in response to oral benazepril in horses with left-sided valvular regurgitation. Prospective, randomised double-blind, placebo-controlled trial. Horses with mitral valve (MR) and/or aortic valve regurgitation (AR) received oral benazepril (n = 6) at a dosage of 1 mg/kg q 12 h or a placebo (n = 5) for 28 days. Echocardiography was performed before drug administration and after 28 days of treatment. Plasma renin activity, serum ACE activity, angiotensin II concentration, aldosterone concentration and biochemical variables were measured before drug administration and after 7 and 28 days of treatment. Relative to baseline, horses treated with benazepril had statistically significant reduction in left ventricular internal diameter in systole (mean difference between groups = -0.97 cm; 95% CI = -1.5 to -0.43 cm), aortic sinus diameter (-0.31 cm; -0.54 to -0.07 cm), and percentage of the aortic annulus diameter occupied by the base of the AR jet (-17.05%; -31.17 to -2.93%) compared with horses receiving a placebo. In addition, horses treated with benazepril had a significantly greater increase in cardiac output (11.95 L/min; 1.17-22.73 L/min) and fractional shortening (7.59%; 3.3-11.88%) compared with horses receiving a placebo. Despite profound serum ACE inhibition, renin activity and concentrations of angiotensin II and aldosterone were not significantly different between treatment groups or among time points. Very small sample size and short treatment period. Treatment with oral benazepril resulted in statistically significant echocardiographic changes that might indicate reduced cardiac afterload in horses with left-sided valvular regurgitation. Additional studies with a larger sample size will be necessary to determine if administration of benazepril is

Serum magnesium, phosphorus, and calcium levels and subclinical calcific aortic valve disease: A population-based study.

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Hisamatsu, Takashi; Miura, Katsuyuki; Fujiyoshi, Akira; Kadota, Aya; Miyagawa, Naoko; Satoh, Atsushi; Zaid, Maryam; Yamamoto, Takashi; Horie, Minoru; Ueshima, Hirotsugu

2018-06-01

Calcific aortic valve disease (CAVD) is the most common valve disease. Although micronutrients are known to contribute to cardiovascular disease, the relationship with CAVD remains poorly evaluated. We examined the association of serum levels of magnesium, phosphorus, and calcium with prevalence, incidence, and progression of aortic valve calcification (AVC). We conducted a prospective study in a population-based sample of Japanese men aged 40-79 years without known cardiovascular disease and chronic kidney disease at baseline, and quantified AVC from serial computed tomographic images with the Agatston method. Of 938 participants at baseline (mean age, 63.7 ± 9.9 years), AVC prevalence was observed in 173 (18.4%). Of 596 participants without baseline AVC at follow-up (median duration, 5.1 years), AVC incidence was observed in 138 (23.2%). After adjustment for demographics, behaviors and cardiovascular risk factors, relative risks (95% confidence intervals) in the highest versus lowest categories of serum magnesium, phosphorus, and calcium were 0.62 (0.44-0.86), 1.45 (1.02-2.04), and 1.43 (0.95-2.15), respectively, for AVC prevalence and 0.62 (0.42-0.92), 1.93 (1.28-2.91), and 1.09 (0.77-1.55), respectively, for AVC incidence. Their linear trends of serum magnesium and phosphorus were also all statistically significant. Of 131 participants with baseline AVC, there was no association of any serum micronutrients with AVC progression. Serum magnesium was inversely associated, while serum phosphorus was positively associated with AVC prevalence and incidence, suggesting that these serum micronutrients may be potential candidates for risk prediction or prevention of CAVD, and warranting further studies. Copyright © 2018 Elsevier B.V. All rights reserved.

[The best of valvular heart disease in 2005].

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de Gevigney, G

2006-01-01

The year 2005 has been rich in publications concerning valvular heart disease. In France, this year has been dominated by the publication of the French Society of Cardiologists' guidelines on the operative and interventional indications for acquired valvular heart disease: discussed and accepted formal indications based on the evidence in the literature. Non-ischaemic mitral insufficiency has been the subject of a major study that showed the high prognostic significance of echographic measuring of the area of the regurgitating orifice; patients with a surface > or =40 mm2 had a worse long-term prognosis and should undergo surgery early. The prognostic significance of BNP in valvular heart disease, such as mitral insufficiency and aortic stenosis, also became apparent. BNP is being used more and more for risk stratification for these conditions. The significance of anti-arrhythmic surgery combined with a mitral procedure has confirmed the harmful effect of atrial fibrillation, before and after the mitral surgery. The first randomised study into the use of statins to slow the progression of aortic stenosis was unfortunately disappointing, despite the various unrandomised studies that had opened a therapeutic pathway for this pathology, for which the prevalence is continually rising due to the ever increasing life expectancy. In mitral stenosis, a randomised study showed the long-term value of mitral commissurotomy in percutaneous mitral valvuloplasty, giving identical long-term results, in terms of mitral area, to those obtained with the classic Inoué balloon. In infectious endocarditis, surveys have confirmed the seriousness of this pathology as well as the slight advances in its prophylaxis. Other studies have confirmed the frequency and the severity of emboli, endocarditis due to Staphylococcus aureus, and the low risk of recurrence for endocarditis with the more and more accepted short course antibiotic treatment for patients undergoing surgery. Of course, this

Association of body mass index and visceral fat with aortic valve calcification and mortality after transcatheter aortic valve replacement: the obesity paradox in severe aortic stenosis

Directory of Open Access Journals (Sweden)

Jennifer Mancio

2017-10-01

Full Text Available Abstract Background Previous studies showed that metabolic syndrome is associated with aortic valve calcification (AVC and poor outcomes in aortic stenosis (AS. However, if these associations change and how body fat impacts the prognosis of patients in late stage of the disease have been not yet explored. Aims To determine the association of body mass index (BMI and visceral fat with AVC and mortality after transcatheter aortic valve replacement (TAVR. Methods This was a prospective cohort of 170 severe AS patients referred to TAVR. We quantified AVC mass score and fat depots including epicardial adipose tissue, intrathoracic fat, and abdominal visceral (VAF and subcutaneous fats by computed tomography. Fat depots were indexed to body surface area. All-cause and cardiovascular-related deaths after TAVR were recorded over a median follow-up of 1.2 years. Results Higher AVC mass was independently associated with low BMI and low VAF. All-cause mortality risk increased with the decrease of BMI and increment of VAF. A stratified analysis by obesity showed that in non-obese, VAF was inversely associated with mortality, whereas in obese, high VAF was associated with higher mortality (p value for interaction < 0.05. At long-term, hazard ratio [HR] with non-obese/low VAF was 2.3 (95% confidence interval [CI] 1.1–4.9; p = 0.021 and HR with obese/high VAF was 2.5 (95% CI 1.1–5.8; p = 0.031 compared with obese/low VAF patients. Conclusions In AS patients submitted to TAVR, BMI and VAF were inversely associated with AVC. Pre-intervention assessment of VAF by computed tomography may provide a better discrimination of mortality than BMI alone.

Aortic microcalcification is associated with elastin fragmentation in Marfan syndrome.

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Wanga, Shaynah; Hibender, Stijntje; Ridwan, Yanto; van Roomen, Cindy; Vos, Mariska; van der Made, Ingeborg; van Vliet, Nicole; Franken, Romy; van Riel, Luigi Amjg; Groenink, Maarten; Zwinderman, Aeilko H; Mulder, Barbara Jm; de Vries, Carlie Jm; Essers, Jeroen; de Waard, Vivian

2017-11-01

Marfan syndrome (MFS) is a connective tissue disorder in which aortic rupture is the major cause of death. MFS patients with an aortic diameter below the advised limit for prophylactic surgery (elastin fragments play a causal role in aortic calcification in MFS, and that microcalcification serves as a marker for aortic disease severity. To address this hypothesis, we analysed MFS patient and mouse aortas. MFS patient aortic tissue showed enhanced microcalcification in areas with extensive elastic lamina fragmentation in the media. A causal relationship between medial injury and microcalcification was revealed by studies in vascular smooth muscle cells (SMCs); elastin peptides were shown to increase the activity of the calcification marker alkaline phosphatase (ALP) and reduce the expression of the calcification inhibitor matrix GLA protein in human SMCs. In murine Fbn1 C1039G/+ MFS aortic SMCs, Alpl mRNA and activity were upregulated as compared with wild-type SMCs. The elastin peptide-induced ALP activity was prevented by incubation with lactose or a neuraminidase inhibitor, which inhibit the elastin receptor complex, and a mitogen-activated protein kinase kinase-1/2 inhibitor, indicating downstream involvement of extracellular signal-regulated kinase-1/2 (ERK1/2) phosphorylation. Histological analyses in MFS mice revealed macrocalcification in the aortic root, whereas the ascending aorta contained microcalcification, as identified with the near-infrared fluorescent bisphosphonate probe OsteoSense-800. Significantly, microcalcification correlated strongly with aortic diameter, distensibility, elastin breaks, and phosphorylated ERK1/2. In conclusion, microcalcification co-localizes with aortic elastin degradation in MFS aortas of humans and mice, where elastin-derived peptides induce a calcification process in SMCs via the elastin receptor complex and ERK1/2 activation. We propose microcalcification as a novel imaging marker to monitor local elastin degradation and

Beyond Framingham risk factors and coronary calcification: does aortic valve calcification improve risk prediction? The Heinz Nixdorf Recall Study.

Science.gov (United States)

Kälsch, Hagen; Lehmann, Nils; Mahabadi, Amir A; Bauer, Marcus; Kara, Kaffer; Hüppe, Patricia; Moebus, Susanne; Möhlenkamp, Stefan; Dragano, Nico; Schmermund, Axel; Stang, Andreas; Jöckel, Karl-Heinz; Erbel, Raimund

2014-06-01

Aortic valve calcification (AVC) is considered a manifestation of atherosclerosis. In this study, we investigated whether AVC adds to cardiovascular risk prediction beyond Framingham risk factors and coronary artery calcification (CAC). A total of 3944 subjects from the population based Heinz Nixdorf Recall Study (59.3±7.7 years; 53% females) were evaluated for coronary events, stroke, and cardiovascular disease (CVD) events (including all plus CV death) over 9.1±1.9 years. CT scans were performed to quantify AVC. Cox proportional hazards regressions and Harrell's C were used to examine AVC as event predictor in addition to risk factors and CAC. During follow-up, 138 (3.5%) subjects experienced coronary events, 101 (2.6%) had a stroke, and 257 (6.5%) experienced CVD events. In subjects with AVC>0 versus AVC=0 the incidence of coronary events was 8.0% versus 3.0% (pAVC scores (pAVC scores (3rd tertile) remained independently associated with coronary events (HR 2.21, 95% CI 1.28 to 3.81) and CVD events (HR 1.67, 95% CI 1.08 to 2.58). After further adjustment for CAC score, HRs were attenuated (coronary events 1.55, 95% CI 0.89 to 2.69; CVD events 1.29, 95% CI 0.83 to 2.00). When adding AVC to the model containing traditional risk factors and CAC, Harrell's C indices did not increase for coronary events (from 0.744 to 0.744) or CVD events (from 0.759 to 0.759). AVC is associated with incident coronary and CVD events independent of Framingham risk factors. However, AVC fails to improve cardiovascular event prediction over Framingham risk factors and CAC. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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

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Widgren Veronica

2012-10-01

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

Calcification of the splenic, iliac, and breast arteries and risk of all-cause and cardiovascular mortality

NARCIS (Netherlands)

Hendriks, Eva J E; Beulens, Joline W J; de Jong, Pim A; van der Schouw, Yvonne T; Sun, Wei-Ning; Wright, C Michael; Criqui, Michael H; Allison, Matthew A; Ix, Joachim H

2017-01-01

BACKGROUND AND AIMS: CVD risks associated with coronary artery calcification (CAC) and aortic calcification (AC) are well known, but less is known about other calcified arteries. We aimed to assess the associations of arterial calcification in the breast, splenic, and internal and external iliac

Cell Phenotype Transitions in Cardiovascular Calcification

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Luis Hortells

2018-03-01

Full Text Available Cardiovascular calcification was originally considered a passive, degenerative process, however with the advance of cellular and molecular biology techniques it is now appreciated that ectopic calcification is an active biological process. Vascular calcification is the most common form of ectopic calcification, and aging as well as specific disease states such as atherosclerosis, diabetes, and genetic mutations, exhibit this pathology. In the vessels and valves, endothelial cells, smooth muscle cells, and fibroblast-like cells contribute to the formation of extracellular calcified nodules. Research suggests that these vascular cells undergo a phenotypic switch whereby they acquire osteoblast-like characteristics, however the mechanisms driving the early aspects of these cell transitions are not fully understood. Osteoblasts are true bone-forming cells and differentiate from their pluripotent precursor, the mesenchymal stem cell (MSC; vascular cells that acquire the ability to calcify share aspects of the transcriptional programs exhibited by MSCs differentiating into osteoblasts. What is unknown is whether a fully-differentiated vascular cell directly acquires the ability to calcify by the upregulation of osteogenic genes or, whether these vascular cells first de-differentiate into an MSC-like state before obtaining a “second hit” that induces them to re-differentiate down an osteogenic lineage. Addressing these questions will enable progress in preventative and regenerative medicine strategies to combat vascular calcification pathologies. In this review, we will summarize what is known about the phenotypic switching of vascular endothelial, smooth muscle, and valvular cells.

Targeted Reduction of Vascular Msx1 and Msx2 Mitigates Arteriosclerotic Calcification and Aortic Stiffness in LDLR-Deficient Mice Fed Diabetogenic Diets

OpenAIRE

Cheng, Su-Li; Behrmann, Abraham; Shao, Jian-Su; Ramachandran, Bindu; Krchma, Karen; Bello Arredondo, Yoanna; Kovacs, Attila; Mead, Megan; Maxson, Robert; Towler, Dwight A.

2014-01-01

When fed high-fat diets, male LDLR?/? mice develop obesity, hyperlipidemia, hyperglycemia, and arteriosclerotic calcification. An osteogenic Msx-Wnt regulatory program is concomitantly upregulated in the vasculature. To better understand the mechanisms of diabetic arteriosclerosis, we generated SM22-Cre;Msx1(fl/fl);Msx2(fl/fl);LDLR?/? mice, assessing the impact of Msx1+Msx2 gene deletion in vascular myofibroblast and smooth muscle cells. Aortic Msx2 and Msx1 were decreased by 95% and 34% in S...

The association of incidentally detected heart valve calcification with future cardiovascular events

OpenAIRE

Gondrie, Martijn J. A.; van der Graaf, Yolanda; Jacobs, Peter C.; Oen, Ay L.; Mali, Willem P. Th. M.

2010-01-01

Objectives This study aims to investigate the prognostic value of incidental aortic valve calcification (AVC), mitral valve calcification (MVC) and mitral annular calcification (MAC) for cardiovascular events and non-rheumatic valve disease in particular on routine diagnostic chest CT. Methods The study followed a case-cohort design. 10410 patients undergoing chest CT were followed for a median period of 17 months. Patients referred for cardiovascular disease were excluded. A random sample of...

Warfarin accelerated vascular calcification and worsened cardiac dysfunction in remnant kidney mice

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Ming-Tsun Tsai

2018-04-01

Full Text Available Background: Vascular calcification is highly prevalent in end-stage renal disease (ESRD and is a significant risk factor for future cardiovascular events and death. Warfarin use results in dysfunction of matrix Gla protein, an inhibitor of vascular calcification. However, the effect of warfarin on vascular calcification in patients with ESRD is still not well characterized. Thus we investigated whether arterial calcification can be accelerated by warfarin treatment both in vitro and in vivo using a mouse remnant kidney model. Methods: Human aortic smooth muscle cells (HASMC were cultured in medium supplemented with warfarin and phosphate to investigate the potential role of this drug in osteoblast transdifferentiation. For in vivo study, adult male C57BL/6 mice underwent 5/6 nephrectomy were treated with active vitamin D3 plus warfarin to determine the extent of vascular calcification and parameters of cardiovascular function. Results: We found that the expressions of Runx2 and osteocalcin in HASMC were markedly enhanced in the culture medium containing warfarin and high phosphate concentration. Warfarin induced calcification of cultured HASMC in the presence of high phosphate levels, and this effect is inhibited by vitamin K2. Severe aortic calcification and reduced left ventricular ejection fractions were also noted in 5/6 nephrectomy mice treated with warfarin and active vitamin D3. Conclusion: Warfarin treatment contributes to the accelerated vascular calcification in animal models of advanced chronic kidney disease. Clinicians should therefore be aware of the profound risk of warfarin use on vascular calcification and cardiac dysfunction in patients with ESRD and atrial fibrillation. Keywords: Left ventricular dysfunction, Uremia, Vascular calcification, Warfarin

Refractory pulmonary edema secondary to severe aortic valvular stenosis - aortic valvuloplasty as bridge therapy to surgery

International Nuclear Information System (INIS)

Santiago, Salazar; Hanna, Franklin; Capasso, Aminta

2009-01-01

Aortic valve stenosis is a progressive disease; when it is severe and symptomatic has a bleak prognosis that affects adversely the patient survival. In these cases, the treatment of choice is valve replacement surgery that under certain circumstances can bear a huge risk that forces the physician to consider less aggressive management alternatives to solve the problem. The case of a 65 years old male with severe aortic valve stenosis is reported. He developed pulmonary edema refractory to medical treatment that was solved by aortic valvuloplasty as bridge therapy to surgery.

On the effect of computed tomography resolution to distinguish between abdominal aortic aneurysm wall tissue and calcification: A proof of concept.

Science.gov (United States)

Barrett, H E; Cunnane, E M; O Brien, J M; Moloney, M A; Kavanagh, E G; Walsh, M T

2017-10-01

The purpose of this study is to determine the optimal target CT spatial resolution for accurately imaging abdominal aortic aneurysm (AAA) wall characteristics, distinguishing between tissue and calcification components, for an accurate assessment of rupture risk. Ruptured and non-ruptured AAA-wall samples were acquired from eight patients undergoing open surgical aneurysm repair upon institutional review board approval and informed consent was obtained from all patients. Physical measurements of AAA-wall cross-section were made using scanning electron microscopy. Samples were scanned using high resolution micro-CT scanning. A resolution range of 15.5-155μm was used to quantify the influence of decreasing resolution on wall area measurements, in terms of tissue and calcification. A statistical comparison between the reference resolution (15.5μm) and multi-detector CT resolution (744μm) was also made. Electron microscopy examination of ruptured AAAs revealed extremely thin outer tissue structure leverage an improved assessment of AAA rupture risk. Copyright © 2017 Elsevier B.V. All rights reserved.

[Phonomechanocardiography in the evaluation of the functional status of valvular prosthesis].

Science.gov (United States)

Esquivel Avila, J; Molina Zapata, B; Martínez Ríos, M A; Flamand, E

1975-01-01

The FMCG in 22 patients with valvular prosthesis is analyzed and its clinical, hemodynamic and surgical correlation are established (11 from the I.N.C. and 11 from the Hospital Infantil I.M.A.N.). The average age of the patients was 15 years old, 18 had a mitral and six aortic valvulopathy, and they all required a valvular replacement. Of the mitral prosthesis, 14 were Starr-Edwards (13 of ball valve and one of disc), three Lillehei-Kaster and one Börck-Shiley. In 5 patients, the FMCG suspected disfunction that was later corroborated by catheterism in three patients and by surgery in all of them. The important differences of the FMCG between the group with good and the one with bad function were: the aparition of a rumble, a decrease in the amplitud of the closing snap, index of closing snap opering snap of less than one, lenghtening of fases PFVP and IVCP, and shortening of IVDRP. In the patients with auricular fibrilation, after long dyastoles; that would represent an adequate atrial emptying; the closing snap was more intense, the PFVP was lennthened the IVDRP was shortened when the prosthesis was not properly functioning. All the aortic prosthesis were ball valve Starr-Edwards type; in one the FMCG suspected disfunction and the patient had a sudden death outside of the Hospital. The significant differences of the FMCG were the decrease in the intensity of the opening snap, with a Hylen index of less than one, lengthening of the PFVP, IVCP and of the expulsive period (EP). The authors conclude that the FMCG is a good method for an early detection of the disfunctions of valvular prosthesis.

Type of Valvular Heart Disease Requiring Surgery in the 21st Century: Mortality and Length-of-Stay Related to Surgery

Science.gov (United States)

Boudoulas, Konstantinos Dean; Ravi, Yazhini; Garcia, Daniel; Saini, Uksha; Sofowora, Gbemiga G.; Gumina, Richard J.; Sai-Sudhakar, Chittoor B.

2013-01-01

Aim: While the incidence of rheumatic heart disease has declined dramatically over the last half-century, the number of valve surgeries has not changed. This study was undertaken to define the most common type of valvular heart disease requiring surgery today, and determine in-hospital surgical mortality and length-of-stay (LOS) for isolated aortic or mitral valve surgery in a United States tertiary-care hospital. Methods: Patients with valve surgery between January 2002 to June 2008 at The Ohio State University Medical Center were studied. Patients only with isolated aortic or mitral valve surgery were analyzed. Results: From 915 patients undergoing at least aortic or mitral valve surgery, the majority had concomitant cardiac proce-dures mostly coronary artery bypass grafting (CABG); only 340 patients had isolated aortic (n=204) or mitral (n=136) valve surgery. In-hospital surgical mortality for mitral regurgitation (n=119), aortic stenosis (n=151), aortic insufficiency (n=53) and mitral stenosis (n=17) was 2.5% (replacement 3.4%; repair 1.6%), 3.9%, 5.6% and 5.8%, respectively (p=NS). Median LOS for aortic insufficiency, aortic stenosis, mitral regurgitation, and mitral stenosis was 7, 8, 9 (replacement 11.5; repair 7) and 11 days, respectively (p<0.05 for group). In-hospital surgical mortality for single valve surgery plus CABG was 10.2% (p<0.005 compared to single valve surgery). Conclusions: Aortic stenosis and mitral regurgitation are the most common valvular lesions requiring surgery today. Surgery for isolated aortic or mitral valve disease has low in-hospital mortality with modest LOS. Concomitant CABG with valve surgery increases mortality substantially. Hospital analysis is needed to monitor quality and stimulate improvement among Institutions. PMID:24339838

BMD PREDICTION OF DEATH IS ENCAPSULATED BY THE MORPHOLOGICAL ATHEROSCLEROSIS CALCIFICATION DISTRIBUTION (MACD) INDEX

DEFF Research Database (Denmark)

Ganz, Melanie; Nielsen, Mads; Karsdal, Morten

2009-01-01

.3±0.3 years and of which CVD, cancer, and all cause deaths were recorded. The spine BMD and aortic calcification markers, AC24 and the recently proposed Morphological Atherosclerosis Calcification Distribution (MACD) index, were quantified from DXA scans and lateral X-rays respectively. The MACD...

Development of a Patient-Specific Multi-Scale Model to Understand Atherosclerosis and Calcification Locations: Comparison with In vivo Data in an Aortic Dissection

Science.gov (United States)

Alimohammadi, Mona; Pichardo-Almarza, Cesar; Agu, Obiekezie; Díaz-Zuccarini, Vanessa

2016-01-01

Vascular calcification results in stiffening of the aorta and is associated with hypertension and atherosclerosis. Atherogenesis is a complex, multifactorial, and systemic process; the result of a number of factors, each operating simultaneously at several spatial and temporal scales. The ability to predict sites of atherogenesis would be of great use to clinicians in order to improve diagnostic and treatment planning. In this paper, we present a mathematical model as a tool to understand why atherosclerotic plaque and calcifications occur in specific locations. This model is then used to analyze vascular calcification and atherosclerotic areas in an aortic dissection patient using a mechanistic, multi-scale modeling approach, coupling patient-specific, fluid-structure interaction simulations with a model of endothelial mechanotransduction. A number of hemodynamic factors based on state-of-the-art literature are used as inputs to the endothelial permeability model, in order to investigate plaque and calcification distributions, which are compared with clinical imaging data. A significantly improved correlation between elevated hydraulic conductivity or volume flux and the presence of calcification and plaques was achieved by using a shear index comprising both mean and oscillatory shear components (HOLMES) and a non-Newtonian viscosity model as inputs, as compared to widely used hemodynamic indicators. The proposed approach shows promise as a predictive tool. The improvements obtained using the combined biomechanical/biochemical modeling approach highlight the benefits of mechanistic modeling as a powerful tool to understand complex phenomena and provides insight into the relative importance of key hemodynamic parameters. PMID:27445834

Phase-mapping technique for the evaluation of aortic valve stenosis by MR

International Nuclear Information System (INIS)

Engels, G.; Mueller, E.; Reynen, K.; Wilke, N.; Bachmann, K.

1992-01-01

New MR-techniques for quantitative blood flow registration such as phase-mapping (a two-dimensional space-resolved technique with a time-averaged measurement of blood flow) or RACE (real-time acquisition and evaluation of blood flow in one-dimensional space projection) are available for the diagnosis of valvular heart disease. Initial results of grading aortic valve stenosis by these methods are shown in comparison to continuous wave Ultrasound-Doppler. Two groups of 15 patients were examined by RACE or phase-mapping, 12 respectively 8 of whom suffered from an aortic valve stenosis. The shape of blood flow profiles as well as grading of aortic valve stenosis show high concordance when comparing the results of MR and Doppler technique. Good reliability and practicability of the demonstrated MR-method are shown. With respect to the results of RACE and phase-mapping the development of an alternative and competing MR-method for the evaluation of valvular heart disease and shunt diagnostics seems possible. (orig.)

Phase-mapping technique for the evaluation of aortic valve stenosis by MR

Energy Technology Data Exchange (ETDEWEB)

Engels, G. [Medizinische Klinik 2, Univ. of Erlangen (Germany); Mueller, E. [Siemens Medical Engineering Group, Erlangen (Germany); Reynen, K. [Medizinische Klinik 2, Univ. of Erlangen (Germany); Wilke, N. [Siemens Medical Engineering Group, Erlangen (Germany); Bachmann, K. [Medizinische Klinik 2, Univ. of Erlangen (Germany)

1992-08-01

New MR-techniques for quantitative blood flow registration such as phase-mapping (a two-dimensional space-resolved technique with a time-averaged measurement of blood flow) or RACE (real-time acquisition and evaluation of blood flow in one-dimensional space projection) are available for the diagnosis of valvular heart disease. Initial results of grading aortic valve stenosis by these methods are shown in comparison to continuous wave Ultrasound-Doppler. Two groups of 15 patients were examined by RACE or phase-mapping, 12 respectively 8 of whom suffered from an aortic valve stenosis. The shape of blood flow profiles as well as grading of aortic valve stenosis show high concordance when comparing the results of MR and Doppler technique. Good reliability and practicability of the demonstrated MR-method are shown. With respect to the results of RACE and phase-mapping the development of an alternative and competing MR-method for the evaluation of valvular heart disease and shunt diagnostics seems possible. (orig.)

Quantification of Aortic Valve Calcifications Detected During Lung Cancer-Screening CT Helps Stratify Subjects Necessitating Echocardiography for Aortic Stenosis Diagnosis.

Science.gov (United States)

Lee, Hee Young; Kim, Sung Mok; Lee, Kyung Soo; Park, Seung Woo; Chung, Myung Jin; Cho, Hyoun; Jung, Jung Im; Jang, Hye Won; Jung, Sin-Ho; Goo, Juna

2016-05-01

No study has been published on aortic valve calcification (AVC) extent at lung cancer screening low-dose CT (LDCT) and its relationship with aortic stenosis (AS). The purpose of this study was to estimate the cutoff value of AVC on LDCT for detecting AS in asymptomatic Asian subjects. Six thousand three hundred thirty-eight subjects (mean age, 55.9 years ± 8.6) self-referred to health-promotion center underwent LDCT, coronary calcium scoring CT (CSCT), and echocardiography. AVC was quantified using Agatston methods on CT. AVC extent on LDCT was compared with that on CSCT, and AVC threshold for diagnosing AS was calculated. Clinical factors associated with AS and AVC were sought.AVC was observed in 403 subjects (64.9 years ± 8.7) on LDCT (6.4%), and AVC score measured from LDCT showed strong positive correlation with that from CSCT (r = 0.83, P AVC score for detecting AS was 138.37 with sensitivity of 90.0% and specificity 83.2%. On multivariate analysis, age (odds ratio [OR] = 1.10, 95% CI: 1.09-1.12) and hypertension (OR = 1.39, 95% CI: 1.10-1.76) were associated with the presence of AVC, whereas AVC extent at LDCT (OR = 104.32, 95% CI: 16.16-673.70) was the only significant clinical factor associated with AS; AVC extent on LDCT (OR = 104.32, 95% CI: 16.16-673.70) was the significant clinical factor associated with AS.The AVC extent on LDCT is significantly related to the presence of AS, and we recommend echocardiography for screening AS based on quantified AVC values on LDCT.

Association of aortic valve calcification to the presence, extent, and composition of coronary artery plaque burden: from the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) trial.

Science.gov (United States)

Mahabadi, Amir A; Bamberg, Fabian; Toepker, Michael; Schlett, Christopher L; Rogers, Ian S; Nagurney, John T; Brady, Thomas J; Hoffmann, Udo; Truong, Quynh A

2009-10-01

Aortic valve calcification (AVC) is associated with cardiovascular risk factors and coronary artery calcification. We sought to determine whether AVC is associated with the presence and extent of overall plaque burden, as well as to plaque composition (calcified, mixed, and noncalcified). We examined 357 subjects (mean age 53 +/- 12 years, 61% male) who underwent contrast-enhanced electrocardiogram-gated 64-slice multidetector computed tomography from the ROMICAT trial for the assessment of presence and extent of coronary plaque burden according to the 17-coronary segment model and presence of AVC. Patients with AVC (n = 37, 10%) were more likely than those without AVC (n = 320, 90%) to have coexisting presence of any coronary plaque (89% vs 46%, P AVC had >3-fold increase odds of having any plaque (adjusted odds ratio [OR] 3.6, P = .047) and an increase of 2.5 segments of plaque (P AVC. When stratified by plaque composition, AVC was associated most with calcified plaque (OR 5.2, P = .004), then mixed plaque (OR 3.2, P = .02), but not with noncalcified plaque (P = .96). Aortic valve calcification is associated with the presence and greater extent of coronary artery plaque burden and may be part of the later stages of the atherosclerosis process, as its relation is strongest with calcified plaque, less with mixed plaque, and nonsignificant with noncalcified plaque. If AVC is present, consideration for aggressive medical therapy may be warranted.

Do pulmonary artery catheters cause or increase tricuspid or pulmonic valvular regurgitation?

Science.gov (United States)

Sherman, S V; Wall, M H; Kennedy, D J; Brooker, R F; Butterworth, J

2001-05-01

There are few quantitative data on the extent or mechanism of pulmonary artery catheter (PAC)-induced valvular dysfunction. We hypothesized that PACs cause or worsen tricuspid and pulmonic valvular regurgitation, and tested this hypothesis by using transesophageal echocardiography. In 54 anesthetized adult patients, we measured color Doppler jet areas of tricuspid regurgitation (TR) in two planes (midesophageal [ME] 4-chamber and right ventricular inflow-outflow views) and pulmonic insufficiency (PI) in one plane (ME aortic valve long-axis view), both before and after we advanced a PAC into the pulmonary artery. Regurgitant jet areas and hemodynamic measurements were compared by using paired t-test. There were no significant changes in blood pressure or heart rate after passage of the PAC. After PAC placement, the mean PI jet area was not significantly increased. The mean TR jet area increased significantly in the right ventricular inflow-outflow view (+0.37 +/- 0.11 cm(2)) (P = 0.0014), but did not increase at the ME 4-chamber view. Seventeen percent of patients had an increase in TR jet area > or =1 cm(2); 8% of patients had an increase in PI jet area >/=1 cm(2). In patients without pulmonic or tricuspid valvular pathology, placement of a pulmonary artery catheter (PAC) worsened tricuspid regurgitation, which is consistently visualized in the right ventricular inflow-outflow view, and often not seen in the midesophageal 4-chamber view. This is consistent with malcoaptation of the anterior and posterior leaflets. PAC-induced pulmonic insufficiency was rarely detected in the midesophageal aortic valve long-axis view. We conclude that a PAC is very unlikely to be the sole cause of severe tricuspid regurgitation or pulmonic insufficiency.

Sub-aortic obstruction of left ventricular outflow tract secondary to benfluorex-induced endocardial fibrosis

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Catherine Szymanski

2015-12-01

Full Text Available Patients exposed to benfluorex have an increased risk of restrictive organic valvular heart disease. Aortic and mitral regurgitations caused by fibrotic valve disease are the most common features observed in exposure to fenfluramine derivatives in general and benfluorex in particular. We report here, for the first time to our knowledge, a well-documented case in which obstructive sub-aortic endocardium fibrosis within the left ventricular outflow tract is related with exposure to a drug that modifies the metabolism of serotonin. It now remains to be established whether extensive fibrosis of the myocardium in addition to well-documented valvular fibrosis may develop in patients exposed to amphetamine-derived drugs affecting the serotonin system.

Evaluation of valvular regurgitation by cine magnetic resonance imaging in patients with various cardiac diseases

International Nuclear Information System (INIS)

Kubota, Shuuhei; Nishimura, Tsunehiko

1990-01-01

In order to evaluate the clinical value and limitation of magnetic resonance imaging (MRI) for detection and quantification of valvular regurgitation, 98 patients with various cardiac diseases were studied by cine MRI and the results were compared with contrast angiography and doppler color-flow imaging. Cine MRI was carried out using FLASH (fast low angle shot) which employs TE of 10∼20 msec and TR of 30∼40 msec. 22 transverse tomograms per cardiac cycle with a slice thickness of 10 mm were obtained at the level of atrium and ventricle. The jet of valvular regurgitation was easily seen as a discrete are of low signal with cine MRI. Identification of the regurgitation and its severity were visually evaluated based on the relative size of the regurgitant jet from the incompetent valve orifice. Using contrast angiography as a gold standard, the sensitivity of cine MRI for detecting mitral regurgitation was 83% and was 94% for aortic regurgitation, with the specificity of 82% and 100%, respectively. For mitral requrgitation and aortic regurgitation, evaluation by cine MRI and severity agreed well with contrast angiography. By the comparative study with doppler color-flow imaging, relatively good agreement was found between the two methods in detection and quantitative evaluation of valvular regurgitation in any of four valves. Cine MRI was suggested to be useful for both the detection and semiquantification of valvular regurgitation in generally, but its clinical limitation at this point was also found because, 1)its images are not acquired in real times, as in contrast angiography or doppler color-flow imaging, but are compiled from the cumulative information from 128 heart beats, 2)the evaluation of regurgitation is made from only two-dimensional transverse tomograms. (author)

Echocardiographic Evaluation of Hemodynamic Changes in Left-Sided Heart Valves in Pregnant Women With Valvular Heart Disease.

Science.gov (United States)

Samiei, Niloufar; Amirsardari, Mandana; Rezaei, Yousef; Parsaee, Mozhgan; Kashfi, Fahimeh; Hantoosh Zadeh, Sedigheh; Beikmohamadi, Somayeh; Fouladi, Masoumeh; Hosseini, Saeid; Peighambari, Mohammad Mehdi; Mohebbi, Ahmad

2016-10-01

Physiologic changes during pregnancy can deteriorate or improve patients' hemodynamic status in the setting of valvular heart disease. There are sparse data regarding the effect of pregnancy on valve hemodynamics in normal pregnant women with known valvular heart disease. In a prospective study from July 2014 to January 2016, a total of 52 normal pregnant women who had mitral stenosis, aortic stenosis, or a history of mitral valve or aortic valve replacements were assessed. All patients underwent echocardiographic examinations and hemodynamic parameters were measured for both the mitral valve and aortic valve at first, second, and third trimesters. The parameters included mean gradient, peak gradient, mean gradient/heart rate, peak gradient/heart rate, pressure halftime, dimensionless velocity index, and valve area. Although most hemodynamic parameters (i.e., mean gradient, peak gradient, mean gradient/heart rate, and peak gradient/heart rate) increased approximately 50% from first to second trimester and first to third trimester (p 0.05). The ratio of changes between trimesters for valve area and dimensionless velocity index were comparable. No clinical decompensations were observed except for 3 and 7 cases of deterioration to functional class II at second and third trimesters, respectively. In conclusion, during a full-term and uncomplicated pregnancy, mitral and aortic valve gradients increase without significant changes in valve area that are more marked between the second and first trimester than between the third and second trimester. Copyright © 2016 Elsevier Inc. All rights reserved.

[Aortic infective endocarditis: Value of surgery. About 48 cases].

Science.gov (United States)

Tribak, M; Konaté, M; Elhassani, A; Mahfoudi, L; Jaabari, I; Elkenassi, F; Boutayeb, A; Lachhab, F; Filal, J; Maghraoui, A; Bensouda, A; Marmade, L; Moughil, S

2016-02-01

Infective endocarditis (IE) is a serious disease whose prognosis depends on early management. Aortic location is characterized by its evolution toward myocardial failure and the high number of complications reasons for early surgery. To compare the short- and mid-terms results of surgery for aortic infective endocarditis (IE) in the active phase and the healed phase. We analyzed retrospectively the data of 48 consecutive patients operated for aortic infective endocarditis between January 2000 and January 2012. The data on operative mortality, morbidity and major cardiovascular events (mortality, recurrent endocarditis, reintervention, and stroke) were analyzed. Twenty-three patients (48%) underwent surgery during the active phase (group I), 19 on native and 4 on prosthetic valves, and 25 patients (52%) were operated during healed endocarditis (group II) only on native valve. Mean age was 39 years (12-81) with a male predominance (83%). Rheumatic valvular disease was the main etiology of underlying valvular disease in both groups (85%). The clinical feature was dominated by signs of cardiogenic shock in group I and dyspnea exertion stage III-IV NYHA in group II. Streptococcus and Staphylococcus germs were most frequently encountered. Indication for surgery was heart failure in group I, it was related to the symptoms, the severity of valvular disease and its impact on the left ventricle in group II. An aortic valve replacement with a mechanical prosthesis was performed in the majority of cases (83%). Postoperative mortality concerned only one patient in group I. Twenty-one patients (44%) were followed for a mean of 30 months (1-72). One patient in group II died following cerebral hemorrhagic stroke related to accident with vitamin K antagonist. In both groups, there was an improvement in the functional class. No recurrence of endocarditis was noted in both groups during follow-up. The prognosis of infective endocarditis of the aortic valve is severe due to the fast

Additive effects of lupin protein and phytic acid on aortic calcification in ApoE deficient mice

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Alexandra Schutkowski

2015-03-01

A two-factorial study with ApoE knockout mice was conducted in which mice received lupin protein isolate or casein with or without phytase. Phytic acid was added to the casein diets to a final concentration identical to the lupin protein diets. Here we show that the serum concentrations of cholesterol, lathosterol and desmosterol were lower and the faecal bile acid excretion was higher in the groups fed lupin proteins than in the groups fed casein (p < 0.05. Mice that received the lupin protein diet containing phytic acid were characterized by a lower aortic calcification than mice of the other three groups (p < 0.05. In conclusion, our results show that the cholesterol lowering properties of lupin protein isolate were not caused by phytic acid. However, the hypocalcific action of lupin proteins appears to depend on the combination of lupin proteins and phytic acid.

Automated Quantification of the Morphological Atherosclerotic Calcification Distribution on X-Rays Is a Strong Predictor of Mortality in Postmenopausal Women

DEFF Research Database (Denmark)

Christiansen, Claus; Karsdal, Morten; Lauze, Francois Bernard

2008-01-01

Background and Purpose: Aortic calcification is a major risk factor for cardiovascular disease (CVD) related deaths. We investigated the relation between mortality and aspects of number, size, morphology and distribution of calcified plaques in the lumbar aorta of postmenopausal women. Methods: 308...... women aged 48 to 76 were followed for 8.3+-0.3 years and cardiovascular, cancer and all-cause deaths were recorded. Several aortic calcification markers were quantified: number, morphology, distribution, from outlines of the calcified plaques in lumbar X-rays at baseline. These markers were compared...... to SCORE card, Framingham score, and the Aortic Calcification Severity score - AC24. Results: AC24 adjusted by age, waist circumference, and triglyceride levels predicted mortality in postmenopausal women (CVD p=0.03, All-cause p=0.006). The SCORE card and the Framingham score resulted in mortality odds...

Imaging technique and current status of valvular heart disease using cardiac MRI

International Nuclear Information System (INIS)

Lotz, J.; Sohns, J.M.

2013-01-01

The main indications for cardiac magnetic resonance imaging (MRI) in the evaluation of valvular heart disease are pathologies of the aortic and pulmonary valve. For mitral and tricuspid valve pathologies MRI is not the first line modality as these are usually well visualized by echocardiography. The advantages of MRI in valvular heart disease are a high reliability in the evaluation of ventricular volumes and function as well as the assessment of the perivalvular arterial or atrial structures. This reliability and the limitless access to any imaging plane partially compensates for the lower temporal and spatial resolution in comparison to echocardiography. In patients with congenital heart disease, cardiac MRI is established as a valuable diagnostic tool in daily clinical management, especially for the evaluation of pulmonary valve defects. Nevertheless, echocardiography remains the first-line diagnostic imaging tool for the foreseeable future. (orig.) [de

Expression of uPA, tPA, and PAI-1 in Calcified Aortic Valves

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Najlah Kochtebane

2014-01-01

Full Text Available Purpose. Our physiopathological assumption is that u-PA, t-PA, and PAI-1 are released by calcified aortic valves and play a role in the calcification of these valves. Methods. Sixty-five calcified aortic valves were collected from patients suffering from aortic stenosis. Each valve was incubated for 24 hours in culture medium. The supernatants were used to measure u-PA, t-PA, and PAI-1 concentrations; the valve calcification was evaluated using biphotonic absorptiometry. Results. Aortic stenosis valves expressed normal plasminogen activators concentrations and overexpressed PAI-1 (u-PA, t-PA, and PAI-1 mean concentrations were, resp., 1.69 ng/mL ± 0.80, 2.76 ng/mL ± 1.33, and 53.27 ng/mL ± 36.39. There was no correlation between u-PA and PAI-1 (r=0.3 but t-PA and PAI-1 were strongly correlated with each other (r=0.6. Overexpression of PAI-1 was proportional to the calcium content of the AS valves. Conclusions. Our results demonstrate a consistent increase of PAI-1 proportional to the calcification. The overexpression of PAI-1 may be useful as a predictive indicator in patients with aortic stenosis.

[Valve-sparing Replacement in Patients with Aortic Root Dilatation].

Science.gov (United States)

Yamazaki, Kazuhiro; Minatoya, Kenji; Ueda, Ryoma; Takehara, Masato; Sakamoto, Kazuhisa; Ide, Yujiro; Kanemitsu, Hideo; Ueyama, Koji; Ikeda, Tadashi

2018-01-01

Valve-sparing root replacement is increasingly used to overcome drawbacks associated with valvular prostheses. In our institution, 7 patients underwent valve-sparing root replacement from August 2016 to July 2017. The mean age was 45 years (range, 14~69 years). Three patients had Marfan syndrome and 1 had Loeys-Dietz syndrome with acute aortic dissection. All patients underwent surgery with reimplantation technique using a Valsalva graft. Two patients required repair of aortic valve leaflet prolapse. All patients had an excellent clinical course, with mild or no aortic regurgitation and a decrease in end-diastolic volume on echocardiography. These results support the continued use of valve-sparing root replacement in selected patients.

Relation of aortic calcification, wall thickness, and distensibility with severity of coronary artery disease: evaluation with coronary CT angiography

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Jang, Seonah; Yong, Hwan Seok; Doo, Kyung Won; Kang, Eun-Young; Woo, Ok Hee; Choi, Eun Jung [Dept. of Radiology, Korea Univ. Guro Hospital, Korea Univ. College of Medicine, Seoul (Korea, Republic of)], e-mail: yhwanseok@naver.com

2012-10-15

Background Three known risk factors for aortic atherosclerosis predict the severity of coronary artery disease (CAD): aortic calcification (AC), aortic wall thickness (AWT), and aortic distensibility (AD). Purpose To determine the relationship of AC, AWT, and AD with the severity of CAD. Material and Methods A total of 104 patients who underwent both coronary CT angiography (CCTA) and invasive coronary angiography were enrolled. The severity of CAD was assessed by three methods: the segment involvement score (SIS), the segment stenosis score (SSS), and the modified Gensini score (mG). We quantified AC using the Agatston method on low-dose ungated chest CT (LDCT). We measured AWT at the thickest portion of the descending thoracic aorta on CCTA. AD was calculated as the difference between the maximum and minimum areas of the ascending aorta and the pulse pressure. The relationships between the severity of CAD and the three aortic factors were assessed. Results The AC and AWT of the thoracic aorta were significantly higher in the occlusive CAD (OCAD) group (1984.21 {+-} 2986.10 vs. 733.00 {+-} 1648.71, P = 0.01; 4.13 {+-} 1.48 vs. 3.40 {+-} 1.01, P = 0.22). Patients with OCAD had more than one epicardial coronary artery with >50% luminal stenosis. The AC (r = 0.453 with SIS; r = 0.454 with SSS; r = 0.427 with mG) and the AWT (r = 0.279 with SIS; r = 0.324 with SSS; r = 0.304 with mG) were significantly correlated with all three methods, and the AD was negatively correlated with the SIS (r = - 0.221, P < 0.05, respectively) in the unadjusted model. After adjustment for cardiovascular risk factors, only the correlations between AC and all three methods assessing CAD remained significant. Conclusion There are significant relationships between AC, AWT and AD and severity of CAD. In particular, AC measured on LDCT is the most consistent predictor of severity of CAD.

Altered aortic shape in bicuspid aortic valve relatives influences blood flow patterns.

Science.gov (United States)

Schnell, Susanne; Smith, Danielle A; Barker, Alex J; Entezari, Pegah; Honarmand, Amir R; Carr, Maria L; Malaisrie, S Chris; McCarthy, Patrick M; Collins, Jeremy; Carr, James C; Markl, Michael

2016-11-01

Bicuspid aortic valve (BAV) is known to exhibit familial inheritance and is associated with aortopathy and altered aortic haemodynamics. However, it remains unclear whether BAV-related aortopathy can be inherited independently of valve morphology. Four-dimensional flow magnetic resonance imaging for the in vivo assessment of thoracic aortic 3D blood flow was performed in 24 BAV relatives with trileaflet aortic valves (age = 40 ± 14 years) and 15 healthy controls (age = 37 ± 10 years). Data analysis included aortic dimensions, shape (round/gothic/cubic), and 3D blood flow characteristics (semi-quantitative vortex/helix grading and peak velocities). Cubic and gothic aortic shapes were markedly more prevalent in BAV relatives compared with controls (38 vs. 7%). Ascending aorta (AAo) vortex flow in BAV relatives was significantly increased compared with controls (grading = 1.5 ± 1.0 vs. 0.6 ± 0.9, P = 0.015). Aortic haemodynamics were influenced by aortic shape: peak velocities were reduced for gothic aortas vs. round aortas (P = 0.003); vortex flow was increased for cubic aortas in the AAo (P gothic aortas in the AAo and descending aorta (P = 0.003, P = 0.029). Logistic regression demonstrated significant associations of shape with severity of vortex flow in AAo (P < 0.001) and aortic arch (P = 0.016) in BAV relatives. BAV relatives expressed altered aortic shape and increased vortex flow despite the absence of valvular disease or aortic dilatation. These data suggest a heritable component of BAV-related aortopathy affecting aortic shape and aberrant blood flow, independent of valve morphology. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Neonatal aortic stenosis.

Science.gov (United States)

Drury, Nigel E; Veldtman, Gruschen R; Benson, Lee N

2005-09-01

Neonatal aortic stenosis is a complex and heterogeneous condition, defined as left ventricular outflow tract obstruction at valvular level, presenting and often requiring treatment in the first month of life. Initial presentation may be catastrophic, necessitating hemodynamic, respiratory and metabolic resuscitation. Subsequent management is focused on maintaining systemic blood flow, either via a univentricular Norwood palliation or a biventricular route, in which the effective aortic valve area is increased by balloon dilation or surgical valvotomy. In infants with aortic annular hypoplasia but adequately sized left ventricle, the Ross-Konno procedure is also an attractive option. Outcomes after biventricular management have improved in recent years as a consequence of better patient selection, perioperative management and advances in catheter technology. Exciting new developments are likely to significantly modify the natural history of this disorder, including fetal intervention for the salvage of the hypoplastic left ventricle; 3D echocardiography providing better definition of valve morphology and aiding patient selection for a surgical or catheter-based intervention; and new transcutaneous approaches, such as duel beam echo, to perforate the valve.

Automated quantitative 3D analysis of aorta size, morphology, and mural calcification distributions

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Kurugol, Sila, E-mail: sila.kurugol@childrens.harvard.edu; Come, Carolyn E.; Diaz, Alejandro A.; Ross, James C.; Washko, George R.; San Jose Estepar, Raul [Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts 02115 (United States); Kinney, Greg L.; Black-Shinn, Jennifer L.; Hokanson, John E. [Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado 80045 (United States); Budoff, Matthew J. [Los Angeles Biomedical Research Center at Harbor and UCLA Medical Center, Torrance, California 90502 (United States)

2015-09-15

Purpose: The purpose of this work is to develop a fully automated pipeline to compute aorta morphology and calcification measures in large cohorts of CT scans that can be used to investigate the potential of these measures as imaging biomarkers of cardiovascular disease. Methods: The first step of the automated pipeline is aorta segmentation. The algorithm the authors propose first detects an initial aorta boundary by exploiting cross-sectional circularity of aorta in axial slices and aortic arch in reformatted oblique slices. This boundary is then refined by a 3D level-set segmentation that evolves the boundary to the location of nearby edges. The authors then detect the aortic calcifications with thresholding and filter out the false positive regions due to nearby high intensity structures based on their anatomical location. The authors extract the centerline and oblique cross sections of the segmented aortas and compute the aorta morphology and calcification measures of the first 2500 subjects from COPDGene study. These measures include volume and number of calcified plaques and measures of vessel morphology such as average cross-sectional area, tortuosity, and arch width. Results: The authors computed the agreement between the algorithm and expert segmentations on 45 CT scans and obtained a closest point mean error of 0.62 ± 0.09 mm and a Dice coefficient of 0.92 ± 0.01. The calcification detection algorithm resulted in an improved true positive detection rate of 0.96 compared to previous work. The measurements of aorta size agreed with the measurements reported in previous work. The initial results showed associations of aorta morphology with calcification and with aging. These results may indicate aorta stiffening and unwrapping with calcification and aging. Conclusions: The authors have developed an objective tool to assess aorta morphology and aortic calcium plaques on CT scans that may be used to provide information about the presence of cardiovascular

[Cardiac valvular disease and pregnancy. Haemodynamic aspects and importance of decubitus].

Science.gov (United States)

Lo Cicero, G; Cellina, G; Brina, A

1982-01-01

During the 3rd trimester of pregnancy, 26 women with aortic or mitral valve disease (II class NYHA) have undergone bedside right heart catheterization. Total pulmonary resistances (RPT) have been studied in supine (DS) and lateral (DL) decubitus. The results are compared with those of 7 normal women. It is known that the change from the supine to the lateral posture increases venous return (and cardiac output) by removing the compression which the pregnant uterus causes to the inferior vena cava. This is achieved without increasing the mean pulmonary pressure (PPM) and total pulmonary resistances (RPT); women with mitral and aortic stenosis have little or no increase of cardiac output but always a marked increase of PPM and RPT; the response in patients with aortic and mitral incompetence is closer to normal; an intermediate response was observed in patients with a mitral stenosis and insufficiency. The valvular heart diseases with stenosis badly tolerate the increased cardiovascular burden of pregnancy and are unable to accommodate the increased venous return induced by postural changes, which induces marked elevation of pulmonary pressure and resistances.

Bone Morphogenetic Proteins 2/4 Are Upregulated during the Early Development of Vascular Calcification in Chronic Kidney Disease

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Xiao Wei

2018-01-01

Full Text Available Vascular calcification is a main cause of increased cardiovascular morbidity and mortality in chronic kidney disease (CKD patients. This study aimed to investigate the role of the bone morphogenetic protein (BMP signaling pathway in the early development of vascular calcification in CKD. A CKD vascular calcification rat model was established by providing rats with a 1.8% high-phosphorus diet and an intragastric administration of 2.5% adenine suspension. The kidney and aortic pathologies were analyzed. Blood biochemical indicators, serum BMP-2 and BMP-4 levels, and aortic calcium content were determined. The expression levels of BMP-2, BMP-4, bone morphogenetic protein receptor-IA (BMPR-IA, and matrix Gla protein (MGP in aorta were examined by quantitative real-time polymerase chain reaction and immunohistochemistry. Compared with the normal control (Nor rats, the CKD rats exhibited a significantly decreased body weight and an increased kidney weight as well as abnormal renal function and calcium-phosphorus metabolism. Aortic von Kossa and Alizarin red staining showed massive granular deposition and formation of calcified nodules in aorta at 8 weeks. The aortic calcium content was significantly increased, which was positively correlated with the serum BMP-2 (r=0.929; P<0.01 and serum BMP-4 (r=0.702; P<0.01 levels in CKD rats. The rat aortic BMP-2 mRNA level in the CKD rats was persistently increased, and the BMP-4 mRNA level was prominently increased at the 4th week, declining thereafter. Strong staining of BMP-2, BMP-4, BMPR-IA, and MGP proteins was observed in the tunica media of the aorta from the 4th week after model induction. In conclusion, activation of the BMP signaling pathway is involved in the early development of vascular calcification in CKD. Therefore, elevated serum BMP-2 and BMP-4 levels may serve as serum markers for CKD vascular calcification.

Automated aortic calcium scoring on low-dose chest computed tomography

International Nuclear Information System (INIS)

Isgum, Ivana; Rutten, Annemarieke; Prokop, Mathias; Staring, Marius; Klein, Stefan; Pluim, Josien P. W.; Viergever, Max A.; Ginneken, Bram van

2010-01-01

Purpose: Thoracic computed tomography (CT) scans provide information about cardiovascular risk status. These scans are non-ECG synchronized, thus precise quantification of coronary calcifications is difficult. Aortic calcium scoring is less sensitive to cardiac motion, so it is an alternative to coronary calcium scoring as an indicator of cardiovascular risk. The authors developed and evaluated a computer-aided system for automatic detection and quantification of aortic calcifications in low-dose noncontrast-enhanced chest CT. Methods: The system was trained and tested on scans from participants of a lung cancer screening trial. A total of 433 low-dose, non-ECG-synchronized, noncontrast-enhanced 16 detector row examinations of the chest was randomly divided into 340 training and 93 test data sets. A first observer manually identified aortic calcifications on training and test scans. A second observer did the same on the test scans only. First, a multiatlas-based segmentation method was developed to delineate the aorta. Segmented volume was thresholded and potential calcifications (candidate objects) were extracted by three-dimensional connected component labeling. Due to image resolution and noise, in rare cases extracted candidate objects were connected to the spine. They were separated into a part outside and parts inside the aorta, and only the latter was further analyzed. All candidate objects were represented by 63 features describing their size, position, and texture. Subsequently, a two-stage classification with a selection of features and k-nearest neighbor classifiers was performed. Based on the detected aortic calcifications, total calcium volume score was determined for each subject. Results: The computer system correctly detected, on the average, 945 mm 3 out of 965 mm 3 (97.9%) calcified plaque volume in the aorta with an average of 64 mm 3 of false positive volume per scan. Spearman rank correlation coefficient was ρ=0.960 between the system and the

Valvular heart disease

OpenAIRE

Gelson, E; Gatzoulis, M; Johnson, M

2007-01-01

Valvular disease may be unmasked in pregnancy when physiological changes increase demands on the heart. Women with valvular heart disease require close follow-up during pregnancy, delivery, and postpartum

Aortic root repair for thoracic aorta false aneurysm following Bentall procedure.

Science.gov (United States)

Kumar, Sanjay; Jones, Steve; Sivananthan, U M; McGoldrick, J P

2008-08-01

The Bentall procedure for aortic root replacement in Marfan's syndrome is safe and durable. We describe successful repair of periprosthetic valvular leak, 12 years following Bentall repair with composite graft. The aim of this report is to analyse and evaluate technical factors leading to this unusual occurrence.

Bicuspid Aortic Valve Stenosis and the Effect of Vitamin K2 on Calcification Using 18F-Sodium Fluoride Positron Emission Tomography/Magnetic Resonance: The BASIK2 Rationale and Trial Design.

Science.gov (United States)

Peeters, Frederique E C M; van Mourik, Manouk J W; Meex, Steven J R; Bucerius, Jan; Schalla, Simon M; Gerretsen, Suzanne C; Mihl, Casper; Dweck, Marc R; Schurgers, Leon J; Wildberger, Joachim E; Crijns, Harry J G M; Kietselaer, Bas L J H

2018-03-21

BASIK2 is a prospective, double-blind, randomized placebo-controlled trial investigating the effect of vitamin K2 (menaquinone-7;MK7) on imaging measurements of calcification in the bicuspid aortic valve (BAV) and calcific aortic valve stenosis (CAVS). BAV is associated with early development of CAVS. Pathophysiologic mechanisms are incompletely defined, and the only treatment available is valve replacement upon progression to severe symptomatic stenosis. Matrix Gla protein (MGP) inactivity is suggested to be involved in progression. Being a vitamin K dependent protein, supplementation with MK7 is a pharmacological option for activating MGP and intervening in the progression of CAVS. Forty-four subjects with BAV and mild-moderate CAVS will be included in the study, and baseline 18 F-sodiumfluoride ( 18 F-NaF) positron emission tomography (PET)/ magnetic resonance (MR) and computed tomography (CT) assessments will be performed. Thereafter, subjects will be randomized (1:1) to MK7 (360 mcg/day) or placebo. During an 18-month follow-up period, subjects will visit the hospital every 6 months, undergoing a second 18 F-NaF PET/MR after 6 months and CT after 6 and 18 months. The primary endpoint is the change in PET/MR 18 F-NaF uptake (6 months minus baseline) compared to this delta change in the placebo arm. The main secondary endpoints are changes in calcium score (CT), progression of the left ventricularremodeling response and CAVS severity (echocardiography). We will also examine the association between early calcification activity (PET) and later changes in calcium score (CT).

Targeted reduction of vascular Msx1 and Msx2 mitigates arteriosclerotic calcification and aortic stiffness in LDLR-deficient mice fed diabetogenic diets.

Science.gov (United States)

Cheng, Su-Li; Behrmann, Abraham; Shao, Jian-Su; Ramachandran, Bindu; Krchma, Karen; Bello Arredondo, Yoanna; Kovacs, Attila; Mead, Megan; Maxson, Robert; Towler, Dwight A

2014-12-01

When fed high-fat diets, male LDLR(-/-) mice develop obesity, hyperlipidemia, hyperglycemia, and arteriosclerotic calcification. An osteogenic Msx-Wnt regulatory program is concomitantly upregulated in the vasculature. To better understand the mechanisms of diabetic arteriosclerosis, we generated SM22-Cre;Msx1(fl/fl);Msx2(fl/fl);LDLR(-/-) mice, assessing the impact of Msx1+Msx2 gene deletion in vascular myofibroblast and smooth muscle cells. Aortic Msx2 and Msx1 were decreased by 95% and 34% in SM22-Cre;Msx1(fl/fl);Msx2(fl/fl);LDLR(-/-) animals versus Msx1(fl/fl);Msx2(fl/fl);LDLR(-/-) controls, respectively. Aortic calcium was reduced by 31%, and pulse wave velocity, an index of stiffness, was decreased in SM22-Cre;Msx1(fl/fl);Msx2(fl/fl);LDLR(-/-) mice vs. controls. Fasting blood glucose and lipids did not differ, yet SM22-Cre;Msx1(fl/fl);Msx2(fl/fl);LDLR(-/-) siblings became more obese. Aortic adventitial myofibroblasts from SM22-Cre;Msx1(fl/fl);Msx2(fl/fl);LDLR(-/-) mice exhibited reduced osteogenic gene expression and mineralizing potential with concomitant reduction in multiple Wnt genes. Sonic hedgehog (Shh) and Sca1, markers of aortic osteogenic progenitors, were also reduced, paralleling a 78% reduction in alkaline phosphatase (TNAP)-positive adventitial myofibroblasts. RNA interference revealed that although Msx1+Msx2 supports TNAP and Wnt7b expression, Msx1 selectively maintains Shh and Msx2 sustains Wnt2, Wnt5a, and Sca1 expression in aortic adventitial myofibroblast cultures. Thus, Msx1 and Msx2 support vascular mineralization by directing the osteogenic programming of aortic progenitors in diabetic arteriosclerosis. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population.

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Willemink, Martin J; Takx, Richard A P; Išgum, Ivana; de Koning, Harry J; Oudkerk, Matthijs; Mali, Willem P Th M; Budde, Ricardo P J; Leiner, Tim; Vliegenthart, Rozemarijn; de Jong, Pim A

2015-08-01

To assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced low-radiation-dose chest CT for lung cancer screening were included. Non-imaging predictors (age, smoking status and pack-years) were collected and imaging-predictors (calcium volume of the coronary arteries, aorta, aortic valve and mitral valve/annulus) were obtained. The outcome was the occurrence of cardiovascular events. Multivariable Cox proportional-hazards regression was used to calculate hazard-ratios (HRs) with 95% confidence interval (CI). Subsequently, concordance-statistics were calculated. In total 3111 individuals were included, of whom 186 (6.0%) developed a cardiovascular event during a follow-up of 2.9 (Q1-Q3, 2.7-3.3) years. If aortic (n = 657) or mitral (n = 85) annulus/valve calcifications were present, cardiovascular event incidence increased to 9.0% (n = 59) or 12.9% (n = 11), respectively. HRs of aortic and mitral valve/annulus calcium volume for cardiovascular events were 1.46 (95% CI, 1.09-1.84) and 2.74 (95% CI, 0.92-4.56) per 500 mm(3). The c-statistic of a basic model including age, pack-years, current smoking status, coronary and aorta calcium volume was 0.68 (95% CI, 0.63-0.72), which did not change after adding heart valve calcium volume. Aortic valve calcifications are predictors of future cardiovascular events. However, there was no added prognostic value beyond age, number of pack-years, current smoking status, coronary and aorta calcium volume for short term cardiovascular events.

Valvular Heart Disease in Patients ≥80 Years of Age.

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Kodali, Susheel K; Velagapudi, Poonam; Hahn, Rebecca T; Abbott, Dawn; Leon, Martin B

2018-05-08

In the United States, the octogenarian population is projected to triple by 2050. With this aging population, the prevalence of valvular heart disease (VHD) is on the rise. The etiology, approach to treatment, and expected outcomes of VHD are different in the elderly compared with younger patients. Both stenotic and regurgitant lesions are associated with unfavorable outcomes if left untreated. Surgical mortality remains high due to multiple co-morbidities, and long-term survival benefit is dependent on many variables including valvular pathology. Quality of life is an important consideration in treatment decisions in this age group. Increasingly, octogenarian patients are receiving transcatheter therapies, with transcatheter aortic valve replacement having the greatest momentum. Numerous transcatheter devices for management of other valve lesions are currently in early clinical trials. This review will describe the epidemiology, etiology, diagnosis, and therapeutic options for VHD in the oldest old, with a focus on transcatheter technologies. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

The importance of echocardiography in transcatheter aortic valve implantation.

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

2014-01-01

Valvular heart diseases cause serious health problems in Turkey as well as in Western countries. According to a study conducted in Turkey, aortic stenosis (AS) is second after mitral valve disease among all valvular heart diseases. AS is frequently observed in elderly patients who have several cardiovascular risk factors and comorbidities. In symptomatic severe AS, surgical aortic valve replacement (AVR) is a definitive treatment. However, in elderly patients with left ventricular dysfunction and comorbidities, the risk of operative morbidity and mortality increases and outweighs the gain obtained from AVR surgery. As a result, almost one-third of the patients with serious AS are considered ineligible for surgery. Transcatheter aortic valve implantation (TAVI) is an effective treatment in patients with symptomatic severe AS who have high risk for conventional surgery. Since being performed for the first time in 2002, with a procedure success rate reported as 95% and a mortality rate of 5%, TAVI has become a promising method. Assessment of vascular anatomy, aortic annular diameter, and left ventricular function may be useful for the appropriate selection of patients and may reduce the risk of complications. Cardiac imaging methods including 2D and 3D echocardiography and multidetector computed tomography are critical during the evaluation of suitable patients for TAVI as well as during and after the procedure. In this review, we describe the role of echocardiography methods in clinical practice for TAVI procedure in its entirety, i.e. from patient selection to guidance during the procedure, and subsequent monitoring. © 2013, Wiley Periodicals, Inc.

Evaluation of myocardial damage and cardiac residual capacity by Tl-201 myocardial scintigraphy in valvular heart diseases

International Nuclear Information System (INIS)

Indo, Shunju

1992-01-01

This study was performed to clarify whether the extent-score (Ex-Score) calculated by Tl-201 myocardial scintigraphy is a reliable indicator of the severity of myocardial damage and cardiac residual capacity in valvular heart diseases. The subjects consisted of 38 patients (10 with aortic regurgitation (AR), 4 with aortic stenosis (AS), 13 with mitral regurgitation (MR) and 11 with mitral stenosis (MS)). Ex-Scores were significantly correlated with the severity of myocardial damage found in biopsied specimens obtained intraoperatively (correlation efficiency to Ex-Score with cell diameter in AR, % fibrosis in AR, cell diameter in AS, electron microscopic score in MR and % fibrosis in MS was 0.873, 0.734, 0.970, 0.913 and 0.659, respectively). Ex-Scores were also correlated with cardiac residual capacity determined by radioisotope angiography (correlation efficiency to Ex-Score with %Δ ejection fraction in AR, %Δ end-systolic volume in MR, %Δ end-diastolic volume in MS was -0.764, 0.790 and -0.763, respectively). These results suggest that the severity of myocardial damage and cardiac residual capacity can be estimated by Tl-201 myocardial scintigraphy (Ex-Score) in valvular heart diseases. (author)

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

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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.

Aortic valve replacement and prosthesis-patient mismatch in the era of trans-catheter aortic valve implantation.

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Morita, Shigeki

2016-08-01

The treatment strategy for aortic stenosis (AS) has been changing due to newly developed valvular prostheses and trans-catheter aortic valve implantation (TAVI). To determine the role of new modalities for AS with a small aortic root, papers using the concept of prosthesis-patient mismatch (PPM) were reviewed. First, to determine the cut-off value of the indexed effective orifice area (IEOA) for defining PPM, the studies of surgical aortic valve replacement (SAVR) with a follow-up longer than 5 years and a patient number larger than 500 were reviewed. Second, the papers comparing TAVI and SAVR were reviewed. Furthermore, the prevalence of PPM was reviewed, with the addition of papers on aortic root enlargement, sutureless AVR, and aortic valve reconstruction with autologous pericardium. The results of the long-term survival after aortic valve replacement (AVR) have indicated that an IEOA less than 0.65 cm(2)/m(2) should be avoided in all cases, whereas the indications for patients with an IEOA between 065 and 0.85 cm(2)/m(2) should be determined by considering multiple factors. A large body size and younger age have a significantly negative influence on the long-term survival. In Asian population, the prevalence of PPM was low, despite the fact that the size of the aortic annulus was small. The IEOA after TAVI was larger than after surgical AVR in population-matched studies. To evaluate the role of TAVI and other modalities for a small aortic root, studies with a longer follow-up and larger volume are thus warranted.

Fruit Intake and Abdominal Aortic Calcification in Elderly Women: A Prospective Cohort Study

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Bondonno, Nicola P.; Lewis, Joshua R.; Prince, Richard L.; Lim, Wai H.; Wong, Germaine; Schousboe, John T.; Woodman, Richard J.; Kiel, Douglas P.; Bondonno, Catherine P.; Ward, Natalie C.; Croft, Kevin D.; Hodgson, Jonathan M.

2016-01-01

Cardiovascular disease (CVD) is the leading cause of death worldwide. There is a consistent inverse relationship between fruit intake with CVD events and mortality in cross-sectional and prospective observational studies, but the relationship of fruit intake with measurements of atherosclerosis in humans is less clear. Nutritional effects on abdominal aortic calcification (AAC), a marker for subclinical intimal and medial atherosclerotic vascular disease, have not been studied previously. The aim of this study was to examine the cross-sectional relationship of total and individual fruit (apple, pear, orange and other citrus, and banana) intake with AAC, scored between 0 and 24. The current study assessed baseline data for a cohort of 1052 women over 70 years of age who completed both a food frequency questionnaire assessing fruit intake, and underwent AAC measurement using dual energy X-ray absorptiometry. AAC scores were significantly negatively correlated with total fruit and apple intakes (p 0.25). In multivariable-adjusted logistic regression, each standard deviation (SD; 50 g/day) increase in apple intake was associated with a 24% lower odds of having severe AAC (AAC score >5) (odd ratio OR): 0.76 (0.62, 0.93), p = 0.009). Total and other individual fruit intake were not associated with increased odds of having severe AAC. Apple but not total or other fruit intake is independently negatively associated with AAC in older women. PMID:26978394

Exercise stress echocardiography in patients with valvular heart disease.

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Sharma, Vishal; Newby, David E; Stewart, Ralph A H; Lee, Mildred; Gabriel, Ruvin; Van Pelt, Niels; Kerr, Andrew J

2015-09-01

Stress echocardiography is recommended for the assessment of asymptomatic patients with severe valvular heart disease (VHD) when there is discrepancy between symptoms and resting markers of severity. The aim of this study is to determine the prognostic value of exercise stress echocardiography in patients with common valve lesions. One hundred and fifteen patients with VHD (aortic stenosis (n=28); aortic regurgitation (n=35); mitral regurgitation, (n=26); mitral stenosis (n=26)), and age- and sex-matched controls (n=39) with normal ejection fraction underwent exercise stress echocardiography. The primary endpoint was a composite of death or hospitalization for heart failure. Asymptomatic VHD patients had lower exercise capacity than controls and 37% of patients achieved 60 mmHg) was associated with an increased risk of death or hospital admission (14% vs 1%, P<0.0001). The assessment of contractile reserve did not offer additional predictive value. In conclusion, an abnormal stress echocardiogram is associated with death and hospitalization with heart failure at 2 years. Stress echocardiography should be considered as part of the routine follow-up of all asymptomatic patients with VHD.

Calcification of the mitral valve and annulus: systematic evaluation of effects on valve anatomy and function.

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Movva, Rajesh; Murthy, Kinnari; Romero-Corral, Abel; Seetha Rammohan, Harish Raj; Fumo, Peter; Pressman, Gregg S

2013-10-01

Mitral annular calcification (MAC) is common in chronic kidney disease. It is associated with cardiovascular events and can cause valvular dysfunction, but it has not been systematically characterized. The aim of this prospective study was to assess the prevalence and distribution of MAC, its effects on leaflet motion, and its association with mitral stenosis and mitral regurgitation (MR) in a hemodialysis population. Echocardiograms were obtained in 75 consecutive hemodialysis outpatients. MAC extent and distribution were graded semiquantitatively using two-dimensional and three-dimensional echocardiography. Associations with the presence and severity of mitral stenosis and MR were explored. The mean age was 60 ± 14 years; 60% were men, and 87% were African American. MAC was present in 64% (moderate to severe in 48%). Calcium extended more than halfway onto the leaflet in 37% and beyond the annulus in 40%. Leaflet motion was restricted in 37%. Mitral stenosis was present in 28%, and the extent of calcification was associated with mean mitral valve gradient (P < .0001). MR was prevalent (present in 81%) but was severe in none. The severity of MAC was greater in patients with moderate MR than in those with no or mild MR (P = .04). Three-dimensional analysis suggested an uneven distribution of annular calcium; the middle and lateral anterior segments were less often calcified than the anterior-medial or posterior segments. Calcification in any annular segment was highly associated with restricted motion of the attached leaflet segment. MAC is common and often extensive in hemodialysis patients. Calcium may be unevenly distributed among the annular segments. When present, annular calcification reduces the angle of leaflet opening and can cause valvular dysfunction. Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.

Cirurgia das dissecções crónicas da aorta ascendente com insuficiência valvar Surgery of chronic aortic dissection with aortic insufficiency

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Paulo M Pêgo-Fernandes

1990-12-01

menor índice de complicações a médio prazo do que a substituição valvar; 2 a identificação do mecanismno da insuficiência valvar é fundamental para decisão da tática operatória; 3 o uso da cola biológica facilita o manuseio da aorta e pode diminuir o sangramento intra-operatório; 4 quando é necessária a substituição valvar tem-se preferido empregar prótese mecânica dada a maior dificuldade técnica na reoperaçáo nesses pacientes; 5 a aortoplastia não deve ser utilizada devido à alta incidência de redissecção aórtica.In the period of January 1980 to December 1988, 44 patients with chronic aortic dissections and aortic insufficiency were operated on. This group of patients was analized in order to evaluate the evolution of those in which the aortic valve was preserved compared to the group of patients submitted to valvular replacement. The overall preoperative characteristics of these two groups were similar. Valvular replacement was the elected procedure in cases of valvular degeneration or of aortic annular ectasia. In cases of cusp prolapse with enlarged annulus a plastic procedure was used; in 48% of the cases it was possible to preserve the valve. In the 23 patients submitted to valve replacement, the Bentall and De Bono technique was utilized. In six patientes other surgical procedures were associated. Biological adhesives were utilized in every patient operated on from 1986 on. In 41 patients (93% the proximal aorta was substituted and in the remaining three an aortoplasty was performed. Five patients (11% had hospitalar deaths, three due to low-output syndrome, one due to bleeding and one on account of neurological complications. Late death occurred in two patients (4%. The follow-up of the 37 surviving patients varied from two to 108 months (mean: 18 months; of these, 78% were in fuctional class I, and the others in class II. Two patients that had their aortic valve preserved presented mild aortic insufficiency. Three patients with

PREVALENCE AND PREDICTORS OF CORONARY ARTERY DISEASE IN SEVERE AORTIC STENOSIS PATIENTS UNDERGOING SURGERY

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Narayanapilai Jayaprasad

2017-09-01

Full Text Available BACKGROUND The present study is to find out the prevalence of CAD in severe Aortic Stenosis (AS patients undergoing aortic valve replacement and the relation between the conventional risk factors and CAD in them. Calcific aortic stenosis is associated with the same risk factors as coronary artery disease. Studies on calcific aortic stenosis and CAD are rarely reported from India. The aim of the study is to find out the predictive value of angina for presence of CAD in severe aortic stenosis. MATERIALS AND METHODS All cases of isolated severe aortic stenosis undergoing CAG before aortic valve replacement were included in the study. Data regarding various risk factors, symptoms, echocardiographic parameters and angiographic profile were collected. RESULTS Among a total of 94 patients who have undergone aortic valve replacement for severe AS 40 (42.6% had CAD. Risk factors like advanced age, hypertension, diabetes and smoking were more in patients with CAD compared to isolate AS. Mean gradient was more in the AS + CAD group compared with AS group. Presence of angina had a sensitivity of 82.5% and specificity of 51.85% for predicting coexisting CAD. CONCLUSION Among severe aortic stenosis, patients undergoing AVR 42.6% of patients had significant obstructive CAD. The conventional risk factors predict presence of coronary artery disease. Angina has got a fairly good sensitivity, but moderate specificity for CAD.

Valvular Heart Disease.

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Mrsic, Zorana; Hopkins, Scott P; Antevil, Jared L; Mullenix, Philip S

2018-03-01

This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate referral. Echocardiography is the gold standard for diagnosis and severity grading. Patients with progressive valvular heart disease should be followed annually by cardiology and imaging should be performed based on the severity of valvular dysfunction. Surgery or intervention is recommended only when symptoms dictate or when changes in left ventricular function occur. Surgery or intervention should be performed after discussion by a heart team, including cardiologists and cardiac surgeons. Published by Elsevier Inc.

Genome-wide analysis yields new loci associating with aortic valve stenosis

DEFF Research Database (Denmark)

Helgadottir, Anna; Thorleifsson, Gudmar; Gretarsdottir, Solveig

2018-01-01

Aortic valve stenosis (AS) is the most common valvular heart disease, and valve replacement is the only definitive treatment. Here we report a large genome-wide association (GWA) study of 2,457 Icelandic AS cases and 349,342 controls with a follow-up in up to 4,850 cases and 451,731 controls...

Medtronic Freestyle aortic bioprosthesis: a potential option for haemodialysis patients†.

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Hegazy, Yasser Y; Rayan, Amr; Sodian, Ralf; Hassanein, Wael; Ennker, Jürgen

2016-04-01

End-stage renal disease patients on regular haemodialysis are at higher risk of calcification. Therefore, many surgeons have concerns regarding the implantation of bioprostheses in such patients. The haemodynamic advantages of stentless aortic bioprostheses support their use; however, these have not been studied yet in end-stage renal disease patients. We studied accordingly the early and mid-term outcomes of aortic valve replacement (AVR) using Medtronic Freestyle stentless aortic bioprostheses in this subset of patients in comparison with stented aortic bioprostheses. We retrospectively studied two groups of consecutive patients on regular haemodialysis who required AVR between 2007 and 2013. Non-Freestyle (NFS) group received stented aortic bioprostheses (36 patients) and Freestyle (FS) group received Medtronic Freestyle aortic bioprostheses (48 patients). Follow-up ranged from 2 to 76 months with a mean follow-up of 36.3 ± 25 months. Patients in both groups showed similar demographic characters regarding age (76.4 ± 8.1 vs 74.9 ± 7.2 years; P = 0.35), male gender (58 vs 60%; P = 0.57) and diabetes mellitus (42 vs 48%; P = 0.57). Smaller aortic bioprostheses were implanted in the NFS (23.3 ± 1.2 vs 25.4 ± 2.1; P < 0.001) with consequently higher postoperative mean gradients (14.1 ± 4.1 vs 11.9 ± 5.3 mmHg; P = 0.004). No significant differences were noted regarding postoperative neurological disorder (8 vs 12%; P = 0.73), deep sternal wound infection (3 vs 4%; P = 0.68), re-exploration (8 vs 8%; P = 0.91) and in-hospital mortality (6 vs 4%; P = 0.92). Mid-term follow-up showed higher prosthetic valve calcification and/or sclerosis in NFS group (25 vs 6%; P = 0.015), whereas no significant differences were noticed between the two groups regarding stroke (0 vs 8%; P = 0.13), endocarditis (0 vs 4%; P = 0.50), 36- and 72-month survival (51 ± 2%, 14 ± 4% vs 55 ± 2%, 19 ± 3%, respectively; P = 0.45). Aortic bioprostheses are a good option for haemodialysis

Hydroxyapatite and Calcified Elastin Induce Osteoblast-like Differentiation in Rat Aortic Smooth Muscle Cells

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Lei, Yang; Sinha, Aditi; Nosoudi, Nasim; Grover, Ankit; Vyavahare, Naren

2014-01-01

Vascular calcification can be categorized into two different types. Intimal calcification related to atherosclerosis and elastin-specific medial arterial calcification (MAC). Osteoblast-like differentiation of vascular smooth muscle cells (VSMCs) has been shown in both types; however, how this relates to initiation of vascular calcification is unclear. We hypothesize that the initial deposition of hydroxyapatite-like mineral in MAC occurs on degraded elastin first and that causes osteogenic transformation of VSMCs. To test this, rat aortic smooth muscle cells (RASMCs) were cultured on hydroxyapatite crystals and calcified aortic elastin. Using RT-PCR and specific protein assays, we demonstrate that RASMCs lose their smooth muscle lineage markers like alpha smooth muscle actin (SMA) and myosin heavy chain (MHC) and undergo chondrogenic/osteogenic transformation. This is indicated by an increase in the expression of typical chondrogenic proteins such as aggrecan, collagen type II alpha 1(Col2a1) and bone proteins such as runt-related transcription factor 2 (RUNX2), alkaline phosphatase (ALP) and osteocalcin (OCN). Furthermore, when calcified conditions are removed, cells return to their original phenotype. Our data supports the hypothesis that elastin degradation and calcification precedes VSMCs' osteoblast-like differentiation. PMID:24447384

Association Between Gout and Aortic Stenosis.

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Chang, Kevin; Yokose, Chio; Tenner, Craig; Oh, Cheongeun; Donnino, Robert; Choy-Shan, Alana; Pike, Virginia C; Shah, Binita D; Lorin, Jeffrey D; Krasnokutsky, Svetlana; Sedlis, Steven P; Pillinger, Michael H

2017-02-01

An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis. We performed a retrospective case-control study. Aortic stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have aortic stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and aortic stenosis diagnosis. Among 1085 patients who underwent TTE, 112 aortic stenosis cases were identified. Cases and nonaortic stenosis controls (n = 224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n = 24) of aortic stenosis subjects compared with 12.5% (n = 28) of controls (unadjusted odds ratio 1.90, 95% confidence interval 1.05-3.48, P = .038). Multivariate analysis retained significance only for gout (adjusted odds ratio 2.08, 95% confidence interval 1.00-4.32, P = .049). Among subjects with aortic stenosis and gout, gout diagnosis preceded aortic stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of aortic stenosis was similar among patients with and without gout (78.7 ± 1.8 vs 75.8 ± 1.0 years old, P = .16). Aortic stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for, the development of aortic stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of aortic stenosis are warranted and could have therapeutic implications. Published by Elsevier Inc.

ESC Working Group on Valvular Heart Disease Position Paper: assessing the risk of interventions in patients with valvular heart disease

Science.gov (United States)

Rosenhek, Raphael; Iung, Bernard; Tornos, Pilar; Antunes, Manuel J.; Prendergast, Bernard D.; Otto, Catherine M.; Kappetein, Arie Pieter; Stepinska, Janina; Kaden, Jens J.; Naber, Christoph K.; Acartürk, Esmeray; Gohlke-Bärwolf, Christa

2012-01-01

Aims Risk scores provide an important contribution to clinical decision-making, but their validity has been questioned in patients with valvular heart disease (VHD), since current scores have been mainly derived and validated in adults undergoing coronary bypass surgery. The Working Group on Valvular Heart Disease of the European Society of Cardiology reviewed the performance of currently available scores when applied to VHD, in order to guide clinical practice and future development of new scores. Methods and results The most widely used risk scores (EuroSCORE, STS, and Ambler score) were reviewed, analysing variables included and their predictive ability when applied to patients with VHD. These scores provide relatively good discrimination, i.e. a gross estimation of risk category, but cannot be used to estimate the exact operative mortality in an individual patient because of unsatisfactory calibration. Conclusion Current risk scores do not provide a reliable estimate of exact operative mortality in an individual patient with VHD. They should therefore be interpreted with caution and only used as part of an integrated approach, which incorporates other patient characteristics, the clinical context, and local outcome data. Future risk scores should include additional variables, such as cognitive and functional capacity and be prospectively validated in high-risk patients. Specific risk models should also be developed for newer interventions, such as transcatheter aortic valve implantation. PMID:21406443

Relationship between aortic valve calcification and the severity of coronary atherosclerotic disease.

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Qian, Juying; Chen, Zhangwei; Ge, Junbo; Ma, Jianying; Chang, Shufu; Fan, Bing; Liu, Xuebo; Ge, Lei

2010-07-01

Aortic valve calcification (AVC), which has been confirmed to be associated with various risk factors of cardiac disease, is common in the elderly and associated with increased cardiovascular mortality. It has been hypothesized that AVC is associated with coronary atherosclerotic disease, and its severity. Between July 2007 and November 2007, a total of 235 patients with chest pain or chest distress were admitted to the authors' institution for coronary angiography. The severity of coronary atherosclerotic disease (CAD) was evaluated by the Gensini score, the number of stenosed vessels, and the prevalence of total occlusion. All patients underwent transthoracic echocardiography to detect AVC. Patients with CAD had a higher prevalence of AVC than those without CAD (44% versus 26%, p = 0.005). Likewise, the prevalence of AVC was significantly higher in patients with a higher Gensini score than in those with a lower score. Patients with AVC had a higher prevalence of CAD, and higher Gensini scores and numbers of stenosed coronary arteries, even after stratification by age (65 years). On multivariable logistic regression analysis for CAD, the odds ratio (OR) of AVC was 2.315 (95% confidence interval (CI): 1.158-4.629, p = 0.018); this value was higher than that for total cholesterol (OR = 1.637, p = 0.008), lipoprotein-a (OR = 1.003, p = 0.015) and fibrinogen (OR = 1.009, p = 0.006), and marginally less than that for male gender (OR = 2.665, p = 0.005). Patients with AVC had a higher prevalence and greater severity of CAD.

Retrospective analysis of co-occurrence of congenital aortic stenosis and pulmonary artery stenosis in dogs.

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Kander, M; Pasławska, U; Staszczyk, M; Cepiel, A; Pasławski, R; Mazur, G; Noszczyk-Nowak, A

2015-01-01

The study has focused on the retrospective analysis of cases of coexisting congenital aortic stenosis (AS) and pulmonary artery stenosis (PS) in dogs. The research included 5463 dogs which were referred for cardiological examination (including clinical examination, ECG and echocardiography) between 2004 and 2014. Aortic stenosis and PS stenosis were detected in 31 dogs. This complex defect was the most commonly diagnosed in Boxers - 7 dogs, other breeds were represented by: 4 cross-breed dogs, 2 Bichon Maltais, 3 Miniature Pinschers, 2 Bernese Mountain Dogs, 2 French Bulldogs, and individuals of following breeds: Bichon Frise, Bull Terrier, Czech Wolfdog, German Shepherd, Hairless Chinese Crested Dog, Miniature Schnauzer, Pug, Rottweiler, Samoyed, West Highland White Terrier and Yorkshire Terrier. In all the dogs, the murmurs could be heard, graded from 2 to 5 (on a scale of 1-6). Besides, in 9 cases other congenital defects were diagnosed: patent ductus arteriosus, mitral valve dysplasia, pulmonary or aortic valve regurgitation, tricuspid valve dysplasia, ventricular or atrial septal defect. The majority of the dogs suffered from pulmonary valvular stenosis (1 dog had supravalvular pulmonary artery stenosis) and subvalvular aortic stenosis (2 dogs had valvular aortic stenosis). Conclusions and clinical relevance - co-occurrence of AS and PS is the most common complex congenital heart defect. Boxer breed was predisposed to this complex defect. It was found that coexisting AS and PS is more common in male dogs and the degree of PS and AS was mostly similar.

Fruit Intake and Abdominal Aortic Calcification in Elderly Women: A Prospective Cohort Study

Directory of Open Access Journals (Sweden)

Nicola P. Bondonno

2016-03-01

Full Text Available Cardiovascular disease (CVD is the leading cause of death worldwide. There is a consistent inverse relationship between fruit intake with CVD events and mortality in cross-sectional and prospective observational studies, but the relationship of fruit intake with measurements of atherosclerosis in humans is less clear. Nutritional effects on abdominal aortic calcification (AAC, a marker for subclinical intimal and medial atherosclerotic vascular disease, have not been studied previously. The aim of this study was to examine the cross-sectional relationship of total and individual fruit (apple, pear, orange and other citrus, and banana intake with AAC, scored between 0 and 24. The current study assessed baseline data for a cohort of 1052 women over 70 years of age who completed both a food frequency questionnaire assessing fruit intake, and underwent AAC measurement using dual energy X-ray absorptiometry. AAC scores were significantly negatively correlated with total fruit and apple intakes (p < 0.05, but not with pear, orange or banana intakes (p > 0.25. In multivariable-adjusted logistic regression, each standard deviation (SD; 50 g/day increase in apple intake was associated with a 24% lower odds of having severe AAC (AAC score >5 (odd ratio OR: 0.76 (0.62, 0.93, p = 0.009. Total and other individual fruit intake were not associated with increased odds of having severe AAC. Apple but not total or other fruit intake is independently negatively associated with AAC in older women.

Aortic stenosis: From diagnosis to optimal treatment

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Tavčiovski Dragan

2008-01-01

Full Text Available Aortic stenosis is the most frequent valvular heart disease. Aortic sclerosis is the first characteristic lesion of the cusps, which is considered today as the process similar to atherosclerosis. Progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. It is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Proper physical examination remains an essential diagnostic tool in aortic stenosis. Recognition of characteristic systolic murmur draws attention and guides further diagnosis in the right direction. Doppler echocardiography is an ideal tool to confirm diagnosis. It is well known that exercise tests help in stratification risk of asymptomatic aortic stenosis. Serial measurements of brain natriuretic peptide during a follow-up period may help to identify the optimal time for surgery. Heart catheterization is mostly restricted to preoperative evaluation of coronary arteries rather than to evaluation of the valve lesion itself. Currently, there is no ideal medical treatment for slowing down the disease progression. The first results about the effect of ACE inhibitors and statins in aortic sclerosis and stenosis are encouraging, but there is still not enough evidence. Onset symptoms based on current ACC/AHA/ESC recommendations are I class indication for aortic valve replacement. Aortic valve can be replaced with a biological or prosthetic valve. There is a possibility of percutaneous aortic valve implantation and transapical operation for patients that are contraindicated for standard cardiac surgery.

Recommendations for the management of individuals with acquired valvular heart diseases who are involved in leisure-time physical activities or competitive sports.

Science.gov (United States)

Mellwig, Klaus Peter; van Buuren, Frank; Gohlke-Baerwolf, Christa; Bjørnstad, Hans Halvor

2008-02-01

Physical check-ups among athletes with valvular heart disease are of significant relevance. In athletes with mitral valve stenosis the extent of allowed physical activity is dependant on the size of the left atrium and the severity of the valve defect. Patients with mild-to-moderate mitral valve regurgitation can participate in all types of sport associated with low and moderate isometric stress and moderate dynamic stress. Patients under anticoagulation should not participate in any type of contact sport. Asymptomatic athletes with mild aortic valve stenosis can take part in all types of sport, as long as left ventricular function and size are normal, a normal response to exercise at the level performed during athletic activities is present and there are no arrhythmias. Asymptomatic athletes with moderate aortic valve stenosis should only take part in sports with low dynamic and static stress. Aortic valve regurgitation is often present due to connective tissue disease of a bicuspid valve. Athletes with mild aortic valve regurgitation, with normal end diastolic left ventricular size and systolic function can participate in all types of sport. A mitral valve prolapse is often associated with structural diseases of the myocardium and endocardium. In patients with mitral valve prolapse Holter-ECG monitoring should also be performed to detect significant arrhythmias. All athletes with known valvular heart disease, a previous history of infective endocarditis and valve surgery should receive endocarditis prophylaxis before dental, oral, respiratory, intestinal and genitourinary procedures associated with bacteraemia. Sport activities have to be avoided during active infection with fever.

Calcification of a Synthetic Renovascular Graft in a Child

Directory of Open Access Journals (Sweden)

D.S.T. Chong

Full Text Available : Introduction: Vascular grafts, especially in paediatric cases, need to be durable. Common failures such as thrombosis are well documented with research efforts directed towards them. However, there are lesser known causes of graft failure, such as graft calcification, and these also require further research focus. Report: A paediatric case is described in which a synthetic renovascular graft, implanted for mid-aortic syndrome, became calcified, necessitating surgical intervention to resolve graft malfunction. Significant calcification in the limb of a bifurcated polyethylene terephthalate graft was found to be the cause of resistant stenosis and refractory hypertension. Histology conducted on the explanted limb showed the presence of multinuclear giant cells, indicating a chronic foreign body response. Discussion: Calcification of vascular grafts is probably more common than previously recognised. Stenosis typically resistant to angioplasty may result in the long term and thus leading to surgical intervention. In young children, this is suboptimal as these grafts need to last throughout adulthood. Explanted prosthetic grafts should be sent to specialist registries such as that in Strasbourg to be optimally assessed so that contributory factors can be identified. Keywords: Renovascular graft, Paediatric, Calcification

The effect of aging on atherosclerotic plaque inflammation and molecular calcification: A PET CT imaging study

DEFF Research Database (Denmark)

Blomberg, Björn; Thomassen, Anders; Simonsen, Jane Angel

Aim: Aging is an important independent risk factor for the inception and maturation of atherosclerotic plaques. This study aimed to investigate the effect of aging on atherosclerotic plaque inflammation and molecular calcification. Methods: Thirteen healthy volunteers without traditional......SUV) [Mean SUVAORTA - Mean SUVBLOOD POOL]. Furthermore, the average maximum 18F-NaF cSUV was determined in the coronary arteries. Calculating regression and correlation coefficients summarized the data. Results: A quadratic relationship was observed between aging and aortic 18F-FDG avidity. A second order...... polynomial regression established that aging is a strong predictor of the degree of aortic plaque inflammation (R2 = 0.71, F statistic = 11.98, P = 0.002). A linear relationship was observed between aging and molecular calcification. Linear regression established that aging is a predictor of both the degree...

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

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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.

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

International Nuclear Information System (INIS)

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

1991-01-01

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

Aortic valve calcification as a predictor of location and severity of paravalvular regurgitation after transcatheter aortic valve implantation

NARCIS (Netherlands)

Koh, Ezra Y.; Lam, Kayan Y.; Bindraban, Navin R.; Cocchieri, Riccardo; Planken, R. Nils; Koch, Karel T.; Baan, Jan; de Mol, Bas A.; Marquering, Henk A.

2015-01-01

To determine whether the location of aortic valve calcium (AVC) influences the location of paravalvular regurgitation (PR). PR is an adverse effect of transcatheter aortic valve implantation (TAVI) with a negative effect on long-term patient survival. The relationship between AVC and the occurrence

[Selection of patients for transcatheter aortic valve implantation].

Science.gov (United States)

Tron, Christophe; Godin, Matthieu; Litzler, Pierre-Yves; Bauer, Fabrice; Caudron, Jérome; Dacher, Jean-Nicolas; Borz, Bogdan; Canville, Alexandre; Kurtz, Baptiste; Bessou, Jean-Paul; Cribier, Alain; Eltchaninoff, Hélène

2012-06-01

A good selection of patients is a crucial step before transcatheter aortic valve implantation (TAVI) in order to select the good indications and choose the access route. TAVI should be considered only in patients with symptomatic severe aortic stenosis and either contraindication or high surgical risk. Indication for TAVI should be discussed in a multidisciplinary team meeting. Echocardiography and/or CT scan are mandatory to evaluate the aortic annulus size and select the good prosthesis size. The possibility of transfemoral implantation is evaluated by angiography and CT scan, and based on the arterial diameters, but also on the presence of tortuosities and arterial calcifications. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Coronary risk stratification of patients undergoing surgery for valvular heart disease.

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Hasselbalch, Rasmus Bo; Engstrøm, Thomas; Pries-Heje, Mia; Heitmann, Merete; Pedersen, Frants; Schou, Morten; Mickley, Hans; Elming, Hanne; Steffensen, Rolf; Køber, Lars; Iversen, Kasper

2017-01-15

Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG. The study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry. The study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction <30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%. A score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population

NARCIS (Netherlands)

M.J. Willemink (Martin J.); R.A.P. Takx (Richard A.); I. Isgum (Ivana); H.J. de Koning (Harry); M. Oudkerk (Matthijs); W.P. Mali (Willem); R.P.J. Budde (Ricardo); I. Leiner (Tim); R. Vliegenthart (Rozemarijn); P.A. de Jong (Pim)

2015-01-01

textabstractTo assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced

Transcatheter aortic valve implantation and cerebrovascular accidents.

Science.gov (United States)

Stortecky, Stefan; Wenaweser, Peter; Windecker, Stephan

2012-09-01

Transcatheter aortic valve implantation (TAVI) is an evidence-based treatment alternative for selected high-risk patients with symptomatic severe aortic stenosis as acknowledged in the most recent edition of the ESC Guidelines on Valvular Heart Disease 2012. However, periprocedural complications and in particular cerebrovascular accidents remain a matter of concern. While transcatheter heart valve technology continuously improves and the development of novel and even less invasive implantation techniques is on-going, cerebrovascular events complicating TAVI may abrogate the usual improvement in terms of prognosis and quality of life. This article describes the incidence of cerebrovascular events after cardiovascular procedures, provides an overview of the pathophysiological mechanisms as well as the impact on outcomes and provides some insights into preventive strategies as well as the acute management of these events.

[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.

Updated standardized endpoint definitions for transcatheter aortic valve implantation: The Valve Academic Research Consortium-2 consensus document

NARCIS (Netherlands)

A.P. Kappetein (Arie Pieter); S.J. Head (Stuart); P. Généreux (Philippe); N. Piazza (Nicolo); N.M. van Mieghem (Nicolas); E.H. Blackstone (Eugene); T.G. Brott (Thomas); D.J. Cohen (David J.); D.E. Cutlip (Donald); G.A. van Es (Gerrit Anne); R.T. Hahn (Rebecca); A.J. Kirtane (Ajay); M. Krucoff (Mitchell); S. Kodali (Susheel); M.J. Mack (Michael); R. Mehran (Roxana); J. Rodés-Cabau (Josep); P. Vranckx (Pascal); J.G. Webb (John); S.W. Windecker (Stephan); P.W.J.C. Serruys (Patrick); M.B. Leon (Martin)

2012-01-01

textabstractObjectives: The aim of the current Valvular Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI)- clinical endpoints to make them more suitable to the present and future needs of clinical trials.

Fibrin glue on an aortic cusp detected by transesophageal echocardiography after valve-sparing aortic valve replacement: a case report.

Science.gov (United States)

Nakahira, Junko; Ishii, Hisanari; Sawai, Toshiyuki; Minami, Toshiaki

2015-03-07

Fibrin glue is used commonly during cardiac surgery but can behave as an intracardiac abnormal foreign body following surgery. There have been few such cases reported, and they were typically noticed only because of the resulting catastrophic cardiac conditions, such as valvular malfunction. We report a case where, for the first time, transesophageal echocardiography was used to detected fibrin glue that was adherent to the ventricular side of a patient's aortic valve immediately after aortic declamping. A 45-year-old Japanese man with Marfan syndrome underwent an aortic valve-sparing operation to treat moderate aortic valve regurgitation resulting from enlargement of his right coronary cusp. Fibrin glue was lightly applied to the suture line between the previous and new grafts. Transesophageal echocardiography performed prior to weaning from the cardiopulmonary bypass revealed mild aortic valve regurgitation in addition to a mobile membranous structure attached to the ventricular side of his aortic valve. It was identified as fibrin glue. We resolved the regurgitation by removing the fibrin glue and repeating the aortic cusp plication. The patient had no complications during recovery. Fibrin glue can act as an intracardiac foreign body and lead to a potentially fatal embolism. We demonstrated the use of transesophageal echocardiography to detect a fibrin glue-derived intracardiac abnormal foreign body and to confirm its removal. To the best of our knowledge, this is the first case where fibrin glue adherent to the aortic valve was detected by transesophageal echocardiography. These findings demonstrate the importance of using transesophageal echocardiography during cardiac surgery that involves using biological glues.

Magnetic resonance imaging of valvular heart disease

DEFF Research Database (Denmark)

Søndergaard, Lise; Ståhlberg, F; Thomsen, C

1999-01-01

The optimum management of patients with valvular heart diseases requires accurate and reproducible assessment of the valvular lesion and its hemodynamic consequences. Magnetic resonance imaging (MRI) techniques, such as volume measurements, signal-void phenomena, and velocity mapping, can be used...... in an integrated approach to gain qualitative and quantitative information on valvular heart disease as well as ventricular dimensions and functions. Thus, MRI may be advantageous to the established diagnostic tools in assessing the severity of valvular heart disease as well as monitoring the lesion and predicting...... the optimal timing for valvular surgery. This paper reviews the validation of these MRI techniques in assessing valvular heart disease and discusses some typical pitfalls of the techniques, including suggestions for solutions.J. Magn. Reson. Imaging 1999;10:627-638....

Effect of Patient-Prosthesis Mismatch in Aortic Position on Late-Onset Tricuspid Regurgitation and Clinical Outcomes after Double Valve Replacement.

Science.gov (United States)

Lee, Seung Hyun; Youn, Young Nam; Chang, Byung Chul; Joo, Hyun Chel; Lee, Sak; Yoo, Kyung Jong

2017-09-01

Significant late-onset tricuspid regurgitation (TR) is unfortunately common after double valve replacement (DVR); however, its underlying factors remain undefined. We evaluated the effect of aortic patient-prosthesis mismatch (PPM) on late-onset TR and clinical outcomes after DVR. Of the 2392 consecutive patients who underwent aortic valve replacement between January 1990 and May 2014 at our institution, we retrospectively studied 462 patients who underwent DVR (excluding concomitant tricuspid valvular annuloplasty or replacement). Survival and freedom from grade >3 TR were compared between PPM (n=152) and non-PPM (n=310) groups using the Kaplan-Meier method. Although the overall survival rates were similar between the two groups at 5 and 10 years (95%, 91% vs. 96%, 93%, p=0.412), grade >3 TR-free survival was significantly lower in the PPM group (98%, 91% vs. 99%, 95%, p=0.014). Small body-surface area, atrial fibrillation, PPM, and subaortic pannus were risk factors for TR progression. However, aortic prosthesis size and trans-valvular pressure gradient were not significant factors for either TR progression or overall survival. Aortic PPM in DVR, regardless of mitral prosthesis size, was associated with late TR progression, but was not significantly correlated with overall survival. Therefore, we recommend careful echocardiographic follow-up for the early detection of TR progression in patients with aortic PPM in DVR. © Copyright: Yonsei University College of Medicine 2017

Doppler evaluation of valvular stenosis

International Nuclear Information System (INIS)

Kisslo, J.; Krafchek, J.; Adams, D.; Mark, D.B.

1986-01-01

One of the reasons why use of Doppler echocardiography is growing rapidly is because of its utility in detecting the presence of valvular stenosis and in estimating its severity. Detection of the presence of stenotic valvular heart disease using Doppler echocardiography was originally described over 10 years ago. It has been demonstrated that Doppler blood velocity data could be used to estimate the severity of a stenotic lesion. This chapter discusses the evaluation of valvular stenois using Doppler

Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population

NARCIS (Netherlands)

Willemink, Martin J.; Takx, Richard A. P.; Isgum, I; de Koning, Harry J.; Oudkerk, Matthijs; Mali, Willem P. Th. M.; Budde, Ricardo P. J.; Leiner, Tim; Vliegenthart, Rozemarijn; de Jong, Pim A.

To assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced low-radiation-dose

Bicuspid aortic valve syndrome and fibrillinopathies: potential impact on clinical approach

Directory of Open Access Journals (Sweden)

Rosina De Cario

2014-01-01

Full Text Available Bicuspid aortic valve (BAV is a common heterogeneous disorder whose natural history is determined by hemodynamic valvular impairment and/or increased prevalence of aortic abnormalities ranging from dilatation to aneurysm and dissection. BAV-related aortopathy is frequently associated with relevant aortic pathologic changes leading to structural alterations, characteristic degenerative lesions and histological changes of the aorta very similar to those identified and described in patients with Marfan syndrome (MFS, an inherited connective tissue disorder associated with mutations in fibrillin 1 (FBN1 gene in more than 90% of patients. Recently, a 4-fold increase in the prevalence of BAV in MFS patients has been reported. Subsequently, pathogenetic FBN1 mutations in patients with BAV and aortic dilatation/aneurysm in whom MFS and other more severe type 1 fibrillinopathies were clinically excluded have been identified. In this review we discuss how this evidence, together with that of the wide heterogeneity in pathogenetic mechanisms of BAV-related aortopathy, may impact the clinical management of BAV.

Differential expression of TRAIL and its receptors relative to calcification in AAA

International Nuclear Information System (INIS)

Liu, Xun; Winrow, Vivienne R.; Horrocks, Michael; Stevens, Cliff R.

2007-01-01

Abdominal aortic aneurysm (AAA) is commonly associated with atherosclerosis. Human AAA tissue displays cells undergoing all stages of apoptosis. Tumour necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) induces apoptosis in tumour cells but not in normal cells. It has death receptors and decoy receptors. An inhibitor of TRAIL, osteoprotegerin (OPG), is involved in osteogenesis and vascular calcification. We investigated TRAIL and its receptors in AAA compared within normal aorta (NA). Both qualitative and quantitative analyses of calcification in AAA walls were determined using Von Kossa staining and pre-operation computer tomography (CT) scans. There was a significant difference in calcification level at different locations in the AAA wall (p < 0.05). Apoptosis was confirmed in AAA by TUNEL assay. A significant difference in TRAIL and its receptor expression was observed between normal aortae and AAA (p < 0.05). Significant differences were also observed between tissues displaying different extents of calcification for TRAIL mRNA (p < 0.05) by RT-PCR examination and OPG protein (p < 0.01) by protein blotting examination. We propose that this pattern of expression of TRAIL and its receptors may contribute to AAA formation and calcification in the AAA wall

Blackish Pigmentation of the Aorta in Patient with Alkaptonuria and Heyde's Syndrome

Science.gov (United States)

Capuano, Fabio; Angeloni, Emiliano; Roscitano, Antonino; Bianchini, Roberto; Refice, Simone; Lechiancole, Andrea; Melina, Giovanni; Comito, Cosimo; Sinatra, Riccardo

2014-01-01

Alkaptonuria is an autosomal recessive trait resulting in an error of aromatic amino acids metabolism. Heyde's syndrome is a condition clustering together aortic valve stenosis and gastrointestinal bleeding from colonic angiodysplasia. At present, there is no report describing the association of the latter two syndromes in the same patient. Here we present the case of a patient with severe aortic stenosis, alkaptonuria, and Heyde's syndrome. The patient underwent aortic valve replacement by means of a valvular bioprosthesis and the histological examination of the aortic cusps revealed calcific degeneration. This was associated with stromal degeneration characterized by extra-cellular deposition of granular, brownish-pigmented material along with macrophages and multiple foci of calfication showing the same brownish pigmentation. This configuration represents the typical pattern of homogentisic acid accumulation known as ochronosis. The postoperative course was uneventful and the echocardiographic follow-up at 6 months postoperatively showed good-functioning of the aortic valve bioprosthesis. PMID:26798717

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.)

ECG-gated computed tomography: a new role for patients with suspected aortic prosthetic valve endocarditis

International Nuclear Information System (INIS)

Fagman, Erika; Flinck, Agneta; Lamm, Carl; Perrotta, Sossio; Bech-Hanssen, Odd; Olaison, Lars; Svensson, Gunnar

2012-01-01

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.)

Thrombosed false channel in acute aortic dissections

International Nuclear Information System (INIS)

Alerci, M.; Dore, R.; Kluzer, A.; Digiulio, G.; D'Andrea, F.; De Agostini, A.

1987-01-01

Three cases are reported of acute dissection with complete thrombosis of the false channel, which is a very uncommonevent in DeBakey's I and II type aortic dissections. The 3 patients entered hospital because of severe thoracic pain without any ECG sign of myocardial infarction. Emergency CT showed evidence of pericardial effusion suggesting hemopericardium, enlargement of the ascending aorta and a peripheral semilunar filling defect which caused a slight deformation of the true channel. On precontrast scans, only one case showed inward displacement of peripheral calcifications and high-density aortic wall. No tipical signs of aortic dissection were reported, expect in the first patient - where a double contrast filled lumen, separated by an intimal flap was seen. CT findings are individually discussed. It is emphasized that in all patients more than one CT sign was present at a time. The correct evaluation of these signs together with the clinacal data could lead to the right diagnosis of aortic dissection in spite of the lack of a f???

Pseudoaneurysm of mitral-aortic intervalvular fibrosa in a child: Demonstration by MDCT and MRI

International Nuclear Information System (INIS)

Choh, Naseer A; Shaheen, Feroze; Rather, Hilal; Aslam, Khursheed

2013-01-01

Subaortic left ventricular outflow tract pseudoaneurysms are rare lesions that are associated with aortic valve diseases, infective endocarditis, trauma or surgery. We present dynamic multidetector computerized tomography and cine magnetic resonance imaging features of a case of subaortic aneurysm arising from interaortic-mitral valvular region in a child with past history of infective endocarditis

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

International Nuclear Information System (INIS)

Mahnken, A.H.; Wildberger, J.E.; Das, M.; Muehlenbruch, G.; Guenther, R.W.; Koos, R.; Sinha, A.M.; Stanzel, S.

2004-01-01

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

Association of Cardiac Hemodynamic Factors With Severity of White Matter Hyperintensities in Chronic Valvular Heart Disease.

Science.gov (United States)

Lee, Woo-Jin; Jung, Keun-Hwa; Ryu, Young Jin; Kim, Jeong-Min; Lee, Soon-Tae; Chu, Kon; Kim, Manho; Lee, Sang Kun; Roh, Jae-Kyu

2018-01-01

The cerebral white matter hyperintensity (WMH) is frequently noted in patients with chronic heart disease. Long-term alteration of cardiac hemodynamics might have an influence on the mechanism of cerebral WMH. To investigate the association between chronically altered cardiac hemodynamics and severity of cerebral WMH in patients with chronic valvular heart disease. This cross-sectional analysis identified 303 consecutive patients at a tertiary referral center between 2008 and 2016 who were 50 years or older, and diagnosed with severe chronic valvular heart disease and underwent cardiac catherization, echocardiography, and received brain magnetic resonance imaging. Among these patients, 71 with other demonstrated cardiac disease, central nervous system disease, and/or without sufficient catheterization data were excluded, and the remaining 232 patients were included in further analyses. The site and mechanism of valve diseases, as well as clinical and medication profiles, were reviewed. Cardiac catheterization parameters such as right atrial (RA) mean pressure, right ventricular pressure, and aortic mean pressure were obtained. Comprehensive echocardiographic hemodynamic markers such as left ventricular (LV) ejection fraction, LV mass index, LV end diastolic volume, cardiac index, and E/e' ratio were also obtained. White matter hyperintensity volume was quantitatively evaluated using volumetric analysis. This study included 232 patients (103 men [44.4%] and 129 women [55.6%]; mean [SD] (range) age, 65.6 [8.8] (51-88) years) in the final analysis. The mean (SD) WMH volume was 5.93 (7.14) mL (median [interquartile range], 4.33 [1.33-8.62] mL), and mean (SD) RA pressure was 10.0 (4.7) mm Hg. From the catheterization data, 147 patients (63.4%) were classified as having a disease involving the mitral valve; 93 (40.1%), aortic valve; 37 (15.9%), tricuspid valve; and 4 (1.7%), pulmonary valve. In multivariate linear regression analysis, adjusting the type and mechanism of

LncRNA TUG1 sponges miR-204-5p to promote osteoblast differentiation through upregulating Runx2 in aortic valve calcification.

Science.gov (United States)

Yu, Cong; Li, Lifu; Xie, Fei; Guo, Shichao; Liu, Fayuan; Dong, Nianguo; Wang, Yongjun

2018-01-01

Emerging evidence indicates that long non-coding RNAs (lncRNAs) play a vital role in cardiovascular physiology and pathology. Although the lncRNA TUG1 is implicated in atherosclerosis, its function in calcific aortic valve disease (CAVD) remains unknown. In this study, we found that TUG1 was highly expressed in human aortic valves and primary valve interstitial cells (VICs). Moreover, TUG1 knockdown induced inhibition of osteoblast differentiation in CAVD both in vitro and in vivo. Mechanistically, silencing of TUG1 increased the expression of miR-204-5p and subsequently inhibited Runx2 expression at the post-transcriptional level. Importantly, TUG1 directly interacted with miR-204-5p and downregulation of miR-204-5p efficiently reversed the suppression of Runx2 induced by TUG1 short hairpin RNA (shRNA). Thus, TUG1 positively regulated the expression of Runx2, through sponging miR-204-5p, and promoted osteogenic differentiation in CAVD. All together, the evidence generated by our study elucidates the role of lncRNA TUG1 as a miRNA sponge in CAVD, and sheds new light on lncRNA-directed diagnostics and therapeutics in CAVD. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions please email: journals.permissions@oup.com.

Aortic valve calcification and mild tricuspid regurgitation but no clinical heart disease after 8 years of dopamine agonist therapy for prolactinoma

NARCIS (Netherlands)

M. Kars; V. Delgado (Victoria); E.R. Holman (Eduard); R.A. Feelders (Richard); J.W.A. Smit (Jan); J.A. Romijn (Johannes); J.J. Bax (Jeroen); A.M. Pereira (Alberto)

2008-01-01

textabstractObjective: Treatment with ergot-derived dopamine agonists, pergolide, and cabergoline has been associated with an increased frequency of valvular heart disease in Parkinson's disease. The aim of the present study was to assess the prevalence of valvular heart disease in patients treated

Abdominal aortic calcification quantified by the Morphological Atherosclerotic Calcification Distribution (MACD) index is associated with features of the metabolic syndrome

DEFF Research Database (Denmark)

Barascuk, Natasha; Ganz, Melanie; Nielsen, Mads

2011-01-01

. Three hundred and eight healthy women aged 48 to 76 years, were followed for 8.3 ± 0.3 years. AAC was quantified using lumbar radiographs. Baseline data included age, weight, blood pressure, blood lipids, and glucose levels. Pearson correlation coefficients were used to test for relationships....... At baseline and across all patients, MACD correlated with blood glucose (r2 = 0.1, Pcorrelations between baseline biological parameters and the follow-up calcification assessment...... index was not correlated with blood parameters. Patterns of calcification identified by the MACD, but not the AC24 index, appear to contain useful biological information perhaps explaining part of the improved identification of risk of cardiovascular death of the MACD index. Correlations of MACD...

Association of conjunctival and corneal calcification with vascular calcification among hepatitis-C-seropositive hemodialysis patients.

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AbouSeif, Khaled; Sany, Dawlat; Elshahawy, Yasser; Seddik, Ayman; Rahman, Khedr; Gaber, Moustapha

2016-01-01

Disorders associated with the hepatitis C virus (HCV) have been reported including cardiovascular, metabolic, and central nervous system diseases. Since chronic HCV infections may be curable, their identification as causal contributors to cardiovascular risk could offer new perspectives in the prevention of cardiovascular disease. The aim of this study is to investigate the association between HCV and aortic arch calcification (AAC) and corneal and conjunctival calcification (CCC) in maintenance hemodialysis (MHD) patients; further, we assessed the correlation of CCC with vascular calcification. A total of 100 patients undergoing hemodialysis (HD) in our hospital were included in this study. Patients underwent a complete ocular examination including intraocular pressure, and CCC was looked for by slit lamp and fundoscopy. CCC was graded according to modified Porter and Crombie classification system described by Tokuyama et al. Helical computerized tomographic chest examination was used to evaluate the grading of AAC. Demographic, hematological, biochemical, and dialysis-related data were obtained. There was significant difference between seropositive (n = 51) and seronegative patients (n = 49) regarding grading of AAC and CCC (P <0.001). Significant positive correlation was found between grading of CCC, AAC, age (P <0.001), duration on HD (P <0.001), HCV-antibody positivity (P <0.001), serum calcium level (P <0.001), serum phosphorus level (P <0.001), calcium × phosphorus product (P <0.001), and i-parathormone level (P < 0.001). In addition, CCC grading positively correlated with AAC. Our results suggest that patients undergoing HD infected with the HCV have high degree of CCC, AAC, and mineral metabolism disorder. The strong correlation between CCC and AAC indicates that CCC evaluation is an easy, fast, non-invasive method, and might be used as an indirect indicator to detect vascular calcification in patients undergoing MHD.

Association of conjunctival and corneal calcification with vascular calcification among hepatitis-C-seropositive hemodialysis patients

Directory of Open Access Journals (Sweden)

Khaled AbouSeif

2016-01-01

Full Text Available Disorders associated with the hepatitis C virus (HCV have been reported including cardiovascular, metabolic, and central nervous system diseases. Since chronic HCV infections may be curable, their identification as causal contributors to cardiovascular risk could offer new perspectives in the prevention of cardiovascular disease. The aim of this study is to investigate the association between HCV and aortic arch calcification (AAC and corneal and conjunctival calcification (CCC in maintenance hemodialysis (MHD patients; further, we assessed the correlation of CCC with vascular calcification. A total of 100 patients undergoing hemodialysis (HD in our hospital were included in this study. Patients underwent a complete ocular examination including intraocular pressure, and CCC was looked for by slit lamp and fundoscopy. CCC was graded according to modified Porter and Crombie classification system described by Tokuyama et al. Helical computerized tomographic chest examination was used to evaluate the grading of AAC. Demographic, hematological, biochemical, and dialysis-related data were obtained. There was significant difference between seropositive (n = 51 and seronegative patients (n = 49 regarding grading of AAC and CCC (P <0.001. Significant positive correlation was found between grading of CCC, AAC, age (P <0.001, duration on HD (P <0.001, HCV-antibody positivity (P <0.001, serum calcium level (P <0.001, serum phosphorus level (P <0.001, calcium × phosphorus product (P <0.001, and i-parathormone level (P < 0.001. In addition, CCC grading positively correlated with AAC. Our results suggest that patients undergoing HD infected with the HCV have high degree of CCC, AAC, and mineral metabolism disorder. The strong correlation between CCC and AAC indicates that CCC evaluation is an easy, fast, non-invasive method, and might be used as an indirect indicator to detect vascular calcification in patients undergoing MHD.

Aortic valve calcification and mild tricuspid regurgitation but no clinical heart disease after 8 years of dopamine agonist therapy for prolactinoma

NARCIS (Netherlands)

Kars, Marleen; Delgado, Victoria; Holman, Eduard R.; Feelders, Richard A.; Smit, Johannes W. A.; Romijn, Johannes A.; Bax, Jeroen J.; Pereira, Alberto M.

2008-01-01

Treatment with ergot-derived dopamine agonists, pergolide, and cabergoline has been associated with an increased frequency of valvular heart disease in Parkinson's disease. The aim of the present study was to assess the prevalence of valvular heart disease in patients treated with dopamine agonists

[Left atrial electric isolation in the treatment of atrial fibrillation secondary to rheumatic valvular disease].

Science.gov (United States)

Graffigna, A; Pagani, F; Minzioni, G; Salerno, J; Viganò, M

1992-08-01

Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent valve surgery. From May 1989 to September 1991, 62 patients underwent mitral valve surgery (Group I), 19 underwent mitral valve surgery and DeVega tricuspid annuloplasty (Group II), 15 underwent mitral and aortic surgery (Group III), and 4 patients underwent mitral and aortic surgery and DeVega tricuspid annuloplasty (Group IV). Left atrial isolation was performed prolonging the usual left paraseptal atriotomy towards the left fibrous trigone anteriorly, and the postero-medial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesion were placed at the edges to ensure complete electrophysiological isolation of the left atrium. Operative mortality accounted for 3 cases (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (Group I: 80.7%; Group II: 68.5%; Group III 86.7%, Group IV 75% - p = N.S.). Three cases of late mortality (3.1%) were registered. long-term results showed persistence of SR in 71% of Group I, 61.2% of Group II, 85.8% of Group III, and 100% of Group IV. The unique risk factor for late recurrency of atrial fibrillation was found to be a duration of preoperative AF longer than 6 months. Due to the high success rate in recovering the sinus rhythm, we suggest left atrial isolation in patients with chronic atrial fibrillation undergoing valvular surgery.

Optimal sizing for SAPIEN 3 transcatheter aortic valve replacement in patients with or without left ventricular outflow tract calcification.

Science.gov (United States)

Maeno, Yoshio; Abramowitz, Yigal; Jilaihawi, Hasan; Israr, Sharjeel; Yoon, Sunghan; Sharma, Rahul P; Kazuno, Yoshio; Kawamori, Hiroyuki; Miyasaka, Masaki; Rami, Tanya; Mangat, Geeteshwar; Takahashi, Nobuyuki; Okuyama, Kazuaki; Kashif, Mohammad; Chakravarty, Tarun; Nakamura, Mamoo; Cheng, Wen; Makkar, Raj R

2017-04-07

The impact of left ventricular outflow tract calcification (LVOT-CA) on SAPIEN 3 transcatheter aortic valve replacement (S3-TAVR) is not well understood. The aims of the present study were to determine optimal device sizing for S3-TAVR in patients with or without LVOT-CA and to evaluate the influence of residual paravalvular leak (PVL) on survival after S3-TAVR in these patients. This study analysed 280 patients (LVOT-CA=144, no LVOT-CA=136) undergoing S3-TAVR. Optimal annular area sizing was defined as % annular area sizing related to lower rates of ≥mild PVL. Annular area sizing was determined as follows: (prosthesis area/CT annulus area-1)×100. Overall, ≥mild PVL was present in 25.7%. Receiver operating characteristic curve analysis for prediction of ≥mild PVL in patients with LVOT-CA showed that 7.2% annular area sizing was identified as the optimal threshold (area under the curve [AUC] 0.71). Conversely, annular area sizing for no LVOT-CA appeared unrelated to PVL (AUC 0.58). Aortic annular injury was seen in four patients (average 15.5% annular area oversizing), three of whom had LVOT-CA. Although there was no difference in one-year survival between patients with ≥mild PVL and without PVL (log-rank p=0.91), subgroup analysis demonstrated that patients with ≥moderate LVOT-CA who had ≥mild PVL had lower survival compared to patients with ≥mild PVL and none or mild LVOT-CA (log-rank p=0.010). In the setting of LVOT-CA, an optimally sized S3 valve is required to reduce PVL and to increase survival following TAVR.

Detection of a prosthetic aortic valvular abscess with indium-111-labeled leukocytes

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Oates, E.; Sarno, R.C.

1988-10-01

An unsuspected annular abscess at the base of a prosthetic aortic valve in a patient with endocarditis was identified by indium-111-labeled leukocyte scintigraphy alone. This highly sensitive and specific technique expediently demonstrated the surgically proven inflammatory focus.

Detection of a prosthetic aortic valvular abscess with indium-111-labeled leukocytes

International Nuclear Information System (INIS)

Oates, E.; Sarno, R.C.

1988-01-01

An unsuspected annular abscess at the base of a prosthetic aortic valve in a patient with endocarditis was identified by indium-111-labeled leukocyte scintigraphy alone. This highly sensitive and specific technique expediently demonstrated the surgically proven inflammatory focus

Valve Calcification in Aortic Stenosis: Etiology and Diagnostic Imaging Techniques

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María Manuela Izquierdo-Gómez

2017-01-01

Full Text Available Aortic stenosis is the most common valvulopathy in the Western world. Its prevalence has increased significantly in recent years due to population aging; hence, up to 8% of westerners above the age of 84 now have severe aortic stenosis (Lindroos et al., 1993. This causes increased morbidity and mortality and therein lies the importance of adequate diagnosis and stratification of the degree of severity which allows planning the best therapeutic option in each case. Long understood as a passive age-related degenerative process, it is now considered a rather more complex entity involving mechanisms and factors similar to those of atherosclerosis (Stewart et al., 1997. In this review, we summarize the pathophysiological mechanisms underlying the onset and progression of the disease and analyze the current role of cardiac imaging techniques for diagnosis.

Does lowering cholesterol have an impact on the progression of aortic stenosis?

DEFF Research Database (Denmark)

Greve, A.M.; Wachtell, K.

2008-01-01

reviews the pathophysiological mechanisms of calcific AS, reviews current clinical trials of statin use in aortic stenosis and reports on on-going trials, evaluating whether cholesterol lowering therapy can slow disease progression in different populations. Finally, we review if computerized tomography...

Prevalence and severity of coronary artery disease in diabetic patients with aortic valve calcification.

Science.gov (United States)

Chen, Zhang-wei; Qian, Ju-ying; Jian, Ying; Ge, Lei; Liu, Xue-bo; Shu, Xian-hong; Ge, Junbo

2011-02-01

Aortic valve calcification (AVC) is common in the elderly and associated with increased cardiovascular mortality, while diabetes is one of the confirmed risk factors for coronary artery disease (CAD). In this study, we aimed to evaluate the prevalence and severity of CAD in type-2 diabetic patients with AVC. From June to December in 2007, a total of 325 consecutive patients with chest pain or chest distress were admitted for coronary angiography. The severity of CAD was evaluated by the Gensini score and the number of stenosed vessels. All patients underwent transthoracic echocardiography for detecting AVC. Compared with the patients without diabetes (n = 221), the type-2 diabetic patients (n = 104) had a similar prevalence of CAD (66.5% vs. 72.1%, P = 0.312). Further classified by the presence of AVC, patients with AVC had a higher prevalence of CAD, average Gensini score and the number of stenosed vessels, both in the group with and without diabetes. It was also demonstrated that the odds ratio (OR) of AVC for CAD in the diabetic patients was higher than in the non-diabetic ones (3.405 vs 2.515) after chi-square analysis (single-variable). However, at multivariable logistic regression analysis for CAD, the OR of AVC was 3.757 (P = 0.03) in diabetic group, while it did not achieve statistical significance in the non-diabetic group (OR = 2.130, P= 0.074). Type-2 diabetic patients with AVC had a higher prevalence of and more severe CAD.

Why aortic elasticity differs among classical and non-classical mitral valve prolapsed?

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Unlu, Murat; Demirkol, Sait; Aparci, Mustafa; Arslan, Zekeriya; Balta, Sevket; Dogan, Umuttan; Kilicarslan, Baris; Ozeke, Ozcan; Celik, Turgay; Iyisoy, Atila

2014-01-01

Mitral valve prolapse (MVP) is the most common valvular heart disease and characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. There are two types of MVP, broadly classified as classic (thickness ≥5 mm) and non-classic (thickness elastic properties of the aorta in young male patients with classical and non-classical MVP. In the present study, 63 young adult males (mean age: 22.7 ± 4.2) were included. Patients were divided into classic MVP (n = 27) and non-classic MVP (n = 36) groups. Aortic strain, aortic distensibility and aortic stiffness index were calculated by using aortic diameters obtained by echocardiography and blood pressures measured by sphygmomanometer. There was no significant difference between the groups in terms of age, body mass index, left ventricular mass and ejection fraction. When comparing the MVP group it was found that aortic strain and aortic distensibility were increased (p = 0.0027, p = 0.016, respectively) whereas the aortic stiffness index was decreased (p = 0.06) in the classical MVP group. We concluded that the elastic properties of the aorta is increased in patients with classic MVP. Further large scale studies should be performed to understand of morphological and physiological properties of the aorta in patients with MVP.

Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs.

Science.gov (United States)

Bettinger, Nicolas; Khalique, Omar K; Krepp, Joseph M; Hamid, Nadira B; Bae, David J; Pulerwitz, Todd C; Liao, Ming; Hahn, Rebecca T; Vahl, Torsten P; Nazif, Tamim M; George, Isaac; Leon, Martin B; Einstein, Andrew J; Kodali, Susheel K

The threshold for the optimal computed tomography (CT) number in Hounsfield Units (HU) to quantify aortic valvular calcium on contrast-enhanced scans has not been standardized. Our aim was to find the most accurate threshold to predict paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). 104 patients who underwent TAVR with the CoreValve prosthesis were studied retrospectively. Luminal attenuation (LA) in HU was measured at the level of the aortic annulus. Calcium volume score for the aortic valvular complex was measured using 6 threshold cutoffs (650 HU, 850 HU, LA × 1.25, LA × 1.5, LA+50, LA+100). Receiver-operating characteristic (ROC) analysis was performed to assess the predictive value for > mild PVR (n = 16). Multivariable analysis was performed to determine the accuracy to predict > mild PVR after adjustment for depth and perimeter oversizing. ROC analysis showed lower area under the curve (AUC) values for fixed threshold cutoffs (650 or 850 HU) compared to thresholds relative to LA. The LA+100 threshold had the highest AUC (0.81), and AUC was higher than all studied protocols, other than the LA x 1.25 and LA + 50 protocols, where the difference approached statistical significance (p = 0.05, and 0.068, respectively). Multivariable analysis showed calcium volume determined by the LAx1.25, LAx1.5, LA+50, and LA+ 100 HU protocols to independently predict PVR. Calcium volume scoring thresholds which are relative to LA are more predictive of PVR post-TAVR than those which use fixed cutoffs. A threshold of LA+100 HU had the highest predictive value. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

Aortic valve sparing root surgery for Marfan syndrome.

Science.gov (United States)

Matalanis, George; Perera, Nisal K

2017-11-01

Aortic valve sparing root surgery (AVSRS) is a safe and durable alternative for patients with dilated roots or pure aortic regurgitation (AR), which avoids the risks of anticoagulation or valvular degeneration with prosthetic valves. Notwithstanding the theoretical challenges of greater tissue fragility in Marfan syndrome (MFS), AVSRS has been demonstrated to have equal outcomes in this condition as it does in those without MFS. The benefits of retaining the native aortic valve in this generally younger age group extend beyond those of avoiding the inconvenience and complications of prolonged exposure to anticoagulants and include ease of management for future aortic, cardiac and non-cardiac procedures which are the norm for these patients. The essential principles of AVSRS in MFS do not differ from those for the rest of the population. Successful repair and durable valve function depend on a sound understanding of the close interaction between the structure and function of this exquisitely designed piece of engineering. We are fortunate to have numerous tools in our surgical armamentarium to preserve these valves. It is the purpose of this paper to demystify the complex structure-function interactions of the aortic valve, thereby gaining an intuition for AVSRS. We will also elaborate on specific technical details of established techniques that we have found successful in preserving the normal function of these valves in the long term.

Organizing Thrombus Mimicking a Cardiac Tumor Located at the Mitral-Aortic Intervalvular Fibrosa

Directory of Open Access Journals (Sweden)

Ji Seong Lee

2016-02-01

Full Text Available Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intraoperative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.

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

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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.)

Cohort profile: prevalence of valvular heart disease in community patients with suspected heart failure in UK.

Science.gov (United States)

Marciniak, Anna; Glover, Keli; Sharma, Rajan

2017-01-27

The aim of this study was to evaluate the proportion of suspected heart failure patients with significant valvular heart disease. Early diagnosis of valve disease is essential as delay can limit treatment and negatively affect prognosis for undiagnosed patients. The prevalence of unsuspected valve disease in the community is uncertain. We prospectively evaluated 79 043 patients, between 2001 and 2011, who were referred to a community open access echocardiography service for suspected heart failure. All patients underwent a standard transthoracic echocardiogram according to British Society of Echocardiography guidelines. Of the total number, 29 682 patients (37.5%) were diagnosed with mild valve disease, 8983 patients (11.3%) had moderate valve disease and 2134 (2.7%) had severe valve disease. Of the total number of patients scanned, the prevalence of aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation was 10%, 8.4%, 1%, and 12.5% respectively. 18% had tricuspid regurgitation. 5% had disease involving one or more valves. Of patients with suspected heart failure in the primary care setting, a significant proportion have important valvular heart disease. These patients are at high risk of future cardiac events and will require onward referral for further evaluation. We recommend that readily available community echocardiography services should be provided for general practitioners as this will result in early detection of valve disease. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

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. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Chronic sustained inflammation links to left ventricular hypertrophy and aortic valve sclerosis: a new link between S100/RAGE and FGF23.

Science.gov (United States)

Yan, Ling; Bowman, Marion A Hofmann

Cardiovascular disease including left ventricular hypertrophy, diastolic dysfunction and ectopic valvular calcification are common in patients with chronic kidney disease (CKD). Both S100A12 and fibroblast growth factor 23 (FGF23) have been identified as biomarkers of cardiovascular morbidity and mortality in patients with CKD. We tested the hypothesis that human S100/calgranulin would accelerate cardiovascular disease in mice subjected to CKD. This review paper focuses on S100 proteins and their receptor for advanced glycation end products (RAGE) and summarizes recent findings obtained in novel developed transgenic hBAC-S100 mice that express S100A12 and S100A8/9 proteins. A bacterial artificial chromosome of the human S100/calgranulin gene cluster containing the genes and regulatory elements for S100A8, S100A9 and S100A12 was expressed in C57BL/6J mice (hBAC-S100). CKD was induced by ureteral ligation, and hBAC-S100 mice and WT mice were studied after 10 weeks of chronic uremia. hBAC-S100 mice with CKD showed increased FGF23 in the heart, left ventricular hypertrophy (LVH), diastolic dysfunction, focal cartilaginous metaplasia and calcification of the mitral and aortic valve annulus together with aortic valve sclerosis. This phenotype was not observed in WT mice with CKD or in hBAC-S100 mice lacking RAGE with CKD, suggesting that the inflammatory milieu mediated by S100/RAGE promotes pathological cardiac hypertrophy in CKD. In vitro, inflammatory stimuli including IL-6, TNFα, LPS, or serum from hBAC-S100 mice up regulated FGF23 mRNA and protein in primary murine neonatal and adult cardiac fibroblasts. Taken together, our study shows that myeloid-derived human S100/calgranulin is associated with the development of cardiac hypertrophy and ectopic cardiac calcification in a RAGE dependent manner in a mouse model of CKD. We speculate that FGF23 produced by cardiac fibroblasts in response to cytokines may act in a paracrine manner to accelerate LVH and diastolic

Rapid dynamic MR imaging of the heart in the evaluation of valvular function

International Nuclear Information System (INIS)

Utz, J.A.; Herfkens, R.J.; Heinsimer, J.; Glover, G.H.; Pelc, N.J.; Shimakawa, A.

1986-01-01

Dynamic MR images were obtained utilizing a repetition time of 21 msec, a 30-degree flip angle, and 12-msec gradient refocused echoes. Images were ECG-triggered and constructed at 16 images per cardiac cycle. To assess the sensitivity of dynamic MR imaging of valvular regurgitation, 17 patients were so examined and results were compared with results of echocardiography or cardiac catheterization. Mitral and tricuspid valves were well visualized in all patients. Regurgitation was demonstrated in 14 cases as an area of decreased signal extending from the valve into the regurgitant chamber, corresponding in time to ventricular systole for mitral and tricuspid regurgitation and diastole for aortic insufficiency. There were no false-negative MR imaging studies

Calcium Overload Accelerates Phosphate-Induced Vascular Calcification Via Pit-1, but not the Calcium-Sensing Receptor.

Science.gov (United States)

Masumoto, Asuka; Sonou, Tomohiro; Ohya, Masaki; Yashiro, Mitsuru; Nakashima, Yuri; Okuda, Kouji; Iwashita, Yuko; Mima, Toru; Negi, Shigeo; Shigematsu, Takashi

2017-07-01

Vascular calcification (VC) is a risk factor of cardiovascular and all-cause mortality in patients with chronic kidney disease (CKD). CKD-mineral and bone metabolism disorder is an important problem in patients with renal failure. Abnormal levels of serum phosphate and calcium affect CKD-mineral and bone metabolism disorder and contribute to bone disease, VC, and cardiovascular disease. Hypercalcemia is a contributing factor in progression of VC in patients with CKD. However, the mechanisms of how calcium promotes intracellular calcification are still unclear. This study aimed to examine the mechanisms underlying calcium-induced calcification in a rat aortic tissue culture model. Aortic segments from 7-week-old male Sprague-Dawley rats were cultured in serum-supplemented medium for 10 days. We added high calcium (HiCa; calcium 3.0 mM) to high phosphate (HPi; phosphate 3.8 mM) medium to accelerate phosphate and calcium-induced VC. We used phosphonoformic acid and the calcimimetic R-568 to determine whether the mechanism of calcification involves Pit-1 or the calcium-sensing receptor. Medial VC was significantly augmented by HPi+HiCa medium compared with HPi alone (300%, p＜0.05), and was associated with upregulation of Pit-1 protein. Pit-1 protein concentrations in HPi+HiCa medium were greater than those in HPi medium. Phosphonoformic acid completely negated the augmentation of medial VC induced by HPi+HiCa. R-568 had no additive direct effect on medial VC. These results indicated that exposure to HPi+HiCa accelerates medial VC, and this is mediated through Pit-1, not the calcium-sensing receptor.

Excessive strut wear allowing ball-poppet embolization in a DeBakey-Surgitool aortic valve prosthesis.

Science.gov (United States)

Sutherland, R D; Guynes, W A; Nichols, C T; Martinez, H E

1982-01-01

Excessive cage strut wear allowing ball-poppet embolization caused the sudden death of a 47 year old lady in whom a DeBakey-Surgitool aortic prosthesis had been implanted nine years earlier. Patients with this type of prosthesis should have periodic valvular cine fluoroscopy with image intensification to allow visualization of significant strut wear or fracture, and appropriate prosthetic valve replacement.

Diagnostic approach to assessment of valvular heart disease using MRI—Part I: a practical approach for valvular regurgitation

Science.gov (United States)

Chaothawee, Lertlak

2012-01-01

Valvular heart diseases from any cause are divided into two categories: stenosis and regurgitation. Acquired knowledge of the pathological aetiology and disease severity are the important clues for optimal treatment, which may be medication or combination with surgery. The non-invasive techniques have been established for valvular heart disease evaluation for many years especially in demonstrating valvular structure and assessing severity. Transthoracic echocardiography still plays the major role. However, not every case can be clearly evaluated by transthoracic echocardiography because of rib space window limitation. In the present-day practice, MRI has been extensively used for the evaluation of heart diseases in both unique and complementary categories. However, valvular heart disease assessment using cardiac MRI still remains an important challenge. PMID:27326026

[Atrial fibrillation concomitant with valvular heart disease].

Science.gov (United States)

Ishii, Yosuke

2013-01-01

Patients with valvular heart disease frequently have atrial fibrillation(AF) due to elevated pressure and dilatation of the left and right atria and pulmonary veins. Guidelines for valvular heart disease and AF recommend that surgical treatment for the valvular heart disease should be performed concomitantly with AF surgery. The Full-Maze procedure has evolved into the gold standard of treatment for medically refractory AF. In addition to the pulmonary vein isolation, the right and left atrial incisions of the Full-Maze procedure are designed to block potential macroreentrant pathways. According to the mechanisms of AF with valvular heart disease, the Full-Maze procedure is more effective for the patients than the pulmonary vein isolation alone.

Aortic valve bypass surgery in severe aortic valve stenosis: Insights from cardiac and brain magnetic resonance imaging.

Science.gov (United States)

Mantini, Cesare; Caulo, Massimo; Marinelli, Daniele; Chiacchiaretta, Piero; Tartaro, Armando; Cotroneo, Antonio Raffaele; Di Giammarco, Gabriele

2018-04-13

To investigate and describe the distribution of aortic and cerebral blood flow (CBF) in patients with severe valvular aortic stenosis (AS) before and after aortic valve bypass (AVB) surgery. We enrolled 10 consecutive patients who underwent AVB surgery for severe AS. Cardiovascular magnetic resonance imaging (CMR) and brain magnetic resonance imaging were performed as baseline before surgery and twice after surgery. Quantitative flow measurements were obtained using 1.5-T magnetic resonance imaging (MRI) scanner phase-contrast images of the ascending aorta, descending thoracic aorta (3 cm proximally and distally from the conduit-to-aorta anastomosis), and ventricular outflow portion of the conduit. The evaluation of CBF was performed using 3.0-T MRI scanner arterial spin labeling (ASL) through sequences acquired at the gray matter, dorsal default-mode network, and sensorimotor levels. Conduit flow, expressed as the percentage of total antegrade flow through the conduit, was 63.5 ± 8% and 67.8 ± 7% on early and mid-term postoperative CMR, respectively (P surgery in patients with severe AS, cardiac output is split between the native left ventricular outflow tract and the apico-aortic bypass, with two-thirds of the total antegrade flow passing through the latter and one-third passing through the former. In our experience, CBF assessment confirms that the flow redistribution does not jeopardize cerebral blood supply. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

The association between systemic lupus erythematosus and valvular heart disease: an extensive data analysis.

Science.gov (United States)

Watad, Abdulla; Tiosano, Shmuel; Grysman, Noam; Comaneshter, Doron; Cohen, Arnon D; Shoenfeld, Yehuda; Amital, Howard

2017-05-01

Association between antiphospholipid syndrome in systemic lupus erythematosus (SLE) and valvular heart disease (VHD) is well reported, but relatively few studies have been carried out to establish the linkage between VHD and SLE itself. We aimed to investigate link between VHD and SLE and to evaluate the association of diverse factors with VHD among these patients in a large-scale population-based study. We used the databases of the largest state-mandated health service organization in Israel. All SLE patients were included (n = 5018) as well as their age and sex-matched controls (n = 25 090), creating a cross-sectional population-based study. Medical records of all subjects were analysed for documented VHD and the presence of antiphospholipid antibodies (aPLs). A logistic regression model was carried out to evaluate the diverse factors including SLE and aPLs as independent risk factors for VHD. Valvular heart disease were found to be more frequent among SLE group when compared to controls (aortic stenosis, 1·08% vs. 0·35% respectively, P < 0·001; aortic insufficiency, 1·32% vs. 0·29% respectively, P < 0·001; mitral stenosis, 0·74% vs. 0·21% respectively, P < 0·001; mitral insufficiency, 1·91% vs. 0·39% respectively, P < 0·001). Male sex, hypertension, aPLs and SLE were found to be significant independent risk factors for VHD. All VHD are more prevalent among SLE patients when compared to controls. SLE and aPLs are independent risk factor for VHD (OR of 2·46 and 1·7, respectively). Physicians must be aware of such significant association, and routine echocardiography should be considered in SLE patients regardless of their aPL status. © 2017 Stichting European Society for Clinical Investigation Journal Foundation.

[A clinical experience of continuous warm blood cardioplegia in two cases of repeat aortic valve surgery].

Science.gov (United States)

Nagaoka, H; In-nami, R; Watanabe, M; Funakoshi, N; Hirooka, K; Fujiwara, A

1992-11-01

The continuous warm blood cardioplegia (CWBC) was used for myocardial protection during aortic cross clamping in two cases of repeat aortic valve operations with good results. Case 1: A 46-year-old man, who underwent an aortic valve replacement because of the rheumatic aortic regurgitation (AR) in 1978, have suffered from orthopnea due to para-prosthetic valvular regurgitation since 1983. He was revealed to have bi-ventricular hypertrophy with myocardial damage on ECG, EF 0.27 on UCG, PCWP 20 mmHg and severe AR on cardiac catheterization. Case 2: A 43-year-old man, who had an aortic valvuloplasty for the non-rheumatic incompetency in 1981, have had a recurrent regurgitation, resulting in left ventricular hypertrophy accompanied by chest pain. Both cases were reoperated upon, having aortic valve replacement with mechanical prosthetic valves through the re-median sternotomy, utilizing CWBC with good recovery. CWBC provides an ideal circumstances for myocardial oxygen utilization during aortic cross clamping and moreover a benefit that needs not the wide dissection of the heart in a redo case because it has no need of topical cooling and ventricular defibrillation following aortic declamping. In conclusion, CWBC is very useful in a repeat aortic valve surgery.

Quantitative assessment of an aortic and pulmonary valve function according to valve fenestration

International Nuclear Information System (INIS)

Mirkhani, S.H.; Golestani, M.G.; Hosini, M.; Kazemian, A.

1999-01-01

There are some reasons for malfunction of aortic and pulmonary valve like fibrosis, calcification, and atheroma. Although, in some papers fenestration were known as a pathologic sign, but it is not generally accepted, while this matter is important in choosing suitable Homograft Heart Valve. In this paper fenestrations and its size, numbers and situation effect was studied. We collected 98 hearts, the donors died because of accident, we excluded valves with atheroma, calcification, fibrosis and unequal cusps, 91 aortic and 93 pulmonary valves were given further consideration. We classified valves according to situation, number and size of fenestration. Each valve was tested with 104 cm of non-nal saline column pressure which is equal to 76 mm Hg. Valve efficacy was detected by fluid flow assay. With study of 184 valves, 95 had no fenestration, 64 had less than 2 fenestration and 25 had more than 2 fenestration. Valve efficacy in condition of less than 2 fenestration was more than others (p <0.01). Malfunction effects of fenestration increased in larger valve and it will be decreased if their situation would be marginal (free margin of cusp). In the comparison of aortic and pulmonary valve we saw that malfunction effect of fenestration in pulmonary valve was more than aortic valve. Our experience in Immam Khomeini Homograft Valve Bank has shown that a great deal of valves is fenestrated. It seems that fenestration must be considered as a quality criterion in homograft valve preparation, especially in pulmonary and large aortic valves; but complementary studies is necessary

Cardiac imaging in valvular heart disease

Science.gov (United States)

Choo, W S; Steeds, R P

2011-01-01

The aim of this article is to provide a perspective on the relative importance and contribution of different imaging modalities in patients with valvular heart disease. Valvular heart disease is increasing in prevalence across Europe, at a time when the clinical ability of physicians to diagnose and assess severity is declining. Increasing reliance is placed on echocardiography, which is the mainstay of cardiac imaging in valvular heart disease. This article outlines the techniques used in this context and their limitations, identifying areas in which dynamic imaging with cardiovascular magnetic resonance and multislice CT are expanding. PMID:22723532

Alkaptonuria Presenting with Impressive Osteoarticular Changes and Severe Aortic Stenosis.

Science.gov (United States)

Roca, Bernardino; Roca, Manuel; Monferrer, Raquel

2016-03-01

Alkaptonuria, or ochronosis, a rare autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in dark pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular complications are also typical of the disease. We report the case of a 78-year-old male who presented with impressive osteoarticular changes and aortic stenosis associated with alkaptonuria.

Relationship of aortic valve calcification with coronary artery calcium severity: the Multi-Ethnic Study of Atherosclerosis (MESA).

Science.gov (United States)

Nasir, Khurram; Katz, Ronit; Al-Mallah, Mouaz; Takasu, Junichiro; Shavelle, David M; Carr, Jeffery J; Kronmal, Richard; Blumenthal, Roger S; O'Brien, Kevin; Budoff, Matthew J

2010-01-01

Aortic valve calcification (AVC) and atherosclerosis share causative and pathologic features. We evaluated the relationship between AVC and coronary artery calcium (CAC) severity in the Multi-Ethnic Study of Atherosclerosis (MESA). Men and women aged 45-84 years (n=6809; mean age, 62 years) were studied. The presence and burden of AVC and CAC were determined by noncontrast cardiac computed tomography. Relative risk regression was used to model the probability of AVC as a function of CAC > 0 as well as CAC categories (0, 1-99, 100-399, and > or = 400) with the reference group being CAC=0. The prevalence of AVC and CAC was 13% and 50%, respectively. Among those without CAC, the prevalence of AVC was 5% and increased across levels of CAC severity such that 14%, 25%, and 38% had AVC with increasing CAC scores of 1-99, 100-399, and > or = 400, respectively (P for trendAVC among those with mild CAC (1-99) was 1.83 (95% CI, 1.45-2.31) and increased to 3.36 (95% CI, 2.56-4.42) for CAC > or = 400. Similar statistically significant increased risk of AVC was found when CAC was assessed as a continuous variable. Our study shows that AVC is independently associated with increasing severity of CAC. 2010 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

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

Aortic valve surgery of the 21st century: sutureless AVR versus TAVI.

Science.gov (United States)

Costache, Victor S; Moldovan, Horatiu; Arsenescu, Catalina; Costache, Andreea

2018-04-01

Surgical aortic valve replacement (sAVR) has been a safe, effective and time-proven technique and is still the standard of care all over the world for aortic valve treatment. The vast majority of centers perform this procedure by doing a median sternotomy with several disadvantages. While many others specialties went minimally invasive decades ago, in cardiovascular field transcatheter valve implantation was the first minimally invasive valvular procedure that gained rapid worldwide acceptance. Transcatheter valve replacement (TAVR) is now marketed as a procedure that should be performed under local anesthesia, by an interventional cardiologist via trans femoral route with no other healthcare professional invited to the patient selection or case planning. An increasing number of surgeons are promoting minimally invasive aortic valve replacement, which is gaining grounds, especially with the help of the new sutureless valve technology. With these two new technologies emerging, legitimate questions arise and need to be answered - which has the longest durability, lower complication rate and lower overall mortality.

A magnesium based phosphate binder reduces vascular calcification without affecting bone in chronic renal failure rats.

Directory of Open Access Journals (Sweden)

Ellen Neven

Full Text Available The alternative phosphate binder calcium acetate/magnesium carbonate (CaMg effectively reduces hyperphosphatemia, the most important inducer of vascular calcification, in chronic renal failure (CRF. In this study, the effect of low dose CaMg on vascular calcification and possible effects of CaMg on bone turnover, a persistent clinical controversy, were evaluated in chronic renal failure rats. Adenine-induced CRF rats were treated daily with 185 mg/kg CaMg or vehicle for 5 weeks. The aortic calcium content and area% calcification were measured to evaluate the effect of CaMg. To study the effect of CaMg on bone remodeling, rats underwent 5/6th nephrectomy combined with either a normal phosphorus diet or a high phosphorus diet to differentiate between possible bone effects resulting from either CaMg-induced phosphate deficiency or a direct effect of Mg. Vehicle or CaMg was administered at doses of 185 and 375 mg/kg/day for 8 weeks. Bone histomorphometry was performed. Aortic calcium content was significantly reduced by 185 mg/kg/day CaMg. CaMg ameliorated features of hyperparathyroid bone disease. In CRF rats on a normal phosphorus diet, the highest CaMg dose caused an increase in osteoid area due to phosphate depletion. The high phosphorus diet combined with the highest CaMg dose prevented the phosphate depletion and thus the rise in osteoid area. CaMg had no effect on osteoblast/osteoclast or dynamic bone parameters, and did not alter bone Mg levels. CaMg at doses that reduce vascular calcification did not show any harmful effect on bone turnover.

Uncontrolled acromegaly is associated with progressive mitral valvular regurgitation

NARCIS (Netherlands)

van der Klaauw, A. A.; Bax, J. J.; Roelfsema, F.; Bleeker, G. B.; Holman, E. R.; Corssmit, E. P. M.; van der Wall, E. E.; Smit, J. W. A.; Romijn, J. A.; Pereira, A. M.

2006-01-01

Recent cross-sectional studies have documented an association between acromegaly and regurgitant valvular heart disease. The aim of this study was to evaluate the change in prevalence of valvular heart disease in relation to the clinical activity, because the natural history of valvular changes in

Prognostic value of clinical and Doppler echocardiographic findings in children and adolescents with significant rheumatic valvular disease

International Nuclear Information System (INIS)

Araújo, Fátima Derlene da Rocha; Goulart, Eugênio Marcos Andrade; Meira, Zilda Maria Alves

2012-01-01

The diagnosis of acute rheumatic fever (RF) is based on clinical findings. However, during the chronic phase of the disease, the clinical approach is not sufficient for the follow-up of the patients and the Doppler echocardiography is a tool for the diagnosis of cardiac involvement. Prognostic variables that influence long-term outcomes are not well known. 462 patients with RF according to Jones criteria were studied, and followed-up from the initial attack to 13.6 ± 4.6 years. All patients underwent clinical assessment and Doppler echocardiography for the detection of heart valve involvement in the acute and chronic phases. Multivariate logistic regression analysis was used to identify the factors influencing long-term heart valve disease. Carditis occurred in 55.8% and subclinical valvulitis in 35.3% patients. In the chronic phase, 33% of the patients had significant valvular heart disease. No normal Doppler echocardiography exam was observed on patients who had severe valvulitis, although heart auscultation had become normal in 13% of these. In the multivariate analysis, only the severity of carditis and the mitral and/or aortic valvulitis were associated with significant valvular heart disease. Chorea or arthritis were protective factors for significant valvular heart disease, odds ratio 0.41 (95% C.I. 0.22 – 0.77) and 0.43 (95% C.I. 0.23 – 0.82), respectively. Our study suggests that the use of Doppler echocardiography during RF helps to identify prognostic factors regarding the development of significant valvular heart disease. Initial severe carditis is an important factor in the long-term prognosis of chronic RHD, whereas arthritis and chore during the initial episode of RF appears to be protective. Strict secondary prophylaxis should be mandatory in high risk patients

Update on Valvular Heart Disease in Pregnancy.

Science.gov (United States)

Safi, Lucy M; Tsiaras, Sarah V

2017-09-01

Valvular heart disease in women of childbearing age poses an increased risk of adverse maternal and fetal outcomes, and management in pregnancy can be challenging. Ideally, patients with suspected valvular disease should have preconception counseling by a multidisciplinary team including cardiologists with expertise in pregnancy and a maternal-fetal medicine specialist. Preconception planning should include a cardiac assessment of maternal risk, determination of frequency of surveillance, and a cardiovascular management plan during delivery. Women with valvular heart disease should be followed closely by a cardiologist and monitored for signs and symptoms of congestive heart failure and arrhythmias. In general, stenotic lesions may become more symptomatic in pregnancy, whereas regurgitant lesions are generally well tolerated. Left-sided valvular lesions have higher complication rates than right-sided lesions. For patients with asymptomatic valvular stenosis, medical management during pregnancy may include beta blockade and/or diuretics. Exercise stress testing prior to pregnancy in sedentary patients can be helpful to unmask symptoms and determine functional capacity. Patients with symptomatic, severe left-sided valvular obstruction have a high maternal risk of cardiovascular events during pregnancy, and percutaneous balloon valvuloplasty or surgery is recommended prior to pregnancy. The type of prosthetic valve (mechanical vs bioprosthetic) should be selected after a careful discussion with the patient. Invasive procedures are generally reserved for when medical management fails. The second trimester may be the optimal time for intervention as fetal organogenesis is complete and the cardiac positioning has not been affected by the gravid uterus.

Palliative care in end-stage valvular heart disease.

Science.gov (United States)

Steiner, Jill M; Cooper, Stephanie; Kirkpatrick, James N

2017-08-01

Valvular heart disease (VHD), particularly aortic valve disease, is prevalent with increasing incidence. When surgery is not possible, or when risks outweigh benefits, percutaneous treatment options may offer effective alternatives. However, procedures may not always go as planned, and frail patients or those whose symptoms are caused by other comorbidities may not benefit from valve intervention at all. Significant effort should be made to assess frailty, comorbidities and patient goals prior to intervention. Palliative care (PC) should play a critical role in the care of patients with severe valve disease. PC is specialised medical care that aims to optimise health-related quality of life by managing symptoms and clarifying patient values and goals of care. It should be implemented at the time of diagnosis and continue throughout the disease course. Because of the paucity of studies dedicated to the provision of PC to patients with advanced VHD, further research is needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Reduction of regurgitation in aortic insufficiency by inhibition of the renin/angiotensin conversion enzyme

Energy Technology Data Exchange (ETDEWEB)

Reske, S.N.; Heck, I.; Mattern, H.

1984-10-01

The effect of captopril-mediated afterload reduction on regurgitation was investigated in 10 patients with aortic insufficiency. Regurgitation was quantitated by the regurgitation fraction and the relation of regurgitant volume to end-diastolic volume, which were derived from gated radionuclide ventriculography. 19 patients with coronary artery disease and no evidence of valvular heart disease served as controls. In patients with coronary artery disease no significant reguration was found. In patients with aortic regurgitation the blood concentration of angiotensin I increased whereas that of angiotensin II decreased significantly after captopril-medication; thus, the conversion of angiotensin I to II was reduced to about 50% of the control value. Whereas blood pressure and heart rate did not change significantly, the regurgitation fraction and the normalized regurgitant volume were significantly reduced. The ejection fraction remained essentially unchanged. These findings suggest a favorable influence of captopril-induced afterload reduction on hemodynamics in aortic regurgitation.

TRANSCATHETER AORTIC VALVE IMPLANTATION. STATE OF THE PROBLEM AND PROSPECTS IN RUSSIA

Directory of Open Access Journals (Sweden)

T. E. Imaev

2015-01-01

Full Text Available Nowadays aortic stenosis is the most common valvular pathology in Europe and North America and its incidence increases with age. Long asymptomatic period, the duration of which varies in different patients, is the main clinical feature of this disease. In 80% of asymptomatic patients with the severe aortic stenosis the onset of clinical signs that significantly worsen the prognosis, occurs within the next 4 years. So, if two-year survival rate in asymptomatic period is at least 50%, a 5-year survival rate in patients with symptomatic aortic stenosis without surgery, according to some estimates, is reduced to 15%. Therefore, these patients do not have any alternative to surgery. At that, high risk of complications after surgery and perioperative mortality related to them are the most essential problems of surgical treatment of the aortic valve diseases in the setting of cardiopulmonary bypass. This was the decisive factor for the development of alternative methods of surgical correction of the aortic valve diseases. Indications and contraindications for transcatheter aortic valve implantation (TAVI, which is currently a "disruptive technology", are discussed. Different models of aortic valve prostheses, the use of which is confirmed by the available evidence, are considered. The most important unsolved problems of TAVI use in recent times are mentioned in brief. More than 300 TAVI procedures have been performed in Russia recently which definitely does not cover the actual needs.

TRANSCATHETER AORTIC VALVE IMPLANTATION. STATE OF THE PROBLEM AND PROSPECTS IN RUSSIA

Directory of Open Access Journals (Sweden)

T. E. Imaev

2015-09-01

Full Text Available Nowadays aortic stenosis is the most common valvular pathology in Europe and North America and its incidence increases with age. Long asymptomatic period, the duration of which varies in different patients, is the main clinical feature of this disease. In 80% of asymptomatic patients with the severe aortic stenosis the onset of clinical signs that significantly worsen the prognosis, occurs within the next 4 years. So, if two-year survival rate in asymptomatic period is at least 50%, a 5-year survival rate in patients with symptomatic aortic stenosis without surgery, according to some estimates, is reduced to 15%. Therefore, these patients do not have any alternative to surgery. At that, high risk of complications after surgery and perioperative mortality related to them are the most essential problems of surgical treatment of the aortic valve diseases in the setting of cardiopulmonary bypass. This was the decisive factor for the development of alternative methods of surgical correction of the aortic valve diseases. Indications and contraindications for transcatheter aortic valve implantation (TAVI, which is currently a "disruptive technology", are discussed. Different models of aortic valve prostheses, the use of which is confirmed by the available evidence, are considered. The most important unsolved problems of TAVI use in recent times are mentioned in brief. More than 300 TAVI procedures have been performed in Russia recently which definitely does not cover the actual needs.

Deformation Differences between Tricuspid and Bicuspid Aortic Valves in Vitro

Science.gov (United States)

Szeto, Kai; Rodriguez-Rodriguez, Javier; Pastuszko, Peter; Nigam, Vishal; Lasheras, Juan C.

2011-11-01

It has been shown in clinical studies that patients with congenital bicuspid aortic valves (CBAVs) develop degenerative calcification of the leaflets at young ages compared to patients with the normal tricuspid aortic valves (TAVs). It has been hypothesized that the asymmetrical geometry of the leaflets in CBAVs, flow shear stresses (SS), disturbed flow, and excessive strain rate levels are possible causes for the early calcification and stenosis. Central to the validation of this hypothesis is the need to quantify the differences in strain rate levels between the BAVs and TAVs. We simulate the CBAVs by surgically stitching two of the leaflets of a porcine aortic valve together. To quantify strain differences, we performed in-vitro experiments in both trileaflet and bileaflet valves by tracking the motion of small ink dots marked on each leaflet surface. We then used phase-locked stereo photogrammetry to reconstruct at each instant of time the 3D surface of the leaflets and measure the strain rates in both radial and circumferential directions during the whole cardiac cycle. Our results indicate that the total strain rate of the simulated BAVs is about 15 to 20% higher than the normal leaflets of TAVs at systole. In the BAVs' case, the fused leaflet stretches radially up to 25% higher than the reference length. The excessive stretching in both directions in the fused leaflet results in large changes in the flow patterns and associated wall SS.

Aortic non communicating dissections. A study with helical CT

International Nuclear Information System (INIS)

Midiri, M.; Strada, A.; Stabile Ianora, A.A.; Rotondo, A.; Angelelli, G.; D'Agostino, D.; De Luca Tupputi Schinosa, L.

2000-01-01

The evaluate the signs of aortic intramural hematoma with helical CT and the diagnostic role of this technique in patients with this condition. It was reviewed the CT findings of 396 patients submitted to emergency examinations for suspected aortic dissection from 1995 to 1999. Only 18 patients (6 women and 12 men) had CT signs of aortic intramural hematoma. Helical CT studies were carried out with the following parameters: slice thickness 10 mm, reconstruction index 10, feed 1.5 mm, conventional algorithm with minimum values of 130 kV and 125mA. All patients were examined with dynamic contrast-enhanced CT, before and after a power injection of 130 mL ionic contrast material. It was studied: hematoma localization and longitudinal extension; thickness and density of aortic wall; presence and location of intimal calcifications; integrity of intimal wall; hemo mediastinum and/or hemo thorax. Aortic wall thickening appeared as a high density crescent-shaped area at baseline CT and had low density on enhanced images in all patients. Thickening was eccentric in 14/18 patients and concentric in 4/18 only; it always exceeded 4 mm. It was found some intimal calcifications in 8 patients and hemo thorax and/or hemo mediastinum in 9 patients. A patient with type A hematoma died of cardiac tamponade a few hours after CT diagnosis. Six patients (5 type B and 1 type A) underwent anti-hypertensive treatment and radiological follow-up. Eleven patients (6 type A and 5 type B) underwent prosthesis replacement and 5 of them (3 type A and 2 type B) died of postoperative complications. In the 5 type B patients surgery was performed because of treatment-resistant pain and of the onset of ischemic complications to abdominal organs caused by involvement of the main collateral branches of the aorta. One patient with type A hematoma was submitted to drug treatment because it was judged unresectable. Intramural hematoma of the aorta is a distinct pathological entity, which should not be

Congenital and Acquired Valvular Heart Disease in Pregnancy.

Science.gov (United States)

Goldstein, Sarah A; Ward, Cary C

2017-08-24

The number of pregnancies complicated by valvular heart disease is increasing. This review describes the hemodynamic effects of clinically important valvular abnormalities during pregnancy and reviews current guideline-driven management strategies. Valvular heart disease in women of childbearing age is most commonly caused by congenital abnormalities and rheumatic heart disease. Regurgitant lesions are well tolerated, while stenotic lesions are associated with a higher risk of pregnancy-related complications. Management of symptomatic disease during pregnancy is primarily medical, with percutaneous interventions considered for refractory symptoms. Most guidelines addressing the management of valvular heart disease during pregnancy are based on case reports and observational studies. Additional investigation is required to further advance the care of this growing patient population.

Expanding TAVI options: elective rotational atherectomy during trans-catheter aortic valve implantation

International Nuclear Information System (INIS)

Piccoli, Anna; Lunardi, Mattia; Ariotti, Sara; Ferrero, Valeria; Vassanelli, Corrado; Ribichini, Flavio

2015-01-01

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

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.

RANKL inhibition with denosumab does not influence 3-year progression of aortic calcification or incidence of adverse cardiovascular events in postmenopausal women with osteoporosis and high cardiovascular risk.

Science.gov (United States)

Samelson, Elizabeth J; Miller, Paul D; Christiansen, Claus; Daizadeh, Nadia S; Grazette, Luanda; Anthony, Mary S; Egbuna, Ogo; Wang, Andrea; Siddhanti, Suresh R; Cheung, Angela M; Franchimont, Nathalie; Kiel, Douglas P

2014-02-01

Atherosclerosis and osteoporosis are chronic diseases that progress with age, and studies suggest aortic calcification, an indicator of atherosclerosis, is inversely associated with bone mineral density (BMD). The osteoprotegerin (OPG)/receptor activator of NF-κB (RANK)/RANK ligand (RANKL) system has been proposed as a shared regulatory system for bone and vasculature. Denosumab (DMAb), a monoclonal antibody against RANKL, improved BMD and reduced fracture risk in the Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) trial. We evaluated whether or not treatment with DMAb influenced progression of aortic calcification (AC) and incidence of cardiovascular (CV) adverse events. We included 2363 postmenopausal women with osteoporosis (1142 placebo, 1221 DMAb), selected from 7808 participants in the FREEDOM trial (3906 placebo, 3902 DMAb), at high risk of CV events according to modified Raloxifene Use for the Heart (RUTH) criteria. CV adverse events were reported by participants. AC scores were assessed using a semiquantitative method from lateral spine X-rays. Change in AC score from baseline to 12 (n = 1377), 24 (n = 1231), and 36 months (n = 1045) was calculated as AC score at follow-up minus AC score at baseline. AC progression was defined as change in AC score >0. Baseline characteristics, CV risk factors, and AC scores were similar between treatment groups. Mean age of participants was 74 years (range, 60-90), 88% were white, and 77% had AC score >0 at baseline. Frequency of AC progression over 3 years did not differ between women in placebo (22%) and DMAb (22%) groups (p = 0.98). AC progression did not differ between treatment groups when analyzed by baseline estimated glomerular filtration rate or by baseline AC scores. Frequency of CV adverse events did not differ between placebo (40%) and DMAb (38%) groups (p = 0.26). In conclusion, DMAb treatment had no effect on progression of AC or incidence of CV

Inter-ethnic differences in valve morphology, valvular dysfunction, and aortopathy between Asian and European patients with bicuspid aortic valve.

Science.gov (United States)

Kong, William K F; Regeer, Madelien V; Poh, Kian K; Yip, James W; van Rosendael, Philippe J; Yeo, Tiong C; Tay, Edgar; Kamperidis, Vasileios; van der Velde, Enno T; Mertens, Bart; Ajmone Marsan, Nina; Delgado, Victoria; Bax, Jeroen J

2018-04-14

Transcatheter aortic valve replacement (TAVR) has been shown safe and feasible in patients with bicuspid aortic valve (BAV) morphology. Evaluation of inter-ethnic differences in valve morphology and function and aortic root dimensions in patients with BAV is important for the worldwide spread of this therapy in this subgroup of patients. Comparisons between large European and Asian cohorts of patients with BAV have not been performed, and potential differences between populations may have important implications for TAVR. The present study evaluated the differences in valve morphology and function and aortic root dimensions between two large cohorts of European and Asian patients with BAV. Aortic valve morphology was defined on transthoracic echocardiography according to the number of commissures and raphe: type 0 = no raphe and two commissures, type 1 = one raphe and two commissures, type 2 = two raphes and one commissure. Aortic stenosis and regurgitation were graded according to current recommendations. For this study, aortic root dimensions were manually measured on transthoracic echocardiograms at the level of the aortic annulus, sinus of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta (AA). Of 1427 patients with BAV (45.2 ± 18.1 years, 71.9% men), 794 (55.6%) were Europeans and 633 (44.4%) were Asians. The groups were comparable in age and proportion of male sex. Asians had higher prevalence of type 1 BAV with raphe between right and non-coronary cusps than Europeans (19.7% vs. 13.6%, respectively; P < 0.001), whereas the Europeans had higher prevalence of type 0 BAV (two commissures, no raphe) than Asians (14.5% vs. 6.8%, respectively; P < 0.001). The prevalence of moderate and severe aortic regurgitation was higher in Europeans than Asians (44.2% vs. 26.8%, respectively; P < 0.001) whereas there were no differences in BAV with normal function or aortic stenosis. After adjusting for demographics, comorbidities

Engineering a 3D-Bioprinted Model of Human Heart Valve Disease Using Nanoindentation-Based Biomechanics

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Dewy C. van der Valk

2018-05-01

Full Text Available In calcific aortic valve disease (CAVD, microcalcifications originating from nanoscale calcifying vesicles disrupt the aortic valve (AV leaflets, which consist of three (biomechanically distinct layers: the fibrosa, spongiosa, and ventricularis. CAVD has no pharmacotherapy and lacks in vitro models as a result of complex valvular biomechanical features surrounding resident mechanosensitive valvular interstitial cells (VICs. We measured layer-specific mechanical properties of the human AV and engineered a three-dimensional (3D-bioprinted CAVD model that recapitulates leaflet layer biomechanics for the first time. Human AV leaflet layers were separated by microdissection, and nanoindentation determined layer-specific Young’s moduli. Methacrylated gelatin (GelMA/methacrylated hyaluronic acid (HAMA hydrogels were tuned to duplicate layer-specific mechanical characteristics, followed by 3D-printing with encapsulated human VICs. Hydrogels were exposed to osteogenic media (OM to induce microcalcification, and VIC pathogenesis was assessed by near infrared or immunofluorescence microscopy. Median Young’s moduli of the AV layers were 37.1, 15.4, and 26.9 kPa (fibrosa/spongiosa/ventricularis, respectively. The fibrosa and spongiosa Young’s moduli matched the 3D 5% GelMa/1% HAMA UV-crosslinked hydrogels. OM stimulation of VIC-laden bioprinted hydrogels induced microcalcification without apoptosis. We report the first layer-specific measurements of human AV moduli and a novel 3D-bioprinted CAVD model that potentiates microcalcification by mimicking the native AV mechanical environment. This work sheds light on valvular mechanobiology and could facilitate high-throughput drug-screening in CAVD.

Evaluation of aortic regurgitation using cine magnetic resonance imaging

International Nuclear Information System (INIS)

Tamai, Takuya; Konishi, Tokuji; Okamoto, Shinya; Sakuma, Hajime; Takeda, Kan; Nakano, Takeshi

1993-01-01

Cine magnetic resonance imaging (MRI) was used to assess aortic regurgitation (AR) in 13 patients with valvular disease and 3 normal subjects, and the results were compared to color Doppler flow mapping findings. AR produced a signal void in the left ventricle during the diastolic phase in all patients by MRI. There were no false positive or negative results compared with echocardiographic findings. Visual grading of cine MRI gave results similar to color flow Doppler echocardiography (88%). The distance and the area of aortic regurgitation using MRI correlated well with color Doppler flow mapping (r=0.82 and 0.88). However, measurements of distance and area by color flow Doppler tended to be larger than those by cine MRI. With current techniques echocardiography may overestimate the severity of AR as compared with cine MRI. In addition, MRI gives clinically useful information in patients in whom transthoracic Doppler echocardiography is not adequate. (author)

Imaging of aortic valve dynamics in 4D OCT

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Schnabel Christian

2015-09-01

Full Text Available The mechanical components of the heart, especially the valves and leaflets, are enormous stressed during lifetime. Therefore, those structures undergo different pathophysiological tissue transformations which affect cardiac output and in consequence living comfort of affected patients. These changes may lead to calcific aortic valve stenosis (AVS, the major heart valve disease in humans. The knowledge about changes of the dynamic behaviour during the course of this disease and the possibility of early stage diagnosis is of particular interest and could lead to the development of new treatment strategies and drug based options of prevention or therapy. 4D optical coherence tomography (OCT in combination with high-speed video microscopy were applied to characterize dynamic behaviour of the murine aortic valve and to characterize dynamic properties during artificial stimulation. We present a promising tool to investigate the aortic valve dynamics in an ex vivo disease model with a high spatial and temporal resolution using a multimodal imaging setup.

Bentall Procedure Using Cryopreserved Valved Aortic Homografts

Science.gov (United States)

Christenson, Jan T.; Sierra, Jorge; Trindade, Pedro T.; Didier, Dominique; Kalangos, Afksendiyos

2004-01-01

The Bentall procedure is the standard operation for patients who have lesions of the ascending aorta associated with aortic valve disease. In many cases, however, mechanical prosthetic conduits are not suitable. There are few reports in the English-language medical literature concerning the mid- to long-term outcome of Bentall operations with cryopreserved homografts. Therefore, we reviewed our experience with this procedure and valved homografts. From January 1997 through December 2002, 21 patients underwent a Bentall operation with cryopreserved homografts at our institution. There were 14 males and 7 females; the mean age was 36 ± 21 years (range, 15–74 years). Eleven patients had undergone previous aortic valve surgery. All patients had aortic dilatation or aneurysms involving the ascending aorta. Indications for surgery included aortic valve stenosis or insufficiency, and aortic valve endocarditis (native valve or prosthetic). One patient had Takayasu's arteritis and 3 had Marfan syndrome. There was 1 hospital death (due to sepsis), but no other major postoperative complications. The mean hospital stay was 14 ± 7 days. Follow-up echocardiographic and computed tomographic scans were performed yearly. The mean follow-up was 34 months (6–72 months). Follow-up imaging revealed no calcifications or degenerative processes related to the homograft. Four patients had minimal valve regurgitation. Two patients died during follow-up. The 3-year actuarial survival rate was 85.7%. Our data suggest that the Bentall procedure with a valved homograft conduit is a safe procedure with excellent mid- to long-term results, comparable to results reported with aortic valve replacement with a homograft. PMID:15745290

CT screened arterial calcification as a risk factor for mortality after trauma.

Science.gov (United States)

De'Ath, Henry D; Oakland, Kathryn; Brohi, Karim

2016-10-10

Arterial calcification on Computerised Tomography (CT) is a marker of cardiovascular disease. It is predictive of future adverse cardiac events and mortality in many disease states. The incidence of arterial disease and its impact on outcomes of the injured is not known. The objectives of this study were to describe the incidence of arterial calcification in trauma patients, and establish its impact on mortality. A retrospective cohort study of all injured patients aged over 45 years presenting to a major trauma centre over a 34-month period. The presence and quantity of coronary, aortic and abdominal arterial calcification on admission CT scans of the chest, abdomen and pelvis was established, and the association between cardiovascular disease and in-hospital mortality following trauma was determined. Five hundred ninety-one patients were included in the study. Cardiac calcium was visible on 432 (73 %) scans, and abdominal arterial calcification on 472 (79.9 %). Fifty (8.5 %) patients died. Patients with Superior Mesenteric (SMA) and Common Iliac Artery calcification had a significantly higher mortality than those without (p < 0.01). In multivariarate analysis, only SMA calcification was independently associated with mortality (OR 2.462, 95 % CI 1.08-5.60, p = 0.032). Coronary calcium demonstrated no independent statistical relationship with death (Left Anterior Descending Artery OR 1.189, 95 % CI 0.51-2.78, Circumflex OR 1.290, 95 % CI 0.56-2.98, Right Coronary Artery OR 0.483, 95 % CI 0.21-1.10). This study has demonstrated that the identification of arterial calcification on admission CT scans of trauma patients is possible. Calcification was common, and present in around three-quarters of injured individuals over the age of 45 years. SMA calcium was an independent predictor of mortality. However, whilst the presence of arterial calcium demonstrated a tendency towards lower survival, this association was not significant in other territories

Challenges in developing a reseeded, tissue-engineered aortic valve prosthesis.

Science.gov (United States)

Hof, Alexander; Raschke, Silja; Baier, Karina; Nehrenheim, Laura; Selig, Jessica Isabel; Schomaker, Markus; Lichtenberg, Artur; Meyer, Heiko; Akhyari, Payam

2016-09-01

Biological heart valve prostheses are characterized by a limited durability due to the degenerative processes after implantation. Tissue engineering may provide new approaches in the development of optimized valvular grafts. While re-endothelialization of decellularized heart valves has already been successfully implemented, interstitial repopulation still remains an unaccomplished objective although it is essential for valvular functionality and regeneration potential. The aim of this study was to compare different concepts for an improved in vitro interstitial repopulation of decellularized heart valves. A novel 3D heart valve model has been developed to investigate the cell behaviour of valvular interstitial cells (VIC) in their physiological environment and to evaluate the potential of in vitro repopulation of acellular heart valves. Ovine aortic heart valves were decellularized by detergent solutions and additionally treated with trypsin or laser perforation. Subsequently, the decellularized extracellular matrices (dECM) were reseeded with ovine VIC using reseeding devices to provide a repopulation of the matrix on a defined area under controlled conditions. After an initial attachment of the VIC, reseeded dECM were transferred into a transwell system to improve the nutrient supply inside the valvular matrix. Cell migration and expression of cell markers were analysed histologically. The results were compared with VIC cultivation in a biological scaffold. VIC did not migrate into the matrix of untreated dECM and reseeding in laser perforated dECM showed inconsistent results. However, trypsinization increased the susceptibility of the valvular cusps to VIC penetration and repopulation of superficial areas. Additionally, the cultivation of reseeded dECM in a transwell system significantly increased the total number of cells repopulating the valvular matrix and their mean migration distance, representing the best repopulation results. Immunohistological analysis

Effects of rosuvastatin on progression of stenosis in adult patients with congenital aortic stenosis (PROCAS Trial)

NARCIS (Netherlands)

Linde, D. van der; Yap, S.C.; Dijk, A.P. van; Budts, W.; Pieper, P.G.; Burgh, P.H. van der; Mulder, B.J.; Witsenburg, M.; Cuypers, J.A.; Lindemans, J.; Takkenberg, J.J.; Roos-Hesselink, J.W.

2011-01-01

Recent trials have failed to show that statin therapy halts the progression of calcific aortic stenosis (AS). We hypothesized that statin therapy in younger patients with congenital AS would be more beneficial, because the valve is less calcified. In the present double-blind, placebo-controlled

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

Science.gov (United States)

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

2009-11-01

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

Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population

OpenAIRE

Willemink, Martin J.; Takx, Richard A. P.; I?gum, Ivana; de Koning, Harry J.; Oudkerk, Matthijs; Mali, Willem P. Th. M.; Budde, Ricardo P. J.; Leiner, Tim; Vliegenthart, Rozemarijn; de Jong, Pim A.

2015-01-01

textabstractTo assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced low-radiation-dose chest CT for lung cancer screening were included. Non-imaging predictors (age, smoking status and pack-years) were collected and imaging-predictors (calcium volume of the coronary arteries...

Dynamic studies of cardiac valvular disease using a new fast multiphase MR imaging technique

International Nuclear Information System (INIS)

Pettigrew, R.; Churchwell, A.; Parks, W.J.; Dannels, W.; Smith, H. III; Baron, M.G.

1986-01-01

To determine the potential utility of fast multiphase (FM) imaging for the assessment of cardiac valvular disease, ten healthy volunteers and 18 patients were studied. The FM technique employed gradient echoes with TE -- 15 msec and small exitation angles with TR -- 50 msec. Cine display of the electrocardiographically gated FM images allowed clear visualization of regurgitant blood flow in each of 15 patients with tricuspid or mitral insufficiency. Magnetic field distortions in two patients with Bjork-Shiley aortic prostheses and regurgitation prevented definitive visualization of the flow patterns. An equivocal flow pattern was seen in one case of mitral stenosis. Thus, FM imaging may have significant utility as an adjunctive procedure for the assessment of atrioventricular valve insufficiently, without requiring a contrast agent. Difficulties may exist with some prosthetic valves

Evaluation of Cardiac and Valvular Function after Arterial Switch Operation: A Midterm Follow-Up

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Hamid Amoozgar

2013-09-01

Full Text Available Objectives: Transposition of Great Arteries (TGA is a serious congenital heart disease and anatomic correction in the first few weeks of life has revealed good outcomes nowadays. In this study, we aimed to evaluate the myocardial and valvular function at midterm postoperative follow-up. Patients and Methods: In this study, thirty-three patients with TGA and Arterial Switch Operation (ASO were evaluated by 2-dimensional, M-mode, Doppler, and pulsed Tissue Doppler. These patients were compared with 33 healthy children of the same age and gender as the normal control group. Student’s t-test and Pearson correlation were used to analyze the data. Besides, P<0.05 was considered as statistically significant. Results: The mean follow up time was 40.9±5.6 months. Among the 33 patients with ASO, 6% had mild pulmonary stenosis, while 3% had mild pulmonary insufficiency. Aortic stenosis and aortic insufficiency of trivial to mild degree was seen in 12% and 12% of the patients, respectively. The patients’ systolic velocity of tricuspid (S, early diastolic velocity of tricuspid (Ea, and late velocity of tricuspid valve (Aa were significantly different from those of the controls (P<0.001. Also, pulmonary annulus diameter was significantly dilated in the patients compared to the controls (1.67±0.41 vs. 1.29±0.28, P≤0.001. Besides, aortic annulus diameter (1.56±0.42 vs. 1.24±0.21, P=0.001 and also aortic sinus diameter (2.06±0.41 vs. 1.44±0.34, P=0.002 were significantly dilated, while sinutuboar junction diameter (1.65±0.5 vs. 1.28±0.29, P=0.094 was not dilated. Left ventricular function was in the normal range. Conclusions: This study showed good left ventricular function, but some abnormalities in lateral tricuspid tissue Doppler velocities. Neoaortic and pulmonary diameters were significantly dilated, while aortic and pulmonary insufficiencies were clinically insignificant in most of the patients. Long-term follow-up is necessary in these

Idiopathic mitral valve prolapse with tricuspid, aortic and pulmonary valve involvement: An autopsy case report

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Heena M Desai

2015-01-01

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

The influence of aortic valve calcification on the risk of periprocedural myocardial injury after elective coronary intervention.

Science.gov (United States)

Chen, Zhang-Wei; Yang, Hong-Bo; Chen, Ying-Hua; Qian, Ju-Ying; Shu, Xian-Hong; Ge, Jun-Bo

2015-10-01

Aortic valve calcification (AVC) is a common progressive condition that involves several inflammatory and atherosclerotic mediators. However, it is unclear whether the occurrence of periprocedural myocardial injury (PMI) after elective coronary intervention is associated with AVC in stable coronary artery disease (CAD) patients. A total of 530 stable CAD patients who underwent elective coronary intervention were enrolled in this clinical study. High sensitive cardiac troponin T (hs-cTnT) was detected before and after the procedure. PMI was defined as hs-cTnT after coronary intervention higher than 99th percentile upper reference limit (URL). All patients underwent echocardiography to detect the occurrence of AVC. Univariate and multivariate analyses were applied to analyze risk factors of PMI. A total of 210 patients (39.6 %) were diagnosed with PMI after elective coronary intervention. Compared with non-AVC patients (n = 386), AVC patients (n = 144) had higher rate of PMI (64.6 vs. 30.3 %, P AVC had higher Gensini score (39.9 ± 26.6 vs. 34.2 ± 22.1, P AVC patients had increased risk of PMI compared with non-AVC patients. Importantly, even after being adjusted by multivariate analysis, AVC still independently increased the risk of PMI (OR = 3.329, 95 % CI = 2.087-5.308, P AVC significantly increased the risk of PMI after elective coronary intervention. It could be one of the independent predictors for PMI in stable CAD patients.

Postoperative CT findings of aortic aneurysm and dissection

International Nuclear Information System (INIS)

Seong, Su Ok; Lee, Ghi Jai; Kim, Mi Young; Moon, Hi Eun; Shim, Jae Chan; Lee, Hong Sup; Kim, Ho Kyun; Han, Chang Yul

1995-01-01

To assess the postoperative CT findings of aortic aneurysms or dissections treared by resection-and graft replacement or continuous-suture graft-inclusion technique. We reviewed postoperative follow-up CT findings of 14 patients, 19 cases. There were 8 patients (10 cases) of aortic aneurysm and 6 patients (9 cases) of aortic dissection which involved the thoracic aorta in 9 patients (13 cases) and abdominal aorta in 5 patients (6 cases). The interval of follow-up after operation was from 9 days to 2 year 9 months. On CT scans, we analyzed the appearance of graft materials, differences of CT findings between two surgical techniques, and normal or abnormal postoperative CT findings. Most of grafts appeared as hyperdense ring on precontrast scan, and all of them were not separated from aortic lumen on postcontrast scan. On CT findings of patients who were operated by continuous-suture graft-inclusion technique, perigraft thrombus was concentrically located with sharp demarcation by native aortic wall and its density was homogeneous, but in cases of those operated by resection-and graft replacement, perigraft hematoma was eccentrically located with indistinct margin and its density was heterogeneous and native aortic wall could not be delineated. In patients without complication, perigraft thrombus or hematoma (15 cases), perigraft calcification (11 cases), residual intimal flap (6 cases), graft deformity (4 cases), perigraft air (2 cases) and reconstructed vessels (1 cases) were noted. And in one patient with complication, perigraft flow was noted with more increased perigraft hematoma. Precise knowledge of the differences of CT findings between two surgical techniques and normal postoperative CT findings is crucial to evaluated the postoperative CT findings in aortic aneurysm and dissection

Bicuspid aortic valve demonstrated with multislice computed tomography - a case report

International Nuclear Information System (INIS)

Marzec, M.; Lasek, W.; Serafin, Z.; Laskowska, K.; Swiatkiewicz, I.; Kubica, J.

2004-01-01

Bicuspid aortic valve (BAV) is one of the most common congenital heart defects and often coexists with other congenital abnormalities of the heart and great vessels. A standard diagnostic technique for valve imaging is echocardiography. However, suboptimal images may cause a diagnostic problem, especially in obese patients, women and in case of significant valve calcifications. The paper reports a case of a 27-year-old male patient with recurrent chest pain, appearing regardless of exertion. Routine physical examination, laboratory tests and echocardiography were negative. Multislice computed tomography (MSCT) showed normal coronary arteries and bicuspid aortic valve. The diagnostics of bicuspid aortic valve and the diagnostic value of MSCT are discussed. MSCT seems to be an important point in cardiac diagnostic algorithms, being an alternative modality for MR in BAV imaging. The presented case emphasizes the potential of MSCT for the diagnostics of cardiac valve congenital diseases. (author)

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement.

Science.gov (United States)

Tavakoli, Reza; Leprince, Pascal; Gassmann, Max; Jamshidi, Peiman; Yamani, Nassrin; Amour, Julien; Lebreton, Guillaume

2018-03-26

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer

Aortic insufficiency and hydralazine: behaviour of left ventricular ejection fraction and of stroke index ratio at rest and during exercise

International Nuclear Information System (INIS)

Sole, C.; Florenzano, F.; Morales, B.; Neubauer, S.; Escobar, E.; Mollerach, F.; Mollerach, A.; Avella, O.

1982-01-01

The gated blood pool ventriculography in patients undergoing in vivo red blood cells labelling with 99mTc-pertechnetate, was evaluated critically as a form of quantifying aortic valvular regurgitation (AVR) and was applicated in severe aortic insufficiency (AI) to determine the effects of Hydralazine at rest and during exercise on the ventricular function parameters thus obtained. The beneficious effects of Hydralazine on left ventricular performance in patients with AI, have already been reported. The results confirm this too, but using a non-invasive method. These beneficious effects of Hydralazine in patients with AI were proved to be a consequence of significant increase in left ventricular ejection fraction (LVEF)

Predictive value of platelet-to-lymphocyte ratio in severe degenerative aortic valve stenosis

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Efe Edem

2016-01-01

Full Text Available Background: Aortic valve stenosis (AVS is the most common cause of left ventricular outflow obstruction, and its prevalence among elderly patients causes a major public health burden. Recently, platelet-to-lymphocyte ratio (PLR has been recognized as a novel prognostic biomarker that offers information about both aggregation and inflammation pathways. Since PLR indicates inflammation, we hypothesized that PLR may be associated with the severity of AVS due to chronic inflammation pathways that cause stiffness and calcification of the aortic valve. Materials and Methods: We retrospectively enrolled 117 patients with severe degenerative AVS, who underwent aortic valve replacement and 117 control patients in our clinic. PLR was defined as the absolute platelet count divided by the absolute lymphocyte count. Severe AVS was defined as calcification and sclerosis of the valve with a mean pressure gradient of >40 mmHg. Results: PLR was 197.03 ± 49.61 in the AVS group and 144.9 ± 40.35 in the control group, which indicated a statistically significant difference (P < 0.001. A receiver operating characteristic (ROC curve analysis demonstrated that PLR values over 188 predicted the severity of aortic stenosis with a sensitivity of 87% and a specificity of 70% (95% confidence interval = 0.734–0.882; P < 0.001; area under ROC curve: 0.808. Conclusion: We suggest that the level of PLR elevation is related to the severity of degenerative AVS, and PLR should be used to monitor patients' inflammatory responses and the efficacy of treatment, which will lead us to more closely monitor this high-risk population to detect severe degenerative AVS at an early stage.

Carotenoids co-localize with hydroxyapatite, cholesterol, and other lipids in calcified stenotic aortic valves. Ex vivo Raman maps compared to histological patterns.

OpenAIRE

Bonetti, A.; Bonifacio, A.; Della Mora, A.; Livi, U.; Marchini, M.; Ortolani, F.

2015-01-01

Unlike its application for atherosclerotic plaque analysis, Raman microspectroscopy was sporadically used to check the sole nature of bioapatite deposits in stenotic aortic valves, neglecting the involvement of accumulated lipids/lipoproteins in the calcific process. Here, Raman microspectroscopy was employed for examination of stenotic aortic valve leaflets to add information on nature and distribution of accumulated lipids and their correlation with mineralization in the light of its potent...

Early Outcomes of Sutureless Aortic Valves

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Muhammet Onur Hanedan

2016-06-01

Full Text Available Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA valves were used. Results: The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7% were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69% died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

Early Outcomes of Sutureless Aortic Valves.

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Hanedan, Muhammet Onur; Mataracı, İlker; Yürük, Mehmet Ali; Özer, Tanıl; Sayar, Ufuk; Arslan, Ali Kemal; Ziyrek, Uğur; Yücel, Murat

2016-06-01

In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%. In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

Clinical studies on hemodynamic assessments of valvular heart disease by means of radiopulmonary cardiography (RPCG)

International Nuclear Information System (INIS)

Doi, Shuji

1978-01-01

Radiopulmonary cardiography and lung scinti-scanning methods were employed for this study and performed on 59 patients with mitral valve disease and on 6 patients with aortic valve disease. For these examination, sup(99m)Tc-Pertechnetate and 131 I-MAA were administered intravenously as usual. Circulation time from the right heart to the lung (R-P), and from the lung to the left heart (P-L), and from the right heart to the left heart (R-L), as well as the value to the R-P and P-L ratio, and the U/L ratio in terms of blood distribution in the upper and lower parts of the lung were carefully estimated through these methods. Significant prolongation of the P-L interval and decrease in the R-P/P-L ratio were clearly observed in aortic insufficiency, mitral insufficiency, mitral stnosis, and mitral steno-insufficiency (MSI). On the contrary, prolongation of the R-P interval and an increase in the R-P/P-L ratio were recognized in patients with MSI + tricuspid insufficiency (TI). Radiopulmonary cardiograms revealed such characteristic patterns in each valvular heart disease, that differential diagnosis among valvular heart disease could be confirmed. The R-L interval was over 16 seconds in patients with MSI + TI who developed cardiac failure. The more the R-L interval was prolonged, the more severe the cardiac failure was found to be. A significant prolongation of the R-P interval and an increase in the R-P/P-L ratio, as well as a slight increase in the U/L ratio were clarly observed in the cases with severe right cardiac failure due to TI. On the other hand, remarked prolongation of the P-L interval, and a low value in the R-P/P-L ratio, as well as high value in the U/L ratio were seen in the cases with left cardiac failure. From these findings, the degree of severity and location of cardiac failure or of TI could be approximately evaluated. (author)

Paradoxical aortic stenosis: A systematic review.

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Cavaca, Rita; Teixeira, Rogério; Vieira, Maria João; Gonçalves, Lino

2017-04-01

Aortic stenosis (AS) is a complex systemic valvular and vascular disease with a high prevalence in developed countries. The new entity "paradoxical low-flow, low-gradient aortic stenosis" refers to cases in which patients have severe AS based on assessment of aortic valve area (AVA) (≤1 cm 2 ) or indexed AVA (≤0.6 cm 2 /m 2 ), but paradoxically have a low mean transvalvular gradient (<40 mmHg) and a low stroke volume index (≤35 ml/m 2 ), despite preserved left ventricular ejection fraction (≥50%). A search was carried out in the PubMed database on paradoxical AS for the period 2007-2014. A total of 57 articles were included for this review. The prevalence of paradoxical AS ranged from 3% to 35% of the population with severe degenerative AS. It was more frequent in females and in older patients. Paradoxical AS was associated with characteristic left ventricular remodeling as well as an increase in systemic arterial stiffness. It was noted that there may be errors and inaccuracies in the calculation of AVA by the continuity equation, which could erroneously suggest the paradoxical phenotype. There are new diagnostic methods to facilitate the study of AS, such as aortic valve calcium score, valvuloarterial impedance and the longitudinal mechanics of the left ventricle. With regard to its natural history, it is not clear whether paradoxical AS corresponds to an advance stage of the disease or if paradoxical AS patients have a distinct phenotype with specific characteristics. Valve replacement, either surgical or percutaneous, may be indicated in patients with severe and symptomatic paradoxical AS. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

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

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

2015-01-01

BACKGROUND: Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population. METHODS AND RESULTS: We identified the temporal trends in referral patterns, disease severity, and assoc......BACKGROUND: Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population. METHODS AND RESULTS: We identified the temporal trends in referral patterns, disease severity......, and associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased...... with a finding of severe AS, the proportion of patients aged older than 80 years increased to 51.0% in the most recent time period (2010-2012) compared with 32.6% in the preceding time period (P proportion of patients with a logistic EuroSCORE greater than 20...

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

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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.

Invasive Hemodynamics of Valvular Heart Disease.

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Pighi, Michele; Asgar, Anita W

2017-07-01

In the current era, diagnosis and follow-up of valvular heart disease is performed noninvasively using echocardiography. In some cases, the results of echocardiographic evaluation are inconclusive or discrepant with the patient's clinical symptoms. In such cases, a well-planned and executed cardiac catheterization is invaluable to clarify the clinical dilemma and assist in planning further management. This article reviews the indications, technique, and interpretation of cardiac catheterization in the setting of valvular stenosis and regurgitation. Copyright © 2017 Elsevier Inc. All rights reserved.

Statins for aortic valve stenosis

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Luciana Thiago

Full Text Available ABSTRACT BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria: Randomized controlled clinical trials (RCTs comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity, freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS: We included four RCTs with 2360 participants comparing statins (1185 participants with placebo (1175 participants. We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD -0.54, 95% confidence interval (CI -1.88 to 0.80; participants = 1935; studies = 2, valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2

Statins for aortic valve stenosis.

Science.gov (United States)

Thiago, Luciana; Tsuji, Selma Rumiko; Nyong, Jonathan; Puga, Maria Eduarda Dos Santos; Góis, Aécio Flávio Teixeira de; Macedo, Cristiane Rufino; Valente, Orsine; Atallah, Álvaro Nagib

2016-01-01

Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. To evaluate the effectiveness and safety of statins in aortic valve stenosis. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions.Selection criteria: Randomized controlled clinical trials (RCTs) comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity), freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life.Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO) was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. We included four RCTs with 2360 participants comparing statins (1185 participants) with placebo (1175 participants). We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD) -0.54, 95% confidence interval (CI) -1.88 to 0.80; participants = 1935; studies = 2), valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0

Abdominal Aortic Calcifications Influences the Systemic and Renal Hemodynamic Response to Renal Denervation in the DENERHTN (Renal Denervation for Hypertension) Trial.

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Courand, Pierre-Yves; Pereira, Helena; Del Giudice, Costantino; Gosse, Philippe; Monge, Matthieu; Bobrie, Guillaume; Delsart, Pascal; Mounier-Vehier, Claire; Lantelme, Pierre; Denolle, Thierry; Dourmap, Caroline; Halimi, Jean Michel; Girerd, Xavier; Rossignol, Patrick; Zannad, Faiez; Ormezzano, Olivier; Vaisse, Bernard; Herpin, Daniel; Ribstein, Jean; Bouhanick, Beatrice; Mourad, Jean-Jacques; Ferrari, Emile; Chatellier, Gilles; Sapoval, Marc; Azarine, Arshid; Azizi, Michel

2017-10-10

The DENERHTN (Renal Denervation for Hypertension) trial confirmed the efficacy of renal denervation (RDN) in lowering daytime ambulatory systolic blood pressure when added to standardized stepped-care antihypertensive treatment (SSAHT) for resistant hypertension at 6 months. This post hoc exploratory analysis assessed the impact of abdominal aortic calcifications (AAC) on the hemodynamic and renal response to RDN at 6 months. In total, 106 patients with resistant hypertension were randomly assigned to RDN plus SSAHT or to the same SSAHT alone (control group). Total AAC volume was measured, with semiautomatic software and blind to randomization, from the aortic hiatus to the iliac bifurcation using the prerandomization noncontrast abdominal computed tomography scans of 90 patients. Measurements were expressed as tertiles. The baseline-adjusted difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the RDN and control groups was -10.1 mm Hg ( P =0.0462) in the lowest tertile and -2.5 mm Hg ( P =0.4987) in the 2 highest tertiles of AAC volume. Estimated glomerular filtration rate remained stable at 6 months for the patients in the lowest tertile of AAC volume who underwent RDN (+2.5 mL/min per 1.73 m 2 ) but decreased in the control group (-8.0 mL/min per 1.73 m 2 , P =0.0148). In the 2 highest tertiles of AAC volume, estimated glomerular filtration rate decreased similarly in the RDN and control groups ( P =0.2640). RDN plus SSAHT resulted in a larger decrease in daytime ambulatory systolic blood pressure than SSAHT alone in patients with a lower AAC burden than in those with a higher AAC burden. This larger decrease in daytime ambulatory systolic blood pressure was not associated with a decrease in estimated glomerular filtration rate. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01570777. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

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

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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

Recent advances in echocardiography for valvular heart disease.

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Hahn, Rebecca

2015-01-01

Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population.

Study of chronic kidney disease-mineral bone disorders in newly detected advanced renal failure patients: A Hospital-based cross-sectional study

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Praveen Kumar Etta

2017-01-01

Full Text Available We aim to evaluate the disturbances in mineral metabolism, abnormalities in bone mineral density (BMD, and extraskeletal calcification in newly detected, untreated predialysis stage 4 and 5 chronic kidney disease (CKD patients at a tertiary care hospital in North India. This is cross-sectional observational study. A total of 95 (68 males, 27 females newly detected patients underwent clinical evaluation, biochemical assessment [serum calcium, phosphorus, alkaline phosphatase (ALP, albumin, creatinine, intact parathyroid hormone (iPTH, 25- hydroxyvitamin D (25(OHD], BMD measurement (at spine, hip, and forearm by dual-energy X-ray absorptiometry (DXA, lateral abdominal radiograph [for abdominal aortic calcification (AAC], skeletal survey (to look for any abnormality including fractures, and echocardiography [for any cardiac valvular calcification (CVC]. Symptoms related to CKD-mineral bone disorder were seen in 33.6% of the study patients. Prevalence of hypocalcemia, hyperphosphatemia, hyperparathyroidism, and hypovitaminosis D was 64.2%, 81.1%, 49.5%, and 89.5%, respectively. CVC was seen in 22.1% of patients on echocardiography, mostly involving the mitral valve. Patients with CVC were more likely to be males and smokers. There was no significant difference in iPTH levels between patients with or without CVC. AAC was seen in 10.5% of patients on lateral abdominal X-ray. Patients with AAC had higher levels of iPTH, phosphorus, and ALP and lower levels of calcium compared to patients without AAC. BMD by DXA showed a low bone mass in 41.05% of our patients and was more prevalent in CKD stage 5. Most of the study patients had hyperparathyroidism and low 25(OHD levels. Our study shows that newly detected, naïve Indian CKD patients have a high prevalence of disturbances of mineral metabolism including hyperparathyroidism, Vitamin D deficiency, abnormal BMD, and valvular and vascular calcification, even before initiating dialysis.

Is There Association Between Changes in eGFR Value and the Risk of Permanent Type of Atrial Fibrillation? - Analysis of Valvular and Non-Valvular Atrial Fibrillation Population

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Elzbieta Mlodawska

2014-12-01

Full Text Available Background/Aims: There are no data concerning renal function in population with valvular and non-valvular atrial fibrillation (AF. To assess renal function in patients with AF, the association between eGFR and AF perpetuation, in-hospital mortality. Methods: We studied 1523 patients with AF. Patients with chronic kidney disease (CKD were compared to population with preserved renal function. Results: CKD was more frequently observed in patients with valvular AF(p=0.009. In non-valvular AF patients eGFR 2 had more often permanent AF(p2DS2VASc score was 4.1±1.5 and HAS-BLED score was 2.1±1.2 and it was higher as compared to population with preserved renal function (p75 years old(OR=3.70,p=0.01,95%CI1.33-10.28, with CKD (OR=2.61,p=0.03,95%CI1.09-6.23. The type of AF had no significant influence on in-hospital mortality(OR=0.71,p=0.45,95%CI0.30-1.70. Conclusions: CKD is more often observed in patients with valvular AF. In population with non-valvular AF decreased eGFR is associated with permanent type of AF and with higher CHA2DS2VASc and HAS-BLED score. Among valvular AF patients there are no differences in type of AF between patients with and without CKD. There is the correlation between CKD and AF perpetuation but only in non-valvular population.

Calcific shoulder joint periarthritis. Disappearance of calcifications after laser therapy

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Gussetti, P; Moroso, P; Palazzo, C

1986-01-01

The authors report their results in the laser therapy of 30 calcific joint periarthritis. In two out of the ten radiographed cases, at the end of therapy, the complete disappearance of calcifications has been shown and in one case a decrease in calcification volume has been demonstrated. In the follow up after 6 months, 80% of clinically checked patients had no painful relapse.

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

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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.

Food and Drug Administration criteria for the diagnosis of drug-induced valvular heart disease in patients previously exposed to benfluorex: a prospective multicentre study.

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Maréchaux, Sylvestre; Rusinaru, Dan; Jobic, Yannick; Ederhy, Stéphane; Donal, Erwan; Réant, Patricia; Arnalsteen, Elise; Boulanger, Jacques; Garban, Thierry; Ennezat, Pierre-Vladimir; Jeu, Antoine; Szymanski, Catherine; Tribouilloy, Christophe

2015-02-01

The Food and Drug Administration (FDA) criteria for diagnosis of drug-induced valvular heart disease (DIVHD) are only based on the observation of aortic regurgitation ≥ mild and/or mitral regurgitation ≥ moderate. We sought to evaluate the diagnostic value of FDA criteria in a cohort of control patients and in a cohort of patients exposed to a drug (benfluorex) known to induce VHD. This prospective, multicentre study included 376 diabetic control patients not exposed to valvulopathic drugs and 1000 subjects previously exposed to benfluorex. Diagnosis of mitral or aortic DIVHD was based on a combined functional and morphological echocardiographic analysis of cardiac valves. Patients were classified according to the FDA criteria [mitral or aortic-FDA(+) and mitral or aortic-FDA(-)]. Among the 376 control patients, 2 were wrongly classified as mitral-FDA(+) and 17 as aortic-FDA(+) (0.53 and 4.5% of false positives, respectively). Of those exposed to benfluorex, 48 of 58 with a diagnosis of mitral DIVHD (83%) were classified as mitral-FDA(-), and 901 of the 910 patients (99%) without a diagnosis of the mitral DIVHD group were classified as mitral-FDA(-). All 40 patients with a diagnosis of aortic DIVHD were classified as aortic-FDA(+), and 105 of the 910 patients without a diagnosis of aortic DIVHD (12%) were classified aortic-FDA(+). Older age and lower BMI were independent predictors of disagreement between FDA criteria and the diagnosis of DIVHD in patients exposed to benfluorex (both P ≤ 0.001). FDA criteria solely based on the Doppler detection of cardiac valve regurgitation underestimate for the mitral valve and overestimate for the aortic valve the frequency of DIVHD. Therefore, the diagnosis of DIVHD must be based on a combined echocardiographic and Doppler morphological and functional analysis of cardiac valves. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Magnetic resonance imaging in patients with valvular heart disease

International Nuclear Information System (INIS)

Sechtem, U.; Welslau, R.; Hilger, H.H.; Theissen, P.; Jungehuelsing, M.; Schicha, H.

1989-01-01

In spite of the great number of imaging procedures available, it is still difficult to quantify the severity of valvular heart disease. Dynamic MRI offers new approaches to visualize the turbulent blood flow through stenosed or insufficient heart valves. In addition, it is possible to assess the severity of valvular insufficiency based on precise measurements of rigth- and left-ventricular stroke volumes or of systemic and pulmonary flow. Valvular stenoses are difficult to quantify by MRI because flow velocity measurements based on phase analysis can only be made at low flow rates at present. Some progress may be achieved by further shortening of echo times. In patients with cardiac valve replacement MRI is often superior to other imaging procedures because variable imaging planes facilitate differentiation between transvalvular and paravalvular leaks. Additionally, the severity of valvular incompetence can be assessed in such cases in the same way as in patients with insufficiency of the native heart valve. (orig.) [de

A quantitative approach of abdominal aortic atherosclerosis with x-ray computed tomography

International Nuclear Information System (INIS)

Watanabe, Hiromi; Kubota, Kazuo; Ito, Kengo; Ono, Shuichi; Matsuzawa, Taiju

1983-01-01

Currently epidemiologic studies of aortic atherosclerosis are most commonly done by the conventional roentgenological or pathological methods before and after death respectively. Pathological method is difficult and only possible after death. Roentgenological method is simple and useful before death, but its inability to evaluate atherosclerosis in a constant manner is serious drawback. A simple and quantitative method for epidemiological and clinical study of atherosclerosis has been needed. It this study, we examined the usefulness of Calcification Index (C.I.) caliculated from CT films for the evaluation of abdominal aortic atherosclerosis. We analysed 42 patients (32 males, 10 females). They recieved abdominal CT examination and died within a year. First, we got C.I. from their CT films. Then we got Surface Involved (S.I.) of atherosclerotic lesion from their autopsied abdominal aorta with pathological observation. The correlation coefficient between C.I. and S.I. was 0.83 (p<0.001). So we may use C.I. for the evaluation of abdominal aortic atherosclerosis. (author)

High sensitivity troponin and valvular heart disease.

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McCarthy, Cian P; Donnellan, Eoin; Phelan, Dermot; Griffin, Brian P; Enriquez-Sarano, Maurice; McEvoy, John W

2017-07-01

Blood-based biomarkers have been extensively studied in a range of cardiovascular diseases and have established utility in routine clinical care, most notably in the diagnosis of acute coronary syndrome (e.g., troponin) and the management of heart failure (e.g., brain-natriuretic peptide). The role of biomarkers is less well established in the management of valvular heart disease (VHD), in which the optimal timing of surgical intervention is often challenging. One promising biomarker that has been the subject of a number of recent VHD research studies is high sensitivity troponin (hs-cTn). Novel high-sensitivity assays can detect subclinical myocardial damage in asymptomatic individuals. Thus, hs-cTn may have utility in the assessment of asymptomatic patients with severe VHD who do not have a clear traditional indication for surgical intervention. In this state-of-the-art review, we examine the current evidence for hs-cTn as a potential biomarker in the most commonly encountered VHD conditions, aortic stenosis and mitral regurgitation. This review provides a synopsis of early evidence indicating that hs-cTn has promise as a biomarker in VHD. However, the impact of its measurement on clinical practice and VHD outcomes needs to be further assessed in prospective studies before routine clinical use becomes a reality. Copyright © 2017 Elsevier Inc. All rights reserved.

The evolving approach to the evaluation of low-gradient aortic stenosis.

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Cutting, William B; Bavry, Anthony A

2018-04-07

Severe aortic stenosis (AS) is typically identified by a low valve area (≤1.0 cm 2 ) and high mean gradient (≥40 mm Hg). A subset of patients are found to have a less than severe mean gradient (gradient AS (stage D2) or normal ejection fraction with low-gradient AS (stage D3). Determining the true severity of disease within these categories has proved difficult. In this review we illustrate both traditional and novel techniques that can be used for further valvular assessment. We also propose a simple algorithm that can be used to evaluate low-gradient AS. Published by Elsevier Inc.

Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study.

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Andell, Pontus; Li, Xinjun; Martinsson, Andreas; Andersson, Charlotte; Stagmo, Martin; Zöller, Bengt; Sundquist, Kristina; Smith, J Gustav

2017-11-01

Transitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking. We used nationwide registers to identify all patients with a first diagnosis of VHD at Swedish hospitals between 2003 and 2010. Age-stratified and sex-stratified incidence of each VHD and adjusted comorbidity profiles were assessed. In the Swedish population (n=10 164 211), the incidence of VHD was 63.9 per 100 000 person-years, with aortic stenosis (AS; 47.2%), mitral regurgitation (MR; 24.2%) and aortic regurgitation (AR; 18.0%) contributing most of the VHD diagnoses. The majority of VHDs were diagnosed in the elderly (68.9% in subjects aged ≥65 years), but pulmonary valve disease incidence peaked in newborns. Incidences of AR, AS and MR were higher in men who were also more frequently diagnosed at an earlier age. Mitral stenosis (MS) incidence was higher in women. Rheumatic fever was rare. Half of AS cases had concomitant atherosclerotic vascular disease (48.4%), whereas concomitant heart failure and atrial fibrillation were common in mitral valve disease and tricuspid regurgitation. Other common comorbidities were thoracic aortic aneurysms in AR (10.3%), autoimmune disorders in MS (24.5%) and abdominal hernias or prolapse in MR (10.7%) and TR (10.3%). Clinically diagnosed VHD was primarily a disease of the elderly. Rheumatic fever was rare in Sweden, but specific VHDs showed a range of different comorbidity profiles . Pronounced sex-specific patterns were observed for AR and MS, for which the mechanisms remain incompletely understood. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Long-term healing of mildly cross-linked decellularized bovine pericardial aortic patch.

Science.gov (United States)

Umashankar, P R; Sabareeswaran, A; Shenoy, Sachin J

2017-10-01

Glutaraldehyde treated bovine pericardium is extensively used in cardiovascular surgery. However, frequent occurrence of failure modes, such as calcification and structural failure, has hard pressed the need for finding an alternate technology. Decellularized bovine pericardium is an emerging technology. Mildly cross-linked decellularized bovine pericardium promotes positive remodeling with insignificant calcification and acute inflammation. In the present study, mildly cross-linked decellularized bovine pericardium was evaluated as a cardiovascular patch by studying mechanical strength as well as graft remodeling, resistance to calcific degeneration and inflammatory response using long duration porcine aortic implantation. It was observed that decellularized bovine pericardium, although thinner and less elastic had equivalent tensile properties such as tensile strength and stiffness when compared to commercially available glutaraldehyde-treated bovine pericardium. It showed the potential for site appropriate remodeling evidenced by host cell incorporation, thinner neointima, graft degradation, and neocollagenisation making it suitable for vascular patch application, whereas glutaraldehyde-treated pericardium failed to integrate with host tissue through timely degradation and host cell incorporation or neocollagenization. Conversely, it elicited persistent acute inflammation and produced calcification. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2145-2152, 2017. © 2016 Wiley Periodicals, Inc.

Platelet function and activation in Cavalier King Charles Spaniels with subclinical chronic valvular heart disease.

Science.gov (United States)

Tong, Linda J; Hosgood, Giselle L; French, Anne T; Irwin, Peter J; Shiel, Robert E

2016-08-01

OBJECTIVE To assess platelet closure time (CT), mean platelet component (MPC) concentration, and platelet component distribution width (PCDW) in dogs with subclinical chronic valvular heart disease. ANIMALS 89 Cavalier King Charles Spaniels (CKCSs) and 39 control dogs (not CKCSs). PROCEDURES Platelet count, MPC concentration, PCDW, and Hct were measured by use of a hematology analyzer, and CT was measured by use of a platelet function analyzer. Murmur grade and echocardiographic variables (mitral valve regurgitant jet size relative to left atrial area, left atrial-to-aortic diameter ratio, and left ventricular internal dimensions) were recorded. Associations between explanatory variables (sex, age, murmur grade, echocardiographic variables, platelet count, and Hct) and outcomes (CT, MPC concentration, and PCDW) were examined by use of multivariate regression models. RESULTS A model with 5 variables best explained variation in CT (R(2), 0.74), with > 60% of the variance of CT explained by mitral valve regurgitant jet size. The model of best fit to explain variation in MPC concentration included only platelet count (R(2), 0.24). The model of best fit to explain variation in PCDW included platelet count and sex (R(2), 0.25). CONCLUSIONS AND CLINICAL RELEVANCE In this study, a significant effect of mitral valve regurgitant jet size on CT was consistent with platelet dysfunction. However, platelet activation, as assessed on the basis of the MPC concentration and PCDW, was not a feature of subclinical chronic valvular heart disease in CKCSs.

Hepatocellular calcification

DEFF Research Database (Denmark)

Ladefoged, Claus; Frifelt, J J

1987-01-01

Autopsy of a twenty year old girl dying from complications of renal and cardiac failure demonstrated severe hepatocellular calcification, a rare finding. The pathogenesis is thought to be a combination of dystrophic calcification caused by severe centrilobular necrosis and metastatic calcificatio...

Prognostic Implications of Raphe in Bicuspid Aortic Valve Anatomy.

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Kong, William K F; Delgado, Victoria; Poh, Kian Keong; Regeer, Madelien V; Ng, Arnold C T; McCormack, Louise; Yeo, Tiong Cheng; Shanks, Miriam; Parent, Sarah; Enache, Roxana; Popescu, Bogdan A; Liang, Michael; Yip, James W; Ma, Lawrence C W; Kamperidis, Vasileios; van Rosendael, Philippe J; van der Velde, Enno T; Ajmone Marsan, Nina; Bax, Jeroen J

2017-03-01

Little is known about the association between bicuspid aortic valve (BAV) morphologic findings and the degree of valvular dysfunction, presence of aortopathy, and complications, including aortic valve surgery, aortic dissection, and all-cause mortality. To investigate the association between BAV morphologic findings (raphe vs nonraphe) and the degree of valve dysfunction, presence of aortopathy, and prognosis (including need for aortic valve surgery, aortic dissection, and all-cause mortality). In this large international multicenter registry of patients with BAV treated at tertiary referral centers, 2118 patients with BAV were evaluated. Patients referred for echocardiography from June 1, 1991, through November 31, 2015, were included in the study. Clinical and echocardiographic data were analyzed retrospectively. The morphologic BAV findings were categorized according to the Sievers and Schmidtke classification. Aortic valve function was divided into normal, regurgitation, or stenosis. Patterns of BAV aortopathy included the following: type 1, dilation of the ascending aorta and aortic root; type 2, isolated dilation of the ascending aorta; and type 3, isolated dilation of the sinus of Valsalva and/or sinotubular junction. Association between the presence and location of raphe and the risk of significant (moderate and severe) aortic valve dysfunction and aortic dilation and/or dissection. Of the 2118 patients (mean [SD] age, 47 [18] years; 1525 [72.0%] male), 1881 (88.8%) had BAV with fusion raphe, whereas 237 (11.2%) had BAV without raphe. Bicuspid aortic valves with raphe had a significantly higher prevalence of valve dysfunction, with a significantly higher frequency of aortic regurgitation (622 [33.1%] vs 57 [24.1%], P < .001) and aortic stenosis (728 [38.7%] vs 51 [21.5%], P < .001). Furthermore, aortic valve replacement event rates were significantly higher among patients with BAV with raphe (364 [19.9%] at 1 year, 393 [21.4%] at 2 years, and 447

Utilization of a pressure sensor guidewire to measure bileaflet mechanical valve gradients: hemodynamic and echocardiographic sequelae.

Science.gov (United States)

Doorey, Andrew J; Gakhal, Mandip; Pasquale, Michael J

2006-04-01

Suspected prosthetic valve dysfunction is a difficult clinical problem, because of the high risk of repeat valvular surgery. Echocardiographic measurements of prosthetic valvular dysfunction can be misleading, especially with bileaflet valves. Direct measurement of trans-valvular gradients is problematic because of potentially serious catheter entrapment issues. We report a case in which a high-fidelity pressure sensor angioplasty guidewire was used to cross prosthetic mitral and aortic valves in a patient, with hemodynamic and echocardiographic assessment. This technique was safe and effective, refuting the inaccurate non-invasive tests that over-estimated the aortic valvular gradient.

Characteristics, aetiological spectrum and management of valvular heart disease in a Tunisian cardiovascular centre.

Science.gov (United States)

Triki, Faten; Jdidi, Jihen; Abid, Dorra; Tabbabi, Nada; Charfeddine, Selma; Ben Kahla, Sahar; Hentati, Mourad; Abid, Leila; Kammoun, Samir

Valvular heart diseases occur frequently in Tunisia, but no precise statistics are available. To analyse the characteristics of patients with abnormal valvular structure and function, and to identify the aetiological spectrum, treatment and outcomes of valvular heart disease in a single cardiovascular centre in Tunisia. This retrospective study included patients with abnormal valvular structure and function, who were screened by transthoracic echocardiography at a single cardiology department between January 2010 and December 2013. Data on baseline characteristics, potential aetiology, treatment strategies and discharge outcomes were collected from medical records. There were 959 patients with a significant valvular heart disease (mean age 53±17years; female/male ratio 0.57). Valvular heart disease was native in 77% of patients. Mitral stenosis was the most frequent lesion (44.1%), followed by multiple valve disease (22.3%). Rheumatic origin (66.6%) was the most frequent aetiology, followed by degenerative (17.2%) or ischaemic (8.1%) causes, endocarditis (1.4%) and congenital (0.9%) causes. Native valve disease was severe in 589 patients (61.4%). Percutaneous mitral balloon valvuloplasty was performed in 36.9% of patients with mitral stenosis. Among patients with severe valvular heart disease, surgical treatment was indicated for 446 (75.7%) patients. Only 161 (36.1%) patients were finally operated. Postoperative mortality was 13.6% for all valvular heart diseases. This retrospective study has shown that the main cause of valvular heart disease in Tunisia is rheumatic fever. Mitral stenosis and multiple valve disease are the most frequent valvular heart diseases in Tunisia. Percutaneous mitral balloon valvuloplasty and prosthetic valve replacement are the preferred treatment methods for valvular heart disease. Copyright © 2016. Published by Elsevier Masson SAS.

Genetics of Valvular Heart Disease

Science.gov (United States)

LaHaye, Stephanie; Lincoln, Joy

2015-01-01

Valvular heart disease is associated with significant morbidity and mortality and often the result of congenital malformations. However, the prevalence is increasing in adults not only because of the growing aging population, but also because of improvements in the medical and surgical care of children with congenital heart valve defects. The success of the Human Genome Project and major advances in genetic technologies, in combination with our increased understanding of heart valve development, has led to the discovery of numerous genetic contributors to heart valve disease. These have been uncovered using a variety of approaches including the examination of familial valve disease and genome-wide association studies to investigate sporadic cases. This review will discuss these findings and their implications in the treatment of valvular heart disease. PMID:24743897

Treatment of valvular heart disease during pregnancy for improving maternal and neonatal outcome.

Science.gov (United States)

Henriquez, Dacia Dca; Roos-Hesselink, Jolien W; Schalij, Martin J; Klautz, Robert Jm; Helmerhorst, Frans M; de Groot, Christianne Jm

2011-05-11

Valvular heart disease constitutes the majority of all causes of heart disease in pregnancy. In the presence of valvular heart disease, the necessary haemodynamic changes of pregnancy might cause heart failure, leading to severe maternal and fetal morbidity and even mortality. Treatment of valvular heart disease is indicated when patients experience a deterioration of symptoms and in case of a severe valvular lesion. Whether medical therapy or interventional therapy is the optimal treatment for both mother and child is unclear. To assess effectiveness and adverse effects of the different treatment modalities of valvular heart disease in pregnancy to improve maternal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), EMBASE (1980 to 23 March 2011) and the reference lists of background review articles. Randomised controlled trials, quasi-randomised controlled and cluster-randomised controlled trials comparing medical therapy with percutaneous or surgical intervention for the treatment of valvular heart disease in pregnancy. We identified no (randomised) controlled trials to assess the effectiveness and adverse effects of the treatment of valvular heart disease in pregnancy. There were no randomised controlled trials, quasi-randomised controlled trials or cluster-randomised trials identified from the search strategy. There is insufficient evidence to define the most effective treatment of valvular heart disease in pregnancy to improve maternal and neonatal outcomes.

Krox20 defines a subpopulation of cardiac neural crest cells contributing to arterial valves and bicuspid aortic valve.

Science.gov (United States)

Odelin, Gaëlle; Faure, Emilie; Coulpier, Fanny; Di Bonito, Maria; Bajolle, Fanny; Studer, Michèle; Avierinos, Jean-François; Charnay, Patrick; Topilko, Piotr; Zaffran, Stéphane

2018-01-03

Although cardiac neural crest cells are required at early stages of arterial valve development, their contribution during valvular leaflet maturation remains poorly understood. Here, we show in mouse that neural crest cells from pre-otic and post-otic regions make distinct contributions to the arterial valve leaflets. Genetic fate-mapping analysis of Krox20-expressing neural crest cells shows a large contribution to the borders and the interleaflet triangles of the arterial valves. Loss of Krox20 function results in hyperplastic aortic valve and partially penetrant bicuspid aortic valve formation. Similar defects are observed in neural crest Krox20 -deficient embryos. Genetic lineage tracing in Krox20 -/- mutant mice shows that endothelial-derived cells are normal, whereas neural crest-derived cells are abnormally increased in number and misplaced in the valve leaflets. In contrast, genetic ablation of Krox20 -expressing cells is not sufficient to cause an aortic valve defect, suggesting that adjacent cells can compensate this depletion. Our findings demonstrate a crucial role for Krox20 in arterial valve development and reveal that an excess of neural crest cells may be associated with bicuspid aortic valve. © 2018. Published by The Company of Biologists Ltd.

Protective effects of estrogen against vascular calcification via estrogen receptor α-dependent growth arrest-specific gene 6 transactivation

International Nuclear Information System (INIS)

Nanao-Hamai, Michiko; Son, Bo-Kyung; Hashizume, Tsuyoshi; Ogawa, Sumito; Akishita, Masahiro

2016-01-01

Vascular calcification is one of the major complications of cardiovascular disease and is an independent risk factor for myocardial infarction and cardiac death. Postmenopausal women have a higher prevalence of vascular calcification compared with premenopausal women, suggesting protective effects of estrogen (E2). However, the underlying mechanisms of its beneficial effects remain unclear. In the present study, we examined the inhibitory effects of E2 on vascular smooth muscle cell (VSMC) calcification, and found that growth arrest-specific gene 6 (Gas6), a crucial molecule in vascular calcification, is transactivated by estrogen receptor α (ERα) in response to E2. In human aortic smooth muscle cells, physiological levels of E2 inhibited inorganic phosphate (Pi)-induced calcification in a concentration-dependent manner. This inhibitory effect was significantly abolished by MPP, an ERα-selective antagonist, and ERα siRNA, but not by PHTPP, an ERβ-selective antagonist, and ERβ siRNA, implicating an ERα-dependent action. Apoptosis, an essential process for Pi-induced VSMC calcification, was inhibited by E2 in a concentration-dependent manner and further, MPP abolished this inhibition. Mechanistically, E2 restored the inhibited expression of Gas6 and phospho-Akt in Pi-induced apoptosis through ERα. Furthermore, E2 significantly activated Gas6 transcription, and MPP abrogated this E2-dependent Gas6 transactivation. E2-BSA failed to activate Gas6 transcription and to inhibit Ca deposition in VSMC, suggesting beneficial actions of genomic signaling by E2/nuclear ERα. Taken together, these results indicate that E2 exerts inhibitory effects on VSMC apoptosis and calcification through ERα-mediated Gas6 transactivation. These findings indicate a potential therapeutic strategy for the prevention of vascular calcification, especially in postmenopausal women. - Highlights: • E2 inhibits Pi-induced calcification in vascular smooth muscles cells. • E2 inhibits Pi

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.

Radiological patterns of thyroid calcifications

International Nuclear Information System (INIS)

Lim, Jun; Sim, Do Chul; Park, Seog Hee; Kim, Choon Yul; Bahk, Yong Whee

1986-01-01

The purpose of this study was to analyse the various patterns of calcification demonstrated in the anterior and lateral neck roentgenograms of 213 unselected patients with thyroid enlargement. The patterns of thyroid calcifications were correlated with clinical, surgical and histological findings. The results were as follows: 1. Of 213 cases of thyroid enlargement, 180 cases were benign and 168 cases were female. 2. The calcification rate was high in the chronic thyroid enlargement. 3. The incidence of calcification was 30.2% in the malignancy and 17.2% in the benign disease. There was no calcification in the Hashimoto's disease. 4. The nodular calcification was demonstrated in the both benign and malignant disease but curvilinear calcification was predominantly seen in benign disease.

Antithrombotic therapy in atrial fibrillation associated with valvular heart disease

DEFF Research Database (Denmark)

Lip, Gregory Y H; Collet, Jean Philippe; Caterina, Raffaele de

2017-01-01

Atrial fibrillation (AF) is a major worldwide public health problem, and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on 'non-valvular AF' pati...

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.

Growth Pattern of Atherosclerotic Calcifications

DEFF Research Database (Denmark)

Larsen, Lene Lillemark; Ganz, Melanie; Dam, Erik

2008-01-01

of the calcifications are matched longitudinally using thin plate spline registration and area overlap calculations. The growth of the calcifications is measured by the distribution of the geometry statistics of the calcifications. The method was evaluated on 135 subjects with a total number of 611 calcifications. Our...

Optimal timing of valve replacement in asymptomatic severe aortic stenosis.

Science.gov (United States)

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

2014-09-01

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

Study of the position of calcification in calcific tendinitis of the shoulder

International Nuclear Information System (INIS)

Asakura, Toru; Matsuura, Koumei; Shin, Kunichika; Ooe, Kenjiro

2011-01-01

The commonly occurring position of calcification in the calcific tendinitis of the shoulder is said to be the supraspinatus tendon. In the anatomical field, it has been newly discovered that the infraspinatus tendon crosses over the supraspinatus tendon to the superior facet of the greater tuberosity. In this study, we thus attempted to determine the occurring position of calcification on MRI quantitatively. We measured the angle between the bicipital groove and center of calcification, and found it to be 49.5±16.5 degrees. On the other hand, it has been reported that the boundary line between the superior and middle facets is 45.4 degrees externally rotated from the bicipital groove. The protrusion formed at the greater tuberosity at this position imposes mechanical stress on the rotator cuff tendon. As we confirmed that these two angles are very close in this study, it suggests that calcification occurs at the boundary line of the superior and middle facets. Our findings also indicate that calcification often occurs at the infraspinatus tendon. (author)

Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy.

Science.gov (United States)

Moon, Michael C; Greenberg, Roy K; Morales, Jose P; Martin, Zenia; Lu, Qingsheng; Dowdall, Joseph F; Hernandez, Adrian V

2011-04-01

Proximal aortic dissections are life-threatening conditions that require immediate surgical intervention to avert an untreated mortality rate that approaches 50% at 48 hours. Advances in computed tomography (CT) imaging techniques have permitted increased characterization of aortic dissection that are necessary to assess the design and applicability of new treatment paradigms. All patients presenting during a 2-year period with acute proximal aortic dissections who underwent CT scanning were reviewed in an effort to establish a detailed assessment of their aortic anatomy. Imaging studies were assessed in an effort to document the location of the primary proximal fenestration, the proximal and distal extent of the dissection, and numerous morphologic measurements pertaining to the aortic valve, root, and ascending aorta to determine the potential for an endovascular exclusion of the ascending aorta. During the study period, 162 patients presented with proximal aortic dissections. Digital high-resolution preoperative CT imaging was performed on 76 patients, and 59 scans (77%) were of adequate quality to allow assessment of anatomic suitability for treatment with an endograft. In all cases, the dissection plane was detectable, yet the primary intimal fenestration was identified in only 41% of the studies. Scans showed 24 patients (32%) appeared to be anatomically amenable to such a repair (absence of valvular involvement, appropriate length and diameter of proximal sealing regions, lack of need to occlude coronary vasculature). Of the 42 scans that were determined not to be favorable for endovascular repair, the most common exclusion finding was the absence of a proximal landing zone (n = 15; 36%). Appropriately protocoled CT imaging provides detailed anatomic information about the aortic root and ascending aorta, allowing the assessment of which dissections have proximal fenestrations that may be amenable to an endovascular repair. Copyright © 2011 Society for

Prevalence and predictors of valvular heart disease in patients with systemic lupus erythematosus.

Science.gov (United States)

Vivero, Florencia; Gonzalez-Echavarri, Cristina; Ruiz-Estevez, Beatriz; Maderuelo, Irene; Ruiz-Irastorza, Guillermo

2016-12-01

We aimed to study the frequency, severity and predictors of valvular heart disease (VHD) in our lupus cohort. 211 patients were included. A transthoracic echocardiogram was used for this study. Significant valvular lesions were classified into two groups: valvular thickening and valvular dysfunction. Univariate logistic regression was performed in order to find associations with valvular thickening and dysfunction. Those variables with a p value ≤0.1 in the univariate analysis were subsequently included in multiple logistic regression models. Significant valve lesions were found in 53 patients (25%). The independent predictors of valvular thickening were the age at the time of the echocardiogram (OR 1.05, 95% CI 1.02-1.7), lymphopenia (OR 3.6, 95%CI 1.4-9.5), thrombocytopenia (OR 2.65, 95%CI 1.24-5.72), and anti-Sm antibodies (OR 3.28, 95%CI 1.44-7.33). The independent predictors of valvular dysfunction were age at the time of the echocardiogram (OR 1.045, 95%CI 1.009-1.083), thrombocytopenia (OR 5, 95%CI 1.66-14.86), hypertension (OR 6.2, 95%CI 2.1-18.4) and aPL (OR 6.2, 95%CI 2.1-18.4). Regarding the latter, the independent relation with valvular dysfunction was only seen for the double positivity aCL/LA, (OR 13.2, 95%CI 3.8-45.2, p<0.0001). Our study confirms the high prevalence of significant VHD in SLE patients. Clinical variables related with persistent inflammatory activity were associated with VHD. The association between VHD and aPL positivity was confirmed. Double-positive aCL/LA patients were most likely to suffer from valvular dysfunction. Copyright © 2016 Elsevier B.V. All rights reserved.

Cine MR imaging of valvular heart disease

International Nuclear Information System (INIS)

Underwood, S.R.; Firmin, D.N.; Mohiaddin, R.H.; Klipstein, R.H.; Bogren, H.G.; Rees, R.S.O.; Longmore, D.B.

1987-01-01

Cine MR imaging shows details of cardiac valve motion and the turbulence caused by regurgitation and stenosis. In 30 patients, the area of turbulence proximal to regurgitant valves correlated well with the regurgitant fraction measured from right and left ventricular stroke volumes. Turbulence distal to stenotic valves did not correlate with the pressure gradient because abnormal valves that were not stenosed produced turbulence. Valve motion and the presence of thrombus were easier to assess than in conventional images. Cine MR imaging provides an important addition to conventional imaging in valvular regurgitation, but pressure gradients cannot be assessed in valvular stenosis

Global left ventricular load in asymptomatic aortic stenosis: covariates and prognostic implication (the SEAS trial

Directory of Open Access Journals (Sweden)

Rieck Åshild E

2012-11-01

Full Text Available Abstract Introduction Valvuloarterial impedance (Zva is a measure of global (combined valvular and arterial load opposing left ventricular (LV ejection in aortic stenosis (AS. The present study identified covariates and tested the prognostic significance of global LV load in patients with asymptomatic AS. Methods 1418 patients with mild-moderate, asymptomatic AS in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS study were followed for a mean of 43±14 months during randomized, placebo-controlled treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily. High global LV load was defined as Zva >5 mm Hg/ml/m2. The impact of baseline global LV load on rate of major cardiovascular (CV events, aortic valve events and total mortality was assessed in Cox regression models reporting hazard ratio (HR and 95% Confidence Intervals (CI. Results High global LV load was found in 18% (n=252 of patients and associated with female gender, higher age, hypertension, more severe AS and lower ejection fraction (all p Conclusion In asymptomatic AS, assessment of global LV load adds complementary information on prognosis to that provided by hypertension or established prognosticators like AS severity and LV ejection fraction.

Mid-term results of different aortic valve-sparing procedures in Marfan syndrome.

Science.gov (United States)

Schmidtke, Claudia; Karluss, Antje; Sier, Holger; Hüppe, Michael; Brauer, Kirk; Sievers, Hans-H

2012-03-01

Marfan patients with aortic root aneurysm are typically treated with the Bentall procedure, though aortic valve-sparing procedures (AVSPs) are also possible. The study aim was to compare the authors' experience with two such techniques performed at their institution, namely a reimplantation according to David (David I) and remodeling according to Yacoub. Between 1996 and 2009, a total of 37 Marfan patients underwent an AVSP at the authors' institution. Of these patients, 25 (mean age 32 +/- 14.9 years) underwent surgery according to David (group D), and 12 (mean age 35 +/- 10.9 years) according to Yacoub (group Y). The patients underwent both clinical and echocardiographic follow up examinations at a mean of 42.0 +/- 36.4 months after surgery. One patient from each group had moved abroad and was lost to follow up. The remaining 35 patients were alive at follow up, and none presented with any major neurological or bleeding complications. In addition, no significant differences were noted between the groups in terms of NYHA classification, left ventricular function, or left ventricular diameter. At follow up, aortic valve function was also comparable between groups, with a peak/mean gradient of 9.4 +/- 6.4/5.3 +/- 3.5 mmHg and 5.1 +/- 3.3/2.8 +/- 1.5 mmHg for groups D and Y, respectively (p = 0.081/0.058). The measured mean grades of aortic valve regurgitation were comparable in groups D and Y (0.6 +/- 0.7 and 1.1 +/- 0.6, respectively; p = 0.055). However, aortic root dimensions obtained via M-mode were smaller in group D patients (29.6 +/- 2.3 mm) than in group Y patients (36.1 +/- 6.6 mm) (p = 0.027). Only three patients from group Y required reoperation on the aortic valve due to valvular regurgitation (p = 0.028); two of these had presented with aortic dissection at the first operation. Both types of AVSP can be performed with comparably good interim clinical results, and also low mortality and morbidity, in patients with Marfan syndrome.

[Pannus Formation Six-years after Aortic and Mitral Valve Replacement with Tissue Valves;Report of a Case].

Science.gov (United States)

Nakamura, Makoto; Muraoka, Arata; Aizawa, Kei; Akutsu, Hirohiko; Kurumisawa, Soki; Misawa, Yoshio

2015-07-01

A 77-year-old man presented with exertional dyspnea. He had undergone aortic and mitral valve replacement with tissue valves 6-years earlier. The patient's hemoglobin level was 9.8 g/dl and serum aspartate aminotransferase (70 mU/ml) and lactate dehydrogenase (1,112 mU/ml) were elevated. Echocardiography revealed stenosis of the prosthetic valve in the aortic position with peak flow velocity of 3.8 m/second and massive mitral regurgitation. The patient underwent repeat valve replacement. Pannus formation around both implanted valves was observed. The aortic valve orifice was narrowed by the pannus, and one cusp of the prosthesis in the mitral position was fixed and caused the regurgitation, but they were free from cusp laceration or calcification. The patient's postoperative course was uneventful, and he continues to do well 14 months after surgery.

Valvular heart disease is changing – a challenge for Africa

African Journals Online (AJOL)

The pattern of valvular heart disease is changing in. Western populations [1]. There are implications for Africa as healthcare improves and people live longer. Over the last half century in Western countries there has been a change in the incidence of valvular heart disease from a rheumatic cause to one of degeneration.

Total Percutaneous Aortic Repair: Midterm Outcomes

International Nuclear Information System (INIS)

Bent, Clare L.; Fotiadis, Nikolas; Renfrew, Ian; Walsh, Michael; Brohi, Karim; Kyriakides, Constantinos; Matson, Matthew

2009-01-01

The purpose of this study was to examine the immediate and midterm outcomes of percutaneous endovascular repair of thoracic and abdominal aortic pathology. Between December 2003 and June 2005, 21 patients (mean age: 60.4 ± 17.1 years; 15 males, 6 females) underwent endovascular stent-graft insertion for thoracic (n = 13) or abdominal aortic (n = 8) pathology. Preprocedural computed tomographic angiography (CTA) was performed to assess the suitability of aorto-iliac and common femoral artery (CFA) anatomy, including the degree of CFA calcification, for total percutaneous aortic stent-graft repair. Percutaneous access was used for the introduction of 18- to 26-Fr delivery devices. A 'preclose' closure technique using two Perclose suture devices (Perclose A-T; Abbott Vascular) was used in all cases. Data were prospectively collected. Each CFA puncture site was assessed via clinical examination and CTA at 1, 6, and 12 months, followed by annual review thereafter. Minimum follow-up was 36 months. Outcome measures evaluated were rates of technical success, conversion to open surgical repair, complications, and late incidence of arterial stenosis at the site of Perclose suture deployment. A total of 58 Perclose devices were used to close 29 femoral arteriotomies. Outer diameters of stent-graft delivery devices used were 18 Fr (n = 5), 20 Fr (n = 3), 22 Fr (n = 4), 24 Fr (n = 15), and 26 Fr (n = 2). Percutaneous closure was successful in 96.6% (28/29) of arteriotomies. Conversion to surgical repair was required at one access site (3.4%). Mean follow-up was 50 ± 8 months. No late complications were observed. By CT criteria, no patient developed a >50% reduction in CFA caliber at the site of Perclose deployment during the study period. In conclusion, percutaneous aortic stent-graft insertion can be safely performed, with a low risk of both immediate and midterm access-related complications.

Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes.

Science.gov (United States)

Boodhwani, Munir; de Kerchove, Laurent; Glineur, David; Poncelet, Alain; Rubay, Jean; Astarci, Parla; Verhelst, Robert; Noirhomme, Philippe; El Khoury, Gébrine

2009-02-01

Valve repair for aortic insufficiency requires a tailored surgical approach determined by the leaflet and aortic disease. Over the past decade, we have developed a functional classification of AI, which guides repair strategy and can predict outcome. In this study, we analyze our experience with a systematic approach to aortic valve repair. From 1996 to 2007, 264 patients underwent elective aortic valve repair for aortic insufficiency (mean age - 54 +/- 16 years; 79% male). AV was tricuspid in 171 patients bicuspid in 90 and quadricuspid in 3. One hundred fifty three patients had type I dysfunction (aortic dilatation), 134 had type II (cusp prolapse), and 40 had type III (restrictive). Thirty six percent (96/264) of the patients had more than one identified mechanism. In-hospital mortality was 1.1% (3/264). Six patients experienced early repair failure; 3 underwent re-repair. Functional classification predicted the necessary repair techniques in 82-100% of patients, with adjunctive techniques being employed in up to 35% of patients. Mid-term follow up (median [interquartile range]: 47 [29-73] months) revealed a late mortality rate of 4.2% (11/261, 10 cardiac). Five year overall survival was 95 +/- 3%. Ten patients underwent aortic valve reoperation (1 re-repair). Freedoms from recurrent Al (>2+) and from AV reoperation at 5 years was 88 +/- 3% and 92 +/- 4% respectively and patients with type I (82 +/- 9%; 93 +/- 5%) or II (95 +/- 5%; 94 +/- 6%) had better outcomes compared to type III (76 +/- 17%; 84 +/- 13%). Aortic valve repair is an acceptable therapeutic option for patients with aortic insufficiency. This functional classification allows a systematic approach to the repair of Al and can help to predict the surgical techniques required as well as the durability of repair. Restrictive cusp motion (type III), due to fibrosis or calcification, is an important predictor for recurrent Al following AV repair.

Coronary risk stratification of patients undergoing surgery for valvular heart disease

DEFF Research Database (Denmark)

Hasselbalch, Rasmus Bo; Engstrøm, Thomas; Pries-Heje, Mia

2017-01-01

BACKGROUND: Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular ...

Heart valve disease associated with treatment with ergot-derived dopamine agonists: a clinical and echocardiographic study of patients with Parkinson's disease

DEFF Research Database (Denmark)

Rasmussen, Vibeke Guldbrand; Poulsen, Steen Hvitfeldt; Dupont, E

2007-01-01

regurgitation (n = 5) was found in 22 EDDA patients (25.9%). Two patients had coexistent moderate mitral and tricuspid valvular regurgitation. Two non-EDDA patients had moderate valve insufficiency (3.8%, P insufficiency in the EDDA patients was 7....... Interventions. Patients were screened for valvular heart disease by clinical means and by examiner-blinded echocardiography. Main outcome measure was valvular regurgitation revealed by echocardiography. RESULTS: Severe aortic regurgitation (n = 4) or moderate aortic (n = 12), mitral (n = 3) or tricuspidal valve...

Bentall procedure using cryopreserved valved aortic homografts: mid- to long-term results.

Science.gov (United States)

Christenson, Jan T; Sierra, Jorge; Trindade, Pedro T; Dominique, Didier; Kalangos, Afksendiyos

2004-01-01

The Bentall procedure is the standard operation for patients who have lesions of the ascending aorta associated with aortic valve disease. In many cases, however, mechanical prosthetic conduits are not suitable. There are few reports in the English-language medical literature concerning the mid- to long-term outcome of Bentall operations with cryopreserved homografts. Therefore, we reviewed our experience with this procedure and valved homografts. From January 1997 through December 2002, 21 patients underwent a Bentall operation with cryopreserved homografts at our institution. There were 14 males and 7 females; the mean age was 36 +/- 21 years (range, 15-74 years). Eleven patients had undergone previous aortic valve surgery. All patients had aortic dilatation or aneurysms involving the ascending aorta. Indications for surgery included aortic valve stenosis or insufficiency, and aortic valve endocarditis (native valve or prosthetic). One patient had Takayasu's arteritis and 3 had Marfan syndrome. There was 1 hospital death (due to sepsis), but no other major postoperative complications. The mean hospital stay was 14 +/- 7 days. Follow-up echocardiographic and computed tomographic scans were performed yearly. The mean follow-up was 34 months (6-72 months). Follow-up imaging revealed no calcifications or degenerative processes related to the homograft. Four patients had minimal valve regurgitation. Two patients died during follow-up. The 3-year actuarial survival rate was 85.7%. Our data suggest that the Bentall procedure with a valved homograft conduit is a safe procedure with excellent mid- to long-term results, comparable to results reported with aortic valve replacement with a homograft.

Analysis of maternal-fetal outcomes of valvular heart surgeries in

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Alireza Yaghoubi

2010-03-01

Full Text Available Valvular heart surgery (VHS in pregnancy has its specific complexity and problems.Between years 1983-2007 11 women who underwent VHS during pregnancy were found and analyzed. Valvular heart surgery in pregnancy is associated with the least maternal-fetal side effects. Intensive evaluations before and during pregnancy with a specialized medical team is essential

Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement.

Science.gov (United States)

Jang, Jeong Yoon; Seo, Jeong-Sook; Sun, Byung Joo; Kim, Dae-Hee; Song, Jong-Min; Kang, Duk-Hyun; Song, Jae-Kwan

2016-09-01

Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvular stenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload on LV hypertrophy (LVH) before and after aortic valve replacement (AVR). The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (Z VA ) and LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH. Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm 2 . Z VA was 5.9 ± 1.9 mm Hg/mL/m 2 and showed a stronger correlation (β = 0.601, p regression in 322 patients with follow-up duration >1 year after AVR. Z VA is a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, which should be incorporated in routine evaluation of AS.

Quantitating aortic regurgitation by cardiovascular magnetic resonance: significant variations due to slice location and breath holding

International Nuclear Information System (INIS)

Chaturvedi, Abhishek; Hamilton-Craig, Christian; Cawley, Peter J.; Maki, Jeffrey H.; Mitsumori, Lee M.; Otto, Catherine M.

2016-01-01

Compare variability in flow measurements by phase contrast MRI, performed at different locations in the aorta and pulmonary artery (PA) using breath-held (BH) and free-breathing (FB) sequences. Fifty-seven patients with valvular heart disease, confirmed by echocardiography, were scanned using BH technique at 3 locations in the ascending aorta (SOV = sinus of Valsalva, STJ = sinotubular junction, ASC = ascending aorta at level of right pulmonary artery) and 2 locations in PA. Single FB measurement was obtained at STJ for aorta. Obtained metrics (SV = stroke volume, FV = forward volume, BV = backward volume, RF = regurgitant fraction) were evaluated separately for patients with aortic regurgitation (AR, n = 31) and mitral regurgitation (n = 26). No difference was noted between the two measurements in the PA. Significant differences were noted in measured SV at different aortic locations. SV measurements obtained at ASC correlated best with the measurements obtained in the PA. Strongest correlation of AR was measured at the STJ. Measurements of flow volumes by phase contrast MRI differ depending on slice location. When using stroke volumes to calculate pulmonary to systemic blood flow ratio (Qp/Qs), ASC should be used. For quantifying aortic regurgitation, measurement should be obtained at STJ. (orig.)

Valvoplastia aórtica por cateter-balão em emergência materno-fetal na adolescência Valvuloplastia aórtica por catéter con balón en emergencia materno-fetal en la adolescencia Aortic valvuloplasty with balloon catheter in maternal-fetal emergency in adolescence

Directory of Open Access Journals (Sweden)

Walkiria Samuel Avila

2009-12-01

Full Text Available O aumento do débito cardíaco durante a gravidez é causa de insuficiência cardíaca em portadoras de estenose valvar aórtica grave. A valvoplastia aórtica percutânea tem sido associada a graves complicações e reestenose valvar em curto prazo. O presente caso mostrou que a valvoplastia aórtica percutânea permitiu o alcance do parto com sobrevida da mãe e do feto, e que a interrupção do tratamento no pós-parto resultou em morte materna no puerpério tardio.El aumento del gasto cardiaco durante el embarazo es la causa de insuficiencia cardiaca en portadoras de estenosis valvular aórtica severa. Se viene asociando la valvuloplastia aórtica percutánea a severas complicaciones y reestenosis valvular en corto plazo. El presente caso reveló que la valvuloplastia aórtica percutánea permitió el alcance del parto con sobrevida de la madre y del feto, y que la interrupción del tratamiento en el postparto resultó en muerte materna en el puerperio tardío.The increase of cardiac output during pregnancy is the cause of heart failure in women with severe aortic valvular stenosis. Percutaneous aortic valvuloplasty has been associated with severe complications and short-term valvar restenosis. This case showed that percutaneous aortic valvuloplasty allowed both mother and fetus to survive after childbirth, and that postpartum treatment interruption resulted in maternal death in late postpartum care.

The modern role of transoesophageal echocardiography in the assessment of valvular pathologies

Science.gov (United States)

Bull, Sacha; Newton, James

2017-01-01

Despite significant advancements in the field of cardiovascular imaging, transoesophageal echocardiography remains the key imaging modality in the management of valvular pathologies. This paper provides echocardiographers with an overview of the modern role of TOE in the diagnosis and management of valvular disease. We describe how the introduction of 3D techniques has changed the detection and grading of valvular pathologies and concentrate on its role as a monitoring tool in interventional cardiology. In addition, we focus on the echocardiographic and Doppler techniques used in the assessment of prosthetic valves and provide guidance for the evaluation of prosthetic valves. Finally, we summarise quantitative methods used for the assessment of valvular stenosis and regurgitation and highlight the key areas where echocardiography remains superior over other novel imaging modalities. PMID:28096184

The modern role of transoesophageal echocardiography in the assessment of valvular pathologies

Directory of Open Access Journals (Sweden)

Malgorzata Wamil MD PhD

2017-03-01

Full Text Available Despite significant advancements in the field of cardiovascular imaging, transoesophageal echocardiography remains the key imaging modality in the management of valvular pathologies. This paper provides echocardiographers with an overview of the modern role of TOE in the diagnosis and management of valvular disease. We describe how the introduction of 3D techniques has changed the detection and grading of valvular pathologies and concentrate on its role as a monitoring tool in interventional cardiology. In addition, we focus on the echocardiographic and Doppler techniques used in the assessment of prosthetic valves and provide guidance for the evaluation of prosthetic valves. Finally, we summarise quantitative methods used for the assessment of valvular stenosis and regurgitation and highlight the key areas where echocardiography remains superior over other novel imaging modalities.

Hemodynamics of Aortic Stenosis and Implications for Non-invasive Diagnosis via Auscultation

Science.gov (United States)

Zhu, Chi; Seo, Jung-Hee; Mittal, Rajat

2017-11-01

Aortic stenosis refers to the abnormal narrowing of the aortic valve and it is one of the most common valvular diseases. It is also known to generate ejection murmurs, which contain valuable disease-related information. However, an incomplete understanding of the flow mechanism(s) responsible for the murmur generation, as well as the effect of intervening tissue on murmur propagation has limited the diagnostic information can be extracted through cardiac auscultation. In this study, a canonical model of the aorta with stenosis is used, and a multiphysics computational modeling approach is employed to investigate the generation and propagation of the murmurs. First, direct numerical simulation (DNS) is used to explore the hemodynamics of the post-stenotic flow. Then, a high-order, linear viscoelastic wave solver is used to investigate the wave propagation in a modeled thorax. The results show that both the aortic jet and the secondary flow contribute significantly to the murmur generation. The murmur signals on the epidermal surface are measured and analyzed. The break frequencies obtained from the spectra of cases with different degrees of stenosis are found to follow a universal scaling. The implications of these results for cardiac auscultation are discussed. The authors would like to acknowledge support from NSF Grants IIS-1344772, CBET-1511200, and NSF XSEDE Grant TG-CTS100002.

Life-threatening subdural hematoma after aortic valve replacement in a patient with Heyde syndrome: a case report.

Science.gov (United States)

Uchida, Tetsuro; Hamasaki, Azumi; Ohba, Eiichi; Yamashita, Atsushi; Hayashi, Jun; Sadahiro, Mitsuaki

2017-08-08

Heyde syndrome is known as a triad of calcific aortic stenosis, anemia due to gastrointestinal bleeding from angiodysplasia, and acquired type 2A von Willebrand disease. This acquired hemorrhagic disorder is characterized by the loss of the large von Willebrand factor multimers due to the shear stress across the diseased aortic valve. The most frequently observed type of bleeding in these patients is mucosal or skin bleeding, such as epistaxis, followed by gastrointestinal bleeding. On the other hand, intracranial hemorrhage complicating Heyde syndrome is extremely rare. A 77-year-old woman presented to our hospital with severe aortic stenosis and severe anemia due to gastrointestinal bleeding and was diagnosed with Heyde syndrome. Although aortic valve replacement was performed without recurrent gastrointestinal bleeding, postoperative life-threatening acute subdural hematoma occurred with a marked midline shift. Despite prompt surgical evacuation of the hematoma, she did not recover consciousness and she died 1 month after the operation. Postoperative subdural hematoma is rare, but it should be kept in mind as a devastating hemorrhagic complication, especially in patients with Heyde syndrome.

Diagnosis of calcification on abdominal radiographs

International Nuclear Information System (INIS)

Lamb, C.R.; Kleine, L.J.; McMillan, M.C.

1991-01-01

A wide variety of normal and pathologic factors may induce intraabdominal calcification. In general, the most reliable indication of the cause of a calcification is its location; therefore, if the affected organ can be identified the radiographic diagnosis is often straightforward or, at least, limited to relatively few possibilities. With this principle in mind, a series of patients with abdominal calcification are described for the purpose of illustrating the appearance of calcification of various abdominal organs. In addition, etiology for the calcification in each patient is discussed. Certain extraabdominal calcifications which may be seen on abdominal radiographs are also mentioned

Valvular heart disease: assessment of valve morphology and quantification using MR

International Nuclear Information System (INIS)

Schwitter, J.

2000-01-01

For clinical evaluation and decision-making in patients with valvular heart disease, the diagnostic armamentarium expands steadily. This evolution makes it difficult to choose the most appropriate approach for a specific valvular lesion. It may also reflect our uncertainty of what are the findings that best predict clinical outcome of patients, e. g. after surgery. Accordingly, for each type of valvular lesion, some pathophysiological considerations are stated in order to derive the most important measures that would allow optimal guidance of patients. Based on these considerations the value of an MR study is discussed for each valvular lesion. Newest advances in MR technology allow for highly accurate measurements of regurgitant volumes and hence, MR may be the method of choice for a quantitative evaluation of regurgitant valves. For assessment of stenosis severity, measurement of transvalvular pressure gradient is an appropriate measure and MR may not confer benefits over echocardiography, provided the ultrasound window is adequate (and stroke volume is in the normal range). With respect to surgical treatment, valvular morphology is of pivotal importance, particularly for the mitral valve, and echocardiography still appears to be the first line method. Little data relate lesion severity and/or morphology to clinical outcome. Conversely, the extent of cardiac adaptation to pressure- and/or volume-overload, i. e. ventricular remodeling, is a strong predictor of outcome, and is therefore most important for final judgement of the patient. For assessment of left and right ventricular remodeling, echocardiography typically provides all the necessary information. However, in special cases with discrepant findings, with inadequate ultrasound window, or in the preoperative work-up, MR may provide important information regarding cardiac adaptation to valvular lesion. (orig.) [de

Hydrogels preserve native phenotypes of valvular fibroblasts through an elasticity-regulated PI3K/AKT pathway.

Science.gov (United States)

Wang, Huan; Tibbitt, Mark W; Langer, Stephen J; Leinwand, Leslie A; Anseth, Kristi S

2013-11-26

Matrix elasticity regulates proliferation, apoptosis, and differentiation of many cell types across various tissues. In particular, stiffened matrix in fibrotic lesions has been shown to promote pathogenic myofibroblast activation. To better understand the underlying pathways by which fibroblasts mechano-sense matrix elasticity, we cultured primary valvular interstitial cells (VICs) isolated from porcine aortic valves on poly(ethylene glycol)-based hydrogels with physiologically relevant and tunable elasticities. We show that soft hydrogels preserve the quiescent fibroblast phenotype of VICs much better than stiff plastic plates. We demonstrate that the PI3K/AKT pathway is significantly up-regulated when VICs are cultured on stiff gels or tissue culture polystyrene compared with freshly isolated VICs. In contrast, myofibroblasts de-activate and pAKT/AKT decreases as early as 2 h after reducing the substrate modulus. When PI3K or AKT is inhibited on stiff substrates, myofibroblast activation is blocked. When constitutively active PI3K is overexpressed, the myofibroblast phenotype is promoted even on soft substrates. These data suggest that valvular fibroblasts are sensing the changes in matrix elasticity through the PI3K/AKT pathway. This mechanism may be used by other mechano-sensitive cells in response to substrate modulus, and this pathway may be a worthwhile target for treating matrix stiffness-associated diseases. Furthermore, hydrogels can be designed to recapitulate important mechanical cues in native tissues to preserve aspects of the native phenotype of primary cells for understanding basic cellular responses to biophysical and biochemical signals, and for tissue-engineering applications.

Mucopolysaccharidoses Causing Valvular Heart Disease: Report and Review of Surgical Management.

Science.gov (United States)

Encarnacion, Carlos O; Hang, Dustin; Earing, Michael; Mitchell, Michael E

2017-01-01

Mucopolysaccharidosis type I is a genetic disorder with impaired glycosaminoglycan degradation. Cardiac pathologic involvement in this subset of patients is predominantly valvular heart disease. Valvular heart disease seen in these patients will most likely require surgical intervention in their lifetime. Only a limited amount of reports are dedicated to the cardiac surgical management of mucopolysaccharidoses. We present the case of a 32-year-old female with Hurler-Scheie syndrome who required multiple valve replacements due to progression of valvular dysfunction and decline in the quality of life. Multidisciplinary evaluation and discussion early are crucial for quality of life optimization in this cohort of patients.

Von Willebrand Factor as a Novel Player in Valvular Heart Disease: From Bench to Valve Replacement.

Science.gov (United States)

Gragnano, Felice; Crisci, Mario; Bigazzi, Maurizio Cappelli; Bianchi, Renatomaria; Sperlongano, Simona; Natale, Francesco; Fimiani, Fabio; Concilio, Claudia; Cesaro, Arturo; Pariggiano, Ivana; Diana, Vincenzo; Limongelli, Giuseppe; Cirillo, Plinio; Russo, Mariagiovanna; Golia, Enrica; Calabrò, Paolo

2018-02-01

von Willebrand Factor (vWF) is a well-known mediator of hemostasis and vascular inflammation. Its dynamic modulation in the bloodstream, according to hemodynamic conditions, makes it an appealing biomarker in patients with valvular heart disease (VHD). Recent studies highlight the close connection between vWF and VHD, with possible implications in the pathogenesis of VHD, promoting valve aging and calcification or favoring the development of infective endocarditis. Moreover, vWF has been recently proposed as a new diagnostic and prognostic tool in patients with valve stenosis or regurgitation, showing a strict correlation with severity of valve disease, outcome, and bleeding (Heyde syndrome). A novel role for vWF is also emerging in patients undergoing percutaneous or surgical valve repair/replacement to select and stratify patients, evaluate periprocedural bleeding risk, and detect procedural complications. We also report our single-center experience, suggesting, for the first time, possible clinical implications for vWF in percutaneous mitral valve repair (MitraClip). This review summarizes recent advances in the role of vWF in VHD with an updated overview going from bench to operating room.

Endostatin and osteopontin are elevated in patients with both coronary artery disease and aortic valve calcification

Directory of Open Access Journals (Sweden)

Michael Sponder

2015-12-01

Conclusions: This is the first study showing an association of ES with AVC in CAD-patients independent from age, BMI and CAD-severity which seems to be of distinct interest when trying to understand the process of heart valve calcification. OPN also correlates with AVC-severity but is mostly dependent on the age of the patients.

ANTITHROMBOTIC THERAPY IN PATIENTS WITH VALVULAR HEART DISEASE: WHAT'S NEW?

Directory of Open Access Journals (Sweden)

N. A. Shostak

2017-01-01

Full Text Available The article presents an overview of modern data and an analysis of the recommendations of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery published in 2017 regarding the use of antithrombotic therapy in patients with valvular heart disease. The results of studies devoted to the use of new oral anticoagulants in patients with valvular heart disease are demonstrated.

Cirurgia valvar e coronária simultânea Combined coronary and valvular surgery

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Pablo M. A Pomerantzeff

1994-12-01

Full Text Available Este trabalho analisa 172 pacientes consecutivos operados de cirurgia valvar e coronária simultânea, no período compreendido entre julho de 1980 e junho de 1989.0 número de pacientes submetidos a revascularização do miocárdio e tratamento cirúrgico da valva aórtica (RAo foi de 95, sendo que 75 foram submetidos a tratamento cirúrgico da valva mitral e revascularização do miocárdio (RMi. As lesões valvares mais freqüentes foram a estenose aórtica, 44 casos de insuficiência mitral em 40 casos. O número de anastomoses por paciente foi de 1,87 em média para os pacientes RMi e de 1,56 nos pacientes RAo. A mortalidade hospitalar foi de 9,8% sendo que a mortalidade para os pacientes RAo foi de 7,3% e para os pacientes RMi foi de 12%. Não houve diferença significativa (x²=04423 entre a mortalidade dos pacientes portadores de insuficiência mitral isquémica, operados eletivamente ou em caráter de emergência, sendo a mortalidade de 20% nos eletivos e de 37,5% nos de emergência. Não houve relação entre mortalidade e número de anastomoses por paciente. Houve tendência de melhores resultados com relação à mortalidade nos pacientes RMi com cirurgia conservadora (x²=1,6382. A curva actuarial de sobrevida mostra 82,6% em 19 semestres para os pacientes RMi, 90,4% para os pacientes RAo e 86,3% para o estudo global de pacientes. Com uma evolução de 5172 meses/pacientes, 75% apresentam-se em classe funcional I (NYHA.In the period between July 1980 and June 1989,172 consecutive patients were submitted to combined coronary and valvular surgery. There were patients with predominantly valvular indications and others with predominant coronary indications. In 95 cases, myocardial revascularization and surgical treatment of the aortic valve (RAo were simultaneously performed. Seventy five patients were submitted to myocardial revascularization and surgical treatment of the mitral valve (RMi. The more frequent valvular lesions were

Newer Anticoagulants for Non-Valvular Atrial Fibrillation

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Joseph M. Harburger

2012-05-01

Full Text Available Non-valvular atrial fibrillation is a recognized risk factor for stroke and systemic embolism. It has been clearly established that warfarin reduces the risk of stroke and systemic embolism in persons with atrial fibrillation and additional risk factors for stroke. The use of warfarin, however, requires frequent monitoring, and there is great variability in patient response to warfarin. Warfarin interacts with several medications and foods. In addition, warfarin use portends a significant risk of bleeding. For these reasons, warfarin is frequently not prescribed to persons for whom the drug would provide a clear benefit. Over the past decade, attempts have been made to develop drugs that are at least as safe and effective as warfarin for the treatment of atrial fibrillation that do not require monitoring nor have as many interactions. Initial studies of compounds in this regard ultimately failed due to safety concerns, but over the past two years two novel agents have been approved by the United States Food and Drug Association for anticoagulation in non-valvular atrial fibrillation, another drug is under review, and additional compounds are being studied. This article will review the use of warfarin and these new agents in the treatment of non-valvular atrial fibrillation.

Prosthesis-patient mismatch after transcatheter aortic valve implantation with the Medtronic-Corevalve bioprosthesis.

Science.gov (United States)

Jilaihawi, Hasan; Chin, Derek; Spyt, Tomasz; Jeilan, Mohamed; Vasa-Nicotera, Mariuca; Bence, Johan; Logtens, Elaine; Kovac, Jan

2010-04-01

Prosthesis-patient mismatch (P-PM) is an important determinant of morbidity and mortality following open aortic valve replacement. The aims of this study were to report its incidence and determinants following transcatheter aortic valve implantation (TAVI) with the Corevalve bioprosthesis, which have-thus far-not been described. Patients with severe calcific aortic stenosis received TAVI with the Corevalve bioprosthesis via transfemoral route. Following TAVI, moderate P-PM was defined as indexed aortic valve effective orifice area (AVAi) Clinical, echocardiographic, and procedural factors relating to P-PM were studied. Optimal device position was defined on fluoroscopy as final position of the proximal aspect of the Corevalve stent frame 5-10 mm below the native aortic annulus. Between January 2007 and January 2009, 50 consecutive patients underwent TAVI in a single centre with the Corevalve bioprosthesis. Mean age was 82.8 years (SD 5.9; 70-93) and 48% were male. P-PM occurred in 16 of 50 cases (32%). Optimal position was achieved in 50% of cases. P-PM was unrelated to age, annulus size, LVOT size, Corevalve size, aortic angulation, ejection fraction, and sex. It was inversely correlated to optimal position (Spearman rho r = -0.34, P = 0.015). Those with optimal positioning had a 16% incidence of P-PM relative to 48% of those with suboptimal positioning (Pearson chi(2) P = 0.015). The incidence of P-PM following TAVI with the Corevalve bioprosthesis is compared favourably with that seen after AVR with conventional open stented bioprostheses and its occurrence is influenced by device positioning.

INFLUENCE OF HOMOCYSTEINE AND VERTEBRAL FRACTURES ON PREVALENT ABDOMINAL AORTIC CALCIFICATION IN POSTMENOPAUSAL WOMEN - A MULTICENTRIC CROSS-SECTIONAL STUDY

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Imad GHOZLANI

2017-08-01

Full Text Available The main of this study was to examine the relationship between plasma homocysteine (Hcy, asymptomatic osteoporotic vertebral fractures (VFs using vertebral fracture assessment (VFA and prevalent abdominal aortic calcification (AAC in Moroccan postmenopausal women. The study cohort consisted of 188 consecutive postmenopausal women with no prior known diagnosis of osteoporosis or taking medication interfering with bone metabolism. Mean age, weight, height, body mass index and plasma homocysteine were determined. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy Vision densitometer (GE Healthcare Inc., Waukesha, WI. VFs were defined using a combination of Genant’s semiquantitative approach and morphometry. VFA images were also scored for prevalent AAC using a validated 24 point scale. Fifty-eight (30.9% patients had densitometric osteoporosis. VFs were identified using VFA in 76 (40.4% patients: 61 women had grade 1 VFs and 15 had grade 2 or 3 VFs. One hundred twenty nine women (68.6% did not have any detectable AAC, whereas the prevalence of significant atherosclerotic burden defined as AAC score of 5 or higher, was 13.8%. A significant positive correlation between AAC score and homocysteine was observed. Women with extended AAC, were older, had a lower weight, BMI and BMD, higher homocysteine levels and more prevalent VFs than women without extended AAC. Multiple regression analysis showed that the presence of extended AAC was significantly associated with Age and grade 2/3 VFs and not independently associated with homocysteine levels.This study did not confirm that homocysteine is important determinant of extended AAC in postmenopausal women. However, this significant atherosclerotic marker is independently associated with VFs regardless of age. 

Carotenoids co-localize with hydroxyapatite, cholesterol, and other lipids in calcified stenotic aortic valves. Ex vivo Raman maps compared to histological patterns

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A. Bonetti

2015-04-01

Full Text Available Unlike its application for atherosclerotic plaque analysis, Raman microspectroscopy was sporadically used to check the sole nature of bioapatite deposits in stenotic aortic valves, neglecting the involvement of accumulated lipids/lipoproteins in the calcific process. Here, Raman microspectroscopy was employed for examination of stenotic aortic valve leaflets to add information on nature and distribution of accumulated lipids and their correlation with mineralization in the light of its potential precocious diagnostic use. Cryosections from surgically explanted stenotic aortic valves (n=4 were studied matching Raman maps against specific histological patterns. Raman maps revealed the presence of phospholipids/triglycerides and cholesterol, which showed spatial overlapping with one another and Raman-identified hydroxyapatite. Moreover, the Raman patterns correlated with those displayed by both von-Kossa-calcium- and Nile-blue-stained serial cryosections. Raman analysis also provided the first identification of carotenoids, which co-localized with the identified lipid moieties. Additional fit concerned the distribution of collagen and elastin. The good correlation of Raman maps with high-affinity staining patterns proved that Raman microspectroscopy is a reliable tool in evaluating calcification degree, alteration/displacement of extracellular matrix components, and accumulation rate of different lipid forms in calcified heart valves. In addition, the novel identification of carotenoids supports the concept that valve stenosis is an atherosclerosis-like valve lesion, consistently with their previous Raman microspectroscopical identification inside atherosclerotic plaques.

Carotenoids co-localize with hydroxyapatite, cholesterol, and other lipids in calcified stenotic aortic valves. Ex vivo Raman maps compared to histological patterns.

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Bonetti, A; Bonifacio, A; Della Mora, A; Livi, U; Marchini, M; Ortolani, F

2015-04-20

Unlike its application for atherosclerotic plaque analysis, Raman microspectroscopy was sporadically used to check the sole nature of bioapatite deposits in stenotic aortic valves, neglecting the involvement of accumulated lipids/lipoproteins in the calcific process. Here, Raman microspectroscopy was employed for examination of stenotic aortic valve leaflets to add information on nature and distribution of accumulated lipids and their correlation with mineralization in the light of its potential precocious diagnostic use. Cryosections from surgically explanted stenotic aortic valves (n=4) were studied matching Raman maps against specific histological patterns. Raman maps revealed the presence of phospholipids/triglycerides and cholesterol, which showed spatial overlapping with one another and Raman-identified hydroxyapatite. Moreover, the Raman patterns correlated with those displayed by both von-Kossa-calcium- and Nile-blue-stained serial cryosections. Raman analysis also provided the first identification of carotenoids, which co-localized with the identified lipid moieties. Additional fit concerned the distribution of collagen and elastin. The good correlation of Raman maps with high-affinity staining patterns proved that Raman microspectroscopy is a reliable tool in evaluating calcification degree, alteration/displacement of extracellular matrix components, and accumulation rate of different lipid forms in calcified heart valves. In addition, the novel identification of carotenoids supports the concept that valve stenosis is an atherosclerosis-like valve lesion, consistently with their previous Raman microspectroscopical identification inside atherosclerotic plaques.

Aortic root segmentation in 4D transesophageal echocardiography

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Chechani, Shubham; Suresh, Rahul; Patwardhan, Kedar A.

2018-02-01

The Aortic Valve (AV) is an important anatomical structure which lies on the left side of the human heart. The AV regulates the flow of oxygenated blood from the Left Ventricle (LV) to the rest of the body through aorta. Pathologies associated with the AV manifest themselves in structural and functional abnormalities of the valve. Clinical management of pathologies often requires repair, reconstruction or even replacement of the valve through surgical intervention. Assessment of these pathologies as well as determination of specific intervention procedure requires quantitative evaluation of the valvular anatomy. 4D (3D + t) Transesophageal Echocardiography (TEE) is a widely used imaging technique that clinicians use for quantitative assessment of cardiac structures. However, manual quantification of 3D structures is complex, time consuming and suffers from inter-observer variability. Towards this goal, we present a semiautomated approach for segmentation of the aortic root (AR) structure. Our approach requires user-initialized landmarks in two reference frames to provide AR segmentation for full cardiac cycle. We use `coarse-to-fine' B-spline Explicit Active Surface (BEAS) for AR segmentation and Masked Normalized Cross Correlation (NCC) method for AR tracking. Our method results in approximately 0.51 mm average localization error in comparison with ground truth annotation performed by clinical experts on 10 real patient cases (139 3D volumes).

Clinical Applications of Natriuretic Peptides in Assessment of Valvular Heart Disease

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Abhishek Sharma

2015-01-01

Full Text Available Biomarkers such as natriuretic peptides (NPs have evolving clinical utility beyond the scope of heart failure. The role of NPs in the management of valvular heart disease is a growing area of investigation. NPs have much potential in the assessment of asymptomatic patients with hemodynamically significant valvular lesions who have traditionally been excluded from consideration of surgical intervention. NPs also have a role in the risk stratification of these patients as well as in routine surveillance and monitoring. Together with echocardiographic data and functional status, NPs are being incorporated into the management of valvular heart disease. In this review we examine the evidence for the role of natriuretic peptides in assessment of VHD.

Clinical Applications of Natriuretic Peptides in Assessment of Valvular Heart Disease

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Ahmed, Vaseem; Garg, Aakash; Aggarwal, Chirag

2015-01-01

Biomarkers such as natriuretic peptides (NPs) have evolving clinical utility beyond the scope of heart failure. The role of NPs in the management of valvular heart disease is a growing area of investigation. NPs have much potential in the assessment of asymptomatic patients with hemodynamically significant valvular lesions who have traditionally been excluded from consideration of surgical intervention. NPs also have a role in the risk stratification of these patients as well as in routine surveillance and monitoring. Together with echocardiographic data and functional status, NPs are being incorporated into the management of valvular heart disease. In this review we examine the evidence for the role of natriuretic peptides in assessment of VHD. PMID:26265794

Thymoma calcification: Is it clinically meaningful?

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Alkaied Homam

2011-08-01

Full Text Available Abstract Among anterior mediastinal lesions, thymoma is the most common. Thymomas are tumors of thymic epithelial cell origin that are distinguished by inconsistent histological and biologic behavior. Chest imaging studies typically show a round or lobulated tumor in the anterior mediastinum. Calcifications in thymomas are classically punctuate or amorphous, positioned within the lesion. Chest computed tomography (CT features suggesting higher risk thymoma consist of tumor heterogeneity, vascular involvement, lobulation, pulmonary nodules, lymphadenopathy, and pleural manifestations. Imaging findings have an imperfect ability to predict stage and prognosis for thymoma patients. Our objective is to highlight the clinical implications of thymoma calcifications on the diagnosis, clinical manifestation and prognosis. A pubmed and google search was performed using the following words: thymoma calcification, calcified thymus, mediastinal calcification, anterior mediastinal calcification, and calcified thymoma. After reviewing 370 articles, 32 eligible articles describing thymoma calcifications were found and included in this review. Although the presence of thymus calcifications was more common in patients with invasive thymomas, they were present in significant portion of non-invasive thymomas. The presence of calcifications was not a significant factor in differentiating between benign and malignant thymoma. As a result, the type, location, size or other characteristics of thymus gland calcifications were not relevant features in clinical and radiologic diagnosis of thymoma. The histopathological diagnosis is still the only possible way to confirm the neoplastic nature of thymoma. All types of thymomas should be evaluated and managed independently of the presence of calcifications.

New modalities of ultrasound-based intima-media thickness, arterial stiffness and non-coronary vascular calcifications detection to assess cardiovascular risk.

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Flore, R; Ponziani, F R; Tinelli, G; Arena, V; Fonnesu, C; Nesci, A; Santoro, L; Tondi, P; Santoliquido, A

2015-04-01

Carotid intima-media thickness (c-IMT), arterial stiffness (AS) and vascular calcification (VC) are now considered important new markers of atherosclerosis and have been associated with increased prevalence of cardiovascular events. An accurate, reproducible and easy detection of these parameters could increase the prognostic value of the traditional cardiovascular risk factors in many subjects at low and intermediate risk. Today, c-IMT and AS can be measured by ultrasound, while cardiac computed tomography is the gold standard to quantify coronary VC, although concern about the reproducibility of the former and the safety of the latter have been raised. Nevertheless, a safe and reliable method to quantify non-coronary (i.e., peripheral) VC has not been detected yet. To review the most innovative and accurate ultrasound-based modalities of c-IMT and AS detection and to describe a novel UltraSound-Based Carotid, Aortic and Lower limbs Calcification Score (USB-CALCs, simply named CALC), allowing to quantify peripheral calcifications. Finally, to propose a system for cardiovascular risk reclassification derived from the global evaluation of "Quality Intima-Media Thickness", "Quality Arterial Stiffness", and "CALC score" in addition to the Framingham score.

Profiles in valvular heart disease

International Nuclear Information System (INIS)

Grossman, W.

1986-01-01

In this chapter the author discusses the hemodynamic and angiographic findings in patients with valvular heart disease. He has found it useful to apply the general physiologic principles in the interpretation of catheterization data obtained in patients with disordered valve function. This approach will generally enable the physician to unravel even the most complicated of problems

Non-invasive assessment of coronary calcification

International Nuclear Information System (INIS)

Vliegenthart, Rozemarijn; Oei, Hok-Hay S.; Hofman, Albert; Oudkerk, Matthijs; Witteman, Jackqueline C. M.

2004-01-01

Electron-beam tomography (EBT) and multi-detector computed tomography (MDCT) enable the noninvasive assessment of coronary calcification. The amount of coronary calcification, as detected by EBT, has a close relation with the amount of coronary atherosclerosis, which is the substrate for the occurrence of myocardial infarction and sudden cardiac death. Calcification of the coronary arteries can be seen as a cumulative measure of life-time exposure to cardiovascular risk factors. Several studies have shown that the amount of coronary calcification is associated with the risk of coronary heart disease. Therefore, coronary calcification is a promising method for non-invasive detection of asymptomatic subjects at high risk of developing coronary heart disease. Whether measurement of coronary calcification also increases the predictive power of coronary events based on cardiovascular risk factors is topic of current research

Aortic valve calcification as a predictor of location and severity of paravalvular regurgitation after transcatheter aortic valve implantation.

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Koh, Ezra Y; Lam, Kayan Y; Bindraban, Navin R; Cocchieri, Riccardo; Planken, R Nils; Koch, Karel T; Baan, Jan; de Mol, Bas A; Marquering, Henk A

2015-03-01

To determine whether the location of aortic valve calcium (AVC) influences the location of paravalvular regurgitation (PR). PR is an adverse effect of transcatheter aortic valve implantation (TAVI) with a negative effect on long-term patient survival. The relationship between AVC and the occurrence of PR has been documented. However, the relationship between the distribution of AVC and the location of PR is still sparsely studied. The purpose of this study was to correlate severity and location of AVC with PR in patients treated with TAVI. Fifty-six consecutive patients who underwent transaortic or transapical TAVI and had preoperative computed tomography scans were included in this retrospective study. The volume, mass and location of AVC was determined and compared between patients with and without PR using a non-parametric t-test. Postoperative echocardiography was performed to determine the presence and location of PR, which was associated with the cusp with highest AVC using a χ(2) test. Valve deployment was successful in all 56 patients. PR was present in 38 patients (68%) after TAVI. There was a non-significantly higher volume of AVC in the PR group [214 (70-418) vs 371 (254-606) cm(3), P = 0.15]. AVC mass was significantly higher in patients with PR than in patients without PR [282 (188-421) vs 142 (48-259) mg, respectively, P = 0.043]. The location of PR was determined in 36 of these patients. Of these 36 patients, PR occurred at the cusp with the highest AVC in 20 patients (56%, χ(2) P = 0.030). In our population, PR was associated with greater AVC mass. Moreover, the location of PR was associated with the cusp with the highest amount of AVC. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

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Eduardo Keller Saadi

2008-03-01

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

Bisphosphonates, atherosclerosis and vascular calcification: update and systematic review of clinical studies

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Caffarelli C

2017-10-01

Full Text Available Carla Caffarelli,1 Andrea Montagnani,2 Ranuccio Nuti,1 Stefano Gonnelli1 1Department of Medicine, Surgery and Neuroscience, University of Siena, Italy; 2Division of Internal Medicine, General Hospital Misericordia, Grosseto, Italy Background: Epidemiologic and clinical data have suggested the existence of a biologic linkage between the bone system and the vascular system. Bisphosphonates (BPs are effective inhibitors of bone resorption and are currently considered the drugs of choice for the prevention and treatment of osteoporosis and related fractures. Data from several publications have suggested that BPs may also be effective in reducing the atherosclerotic process and vascular calcification, but the results of these studies are contrasting. This review aimed to allow a better understanding of the relationships between BPs and atherosclerosis in humans.Materials and methods: Electronic databases of Pubmed-Medline, Cochrane Library and SCOPUS from inception to June 30, 2016 were searched. The full texts of the articles potentially eligible were carefully assessed and reviewed. Finally, 20 studies were found to be eligible and were included in the systematic review. All included studies were published between 2000 and 2014.Results: In several studies, etidronate limited the progression of aortic and coronary calcification in hemodialysis patients, whereas the nitrogen-containing-BPs given orally did not significantly reduce vascular calcifications in patients with chronic kidney disease, kidney trasplant or in those with osteoporosis. Nitrogen-containing-BPs present favorable effects both on vessel wall thickness and on arterial elasticity due to both a reduction in serum lipids and the interaction of BPs with the bone tissue, with the consequent release of bone turnover markers and cytokines into the bloodstream.Conclusion: To sum up, the BPs seem to have the potential of influencing atherosclerosis and calcium homeostasis at the level of

Determinants of Aortic Root Dilatation and Reference Values Among Young Adults Over a 20-Year Period: Coronary Artery Risk Development in Young Adults Study.

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Teixido-Tura, Gisela; Almeida, Andre L C; Choi, Eui-Young; Gjesdal, Ola; Jacobs, David R; Dietz, Harry C; Liu, Kiang; Sidney, Stephen; Lewis, Cora E; Garcia-Dorado, David; Evangelista, Artur; Gidding, Samuel; Lima, João A C

2015-07-01

Aortic size increases with age, but factors related to such dilatation in healthy young adult population have not been studied. We aim to evaluate changes in aortic dimensions and its principal correlates among young adults over a 20-year time period. Reference values for aortic dimensions in young adults by echocardiography are also provided. Healthy Coronary Artery Risk Development in Young Adults (CARDIA) study participants aged 23 to 35 years in 1990-1991 (n=3051) were included after excluding 18 individuals with significant valvular dysfunction. Aortic root diameter (ARD) by M-mode echocardiography at year-5 (43.7% men; age, 30.2 ± 3.6 years) and year-25 CARDIA exams was obtained. Univariable and multivariable analyses were performed to assess associations of ARD with clinical data at years-5 and -25. ARD from year-5 was used to establish reference values of ARD in healthy young adults. ARD at year-25 was greater in men (33.3 ± 3.7 versus 28.7 ± 3.4 mm; Pyoung adulthood. Our study also provides reference values for ARD in young adults. © 2015 American Heart Association, Inc.

Relationship between diffuse idiopathic skeletal hyperostosis, abdominal aortic calcification and associated metabolic disorders: Data from the Camargo Cohort.

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Pariente-Rodrigo, Emilio; Sgaramella, Giusi Alessia; Olmos-Martínez, José Manuel; Pini-Valdivieso, Stefanie Francesca; Landeras-Alvaro, Rosa; Hernández-Hernández, José Luis

2017-09-08

Diffuse idiopathic skeletal hyperostosis (DISH) and abdominal aortic calcification (AAC) are related to an increased cardiovascular risk. The aim of this study was to analyse a possible relationship between both entities and also the association between metabolic disorders and DISH. Analytic cross-sectional study in a population-based cohort. DISH (with Resnick-Niwayama criteria) and AAC (with AAC-24 scale) were assessed on plain x-ray images. Interaction terms between DISH and forty clinical covariates were also investigated, through correlation analysis and multivariate regression. Nine hundred eighty-seven males aged≥50 years, with a mean age=65,5±9 years, were evaluated. Prevalence rates of DISH and AAC were 21.6% and 58.7%, respectively. DISH+ subjects were older (68.1±9 vs. 63.8±9 years; P=.0001) and more likely to be affected by metabolic syndrome (MS) (55.6% vs. 36.6%; P=.0001). In DISH+ subjects, the AAC was 3.7±5 points, whereas in DISH- subjects it was 3.3±5 (P=.25). AAC was associated with an increased risk of prevalent DISH (unadjusted OR=1.4 [CI95%: 1.01-1.9]; P=.04), that disappeared when it was adjusted for age (adjusted OR=1.1 [CI95%: 0.8-1.5];P=.47]. No association was found between DISH and hypertension, diabetes or dyslipidaemia; however, age (OR=2.2 [CI95%: 1.6-3]; P=.0001), BMI (OR=1.5 [CI95%: 1.1-2]; P=.007), waist circumference (OR=1.5 [CI95%: 1.04-2,3]; P=.03) and MS (OR=1.7 [CI95%: 1.1-2.4]; P=.005) showed a significant relationship with DISH after adjusting for confounders. The study was not able to demonstrate a consistent association between DISH and AAC, proving only a weak and age-dependent relationship between them. DISH proved to be significantly associated with age, BMI, waist circumference and MS. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

THE MAMMOGRAPHIC CALCIFICATIONS IN BREAST CANCER

Institute of Scientific and Technical Information of China (English)

Tang Ruiying; Liu Jingxian; Gaowen

1998-01-01

Objective: This study was performed to exam the relativeship between mammographic calcifications and breast cancer. Methods: All of the 184 patients with breast diseases underwent mammography before either an open biopsy or a mastectomy. The presence,morphology, and distribution of calcifications visualized on mammograms for breast cancer were compared with the controls who remained cancer free. Statistical comparisons were made by using the x2 test. Results:Of the 184 patients with breast diaeases, 93 malignant and 91 benign lesions were histologically confirmed.Calcifications were visualized on mammograms in 60(64%) of 93 breast cancers and 26 (28%) of 91 non breast cancers. The estimated odds ratio (OR) of breast cancer was 4.5 in women with calcifications seen on mammograms, compared with those having none (P＜0.01). Of the 60 breast carcinomas having mammographic calcifications, 28 (47%) were infiltrating ductal carcinomas.There were only 8 (24%) cases with infiltrating ductal cancers in the group of without calcifications seen on the mammograms (P＜0.05). Conclusion: Our finding suggests that mammographic calcification appears to be a risk factor for breast cancer. The granular and linear cast type calcification provide clues to the presence of breast cancer, especially when the carcinomas without associated masses were seen on mammograms.

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

International Nuclear Information System (INIS)

Lamas, Gloria I.; Kairiyama, Eulogia; Navia, Jose

2000-01-01

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 60 Co 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) [es

Valvular Heart Disease in Cancer Patients: Etiology, Diagnosis, and Management.

Science.gov (United States)

Stewart, Merrill H; Jahangir, Eiman; Polin, Nichole M

2017-07-01

Cardiac valvular disease as consequence of radiation and chemotherapy during treatment for malignancy is growing in its awareness. While the overwhelming emphasis in this population has been on the monitoring and preservation of left ventricular systolic function, we are now developing a greater appreciation for the plethora of cardiac sequelae beyond this basic model. To this end many institutions across the country have developed cardio-oncology programs, which are collaborative practices between oncologists and cardiologists in order to minimize a patient's cardiovascular risk while allowing them to receive the necessary treatment for their cancer. These programs also help to recognize early nuanced treatment complications such as valvular heart disease, and provide consultation for the most appropriate course of action. In this article we will discuss the etiology, prevalence, diagnosis, and current treatment options of valvular heart disease as the result of chemotherapy and radiation.

Acupuncture in patients with valvular heart disease and prosthetic valves.

Science.gov (United States)

Stellon, Anthony

2003-09-01

Endocarditis has been reported in patients with valvular heart disease who have undergone acupuncture treatment, although most have been associated with the use of semi-permanent needles. This has led reviewers to suggest that acupuncture may not only be contraindicated in such patients but that prophylactic antibiotics should be given. This study investigated the use of acupuncture treatment in patients with proven valvular heart disease and observed whether endocarditis developed in such patients. All patients in a single-handed GP practice with proven valvular heart disease, including those with prosthetic valves, were identified over a ten-year period. Those who had undergone acupuncture treatment underwent a clinical examination and diagnostic tests, which focused on the signs, symptoms and laboratory criteria for the diagnosis of endocarditis and included a transthoracic echocardiogram. Autopsy findings were reviewed in any patient who died. Based on these clinical and laboratory data, using the modified Duke's criteria for the diagnosis of endocarditis, patients were identified as having definite or possible endocarditis, or the diagnosis was rejected. All patients underwent brief acupuncture with no skin disinfectant and no prophylactic antibiotics were given. Semi-permanent needles were avoided. Thirty-six patients with valvular heart disease underwent a total of 479 acupuncture treatments over a ten-year period. The median number of treatments was 9 (range 1-72), with a follow-up after treatment of 5.75 years (range 0.5-10 years). Definite endocarditis was not found in any patient, but two patients had possible endocarditis, eventually discounted by both negative blood cultures and echocardiography. In conclusion, brief acupuncture was safe in this small cohort of valvular heart disease patients and no case of endocarditis was detected over a ten-year period.

Direct oral anticoagulant use in nonvalvular atrial fibrillation with valvular heart disease: a systematic review.

Science.gov (United States)

Owens, Ryan E; Kabra, Rajesh; Oliphant, Carrie S

2017-06-01

Direct oral anticoagulants (DOACs) are indicated for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), which, according to the American College of Cardiology/American Heart Association/Heart Rhythm Society atrial fibrillation (AF) guidelines, excludes patients with rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair. However, the data regarding use of DOACs in AF patients with other types of valvular heart disease (VHD) are unclear. We aimed to summarize and evaluate the literature regarding the safety and efficacy of DOAC use in NVAF patients with other types of VHD. After an extensive literature search, a total of 1 prospective controlled trial, 4 subanalyses, and 1 abstract were identified. Efficacy of the DOAC agents in NVAF patients with VHD mirrored the overall trial results. Bleeding risk was significantly increased in VHD patients treated with rivaroxaban, but not for dabigatran or apixaban. Of the bioprosthetic valve patients enrolled in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial, no safety or efficacy concerns were identified. In conclusion, subanalyses of DOAC landmark AF trials revealed that dabigatran, rivaroxaban, and apixaban may be safely used in AF patients with certain types of VHD: aortic stenosis, aortic regurgitation, and mitral regurgitation. More evidence is needed before routinely recommending these agents for patients with bioprosthetic valves or mild mitral stenosis. Patients with moderate to severe mitral stenosis or mechanical valves should continue to receive warfarin, as these patients were excluded from all landmark AF trials. © 2016 Wiley Periodicals, Inc.

Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve.

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Wang, Yongshi; Wu, Boting; Li, Jun; Dong, Lili; Wang, Chunsheng; Shu, Xianhong

2016-05-01

Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial. From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR. With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group. An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Reemplazo valvular mitral en edad pediátrica

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H S Diliz-Nava

2017-01-01

Full Text Available ANTECEDENTES: el reemplazo valvular mitral en pediatría es un procedimiento raro asociado con dificultades técnicas y clínicas únicas. Estudios recientes reportan mejores resultados, a corto y largo plazo, posteriores al procedimiento.   OBJETIVO: analizar la experiencia del reemplazo valvular mitral en el Instituto Nacional de Pediatría.   MATERIALES Y MÉTODOS: se revisaron los expedientes de los pacientes con reemplazo valvular mitral, en el Instituto Nacional de Pediatría, entre agosto del 2002 y agosto del 2012. Las variables de evaluación primaria fueron mortalidad, complicaciones de la anticoagulación y resultados a largo plazo. Se incluyó a doce pacientes, con mediana de edad de 12.5 años (tres pacientes menores de 5 años. RESULTADOS: en 11 casos la anomalía mitral fue considerada congénita. La manifestación clínica más frecuente fue insuficiencia mitral. La mediana de la fracción de eyección del ventrículo izquierdo fue de 62% antes de la cirugía. Se colocó prótesis mecánica en 11 casos. Dos pacientes fallecieron en el postoperatorio inmediato, con supervivencia a 30 días de 83%, sin reporte de ninguna muerte en el periodo de seguimiento. Un paciente presentó sangrado de  tubo digestivo leve y dos arritmia auricular. No se reportaron eventos tromboembólicos ni necesidad de nueva intervención. La mediana del tiempo de seguimiento fue de 16.6 meses.   CONCLUSIÓN: en nuestras condiciones el reemplazo valvular mitral parece ser una buena opción para los pacientes que no pueden beneficiarse de la reparación, con resultados aceptables a corto y mediano plazos.

Five-year epidemiological survey of valvular heart disease: changes in morbidity, etiological spectrum and management in a cardiovascular center of Southern China.

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Liu, Fang-Zhou; Xue, Yu-Mei; Liao, Hong-Tao; Zhan, Xian-Zhang; Guo, Hui-Ming; Huang, Huan-Lei; Fang, Xian-Hong; Wei, Wei; Rao, Fang; Deng, Hai; Liu, Yang; Lin, Wei-Dong; Wu, Shu-Lin

2014-12-01

The objective of the present study is to analyze the epidemiological profile of patients with abnormal valvular structure and function and highlight the etiological spectrum and management of valvular heart disease (VHD) in a single cardiovascular center of Southern China in five years. The retrospective study included 19,428 consecutive patients (9,441 men and 9,987 women with a mean age of 52.03±20.50 years) with abnormal valvular structure and function who were screened by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) at the in-patient department of Guangdong General Hospital from January 2009 to December 2013. Data on baseline characteristics, potential etiology, treatment strategies and discharge outcomes were collected from electronic medical records. There were 13,549 (69.7%) patients with relatively definite etiology for VHD. VHD was rheumatic in 7,197 (37.0%) patients, congenital in 2,697 (13.9%), degenerative in 2,241 (11.5%), ischemic in 2,460 (12.7%). The prevalence decreased significantly in rheumatic VHD from 2009 to 2013 (from 42.8% to 32.8%, P<0.001), but increased markedly in congenital VHD (from 9.0% to 12.3%, P<0.001), ischemic VHD (from 9.2% to 11.3%, P=0.003) and degenerative VHD (from 8.8% to 14.5%, P<0.001). Meantime, the prevalence of ischemic VHD increased after the age of 45, similar to that of degenerative VHD. From 2009 to 2013, the proportion of patients with VHD undergoing open cardiac valvular surgery decreased (from 49.5% to 44.3%, P<0.001) and that of patients treated with general medication increased (from 49.2% to 54.1%, P<0.001). However, there was markedly increment in video-assisted thoracoscopic surgery (VATS) from 2009 to 2013 (from 0.3% to 4.4%, P<0.001). Increasing tendencies were showed in aortic mechanical valve replacement (from 32.1% to 34.5%, P=0.001) and double mechanical valve replacement (from 20.9% to 22.3%, P=0.035), especially in mitral valvuloplasty (from 8.5% to 15.7%, P<0

[Disk calcifications in children].

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Schmit, P; Fauré, C; Denarnaud, L

1985-05-01

It is not unusual for intervertebral disk calcifications to be detected in pediatric practice, the 150 or so cases reported in the literature probably representing only a small proportion of lesions actually diagnosed. Case reports of 33 children with intervertebral disk calcifications were analyzed. In the majority of these patients (31 of 33) a diagnosis of "idiopathic" calcifications had been made, the cervical localization of the lesions being related to repeated ORL infections and/or trauma. A pre-existing pathologic factor was found in two cases (one child with juvenile rheumatoid arthritis treated by corticoids and one child with Williams and Van Beuren's syndrome). An uncomplicated course was noted in 31 cases, the symptomatology (pain, spinal stiffness and febricula) improving after several days. Complications developed in two cases: one child had very disabling dysphagia due to an anteriorly protruding cervical herniated disc and surgery was necessary; the other child developed cervicobrachial neuralgia due to herniated disc protrusion into the cervical spinal canal, but symptoms regressed within several days although calcifications persisted unaltered. These findings and the course of the rare complications documented in the literature suggest the need for the most conservative treatment possible in cases of disc calcifications in children.

Vegetative Valvular Endocarditis and Hepatitis Associated with Helcococcus ovis in a 7-year-old White Leghorn Rooster.

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Crispo, Manuela; Stoute, Simone; Savaris, Thaiza; Bickford, Arthur; Santoro, Tiffany; Sentíes-Cué, C Gabriel

2017-12-01

Helcococcus ovis is a slow-growing, pyridoxal-dependent, Gram-positive coccus belonging to the Peptostreptococcaceae family. Bacteria belonging to the genus Helcococcus are considered normal inhabitants of keratinized epithelium in humans; however, several reports support their role as pathogens in humans and several animal species. This case report describes the identification of H. ovis in a white leghorn rooster with valvular vegetative endocarditis and hepatitis. In February 2017 one dead, 7-yr-old, white leghorn rooster was submitted to the California Animal Health and Food Safety Turlock laboratory for diagnostic testing. Postmortem and microscopic examination revealed vegetative endocarditis and aortic thrombosis associated with large numbers of Gram-positive cocci. Myocarditis and extensive necrotic hepatitis were also noticed. Helcococcus ovis was isolated in large numbers from the aortic endothelium and confirmed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Bacterial colonies become evident 48 hr postincubation and exhibited a satellite growth around Escherichia coli on blood agar plates. A similar relationship has been described between Helcococcus spp. and Staphylococcus aureus. The primary site of infection in this chicken was not determined. To our understanding this is the first report of H. ovis infection in an avian species. The fastidious nature and nutritional requirements of Helcococcus spp. must be considered in order to allow proper identification and avoid misdiagnosis. Further studies are needed to define pathogenesis, virulence factors, and predisposing conditions associated with this microorganism.

Proatherogenic pathways leading to vascular calcification

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Mazzini, Michael J.; Schulze, P. Christian

2006-01-01

Cardiovascular disease is the leading cause of morbidity and mortality in the western world and atherosclerosis is the major common underlying disease. The pathogenesis of atherosclerosis involves local vascular injury, inflammation and oxidative stress as well as vascular calcification. Vascular calcification has long been regarded as a degenerative process leading to mineral deposition in the vascular wall characteristic for late stages of atherosclerosis. However, recent studies identified vascular calcification in early stages of atherosclerosis and its occurrence has been linked to clinical events in patients with cardiovascular disease. Its degree correlates with local vascular inflammation and with the overall impact and the progression of atherosclerosis. Over the last decade, diverse and highly regulated molecular signaling cascades controlling vascular calcification have been described. Local and circulating molecules such as osteopontin, osteoprogerin, leptin and matrix Gla protein were identified as critical regulators of vascular calcification. We here review the current knowledge on molecular pathways of vascular calcification and their relevance for the progression of cardiovascular disease

Is there a rural gradient in the diagnosis of aortic stenosis? An analysis of a remote Scottish cohort.

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Maycock, Matthew I; Farman, Colin; Mort, Alasdair; Turpie, David; Leslie, Stephen J

2013-01-01

Calcific aortic stenosis is the most common cardiac valve lesion and is becoming increasingly prevalent as life expectancy rises. There is evidence that patients in remote and rural areas with certain diseases have worse outcomes and present to specialist services later than their urban counterparts. It is not known whether patients with aortic stenosis follow a similar pattern. The aim of this study was to investigate whether increasing rurality was associated with later presentation to healthcare services at a more advanced stage of aortic stenosis. This was a retrospective cohort study. Using ICD-10 discharge codes and local databases, 605 patients with aortic stenosis who presented between 31 November 1999 and 1 December 2008 were identified. Aortic stenosis was defined as a pressure gradient across the aortic valve of 25 mmHg or more. Patients with prior aortic valve replacement were excluded. Clinical notes were reviewed for all patients. Gender, age and pressure gradient across the aortic valve at presentation and patient GP-practice location were recorded. Patients were then assigned a Clinical Peripherality Index score based on the postcode of their GP's practice to define rurality. Patient data were compared across the six defined levels of clinical peripherality by ANOVA. Mean patient age was 73 ± 13 years, and 336 (54%) were male. The peak gradient across the valve was 41.1 ± 26.7 mmHg. There was no association between the level of clinical peripherality and the stage of aortic stenosis at presentation, age or gender (all p >0.05). There was no urban-rural gradient in the severity of aortic stenosis at presentation in this remote Scottish cohort. This suggests that patients with this condition in remote areas do not present later in their disease trajectory.

Influence of type of aortic valve prosthesis on coronary blood flow velocity.

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Jelenc, Matija; Juvan, Katja Ažman; Medvešček, Nadja Tatjana Ružič; Geršak, Borut

2013-02-01

Severe aortic valve stenosis is associated with high resting and reduced hyperemic coronary blood flow. Coronary blood flow increases after aortic valve replacement (AVR); however, the increase depends on the type of prosthesis used. The present study investigates the influence of type of aortic valve prosthesis on coronary blood flow velocity. The blood flow velocity in the left anterior descending coronary artery (LAD) and the right coronary artery (RCA) was measured intraoperatively before and after AVR with a stentless bioprosthesis (Sorin Freedom Solo; n = 11) or a bileaflet mechanical prosthesis (St. Jude Medical Regent; n = 11). Measurements were made with an X-Plore epicardial Doppler probe (Medistim, Oslo, Norway) following induction of hyperemia with an adenosine infusion. Preoperative and postoperative echocardiography evaluations were used to assess valvular and ventricular function. Velocity time integrals (VTI) were measured from the Doppler signals and used to calculate the proportion of systolic VTI (SF), diastolic VTI (DF), and normalized systolic coronary blood flow velocities (NSF) and normalized diastolic coronary blood flow velocities (NDF). The systolic proportion of the LAD VTI increased after AVR with the St. Jude Medical Regent prosthesis, which produced higher LAD SF and NSF values than the Sorin Freedom Solo prosthesis (SF, 0.41 ± 0.09 versus 0.29 ± 0.13 [P = .04]; NSF, 0.88 ± 0.24 versus 0.55 ± 0.17 [P = .01]). No significant changes in the LAD velocity profile were noted after valve replacement with the Sorin Freedom Solo, despite a significant reduction in transvalvular gradient and an increase in the effective orifice area. AVR had no effect on the RCA flow velocity profile. The coronary flow velocity profile in the LAD was significantly influenced by the type of aortic valve prosthesis used. The differences in the LAD velocity profile probably reflect differences in valve design and the systolic transvalvular flow pattern.

Quantification of progression and regression of descending thoracic aortic wall thickness by enhanced computed tomography

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Yokoyama, Kenichi; Takasu, Junichiro; Yamamoto, Rie; Taguchi, Rie; Itani, Yasutaka; Ito, Yuichi; Watanabe, Shigeru; Masuda, Yoshiaki

2001-01-01

The purpose of this study is to verify the usefulness of the quantification of aortic wall involvement by enhanced computed tomography (CT). One-hundred thirteen Japanese patients underwent two enhanced CT of the descending thoracic aorta at intervals. We sliced the descending thoracic aorta continuously from the level of the tracheal bifurcation with 1 cm intervals, and we defined aortic wall volume (AWV) (cm 3 ) as the sum of a 7-slice area of aortic wall involving calcification. The average of AWV increased from 7.95±2.92 cm 3 to 8.70±2.98 cm 3 . The developmental rate of AWV (ΔAWV) was 0.270±0.281 cm 3 /year. ΔAWV did not have a significant correlation with any risk factor at the baseline. ΔAWV had significant correlation with total cholesterol, (LDL-C) low-density lipoprotein cholesterol and LDL-C/(HDL-C) high-density lipoprotein cholesterol ratio at the follow-up, and by multivariate analysis with only the LDL-C/HDL-C ratio. ΔAWV was not correlated with the intake status of hypoglycemic, antihypertensive or lipid-lowering drugs. The cut-off level of total cholesterol with the most significant odds ratio for progression of aortic wall was 190 mg/dl, and that of LDL-C was 130 mg/dl. This method proved to be useful for the non-invasive assessment of aortic wall thickness. (author)

Mid-Term Results of Surgical Treatment of Atrial Fibrillation in Valvular Heart Disease Assesed by Speckle Tracking Echocardiography.

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Lorenzo, Natalia; Mendez, Irene; Taibo, Mikel; Martinis, Gianfranco; Badia, Sara; Reyes, Guillermo; Aguilar, Rio

2018-03-19

Atrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm. This study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence. Fifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation valvular heart disease surgery.

Personalised external aortic root support (PEARS) in Marfan syndrome: analysis of 1–9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement

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Treasure, Tom; Takkenberg, Johanna J M; Golesworthy, Tal; Rega, Filip; Petrou, Mario; Rosendahl, Ulrich; Mohiaddin, Raad; Rubens, Michael; Thornton, Warren; Lees, Belinda; Pepper, John

2014-01-01

Objective Among people with Marfan syndrome who have a typical aortic root aneurysm, dissection is a characteristic cause of premature death. To pre-empt Type A dissection, composite root replacement with a mechanical valve became the standard of care in the 1980s and 1990s. This is being superseded by valve-sparing aortic root replacement to avoid lifelong anticoagulation. In 2004, a total root and valve-sparing procedure, personalised external aortic support, was introduced. We report here results among the first 30 recipients. Methods From cross-sectional digital images, the patient's own aorta is modelled by computer aided design and a replica is made in thermoplastic by rapid prototyping. On this, a personalised support of a macroporous polymer mesh is manufactured. The mesh is positioned around the aorta, closely applied from the aortoventricular junction to beyond the brachiocephalic artery. The operation is performed with a beating heart and usually without cardiopulmonary bypass. Results Between 2004 and 2011, 30 patients, median age 28 years (IQR 20–44) had this operation and have been prospectively followed for 1.4–8.8 years by February 2013. During a total of 133 patient-years there were no deaths or cerebrovascular, aortic or valve-related events. These early outcomes are better than published results for the more radical extirpative root replacement operations. Conclusions The aortic valve, the root architecture, and the blood/endothelia interface are conserved. The perioperative burden is less and there has been freedom from aortic and valvular events. A prospective comparative study is planned. PMID:24395977

Sustitución valvular mitral. Técnicas quirúrgicas. Prótesis valvulares

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Tarrío, Rubén Fernández

2005-01-01

En pacientes afectos de valvulopatía mitral no susceptible de una intervención reparadora, la operación de elección es la sustitución valvular por prótesis mecánica o biológica. La obtención de buenos resultados depende de un meticuloso conocimiento de su anatomía y sus relaciones anatómicas, las posibles vías de acceso, la técnica quirúrgica y sus posibles complicaciones.

Choice of approaches for surgical correction of tricuspid pathology in patients with rheumatic multi-valvular heart disease

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Hamidullah A. Abdumadzhidov

2017-04-01

Full Text Available Objective: To analyze the results of surgical correction of patients with tricuspid pathology in rheumatic multi-valvular heart disease. Methods: We retrospectively analyzed outcomes of surgical correction of tricuspid valve disease in 292 patients with rheumatic multi-valvular heart defects, who underwent surgery in our clinic. Results: The age of our patients ranged from 12 to 74 years (mean age 36.7 (9.4 years, among them 197 (67.4% women and 95 (32.6% - men. According to the degree of circulatory disorders, 21 (7.2% patients were in NYHA class III and 271 (92.8% patients - class IV. Of them 235 (80.5% patients were operated by the method of De Vega using plastic fibrous ring. After tricuspid valve (TV and fibrous ring repair in 26.9% - tricuspid regurgitation disappeared, in 62.8% - regurgitation decreased to the 1st degree, and the remaining 10.3% of patients had 2nd (moderate degree tricuspid regurgitation. In 7 (2.38% cases of infective endocarditis, the "open heart surgery" correction – replacement of TV with biological prosthesis was made. Creation of the bicuspid tricuspid valve techniques was used in 13.4% of cases. Conclusion: Our study demonstrated that correction of tricuspid valve disease in our cohort of patients, including valve repair and replacement and reconstructive surgery of fibrous ring alone or in combination with mitral or aortic valve replacement/ repair is accompanied by reduction of tricuspid regurgitation and reduction of cardiac chamber size and right ventricular pressure. No complications intrinsic to operative technique of tricuspid valve reconstructive surgery as advanced atrioventricular block or myocardial ischemia and infarction were recorded.

Intracranial calcification on paediatric computed tomography

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Kendall, B.; Cavanagh, N.

1986-01-01

An analysis of the computed tomograms of 18000 children examined consecutively form the basis of an assessment of the diagnostic significance of intracranial calcification. The low incidence of physiological calcification in the pineal and choroid of about 2% up to the age of 8 years, but increasing 5-fold by the age of 15 years, is confirmed. Pathological calcification occurred in 1.6%, the commonest causes being neoplasms (43%), neuroectodermal syndromes (20%) and infections (12%). Diffuse basal ganglia calcification (15%) bore little relation to the diverse clinical symptomatology, and routine bio-chemical studies showed a disorder of metabolism to be present in only 6 cases. Calcification has not been previously noted in acute haemorrhagic leukoencephalitis, Pertussis or Cocksackie encephalitis, infantile neuraxonal dystrophy, Marinesco-Sjoegren syndrome or in the basal ganglia in neurofibromatosis. (orig.)

Role of Pre-incision, Intravenous Prophylactic Amiodarone to Control Arrhythmias in Patients with Rheumatic Valvular Heart Disease undergoing Mitral Valve Replacement

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Ahmad, K.; Naqvi, S.

2013-01-01

Objective: To evaluate the effect of intra-operative single intra venous dose of amiodarone on post operative cardiac arrhythmias in patients undergoing valvular heart surgery. Study Design: Randomized controlled trials. Place and Duration of surgery: This study was performed at Armed forces Institute of Cardiology Rawalpindi from Jan 01, 2011 to Dec 31, 2011. Patients and Methods: In this study 80 patients with rheumatic valvular heart disease and undergoing elective mitral valve replacement were randomly divided into two groups. Group I, n = 40 (Amiodarone group) was given single intravenous dose of amiodarone (5 mg/kg in 100 ml of saline over 30 min) before sternotomy incision. Group II, n = 40(control / placebo group) was given 100 ml of saline over 30 min. Result: In the amiodarone group, after removal of aortic cross clamp 75% patients had sinus rhythm compared to 47.5% in control group. p=0.045. Similarly 15% had AF, 5% JR and 5% VT/VF in amiodarone group in contrast to 32.5% with AF, 12.5% JR and 7.5% Vt/VF in control group. (p=0.045). Response to cardioversion was positive in 75% of the patients requiring shocks in amiodarone group as against 43.75% in the control group. (p=0.044). Conclusion: A single intravenous bolus dose of amiodarone is effective in decreasing the incidence of cardiac arrhythmias after mitral valve replacement in patients with rheumatic MVD. (author)

Plasma brain natriuretic peptide concentrations in patients with valvular heart disease

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Stewart, Ralph A; Lee, Mildred; Gabriel, Ruvin; Van Pelt, Niels; Newby, David E; Kerr, Andrew J

2016-01-01

Objective Plasma brain natriuretic peptide (BNP) concentrations predict prognosis in patients with valvular heart disease (VHD), but it is unclear whether this directly relates to disease severity. We assessed the relationship between BNP and echocardiographic measures of disease severity in patients with VHD. Methods Plasma BNP concentrations were measured in patients with normal left ventricular (LV) systolic function and isolated VHD (mitral regurgitation (MR), n=33; aortic regurgitation (AR), n=39; aortic stenosis (AS), n=34; mitral stenosis (MS), n=30), and age-matched and sex-matched controls (n=39) immediately prior to exercise stress echocardiography. Results Compared with controls, patients with VHD had elevated plasma BNP concentrations (MR median 35 (IQR 23–52), AR 34 (22–45), AS 31 (22–60), MS 58 (34–90); controls 24 (16–33) pg/mL; p<0.01 for all). LV end diastolic volume index varied by valve lesion; (MR (mean 77±14), AR (91±28), AS (50±17), MS (43±11), controls (52±13) mL/m2; p<0.0001). There were no associations between LV volume and BNP. Left atrial (LA) area index varied (MR (18±4 cm2/m2), AR (12±2), AS (11±3), MS (19±6), controls (11±2); p<0.0001), but correlated with plasma BNP concentrations: MR (r=0.42, p=0.02), MS (r=0.86, p<0.0001), AR (r=0.53, p=0.001), AS (r=0.52, p=0.002). Higher plasma BNP concentrations were associated with increased pulmonary artery pressure and reduced exercise capacity. Despite adverse cardiac remodelling, 81 (60%) patients had a BNP concentration within the normal range. Conclusions Despite LV remodelling, plasma BNP concentrations are often normal in patients with VHD. Conversely, mild elevations of BNP occur with LA dilatation in the presence of normal LV. Plasma BNP concentrations should be interpreted with caution when assessing patients with VHD. PMID:27175283

Valvular Heart Disease Patients on Edoxaban or Warfarin in the ENGAGE AF-TIMI 48 Trial.

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De Caterina, Raffaele; Renda, Giulia; Carnicelli, Anthony P; Nordio, Francesco; Trevisan, Marco; Mercuri, Michele F; Ruff, Christian T; Antman, Elliott M; Braunwald, Eugene; Giugliano, Robert P

2017-03-21

The use of non-vitamin K antagonist oral anticoagulants (NOACs) instead of vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and coexisting valvular heart disease (VHD) is of substantial interest. This study explored outcomes in patients with AF with and without VHD in the ENGAGE AF-TIMI 48 (Effective Anticoagulation with factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48) trial, comparing edoxaban with warfarin. Valvular heart disease was defined as history or baseline echocardiography evidence of at least moderate aortic/mitral regurgitation, aortic stenosis, or prior valve surgery (bioprosthesis replacement, valve repair, valvuloplasty). Patients with moderate to severe mitral stenosis or mechanical heart valves were excluded from the trial. Comparisons were made of rates of stroke/systemic embolic event (SSEE), major bleeding, additional efficacy and safety outcomes, as well as net clinical outcomes, in patients with or without VHD treated with edoxaban or warfarin, using adjusted Cox proportional hazards. After adjustment for multiple baseline characteristics, compared with no-VHD patients (n = 18,222), VHD patients (n = 2,824) had a similar rate of SSEE but higher rates of death (hazard ratio [HR]: 1.40; 95% confidence interval [CI]:1.26 to 1.56; p <0.001), major adverse cardiovascular events (HR: 1.29; 95% CI: 1.16 to 1.43; p <0.001), and major bleeding (HR: 1.21; 95% CI: 1.03 to 1.42; p = 0.02). Higher-dose edoxaban regimen had efficacy similar to warfarin in the presence of VHD (for SSEE, HR: 0.69; 95% CI: 0.44 to 1.07, in patients with VHD, and HR: 0.91; 95% CI: 0.77 to 1.07, in patients without VHD; p interaction [p int ] = 0.26; and for less major bleeding, HR: 0.74; 95% CI: 0.53 to 1.02 in patients with VHD, and HR: 0.82; 95% CI: 0.71 to 0.94, in patients with no VHD; p int  = 0.57). The presence of VHD increased the risk of death, major adverse cardiovascular events, and major

Losartan in combination with propranolol slows the aortic root dilatation in neonatal Marfan syndrome

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Lu-Hang Liu

2018-04-01

Full Text Available Neonatal Marfan syndrome, in contrast to classical Marfan syndrome, is characterized by rapidly progressive multi-valvular cardiac disease and death from congestive heart failure, typically within the first year of life. Due to the rarity of this condition, treatment for neonatal Marfan syndrome has not been well studied. In this report, a combination of losartan and propranolol reduced the aortic root dilatation rate after three months of losartan therapy. Genetic analysis in this patient revealed a mutation in exon 25 of the FBN1 gene, which typically results in a shorter life expectancy. However, the patient's heart failure was controlled by losartan, propranolol and other anti-congestive medications, which may have prolonged his survival. Key Words: FBN1, losartan, neonatal Marfan syndrome

Losartan in combination with propranolol slows the aortic root dilatation in neonatal Marfan syndrome.

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Liu, Lu-Hang; Lin, Shan-Miao; Lin, Dar-Shong; Chen, Ming-Ren

2018-04-01

Neonatal Marfan syndrome, in contrast to classical Marfan syndrome, is characterized by rapidly progressive multi-valvular cardiac disease and death from congestive heart failure, typically within the first year of life. Due to the rarity of this condition, treatment for neonatal Marfan syndrome has not been well studied. In this report, a combination of losartan and propranolol reduced the aortic root dilatation rate after three months of losartan therapy. Genetic analysis in this patient revealed a mutation in exon 25 of the FBN1 gene, which typically results in a shorter life expectancy. However, the patient's heart failure was controlled by losartan, propranolol and other anti-congestive medications, which may have prolonged his survival. Copyright © 2017. Published by Elsevier B.V.

Intracranial calcification in central diabetes insipidus

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Al-Kandari, Salwa R.; Pandey, Tarun; Badawi, Mona H.

2008-01-01

Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

Intracranial calcification in central diabetes insipidus

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Al-Kandari, Salwa R. [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); Pandey, Tarun [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); University of Arkansas for Medical Sciences, Radiology Department, Little Rock, AR (United States); Badawi, Mona H. [Al-Adan Hospital, Department of Paediatrics, Kuwait (Kuwait)

2008-01-15

Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

The Aortic Bifurcation Angle as a Factor in Application of the Outback for Femoropopliteal Lesions in Ipsilateral Versus Contralateral Approaches.

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Raskin, Daniel; Khaitovich, Boris; Balan, Shmuel; Silverberg, Daniel; Halak, Moshe; Rimon, Uri

2018-01-01

To assess the technical success of the Outback reentry device in contralateral versus ipsilateral approaches for femoropopliteal arterial occlusion. A retrospective review of patients treated for critical limb ischemia (CLI) using the Outback between January 2013 and July 2016 was performed. Age, gender, length and site of the occlusion, approach site, aortic bifurcation angle, and reentry site were recorded. Calcification score was assigned at both aortic bifurcation and reentry site. Technical success was assessed. During the study period, a total of 1300 endovascular procedures were performed on 489 patients for CLI. The Outback was applied on 50 femoropopliteal chronic total occlusions. Thirty-nine contralateral and 11 ipsilateral antegrade femoral were accessed. The device was used successfully in 41 patients (82%). There were nine failures, all in the contralateral approach group. Six due to inability to deliver the device due to acute aortic bifurcation angle and three due to failure to achieve luminal reentry. Procedural success was significantly affected by the aortic bifurcation angle (p = 0.013). The Outback has high technical success rates in treatment of femoropopliteal occlusion, when applied from either an ipsi- or contralateral approach. When applied in contralateral access, acute aortic bifurcation angle predicts procedural failure.

Papillary fibroelastoma of the aortic valve - a case report and literature review

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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.

Calcification in large cell neuroendocrine carcinoma of the lung

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Takamochi, Kazuya; Yokose, Tomoyuki; Ochiai, Atsushi; Yoshida, Junji; Nishimura, Mitsuyo; Ohmatsu, Hironobu; Nagai, Kanji; Nishiwaki, Yutaka

2003-01-01

The aim was to investigate the prevalence of intratumoral calcification in large cell neuroendocrine carcinoma (LCNEC) and to review computed tomography (CT) and histological findings. From August 1992 through March 2000, 35 out of 1183 surgically resected lung cancer patients were histologically diagnosed as having LCNEC at our institute. We reviewed the pain radiographs and CT scans of these 35 LCNEC patients. In LCNEC cases with intratumoral calcification, we examined the size, number, distribution and pattern of intratumoral calcifications visible on the CT scans and the histological features. Three cases (9%) exhibited calcification. The calcifications were recognized by CT scans alone. The CT scans showed punctate or eccentric intratumoral calcifications, which are considered to be a malignant feature, in all three cases. In two cases, the calcifications were histologically confirmed to be located within the necrotic areas of a tumor nest. We found three LCNEC cases with intratumoral calcification. The prevalence of LCNEC calcification was similar to that in previous reports on lung cancer. The mechanism of the intratumoral calcification in our LCNEC cases is speculated to be dystrophic calcification. (author)

Inverse Relationship Between Membranous Septal Length and the Risk of Atrioventricular Block in Patients Undergoing Transcatheter Aortic Valve Implantation.

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Hamdan, Ashraf; Guetta, Victor; Klempfner, Robert; Konen, Eli; Raanani, Ehud; Glikson, Michael; Goitein, Orly; Segev, Amit; Barbash, Israel; Fefer, Paul; Spiegelstein, Dan; Goldenberg, Ilan; Schwammenthal, Ehud

2015-08-17

This study sought to examine whether imaging of the atrioventricular (AV) membranous septum (MS) by computed tomography (CT) can be used to identify patient-specific anatomic risk of high-degree AV block and permanent pacemaker (PPM) implantation before transcatheter aortic valve implantation (TAVI) with self-expandable valves. MS length represents an anatomic surrogate of the distance between the aortic annulus and the bundle of His and may therefore be inversely related to the risk of conduction system abnormalities after TAVI. Seventy-three consecutive patients with severe aortic stenosis underwent contrast-enhanced CT before TAVI. The aortic annulus, aortic valve, and AV junction were assessed, and MS length was measured in the coronal view. In 13 patients (18%), high-degree AV block developed, and 21 patients (29%) received a PPM. Multivariable logistic regression analysis revealed MS length as the most powerful pre-procedural independent predictor of high-degree AV block (odds ratio [OR]: 1.35, 95% confidence interval [CI]: 1.1 to 1.7, p = 0.01) and PPM implantation (OR: 1.43, 95% CI: 1.1 to 1.8, p = 0.002). When taking into account pre- and post-procedural parameters, the difference between MS length and implantation depth emerged as the most powerful independent predictor of high-degree AV block (OR: 1.4, 95% CI: 1.2 to 1.7, p < 0.001), whereas the difference between MS length and implantation depth and calcification in the basal septum were the most powerful independent predictors of PPM implantation (OR: 1.39, 95% CI: 1.2 to 1.7, p < 0.001 and OR: 4.9, 95% CI: 1.2 to 20.5, p = 0.03; respectively). Short MS, insufficient difference between MS length and implantation depth, and the presence of calcification in the basal septum, factors that may all facilitate mechanical compression of the conduction tissue by the implanted valve, predict conduction abnormalities after TAVI with self-expandable valves. CT assessment of membranous septal anatomy provides

Cardiac and pericardial calcifications on chest radiographs

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Ferguson, E.C., E-mail: ecferguson@hotmail.co [University of Texas Medical School at Houston, Department of Diagnostic and Interventional Imaging, Section of Thoracic Imaging, Houston, TX 77030 (United States); Berkowitz, E.A. [University of Texas Medical School at Houston, Department of Diagnostic and Interventional Imaging, Section of Thoracic Imaging, Houston, TX 77030 (United States)

2010-09-15

Many types of cardiac and pericardial calcifications identified on chest radiographs can be recognized and distinguished based on characteristic locations and appearances. The purpose of this review is to emphasize the importance of detecting cardiac and pericardial calcifications on chest radiographs, and to illustrate and describe the various types of calcifications that may be encountered and how they may be differentiated from one another. Each type of cardiac and pericardial calcification is discussed, its location and appearance described, and its significance explained. Recognizing and understanding these calcifications is important as they are often encountered in daily practice and play an important role in patient care.

Ampliación de anillo aórtico para implantación de prótesis: Evolución en el tiempo Aortic ring widening for prosthesis implantation: Evaluation throughout time

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Oscar Velásquez

2005-02-01

Full Text Available Objetivo: describir las características cardíacas de pacientes sometidos a cambio valvular aórtico con ampliación del anillo para implantación de una prótesis mayor, mediante seguimiento clínico y ecocardiográfico. Materiales y métodos: entre 1997 y 2001 se tomaron 26 pacientes, de los cuales 13 (50%, con edad promedio de 57 años, se sometieron a seguimiento. La ecocardiografía se practicó en el control, obteniéndose área valvular aórtica, masa ventricular y gradientes transprotésicos para luego establecer los índices respectivos. Resultados: hubo mejoría en la clase funcional de los 13 pacientes controlados, con 92.3% en clase I (p= 0.002. La evolución postoperatoria fue de 25 meses en promedio. El índice de masa ventricular y los gradientes valvulares (medio presentaron reducción de 149 a 113 g/m2 y de 67 a 12.2 mm Hg respectivamente (p= 0.001; también se evidenció aumento en el índice de área efectiva valvular protésica que varió de 0.37 a 1 cm/m2 (p= 0.001. Discusión: los resultados evidencian involución en los trastornos ventriculares y mejoría en la clase funcional de los pacientes sometidos a este procedimiento; sin embargo, no se logró establecer comparación con pacientes que presentaran una prótesis menor a 21 mm de diámetro, lo que permitiría confirmar las ventajas de una válvula mayor. Conclusión: la cirugía de cambio valvular aórtico con ampliación del anillo para la implantación de una prótesis mayor, parece ser una alternativa para los pacientes con anillo aórtico nativo pequeño, evidenciándose mejoría clínica y ecocardiográfica en su evolución.Objective: to describe the cardiac characteristics of patients submitted to aortic valvular change with ring widening for a bigger prosthesis implantation, through clinical and echocardiographic follow-up. Material and methods: 26 patients were chosen between 1997 and 2001. Follow-up was possible in 13 patients. Mean age was 57 years. A

Acute Aortic Arch Perforation During Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis and a Gothic Aortic Arch.

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Millan-Iturbe, Oscar; Sawaya, Fadi J; Bieliauskas, Gintautas; Chow, Danny H F; De Backer, Ole; Søndergaard, Lars

2017-09-01

Transcatheter aortic valve replacement (TAVR) has evolved from a novel technology to an established therapy for high/intermediate-risk patients with severe symptomatic aortic stenosis (AS). Although TAVR is used to treat bicuspid severe AS, the large randomized trials typically excluded bicuspid AS because of its unique anatomic features. This case report describes an acute aortic perforation during delivery of a transcatheter heart valve to treat a severe bicuspid AS with a "gothic aortic arch"; more careful evaluation of the preprocedural multislice computed tomographic scan would have unveiled a sharply angulated aortic arch. This life-threatening complication was successfully treated by thoracic endovascular aortic repair. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Large-scale community echocardiographic screening reveals a major burden of undiagnosed valvular heart disease in older people: the OxVALVE Population Cohort Study†

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d'Arcy, Joanna L.; Coffey, Sean; Loudon, Margaret A.; Kennedy, Andrew; Pearson-Stuttard, Jonathan; Birks, Jacqueline; Frangou, Eleni; Farmer, Andrew J.; Mant, David; Wilson, Jo; Myerson, Saul G.; Prendergast, Bernard D.

2016-01-01

Background Valvular heart disease (VHD) is expected to become more common as the population ages. However, current estimates of its natural history and prevalence are based on historical studies with potential sources of bias. We conducted a cross-sectional analysis of the clinical and epidemiological characteristics of VHD identified at recruitment of a large cohort of older people. Methods and results We enrolled 2500 individuals aged ≥65 years from a primary care population and screened for undiagnosed VHD using transthoracic echocardiography. Newly identified (predominantly mild) VHD was detected in 51% of participants. The most common abnormalities were aortic sclerosis (34%), mitral regurgitation (22%), and aortic regurgitation (15%). Aortic stenosis was present in 1.3%. The likelihood of undiagnosed VHD was two-fold higher in the two most deprived socioeconomic quintiles than in the most affluent quintile, and three-fold higher in individuals with atrial fibrillation. Clinically significant (moderate or severe) undiagnosed VHD was identified in 6.4%. In addition, 4.9% of the cohort had pre-existing VHD (a total prevalence of 11.3%). Projecting these findings using population data, we estimate that the prevalence of clinically significant VHD will double before 2050. Conclusions Previously undetected VHD affects 1 in 2 of the elderly population and is more common in lower socioeconomic classes. These unique data demonstrate the contemporary clinical and epidemiological characteristics of VHD in a large population-based cohort of older people and confirm the scale of the emerging epidemic of VHD, with widespread implications for clinicians and healthcare resources. PMID:27354049

Topical thrombin-related corneal calcification.

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Kiratli, Hayyam; Irkeç, Murat; Alaçal, Sibel; Söylemezoğlu, Figen

2006-09-01

To report a highly unusual case of corneal calcification after brief intraoperative use of topical thrombin. A 44-year-old man underwent sclerouvectomy for ciliochoroidal leiomyoma, during which 35 UNIH/mL lyophilized bovine thrombin mixed with 9 mL of diluent containing 1500 mmol/mL calcium chloride was used. From the first postoperative day, corneal and anterior lenticular capsule calcifications developed, and corneal involvement slightly enlarged thereafter. A year later, 2 corneal punch biopsies confirmed calcification mainly in the Bowman layer. Topical treatment with 1.5% ethylenediaminetetraacetic acid significantly restored corneal clarity. Six months later, a standard extracapsular cataract extraction with intraocular lens placement improved visual acuity to 20/60. This case suggests that topical thrombin drops with elevated calcium concentrations may cause acute corneal calcification in Bowman layer and on the anterior lens capsule.

Stress echocardiography in valvular heart disease: a current appraisal.

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Naji, Peyman; Patel, Krishna; Griffin, Brian P; Desai, Milind Y

2015-03-01

Stress echocardiography is increasingly used in the management of patients with valvular heart disease and can aid in evaluation, risk stratification and clinical decision making in these patients. Evaluation of symptoms, exercise capacity and changes in blood pressure can be done during the exercise portion of the test, whereas echocardiographic portion can reveal changes in severity of disease, pulmonary artery pressure and left ventricular function in response to exercise. These parameters, which are not available at rest, can have diagnostic and prognostic importance. In this article, we will review the indications and diagnostic implications, prognostic implications, and clinical impact of stress echocardiography in decision making and management of patients with valvular heart disease.

Asymptomatic aortic stenosis: An assessment of patients' and of their general practitioners' knowledge, after an indexed specialized assessment in community practice.

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Raphaëlle-Ashley Guerbaii

Full Text Available Clinical and echocardiography follow-up is recommended in patients with aortic stenosis to detect symptom onset, thus a watchful waiting approach has to be safe and effective. For both AS patients and their general practitioners, evaluation of valvular heart disease (VHD knowledge, after the indexed specialized assessment has never been measured.To evaluate the knowledge of clinical symptoms of aortic stenosis by both patients and their general practitioner.Sixty-four patients, with moderate to severe and initially asymptomatic AS (median AVA (interquartile range 1.01(0.80-1.15 cm2 previously referred to a tertiary center and medically managed for at least 6 months after the index echocardiogram, and their primary care doctors were interviewed on the phone and asked to answer specific questions related to knowledge of aortic stenosis symptoms.Fifty-six percent of patients quoted shortness of breath as one of the aortic stenosis symptoms, and only 16% knew the 3 aortic stenosis symptoms. Fifty percent of patients reported having received sufficient information regarding aortic stenosis; only 48% remembered receiving information regarding specific symptoms. Only 14% general practitioners quoted the 3 specific symptoms. According to the initial recommendation, only 41 patients (64% benefitted from a 6-to-12 month clinical and echocardiography follow up.GPs are not sufficiently trained to safely manage AS patients in the community and to ensure adequate follow-up and monitoring. AS patients were not properly informed about their diagnosis and symptomatology. Hence, therapeutic education should be improved for patients with asymptomatic AS and continuous medical education on VHD should be reinforced, for GPs.

Calcifications in the breast in Filaria loa infection