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Sample records for human aortic valves

  1. Aortic Valve Disease

    Science.gov (United States)

    ... Tricuspid Valve Disease Cardiac Rhythm Disturbances Thoracic Aortic Aneurysm Pediatric and Congenital Heart Disease Heart abnormalities that are ... Transplantation End-stage Lung Disease Adult Lung Transplantation Pediatric Lung ... Aortic Aneurysm Aortic Valve Disease Overview The human heart has ...

  2. The presence of fructosamine in human aortic valves is associated with valve stiffness.

    Science.gov (United States)

    Kishabongo, Antoine S; Katchunga, Philippe; Cikomola, Justin C; De Somer, Filip M; De Buyzere, Marc L; Speeckaert, Marijn M; Delanghe, Joris R

    2016-09-01

    Human heart valves are prone to glycation, a fundamental process of ageing. The aim of this study was to establish the relationship between fructosamine formation and the mechanical properties of human aortic valves. 67 patients (age: 76±8 years) diagnosed with an aortic valve stenosis, who underwent an aortic valve replacement were enrolled. Fructosamine and calcium concentrations in aortic valves were determined. Using a transthoracic Doppler echocardiography, aortic valve orifice area and transvalvular pressure gradients were measured. In a subgroup of 32 patients, the aortic valve orifice area was sufficient to carry out mechanical testing on a LFPlus Universal material tester. An in vitro removal of fructosamine of the valve was initiated using ATP-dependent fructosamine 3-kinase (FN3K). A significant correlation was found between the aortic valve fructosamine concentration and the calculated aortic valve orifice area: Y (aortic valve orifice area, mm(2))=1.050-0.228X (aortic valve fructosamine concentration, µmol/g valve) (r=-0.38). A significantly higher calcium concentration was measured in the aortic valves of diabetics in comparison with those of non-diabetics. A multiple regression analysis revealed that the presence of diabetes mellitus and aortic valve fructosamine concentration were the main predictors of the extensibility of the aortic valves. In the in vitro deglycation study, a significant lower aortic valve fructosamine concentration was detected after treatment with FN3K. This resulted in an increased flexibility of the aortic valves. Although no direct causativeness is proven with the presented results, which just show an association between fructosamine, the effect of FN3K and aortic valve stiffness, the present study points for the first time towards a possible additional role of the Amadori products in the biomechanical properties of ageing aortic valves. Published by the BMJ Publishing Group Limited. For permission to use (where not

  3. Human tissue valves in aortic position: determinants of reoperation and valve regurgitation

    NARCIS (Netherlands)

    T.P. Willems (Tineke); E.W. Steyerberg (Ewout); V.E. Kleyburg-Linkers; E. Bos (Egbert); L.A. van Herwerden (Lex); J.R.T.C. Roelandt (Jos); J.J.M. Takkenberg (Hanneke)

    2001-01-01

    textabstractBACKGROUND: Human tissue valves for aortic valve replacement have a limited durability that is influenced by interrelated determinants. Hierarchical linear modeling was used to analyze the relation between these determinants of durability and valve

  4. Aortic valve bypass

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  5. Quadricuspid Aortic Valve

    Directory of Open Access Journals (Sweden)

    Mehmet Taşar

    2013-03-01

    Full Text Available Quadricuspid aortic valve is an extremely rare congenital defect. Isolated form appears frequently. It is seen with aortic valve regurgitation in adulthood. This case report presents a rare clinical finding of an isolated quadricuspid aortic valve with aortic regurgitation in an 64-year-old female who was referred for cardiac evaluation due to newly identified murmur.

  6. Interleukin-37 suppresses the osteogenic responses of human aortic valve interstitial cells in vitro and alleviates valve lesions in mice

    Science.gov (United States)

    Zeng, Qingchun; Song, Rui; Fullerton, David A.; Ao, Lihua; Zhai, Yufeng; Li, Suzhao; Ballak, Dov B.; Cleveland, Joseph C.; Reece, T. Brett; McKinsey, Timothy A.; Xu, Dingli; Dinarello, Charles A.; Meng, Xianzhong

    2017-01-01

    Calcific aortic valve disease is a chronic inflammatory process, and aortic valve interstitial cells (AVICs) from diseased aortic valves express greater levels of osteogenic factors in response to proinflammatory stimulation. Here, we report that lower cellular levels of IL-37 in AVICs of diseased human aortic valves likely account for augmented expression of bone morphogenetic protein-2 (BMP-2) and alkaline phosphatase (ALP) following stimulation of Toll-like receptor (TLR) 2 or 4. Treatment of diseased AVICs with recombinant human IL-37 suppresses the levels of BMP-2 and ALP as well as calcium deposit formation. In mice, aortic valve thickening is observed when exposed to a TLR4 agonist or a high fat diet for a prolonged period; however, mice expressing human IL-37 exhibit significantly lower BMP-2 levels and less aortic valve thickening when subjected to the same regimens. A high fat diet in mice results in oxidized low-density lipoprotein (oxLDL) deposition in aortic valve leaflets. Moreover, the osteogenic responses in human AVICs induced by oxLDL are suppressed by recombinant IL-37. Mechanistically, reduced osteogenic responses to oxLDL in human AVICs are associated with the ability of IL-37 to inhibit NF-κB and ERK1/2. These findings suggest that augmented expression of osteogenic factors in AVICs of diseased aortic valves from humans is at least partly due to a relative IL-37 deficiency. Because recombinant IL-37 suppresses the osteogenic responses in human AVICs and alleviates aortic valve lesions in mice exposed to high fat diet or a proinflammatory stimulus, IL-37 has therapeutic potential for progressive calcific aortic valve disease. PMID:28137840

  7. RNA expression profile of calcified bicuspid, tricuspid, and normal human aortic valves by RNA sequencing.

    Science.gov (United States)

    Guauque-Olarte, Sandra; Droit, Arnaud; Tremblay-Marchand, Joël; Gaudreault, Nathalie; Kalavrouziotis, Dimitri; Dagenais, Francois; Seidman, Jonathan G; Body, Simon C; Pibarot, Philippe; Mathieu, Patrick; Bossé, Yohan

    2016-10-01

    The molecular mechanisms leading to premature development of aortic valve stenosis (AS) in individuals with a bicuspid aortic valve are unknown. The objective of this study was to identify genes differentially expressed between calcified bicuspid aortic valves (BAVc) and tricuspid valves with (TAVc) and without (TAVn) AS using RNA sequencing (RNA-Seq). We collected 10 human BAVc and nine TAVc from men who underwent primary aortic valve replacement. Eight TAVn were obtained from men who underwent heart transplantation. mRNA levels were measured by RNA-Seq and compared between valve groups. Two genes were upregulated, and none were downregulated in BAVc compared with TAVc, suggesting a similar gene expression response to AS in individuals with bicuspid and tricuspid valves. There were 462 genes upregulated and 282 downregulated in BAVc compared with TAVn. In TAVc compared with TAVn, 329 genes were up- and 170 were downregulated. A total of 273 upregulated and 147 downregulated genes were concordantly altered between BAVc vs. TAVn and TAVc vs. TAVn, which represent 56 and 84% of significant genes in the first and second comparisons, respectively. This indicates that extra genes and pathways were altered in BAVc. Shared pathways between calcified (BAVc and TAVc) and normal (TAVn) aortic valves were also more extensively altered in BAVc. The top pathway enriched for genes differentially expressed in calcified compared with normal valves was fibrosis, which support the remodeling process as a therapeutic target. These findings are relevant to understand the molecular basis of AS in patients with bicuspid and tricuspid valves.

  8. Aortic Valve Regurgitation

    Science.gov (United States)

    ... inside your heart that involves heart valves. Rheumatic fever. Rheumatic fever — a complication of strep throat and once a ... the United States — can damage the aortic valve. Rheumatic fever is still prevalent in developing countries but rare ...

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

    Science.gov (United States)

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

    2013-01-01

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

  10. Interleukin-37 suppresses the osteogenic responses of human aortic valve interstitial cells in vitro and alleviates valve lesions in mice

    NARCIS (Netherlands)

    Zeng, Q.; Song, R.; Fullerton, D.A.; Ao, L.; Zhai, Y.; Li, S.; Ballak, D.B.; Cleveland, J.C., Jr.; Reece, T.B.; McKinsey, T.A.; Xu, D.; Dinarello, C.A.; Meng, X.

    2017-01-01

    Calcific aortic valve disease is a chronic inflammatory process, and aortic valve interstitial cells (AVICs) from diseased aortic valves express greater levels of osteogenic factors in response to proinflammatory stimulation. Here, we report that lower cellular levels of IL-37 in AVICs of diseased h

  11. Aortic valve replacement

    DEFF Research Database (Denmark)

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

    2008-01-01

    BACKGROUND AND AIMS OF THE STUDY: Prompted by anecdotal evidence and observations by surgeons, an investigation was undertaken into the potential differences in implanted aortic valve prosthesis sizes, during aortic valve replacement (AVR) procedures, between northern and southern European...... countries. METHODS: A multi-institutional, non-randomized, retrospective analysis was conducted among 2,932 patients who underwent AVR surgery at seven tertiary cardiac surgery centers throughout Europe. Demographic and perioperative variables including valve size and type, body surface area (BSA) and early...

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

    Energy Technology Data Exchange (ETDEWEB)

    Czapla-Masztafiak, J. [Institute of Nuclear Physics PAN, Radzikowskiego 152, 31-342 Kraków (Poland); Lis, G.J.; Gajda, M.; Jasek, E. [Department of Histology, Jagiellonian University Medical College, Kopernika 7, 31-034 Kraków (Poland); Czubek, U. [Department of Coronary Disease, Jagiellonian University Medical College, John Paul II Hospital, Prądnicka 80, 31-202 Kraków (Poland); Bolechała, F. [Department of Forensic Medicine, Jagiellonian University Medical College, Grzegórzecka 16, 31-531 Kraków (Poland); Borca, C. [Swiss Light Source, Paul Scherrer Institute, 5232 Villigen PSI (Switzerland); Kwiatek, W.M. [Institute of Nuclear Physics PAN, Radzikowskiego 152, 31-342 Kraków (Poland)

    2015-12-01

    In order to investigate changes in chemical state of iron in normal and pathologically altered human aortic valves X-ray absorption spectroscopy was applied. Since Fe is suspected to play detrimental role in aortic valve stenosis pathogenesis the oxidation state of this element has been determined. The experimental material consisted of 10 μm sections of valves excised during routine surgery and from autopsies. The experiment was performed at the MicroXAS beamline of the SLS synchrotron facility in Villigen (Switzerland). The Fe K-edge XANES spectra obtained from tissue samples were carefully analyzed and compared with the spectra of reference compounds containing iron in various chemical structures. The analysis of absorption edge position and shape of the spectra revealed that both chemical forms of iron are presented in valve tissue but Fe{sup 3+} is the predominant form. Small shift of the absorption edge toward higher energy in the spectra from stenotic valve samples indicates higher content of the Fe{sup 3+} form in pathological tissue. Such a phenomenon suggests the role of Fenton reaction and reactive oxygen species in the etiology of aortic valve stenosis. The comparison of pre-edge regions of XANES spectra for control and stenotic valve tissue confirmed no differences in local symmetry or spin state of iron in analyzed samples.

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

    Directory of Open Access Journals (Sweden)

    Richard C. Godby

    2014-12-01

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

  14. Transcatheter aortic valve implantation with the NVT Allegra transcatheter heart valve system: first-in-human experience with a novel self-expanding transcatheter heart valve.

    Science.gov (United States)

    Wenaweser, Peter; Stortecky, Stefan; Schütz, Torsten; Praz, Fabien; Gloekler, Steffen; Windecker, Stephan; Elsässer, Albrecht

    2016-05-17

    We aimed to demonstrate the feasibility and investigate the safety of a novel, self-expanding trans-catheter heart valve in a selected patient population with severe aortic stenosis. Between January and September 2013, a total of 21 patients with symptomatic severe aortic stenosis were eligible for transcatheter aortic valve implantation (TAVI) with the self-expanding NVT Allegra bioprosthesis (New Valve Technology, Hechingen, Germany) at two cardiovascular centres. Patients were elderly (age 83.8±4 years), predominantly female (95.2%), and all were considered to be at prohibitive risk for surgical aortic valve replacement (logistic EuroSCORE 30.4±11%). Procedural and device success was achieved in 95.2% and 85.7%, respectively. Echocardiographic assessment at discharge showed favourable haemodynamic results with a reduction of the mean transvalvular aortic gradient from 48.0±21 mmHg to 8.9±3 mmHg. In the majority of patients (90.5%), none or trace aortic regurgitation was recorded. Permanent pacemaker implantation was required in 23.8% of patients within the first 30 days of follow-up. Apart from one procedural death, no other serious adverse events were observed during the periprocedural period. TAVI with the NVT Allegra system was highly effective in alleviating symptoms and reducing NYHA functional class at 30-day follow-up. The first-in-human experience with the NVT Allegra transcatheter heart valve prosthesis was associated with a high rate of procedural success. Furthermore, the NVT Allegra bioprosthesis was able to achieve favourable haemodynamic results and effectively alleviate symptoms at 30-day follow-up. The larger, multicentre NAUTILUS study will provide further information on the safety and efficacy of this novel, second-generation transcatheter aortic bioprosthesis.

  15. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra

    Science.gov (United States)

    2016-03-09

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

  16. Embolic capture with updated intra-aortic filter during coronary artery bypass grafting and transaortic transcatheter aortic valve implantation: first-in-human experience.

    Science.gov (United States)

    Ye, Jian; Webb, John G

    2014-12-01

    We report our first-in-human clinical experience in the use of the new version of the EMBOL-X intra-aortic filter (Edwards Lifesciences Corporation, Irvine, Calif) to capture embolic material during transaortic transcatheter aortic valve implantation and cardiac surgery. Five patients were enrolled into the first-in-human clinical assessment of the new version of the EMBOL-X intra-aortic filter. Three patients underwent coronary artery bypass grafting, and 2 patients underwent transaortic transcatheter aortic valve implantation. During coronary artery bypass grafting, the filter was deployed before clamping of the aorta and removal of the aortic clamp. In contrast, the filter was deployed before aortic puncture for transaortic transcatheter aortic valve implantation and kept in the aorta throughout the entire procedure. The filter introducer sheath and filter were easily placed and removed without difficulty. There were no complications related to the use of the filter. Postoperative examination of the retrieved filters revealed the presence of multiple microemboli in the filters from all 5 cases. Histologic study revealed various kinds of tissue and thrombus. This first-in-human clinical experience has demonstrated the safety and feasibility of using the new version of the EMBOL-X intra-aortic filter during either cardiac surgery or transaortic transcatheter aortic valve implantation. We believe that the combination of the transaortic approach without aortic arch manipulation and the use of the EMBOL-X filter with a high capture rate is a promising strategy to reduce the incidence of embolic complications during transcatheter aortic valve implantation. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  17. Transcatheter Aortic Heart Valve Thrombosis

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  18. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease

    DEFF Research Database (Denmark)

    Mylotte, Darren; Lefevre, Thierry; Søndergaard, Lars

    2014-01-01

    BACKGROUND: Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV). OBJECTIVES: This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV. METHODS...

  19. Valve selection in aortic valve endocarditis

    Science.gov (United States)

    Zubrytska, Yana

    2016-01-01

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

  20. Aortic Annular Enlargement during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Selman Dumani

    2016-09-01

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

  1. Heritable retinoblastoma and accelerated aortic valve disease

    Science.gov (United States)

    Abeyratne, L R; Kingston, J E; Onadim, Z; Dubrey, S W

    2013-01-01

    Heritable retinoblastoma is associated with a germline mutation in the tumour suppressor gene RBI. The Rb protein (pRb) arises from the RB1 gene, which was the first demonstrated cancer susceptibility gene in humans. 1 Second primary malignancies are recognised complications of retinoblastoma. Furthermore, pRb is implicated in valve remodelling in calcific aortic valve disease. 2 3 We report a family with hereditary retinoblastoma and associated secondary primary malignancies. There are two interesting aspects to this family. The first is the concept of ‘cancer susceptibility genes’; the RBI gene being the first reported in humans. A further feature of note is that two family members also have bicuspid aortic valves. We discuss a potential association between the gene defect responsible for retinoblastoma (with its associated propensity for further malignancies) and accelerated deterioration of the bicuspid aortic valve in the proband carrying this gene defect. PMID:23595191

  2. CONGENITAL QUADRICUSPID AORTIC-VALVE

    NARCIS (Netherlands)

    BROUWER, MHJ; DEGRAAF, JJ; EBELS, T

    1993-01-01

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

  3. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

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

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy....... The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  4. Effects of Raloxifene on the Proliferation and Apoptosis of Human Aortic Valve Interstitial Cells

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    Zhimin Fu

    2016-01-01

    Full Text Available We aimed to explore the effects of raloxifene (RAL on the proliferation and apoptosis of human aortic valve interstitial cells (AVICs. Different concentrations of RAL were used to act on AVICs. MTS kit is used to test the effects of different concentrations of RAL on the proliferation of AVICs. Cell cycle and apoptosis test used flow cytometry after seven-day treatment. The relative expression levels of caspase-3 and caspase-8 are tested with RT-qPCR and Western blot. The results of MTS testing revealed that the absorbance value (OD value of the cells in the concentration groups of 10 and 100 nmol/L RAL at a wavelength of 490 nm at five, seven, and nine days significantly decreased compared with that in the control group. Meanwhile, the results of flow cytometry of the cells collected after seven days showed that the ratio of the S stage and the cell apoptosis rate of AVICs can be significantly reduced by RAL in the concentration groups of 10 and 100 nmol/L. The mRNA and protein expressions of caspase-3 and caspase-8 were significantly decreased compared with those in the control group. This study laid the foundation for further treatment of aortic valve disease by using RAL.

  5. Bicuspid Aortic Valve

    Science.gov (United States)

    2006-08-01

    aortic valvular disease, endocarditis, ascending aortic aneurysm and aortic dissection.1-4 There is also an association of BAV with coarctation of...for aortic aneurysm , patients with BAV appear to have additional risks for aortic disease. Nistri et al.12 reported significant aortic root...Congenital heart disease in patients with Turner’s syndrome. Italian study group for Turner syndrome (ISGTS). J Pediatr 1998; 133:688-692. 7. Schmid

  6. Double prosthetic aortic valve. Case report.

    Science.gov (United States)

    Liddicoat, J E; Bekassy, S M; De Bakey, M E

    1975-05-01

    A 55-year-old man underwent insection of a Hufnagel valve into his descending thoracic aorta for aortic valve insufficiency 18 years ago. He remained asymptomatic for 16 years. Because of progressive left ventricular failure his incompetent aortic valve was replaced with a De Bakey carbon ball aortic valve prosthesis 2 years later. Currently, 21 months after the operation, he is doing well with two aortic valves. Review of the literature suggests that he is the first patient reported with two aortic valves functioning concomitantly and one of the longest surviving patients with a Hufnagel valve.

  7. Inhibitory role of Notch1 in calcific aortic valve disease.

    Directory of Open Access Journals (Sweden)

    Asha Acharya

    Full Text Available Aortic valve calcification is the most common form of valvular heart disease, but the mechanisms of calcific aortic valve disease (CAVD are unknown. NOTCH1 mutations are associated with aortic valve malformations and adult-onset calcification in families with inherited disease. The Notch signaling pathway is critical for multiple cell differentiation processes, but its role in the development of CAVD is not well understood. The aim of this study was to investigate the molecular changes that occur with inhibition of Notch signaling in the aortic valve. Notch signaling pathway members are expressed in adult aortic valve cusps, and examination of diseased human aortic valves revealed decreased expression of NOTCH1 in areas of calcium deposition. To identify downstream mediators of Notch1, we examined gene expression changes that occur with chemical inhibition of Notch signaling in rat aortic valve interstitial cells (AVICs. We found significant downregulation of Sox9 along with several cartilage-specific genes that were direct targets of the transcription factor, Sox9. Loss of Sox9 expression has been published to be associated with aortic valve calcification. Utilizing an in vitro porcine aortic valve calcification model system, inhibition of Notch activity resulted in accelerated calcification while stimulation of Notch signaling attenuated the calcific process. Finally, the addition of Sox9 was able to prevent the calcification of porcine AVICs that occurs with Notch inhibition. In conclusion, loss of Notch signaling contributes to aortic valve calcification via a Sox9-dependent mechanism.

  8. Mitral Valve Aneurysm: A Rare Complication of Aortic Valve Endocarditis

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    A Moaref

    2008-11-01

    Full Text Available A 20-year-old intravenous drug abuser man, refered to our hospital with dyspnea and orthopnea. Tranesophagealechocardiography revealed severe aortic regurgitation, healed vegetation of aortic valve and an aneurysm of theanterior leaflet of the mitral valve. The patient was discharged after aortic valve replacement and mitral valverepair.

  9. 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

  10. Implantation of the CoreValve percutaneous aortic valve.

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    Lamarche, Yoan; Cartier, Raymond; Denault, André Y; Basmadjian, Arsène; Berry, Colin; Laborde, Jean-Claude; Bonan, Raoul

    2007-01-01

    Surgical aortic valve replacement is the only recommended treatment for significant aortic valve stenosis. Percutaneous aortic valve replacement appears to be a novel option for high-risk patients. We report the implantation of the ReValving system (CoreValve, Paris, France) in a 64-year-old woman who was refused aortic valve replacement surgery for critical aortic stenosis and left ventricular dysfunction because of severe pulmonary fibrosis. After anesthesia, the patient was put on femorofemoral cardiopulmonary bypass, and underwent a balloon valvuloplasty with subsequent retrograde aortic valve replacement by the ReValving system. Transesophageal echocardiographic monitoring of the patient's hemodynamics showed immediate improvements of the valvular area and left ventricular ejection fraction and only traces of paravalvular leaks. The patient was easily weaned from ventilation and resumed activity soon after the surgery. A multidisciplinary approach is presently necessary to offer a reliable and safe procedure.

  11. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    Science.gov (United States)

    Tabata, Minoru

    2016-03-01

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

  12. Aortic Valve Stenosis

    Science.gov (United States)

    ... evaluation of aortic stenosis in adults. http://www.uptodate.com/home. Accessed April 29, 2014. Mohty D, ... Valvular heart disease in elderly adults. http://www.uptodate.com/home. Accessed May 2, 2014. Bonow RO, ...

  13. Bicuspid aortic valve

    Science.gov (United States)

    ... 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 ...

  14. Feasibility of pig and human-derived aortic valve interstitial cells seeding on fixative-free decellularized animal pericardium.

    Science.gov (United States)

    Santoro, Rosaria; Consolo, Filippo; Spiccia, Marco; Piola, Marco; Kassem, Samer; Prandi, Francesca; Vinci, Maria Cristina; Forti, Elisa; Polvani, Gianluca; Fiore, Gianfranco Beniamino; Soncini, Monica; Pesce, Maurizio

    2016-02-01

    Glutaraldehyde-fixed pericardium of animal origin is the elective material for the fabrication of bio-prosthetic valves for surgical replacement of insufficient/stenotic cardiac valves. However, the pericardial tissue employed to this aim undergoes severe calcification due to chronic inflammation resulting from a non-complete immunological compatibility of the animal-derived pericardial tissue resulting from failure to remove animal-derived xeno-antigens. In the mid/long-term, this leads to structural deterioration, mechanical failure, and prosthesis leaflets rupture, with consequent need for re-intervention. In the search for novel procedures to maximize biological compatibility of the pericardial tissue into immunocompetent background, we have recently devised a procedure to decellularize the human pericardium as an alternative to fixation with aldehydes. In the present contribution, we used this procedure to derive sheets of decellularized pig pericardium. The decellularized tissue was first tested for the presence of 1,3 α-galactose (αGal), one of the main xenoantigens involved in prosthetic valve rejection, as well as for mechanical tensile behavior and distensibility, and finally seeded with pig- and human-derived aortic valve interstitial cells. We demonstrate that the decellularization procedure removed the αGAL antigen, maintained the mechanical characteristics of the native pig pericardium, and ensured an efficient surface colonization of the tissue by animal- and human-derived aortic valve interstitial cells. This establishes, for the first time, the feasibility of fixative-free pericardial tissue seeding with valve competent cells for derivation of tissue engineered heart valve leaflets. © 2015 Wiley Periodicals, Inc.

  15. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis

    DEFF Research Database (Denmark)

    Siontis, George C M; Praz, Fabien; Pilgrim, Thomas

    2016-01-01

    AIMS: In view of the currently available evidence from randomized trials, we aimed to compare the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the spectrum of risk and in important subgroups. METHODS AND RESULTS...

  16. [New aspects in aortic valve disease].

    Science.gov (United States)

    Tornos, P

    2001-01-01

    Renewed interest for aortic valve disease has evolved in recent years. Aortic valve replacement has become the second most frequent cause of cardiac surgery, following coronary bypass surgery. In addition, the etiologic and physiopathologic knowledge of this disorder has improved. In the present paper we analyze three aspects of the disease which are, at present, the subject of study and controversy: first, we discuss the possible relationship between degenerative aortic stenosis and atherosclerosis; second, the involvement of the aortic root in cases of bicuspid aortic valve; and third, the surgical indications in asymptomatic patients with either aortic stenosis or regurgitation.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Nagy, Edit, E-mail: edit.nagy@karolinska.se [Department of Medicine, Karolinska Institutet, Stockholm (Sweden); Department of Cardiology, Karolinska University Hospital, Stockholm (Sweden); Caidahl, Kenneth [Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (Sweden); Department of Clinical Physiology, Karolinska University Hospital, Stockholm (Sweden); Franco-Cereceda, Anders [Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm (Sweden); Department of Throracic Surgery, Karolinska University Hospital, Stockholm (Sweden); Baeck, Magnus [Department of Medicine, Karolinska Institutet, Stockholm (Sweden); Department of Cardiology, Karolinska University Hospital, Stockholm (Sweden)

    2012-04-13

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

  19. Aortic valve surgery - open

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otton CM, Bowow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    Transcatheter aortic valve implantation (TAVI) in severe aortic stenosis has proven to be a feasible and effective treatment modality for inoperable patients. Until now, neither aortic regurgitation nor degenerated bioprostheses has been an indication for TAVI. However, this article reports...... a successful valve-in-valve implantation of a CoreValve aortic valve prosthesis through the right subclavian artery in a case of severe aortic regurgitation within a degenerated aortic homograft. The case exemplifies the possibilities of expanding the indications for TAVI, as well as other vascular access...

  1. Aortic Root Enlargement or Sutureless Valve Implantation?

    Directory of Open Access Journals (Sweden)

    Nikolaos G. Baikoussis

    2016-11-01

    Full Text Available Aortic valve replacement (AVR in patients with a small aortic annulus is a challenging issue. The importance of prosthesis–patient mismatch (PPM post aortic valve replacement (AVR is controversial but has to be avoided. Many studies support the fact that PPM has a negative impact on short and long term survival. In order to avoid PPM, aortic root enlargement may be performed. Alternatively and keeping in mind that often some comorbidities are present in old patients with small aortic root, the Perceval S suturelles valve implantation could be a perfect solution. The Perceval sutureless bioprosthesis provides reasonable hemodynamic performance avoiding the PPM and providing the maximum of aortic orifice area. We would like to see in the near future the role of the aortic root enlargement techniques in the era of surgical implantation of the sutureless valve (SAVR and the transcatheter valve implantation (TAVI.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    Surgical aortic valve replacement (SAVR) and, more recently, transcatheter aortic valve implantation (TAVI) have been shown to be the only treatments that can improve the natural cause of severe aortic valve stenosis. However, after SAVR and TAVI, the incidence of new-onset atrial fibrillation...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    Surgical aortic valve replacement (SAVR) and, more recently, transcatheter aortic valve implantation (TAVI) have been shown to be the only treatments that can improve the natural cause of severe aortic valve stenosis. However, after SAVR and TAVI, the incidence of new-onset atrial fibrillation...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    Surgical aortic valve replacement (SAVR) and, more recently, transcatheter aortic valve implantation (TAVI) have been shown to be the only treatments that can improve the natural cause of severe aortic valve stenosis. However, after SAVR and TAVI, the incidence of new-onset atrial fibrillation...

  5. Transcatheter Aortic Valve Replacement for Degenerative Bioprosthetic Surgical Valves

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  6. 57. Aortic valve replacement with sutureless valve and mitral valve repair in patient with infected aortic homograft

    Directory of Open Access Journals (Sweden)

    A. attia

    2016-07-01

    Full Text Available The approach of implanting aortic sutureless valve inside the calcific homograft is suitable in redo surgery especially if associated with mitral valve surgery. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge because of homograft degeneration and the need for a redo Bentall operation. We report a case of redo aortic valve replacement (valve in valve with a sutureless valve and mitral valve repair by miniband annuloplasty in a female patient aged 64 years old who underwent aortic valve replacement with homograft 14 years ago and presented by sever aortic valve regurge and sever mitral valve regurge because of infective endocarditis. This technique allows rapid aortic valve replacement in a heavily calcified aortic root. It also avoids aortic valve size affection after mitral valve repair by ordinary methods especially in patients with small aortic annulus. This technique is particularly suitable in redo procedures for homograft degeneration, it avoids performing a redo Bentall operation with its known problems as well as to avoid patient prosthesis mismatch.

  7. Two-Year Outcomes in Patients With Severe Aortic Valve Stenosis Randomized to Transcatheter Versus Surgical Aortic Valve Replacement

    DEFF Research Database (Denmark)

    Søndergaard, Lars; Steinbrüchel, Daniel Andreas; Ihlemann, Nikolaj

    2016-01-01

    BACKGROUND: The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize all-comers with severe native aortic valve stenosis to either transcatheter aortic valve replacement (TAVR) with the CoreValve self-expanding bioprosthesis or surgical aortic valve replacement (SAVR), inclu...... population. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01057173....

  8. Predictors of mortality after aortic valve replacement

    NARCIS (Netherlands)

    Tjang, Yanto Sandy; van Hees, Yvonne; Koerfer, Reiner; Grobbee, Diederick E.; van der Heijden, Geert J. M. G.

    Aortic valve replacement (AVR) is recommended as a standard surgical procedure for aortic valve disease. Still the evidence for commonly claimed predictors of post-AVR prognosis, in particular mortality, appears scant. This systematic review reports on the evidence for predictors of post-AVR

  9. Transcatheter Aortic Valve Replacement in Europe

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  10. Minimally Invasive Mitral Valve Replacement and Transfemoral Aortic Valve Implantation.

    Science.gov (United States)

    Rustenbach, Christian; Baumbach, Hardy; Hill, Stephan; Franke, Ulrich F W

    2015-01-01

    The case is reported of a symptomatic elderly patient with severe mitral regurgitation, severe aortic valve stenosis, and coronary heart disease. The coronary artery disease had been interventionally treated four years previously with stent implantation into the right coronary artery. Published studies have shown that a combination of mitral and aortic valve surgery is associated with a significantly increased risk of mortality and morbidity, particularly in elderly patients. In the present patient, both valvular malformations were successfully treated with a single-step interdisciplinary approach, namely an initial surgical mitral valve replacement followed by transfemoral transcatheter aortic valve replacement.

  11. Transcatheter aortic valve replacement in elderly patients

    Institute of Scientific and Technical Information of China (English)

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

    2012-01-01

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

  12. [Emergent transcatheter aortic valve implantation in a patient with bicuspid aortic valve stenosis in cardiogenic shock].

    Science.gov (United States)

    Pizzighini, S; Finet, G; Obadia, J-F; Revel, D; Bresson, D; Rioufol, G

    2015-02-01

    Transcatheter aortic valve implantation is a therapeutic option for high-risk patients with severe aortic valve stenosis and with cardiac symptoms. This procedure requires the preliminary evaluation by a "heart team" and presents some contraindications. We report the case of a 58-year-old man with severe bicuspid aortic valve stenosis and cardiogenic shock. In spite of contraindications and because of the failure of balloon aortic valvuloplasty, transcatheter aortic valve implantation was performed in emergency. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. Repair for acquired aortic valve disease.

    Science.gov (United States)

    Antunes, M J

    1996-10-01

    The favorable results of mitral valvuloplasty when compared with valve replacement have renewed the interest of many surgeons in aortic valve repair. However, these efforts have, for the most part, been unsuccessful. Also, the results of aortic valve replacement are usually better than those of mitral valve replacement. Yet, some patients appear to derive benefit from a conservative aortic valve procedure. The best examples are mild or moderate aortic valve disease associated with mitral valve or coronary artery disease, which constitute the primary indication for operation, where "prophylactic" aortic valve replacement does not appear justifiable. Other possible indications for aortic valvuloplasty includes patient's lack of compliance or contraindication to anticoagulation in young patients. Senile aortic stenosis, in very old patients with a small annulus, preserved leaflet morphology and nonsignificant commissural fusion should be considered for repair. However, since the procedure is not easily reproducible and the results not uniformly predictable, it cannot be recommended for generalized use. Nonetheless, experienced surgeons should be encouraged to continue these efforts.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  15. Imaging of aortic valve dynamics in 4D OCT

    Directory of Open Access Journals (Sweden)

    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.

  16. Bacillus cereus endocarditis in native aortic valve.

    Science.gov (United States)

    Ngow, H A; Wan Khairina, W M N

    2013-02-01

    Bacillus cereus endocarditis is rare. It has been implicated in immunocompromised individuals, especially in intravenous drug users as well as in those with a cardiac prosthesis. The patient was a 31-year-old ex-intravenous drug addict with a past history of staphylococcal pulmonary valve endocarditis, who presented with symptoms of decompensated cardiac failure. Echocardiography showed severe aortic regurgitation with an oscillating vegetation seen on the right coronary cusp of the aortic valve. The blood cultures grew Bacillus cereus. We report this as a rare case of Bacillus cereus endocarditis affecting a native aortic valve.

  17. Synergy between sphingosine 1-phosphate and lipopolysaccharide signaling promotes an inflammatory, angiogenic and osteogenic response in human aortic valve interstitial cells.

    Directory of Open Access Journals (Sweden)

    Isabel Fernández-Pisonero

    Full Text Available Given that the bioactive lipid sphingosine 1-phosphate is involved in cardiovascular pathophysiology, and since lipid accumulation and inflammation are hallmarks of calcific aortic stenosis, the role of sphingosine 1-phosphate on the pro-inflammatory/pro-osteogenic pathways in human interstitial cells from aortic and pulmonary valves was investigated. Real-time PCR showed sphingosine 1-phosphate receptor expression in aortic valve interstitial cells. Exposure of cells to sphingosine 1-phosphate induced pro-inflammatory responses characterized by interleukin-6, interleukin-8, and cyclooxygenase-2 up-regulations, as observed by ELISA and Western blot. Strikingly, cell treatment with sphingosine 1-phosphate plus lipopolysaccharide resulted in the synergistic induction of cyclooxygenase-2, and intercellular adhesion molecule 1, as well as the secretion of prostaglandin E2, the soluble form of the intercellular adhesion molecule 1, and the pro-angiogenic factor vascular endothelial growth factor-A. Remarkably, the synergistic effect was significantly higher in aortic valve interstitial cells from stenotic than control valves, and was drastically lower in cells from pulmonary valves, which rarely undergo stenosis. siRNA and pharmacological analysis revealed the involvement of sphingosine 1-phosphate receptors 1/3 and Toll-like receptor-4, and downstream signaling through p38/MAPK, protein kinase C, and NF-κB. As regards pro-osteogenic pathways, sphingosine 1-phosphate induced calcium deposition and the expression of the calcification markers bone morphogenetic protein-2 and alkaline phosphatase, and enhanced the effect of lipopolysaccharide, an effect that was partially blocked by inhibition of sphingosine 1-phosphate receptors 3/2 signaling. In conclusion, the interplay between sphingosine 1-phosphate receptors and Toll-like receptor 4 signaling leads to a cooperative up-regulation of inflammatory, angiogenic, and osteogenic pathways in aortic valve

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

    Science.gov (United States)

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

    2013-11-01

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

  19. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    Medline Plus

    Full Text Available Watch a Broward Health surgeon perform a minimally invasive Transcatheter Aortic Valve Replacement (TAVR) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. ...

  20. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    Medline Plus

    Full Text Available Watch a Broward Health surgeon perform a minimally invasive Transcatheter Aortic Valve Replacement (TAVR) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. ...

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

  2. Prosthetic valve endocarditis after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

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

    2015-01-01

    risk factors. METHODS AND RESULTS: Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years...

  3. Transcatheter Aortic Valve Replacement With Early- and New-Generation Devices in Bicuspid Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Yoon, Sung-Han; Lefèvre, Thierry; Ahn, Jung-Ming

    2016-01-01

    BACKGROUND: Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). Particularly, limited data exist comparing the results of TAVR with new-generation devices versus early-generation devices. OBJECTIVE...

  4. Transcatheter Aortic Valve Replacement: A Review Article

    Directory of Open Access Journals (Sweden)

    Juan A Siordia

    2016-06-01

    Full Text Available Transcatheter aortic valve replacement (TAVR is a novel therapeutic intervention for the replacement of severely stenotic aortic valves in high-risk patients for standard surgical procedures. Since the initial PARTNER trial results, use of TAVR has been on the rise each year. New delivery methods and different valves have been developed and modified in order to promote the minimally invasive procedure and reduce common complications, such as stroke. This review article focuses on the current data on the indications, risks, benefits, and future directions of TAVR. Recently, TAVR has been considered as a standard-of-care procedure. While this technique is used frequently in high-risk surgical candidates, studies have been focusing on the application of this method for younger patients with lower surgical risk. Moreover, several studies have proposed promising results regarding the use of valve-in-valve technique or the procedure in which the valve is placed within a previously implemented bioprosthetic valve. However, ischemic strokes and paravalvular leak remain a matter of debate in these surgeries. New methods and devices have been developed to reduce the incidence of post-procedural stroke. While the third generation of TAVR valves (i.e., Edwards Sapien 3 and Medtronic Evolut R addresses the issue of paravalvular leak structurally, results on their efficacy in reducing the risk of paravalvular leak are yet to be obtained. Furthermore, TAVR enters the field of hybrid methods in the treatment of cardiac issues via both surgical and catheter-based approaches. Finally, while TAVR is primarily performed on cases with aortic stenosis, new valves and methods have been proposed regarding the application of this technique in aortic regurgitation, as well as other aortic pathologies. TAVR is a suitable therapeutic approach for the treatment of aortic stenosis in high-risk patients. Considering the promising results in the current patient population

  5. Comparison of outcomes after aortic valve replacement with a mechanical valve or a bioprosthesis using microsimulation

    NARCIS (Netherlands)

    J.P.A. Puvimanasinghe (John); M.B. Edwards; M.J.C. Eijkemans (René); E.W. Steyerberg (Ewout); L.A. van Herwerden (Lex); K.M. Taylor; G.L. Grunkemeier (Gary); J.D.F. Habbema (Dik); A.J.J.C. Bogers (Ad); J.J.M. Takkenberg (Hanneke)

    2004-01-01

    textabstractBACKGROUND: Mechanical valves and bioprostheses are widely used for aortic valve replacement. Though previous randomised studies indicate that there is no important difference in outcome after implantation with either type of valve, knowledge of outcomes after aortic va

  6. Infective endocarditis following transcatheter aortic valve replacement-

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  7. A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis

    DEFF Research Database (Denmark)

    Nielsen, Hans Henrik Møller; Klaaborg, Kaj E; Nissen, Henrik

    2012-01-01

    In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients.......In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients....

  8. Aortic valve stenosis after previous coronary bypass: Transcatheter valve implantation or aortic valve replacement?

    Directory of Open Access Journals (Sweden)

    Jegaden Olivier

    2012-05-01

    Full Text Available Abstract We report a prospective comparison between transcatheter valve implantation (TAVI, n = 13 and surgical aortic valve replacement (AVR, n = 10 in patients with severe aortic valve stenosis and previous coronary bypass surgery (CABG. All patients had at least bilateral patent internal thoracic arteries bypass without indication of repeat revascularization. After a similar post-procedure outcome, despite one early death in TAVI group, the 1-year survival was 100% in surgical group and in transfemoral TAVI group, and 73% in transapical TAVI group. When previous CABG is the lone surgical risk factor, indications for a TAVI procedure have to be cautious, specially if transfemoral approach is not possible.

  9. Congenital bicuspid aortic valve in an English bulldog.

    Science.gov (United States)

    Visser, Lance C; Scansen, Brian A

    2013-03-01

    A bicuspid aortic valve (BAV) demonstrating moderate valvular stenosis and mild insufficiency was identified in an asymptomatic 1-year-old male cryptorchid English bulldog by transthoracic and transesophageal echocardiography. The BAV was most consistent with type 3 morphology, based upon human classification. Pulmonary valve dysplasia with mild pulmonary stenosis and a suspected persistent left cranial vena cava were also identified. Although BAV is the most common congenital cardiac malformation in humans, it is rare in the dog.

  10. Structural valve deterioration after aortic valve replacement with Medtronic freestyle stentless porcine aortic root bioprostheses.

    Science.gov (United States)

    Nishida, Hidefumi; Komiya, Tatsuhiko; Sakaguchi, Genichi; Shimamoto, Takeshi

    2014-01-01

    The Medtronic freestyle aortic root bioprosthesis (Medtronic, Inc., Minneapolis, MN, USA) is a stentless valve with an effective orifice area that is larger than that observed on other bioprostheses. However, there have been sporadic reports of structural valve deterioration (SVD), such as aortic root wall rupture, leaflet tearing, and pseudoaneurysm formation. We report five cases of SVD of freestyle aortic root bioprostheses. © 2013 The Authors. Journal of Cardiac Surgery Published by Wiley Periodicals, Inc.

  11. 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.

    Science.gov (United States)

    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.

  12. Patient-prosthesis mismatch: surgical aortic valve replacement versus transcatheter aortic valve replacement in high risk patients with aortic stenosis.

    Science.gov (United States)

    Ghanta, Ravi K; Kron, Irving L

    2016-10-01

    Patient prosthesis mismatch (PPM) can occur when a prosthetic aortic valve has an effective orifice area (EOA) less than that of a native valve. A recent study by Zorn and colleagues evaluated the incidence and significance of PPM in high risk patients with severe aortic stenosis who were randomized to transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). TAVR is associated with decreased incidence of severe PPM compared to traditional SAVR valves. Severe PPM increases risk for death at 1 year postoperatively in high risk patients. The increased incidence of PPM is largely due to differences in valve design and should encourage development of newer SAVR valves to reduce risk for PPM. In addition more vigorous approaches to root enlargement in small annulus should be performed with SAVR to prevent PPM.

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

    Directory of Open Access Journals (Sweden)

    Karel Van Praet

    2015-07-01

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

  14. Deformation of Congenital Bicuspid Aortic Valves in Systole

    Science.gov (United States)

    Szeto, Kai; Pastuszko, Peter; Nigam, Vishal; Lasheras, Juan

    2012-11-01

    Clinical studies have shown that patients with congenital bicuspid aortic valves (CBAVs) develop degenerative calcification of the leaflets at young ages compared to normal tricuspid aortic valves (TAVs). It has been hypothesized that the asymmetrical geometry of the leaflets in CBAVs and the associate changes in flow shear stresses and excessive strain rate levels are possible causes for the early calcification. 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 BAVs and TAVs by tracking the 3-D motion of small dots marked on each leaflet surface. We then used phase-locked stereo photogrammetry to measure the strain rates in both radial and circumferential directions during the whole cardiac cycle. In the BAVs' case, the fused leaflet experiences an almost 30% increase in the radial stretching when fully open. RNA profiling of human aortic valve interstitial cells exposed to cyclic stretch shows that the increased stretch experienced by the BAVs results in increased levels of INTERLEUKINS (ILs) and other known inflammatory markers associated with aortic valve calcification. Together, these observations suggest that the abnormal stretch experienced by BAVs activates inflammation gene expression.

  15. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves

    DEFF Research Database (Denmark)

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

    2014-01-01

    IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach......, stroke, and New York Heart Association functional class. RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation...

  16. Minimally invasive "pocket incision" aortic valve surgery.

    Science.gov (United States)

    Yakub, M A; Pau, K K; Awang, Y

    1999-02-01

    A minimally invasive approach to aortic valve surgery through a transverse incision ("pocket incision") at the right second intercostal space was examined. Sixteen patients with a mean age of 30 years underwent this approach. The third costal cartilage was either excised (n = 5) or dislocated (n = 11). The right internal mammary artery was preserved. Cardiopulmonary bypass (CPB) was established with aortic-right atrial cannulation in all except the first case. Aortic valve replacements (AVR) were performed in 15 patients and one had aortic valve repair with concomitant ventricular septal defect closure. There was no mortality and no major complications. The aortic cross-clamp, CPB and operative times were 72 +/- 19 mins, 105 +/- 26 mins and 3 hrs 00 min +/- 29 mins respectively. The mean time to extubation was 5.7 +/- 4.0 hrs, ICU stay of 27 +/- 9 hrs and postoperative hospital stay of 5.1 +/- 1.2 days. Minimally invasive "pocket incision" aortic valve surgery is technically feasible and safe. It has the advantages of central cannulation for CPB, preservation of the internal mammary artery and avoiding sternotomy. This approach is cosmetically acceptable and allows rapid patient recovery.

  17. Reconstructive surgery of the aortic valve

    Directory of Open Access Journals (Sweden)

    Mendonça José Teles de

    2003-01-01

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

  18. Aortic valve replacement in octogenarians

    Directory of Open Access Journals (Sweden)

    Dark John H

    2007-07-01

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

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

    Science.gov (United States)

    Tsur, A; Slutzki, T; Flusser, D

    2015-09-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  1. Spectrum of Aortic Valve Abnormalities Associated with Aortic Dilation Across Age Groups in Turner Syndrome

    Science.gov (United States)

    Olivieri, Laura J.; Baba, Ridhwan Y.; Arai, Andrew E.; Bandettini, W. Patricia; Rosing, Douglas R.; Bakalov, Vladimir; Sachdev, Vandana; Bondy, Carolyn A.

    2014-01-01

    Background Congenital aortic valve fusion is associated with aortic dilation, aneurysm and rupture in girls and women with Turner syndrome (TS). Our objective was to characterize aortic valve structure in subjects with TS, and determine the prevalence of aortic dilation and valve dysfunction associated with different types of aortic valves. Methods and Results The aortic valve and thoracic aorta were characterized by cardiovascular magnetic resonance imaging in 208 subjects with TS in an IRB-approved natural history study. Echocardiography was used to measure peak velocities across the aortic valve, and the degree of aortic regurgitation. Four distinct valve morphologies were identified: tricuspid aortic valve (TAV) 64%(n=133), partially fused aortic valve (PF) 12%(n=25), bicuspid aortic valve (BAV) 23%(n=47), and unicuspid aortic valve (UAV) 1%(n=3). Age and body surface area (BSA) were similar in the 4 valve morphology groups. There was a significant trend, independent of age, towards larger BSA-indexed ascending aortic diameters (AADi) with increasing valve fusion. AADi were (mean +/− SD) 16.9 +/− 3.3 mm/m2, 18.3 +/− 3.3 mm/m2, and 19.8 +/− 3.9 mm/m2 (p<0.0001) for TAV, PF and BAV+UAV respectively. PF, BAV, and UAV were significantly associated with mild aortic regurgitation and elevated peak velocities across the aortic valve. Conclusions Aortic valve abnormalities in TS occur with a spectrum of severity, and are associated with aortic root dilation across age groups. Partial fusion of the aortic valve, traditionally regarded as an acquired valve problem, had an equal age distribution and was associated with an increased AADi. PMID:24084490

  2. A Clinicopathological Study on Aortic Valves in Children

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  3. [Aortic valve replacement for the small aortic annulus].

    Science.gov (United States)

    Oshima, H; Usui, A; Akita, T; Ueda, Y

    2006-04-01

    Aortic valve surgery for the small aortic annulus is still challenging for surgeons. Recently, the new types of high performance prosthesis have been developed and the chance of an aortic root enlargement (ARE) is decreasing. In this study, we propose the ideal strategy of the aortic surgery for the small aortic annulus. We analyzed the clinical records of 158 patients who underwent aortic valve replacement from August 1999 to October 2005 in our institution. The small aortic annulus was observed in 38 patients (24%). Fourteen patients of this group underwent ARE. Patient-prosthesis mismatch (PPM) was less frequently observed in patients with ARE compared to those without ARE. The additional time required for ARE was not considerable, and neither ischemic time nor cardiopulmonary bypass time was significantly prolonged by ARE. In conclusion, we have to select a prosthesis with sufficient orifice area to avoid PPM, otherwise we should choose an option of ARE. For this consideration, we definitely need the chart that demonstrates the relationship between the nominal size of various types of prostheses and the size of a patient's annulus that those prostheses actually fit.

  4. Transcatheter aortic valve implantation: status and challenges.

    Science.gov (United States)

    Fishbein, Gregory A; Schoen, Frederick J; Fishbein, Michael C

    2014-01-01

    Calcific aortic valve disease of the elderly is the most prevalent hemodynamically-significant valvular disease, and the most common lesion requiring valve replacement in industrialized countries. Transcatheter aortic valve implantation is a less invasive alternative to classical aortic valve replacement that can provide a therapeutic option for high-risk or inoperable patients with aortic stenosis. These devices must be biocompatible, have excellent hemodynamic performance, be easy to insert, be securely anchored without sutures, and be durable, without increased risk of thrombosis or infection. To date, complications are related to the site of entry for insertion, the site of implantation (aorta, coronary ostia, base of left ventricle), and to the structure and design of the inserted device. However, as with any novel technology unanticipated complications will develop. Goals for future development will be to make the devices more effective, more durable, safer, and easier to implant, so as to further improve outcome for patients with severe aortic stenosis. The pathologist participating in research and development, and examination of excised devices will have a critical role in improving outcome for these patients.

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

    Science.gov (United States)

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

    2013-09-01

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

  6. Echocardiographic variables associated with mitral regurgitation after aortic valve replacement for aortic valve stenosis

    Directory of Open Access Journals (Sweden)

    Shaimaa A. Mostafa

    2013-06-01

    Conclusion: Preoperative predictors of residual postoperative MR were large LA and AF while the postoperative variables were high peak and mean pressure gradient across the aortic valve and high LVMI.

  7. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

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

  9. Severe aortic valve stenosis and nosebleed

    NARCIS (Netherlands)

    Schoedel, Johannes; Obergfell, Achim; Maass, Alexander H.; Schodel, Johannes

    2007-01-01

    Aortic valve stenosis is known to be associated with loss of high molecular von Willebrand multimers. This can lead to gastrointestinal bleeding in patients with gastrointestinal angiodysplasia, the Heyde syndrome. Here we present a case of anaemia and severe epistaxis associated with acquired von W

  10. Autopsy after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    van Kesteren, F; Wiegerinck, E M A; Rizzo, S

    2017-01-01

    Autopsy after transcatheter aortic valve implantation (TAVI) is a new field of interest in cardiovascular pathology. To identify the cause of death, it is important to be familiar with specific findings related to the time interval between the procedure and death. We aimed to provide an overview...

  11. Conservative aortic valve surgery in adults

    NARCIS (Netherlands)

    Casselman, F.P.A.

    2001-01-01

    118 Chapter 1 reviews the current knowledge of the aortic valve. The normal anatomy and possible variations are described. The different pathological conditions are explained as wel as their natural history and the indications for intervention. The various surgical options with regard to the patholo

  12. Transcatheter aortic valve-in-valve implantation of a CoreValve in a degenerated aortic bioprosthesis.

    Science.gov (United States)

    Bruschi, Giuseppe; DeMarco, Federico; Oreglia, Jacopo; Colombo, Paola; Fratto, Pasquale; Lullo, Francesca; Paino, Roberto; Martinelli, Luigi; Klugmann, Silvio

    2010-03-01

    In recent years percutaneous aortic valve implantation has emerged as an alternative therapy to treat patients with symptomatic aortic stenosis considered to be high-risk surgical candidates. We report our experience of a percutaneous retrograde CoreValve implantation in a 77-year-old female with aortic bioprosthesis structural degeneration. The patient underwent aortic valve replacement for aortic stenosis in 1999 with the implantation of a 23 mm Carpentier-Edwards; her last echocardiography showed a severe bioprosthesis stenosis. After evaluation by cardiac surgeons and cardiologist, considering the high risk re-do surgical procedure (Logistic Euroscore 30%) and severe comorbidities (severe pulmonary hypertension, hepatocellular carcinoma and severe osteoporosis), a percutaneous aortic valve-in-valve replacement was preferred. A successful percutaneous 26 mm CoreValve prosthesis implantation was performed with the patient awake with local anesthesia and mild sedation. The patient was discharged after 10 days of hospitalization and she is in NYHA functional class I at follow-up. Our experience, characterized by a multidisciplinary approach, necessary to offer the safest conditions and care for patients, demonstrates the feasibility of a new, promising indication for the use of a transcatheter valve implantation: percutaneous treatment of a degenerated aortic bioprosthesis.

  13. Apicoaortic conduit for severe hemolytic anemia after aortic valve replacement.

    Science.gov (United States)

    Hatori, Kyohei; Ohki, Satoshi; Obayashi, Tamiyuki; Koyano, Tetsuya; Yasuhara, Kiyomitsu; Hirai, Hanako

    2015-06-01

    We describe the case of an 82-year-old woman who had undergone aortic mechanical valve replacement for aortic stenosis with a small annulus, and coronary artery bypass grafting. Four years after the operation, she began to experience hemolysis. Prosthetic valve obstruction was observed but there was no paravalvular leakage or aortic regurgitation through the mechanical valve. We elected to perform apicoaortic bypass in this patient with severe hemolytic anemia secondary to a mechanical valve malfunction.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-09-15

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

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

    Directory of Open Access Journals (Sweden)

    Penny S Thomas

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

  16. Global Strain in Severe Aortic Valve Stenosis

    DEFF Research Database (Denmark)

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

    2012-01-01

    BACKGROUND: -Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement (AVR) is unknown. METHODS AND RESULTS: -A total of 125 patients with severe...... aortic stenosis and ejection fraction >40% scheduled for AVR were evaluated preoperatively and divided into 4 groups according to GLS quartiles. Patients were followed up for 4 years. The primary endpoint was major adverse cardiac events (MACE) defined as cardiovascular mortality and cardiac......Score, history with ischemic heart disease and ejection fraction. CONCLUSIONS: -In patients with symptomatic severe aortic stenosis undergoing AVR reduced GLS provides important prognostic information beyond standard risk factors. Clinical Trial Registration-URL: http://www.clinicaltrial.gov. Unique identifier...

  17. Management of bicuspid aortic valve with or without involvement of ascending aorta and aortic root.

    Science.gov (United States)

    Neragi-Miandoab, S

    2014-06-01

    Patients with a bicuspid aortic valve (BAV) constitute a heterogeneous population with variable clinical presentation and complications. More than 50% of the patients who require aortic valve replacement have a BAV, a condition that may be associated with dilation of ascending aorta and aortic insufficiency caused by cusp disease or aortic root pathology. Of the potential BAV-related complications, dilation of the aortic root and ascending aorta are among the most serious. The dilation of ascending aorta and aortic root have been the subject of controversy. Whereas some surgeons believe that the dilation of the aorta is caused by the hemodynamic properties of the BAV, others believe that the dilation of the aortic root is secondary to genetic defects associated with the BAV. Management of a BAV should be tailored to each patient's clinical condition. The surgical approach varies from aortic valve replacement to combined aortic valve and root replacement to aortic-valve-sparing root replacement.

  18. Distribution of selected elements in calcific human aortic valves studied by microscopy combined with SR-μXRF: influence of lipids on progression of calcification.

    Science.gov (United States)

    Lis, Grzegorz J; Czapla-Masztafiak, Joanna; Kwiatek, Wojciech M; Gajda, Mariusz; Jasek, Ewa; Jasinska, Malgorzata; Czubek, Urszula; Borchert, Manuela; Appel, Karen; Nessler, Jadwiga; Sadowski, Jerzy; Litwin, Jan A

    2014-12-01

    Calcified heart valves display a significant imbalance in tissue content of trace and essential elements. The valvular calcification is an age-related process and there are data suggesting involvement of lipids. We studied elemental composition and lipid distribution in three distinct regions of calcified human aortic valves, representing successive stages of the calcific degeneration: normal, thickened (early lesion) and calcified (late lesion), using SR-μXRF (Synchrotron Radiation Micro X-Ray Fluorescence) for elemental composition and Oil Red O (ORO) staining for demonstration of lipids. Two-dimensional SR-μXRF maps and precise point spectra were compared with histological stainings on consecutive valve sections to prove topographical localization and colocalization of the examined elements and lipids. In calcified valve areas, accumulation of calcium and phosphorus was accompanied by enhanced concentrations of strontium and zinc. Calcifications preferentially developed in lipid-rich areas of the valves. Calcium concentration ratio between lipid-rich and lipid-free areas was not age-dependent in early lesions, but showed a significant increase with age in late lesions, indicating age-dependent intensification of lipid involvement in calcification process. The results suggest that mechanisms of calcification change with progression of valve degeneration and with age.

  19. Interleukin-37 suppresses the osteogenic responses of human aortic valve interstitial cells in vitro and alleviates valve lesions in mice

    National Research Council Canada - National Science Library

    Zeng, Qingchun; Song, Rui; Fullerton, David A; Ao, Lihua; Zhai, Yufeng; Li, Suzhao; Ballak, Dov B; Cleveland, Joseph C; Reece, T. Brett; McKinsey, Timothy A; Xu, Dingli; Dinarello, Charles A; Meng, Xianzhong

    2017-01-01

    ...) and alkaline phosphatase (ALP) following stimulation of Toll-like receptor (TLR) 2 or 4. Treatment of diseased AVICs with recombinant human IL-37 suppresses the levels of BMP-2 and ALP as well as calcium deposit formation...

  20. Minimally Invasive Transaortic Mitral Decalcification During Aortic Valve Replacement.

    Science.gov (United States)

    Totsugawa, Toshinori; Sakaguchi, Taichi; Hiraoka, Arudo; Matsushita, Hiroshi; Hirai, Yuki; Yoshitaka, Hidenori

    2015-01-01

    Mitral annular calcification accompanied by aortic stenosis is hazardous for both double-valve replacement and transcatheter aortic valve implantation. Less invasive mitral procedure is required in this condition, and minimally invasive approach may further reduce the operative risk in high-risk patients. Here, we report minimally invasive transaortic mitral decalcification during aortic valve replacement through minithoracotomy. We believe that this option is feasible in patients who are at prohibitive risk for double-valve replacement or transcatheter aortic valve implantation because of severe mitral annular calcification.

  1. Transcatheter Aortic Valve Implantation: Insights into Clinical Complications

    NARCIS (Netherlands)

    R.M.A. van der Boon (Robert)

    2014-01-01

    markdownabstract__Abstract__ Transcatheter Aortic Valve Implantation (TAVI) has emerged as a viable and safe treatment for patients with severe aortic stenosis (AS) who are considered ineligible or at prohibitive risk for Surgical Aortic Valve Replacement (SAVR)1–4. The aim of the present thesis wa

  2. Aortic valve replacement with cryopreserved aortic allograft: ten-year experience.

    Science.gov (United States)

    Doty, J R; Salazar, J D; Liddicoat, J R; Flores, J H; Doty, D B

    1998-02-01

    Cryopreserved aortic allograft can be used for aortic valve replacement in congenital, rheumatic, degenerative, and infected native valve conditions, as well as failed prosthetic valves. This study was conducted to determine the long-term results of aortic valve replacement with cryopreserved aortic allografts. Aortic valve replacement with cryopreserved aortic allografts was performed in 117 patients from July 1985 until August 1996. All patients requiring aortic valve replacement regardless of valve disease were considered for allograft replacement; the valve was preferentially used in patients under age 55 years and in the setting of bacterial endocarditis. Four operative techniques involving cryopreserved aortic allografts were used: freehand aortic valve replacement with 120-degree rotation, freehand aortic valve replacement with intact noncoronary sinus, aortic root enlargement with intact noncoronary sinus, and total aortic root replacement. Valve function was assessed by echocardiography during the operation in 78 patients (66%) and after the operation in 77 patients (65%). One-hundred eighteen aortic valve replacements with cryopreserved aortic allografts were performed on 117 patients; mean age was 45.6 years (range 15 to 83 years) and mean follow-up was 4.6 years (range up to 11 years). Intraoperative echocardiography disclosed no significant aortic valve incompetence. There were four operative deaths (3%) and seven late deaths; freedom from valve-related mortality at 10 years was 9:3% +/- 4.55%. New York Heart Association functional status at latest follow-up was normal in 98 (94%) patients. On postoperative echocardiography, 90% had no or trivial aortic valve incompetence. Freedom from thromboembolism at 10 years was 100% and from endocarditis, 98% +/- 2.47%. Seven (6%) patients required valve explantation, four for structural deterioration. At 10 years, freedom from reoperation for allograft-related causes was 92% +/- 3.47%. Aortic valve replacement

  3. Aortic valve replacement with the Nicks annulus enlargement procedure 12 years after mitral valve replacement.

    Science.gov (United States)

    Kazama, S; Kurata, A; Yamashita, Y

    1999-10-01

    An aortic valve replacement was successfully performed employing the Nicks annulus enlargement procedure in a case of aortic valve stenosis with small annulus 12 years after mitral valve replacement. Previous mitral valve replacement does not preclude feasibility of the Nicks procedure.

  4. Incidental necropsy finding of a quadricuspid aortic valve

    NARCIS (Netherlands)

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

    2015-01-01

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

  5. Endovascular Repair for Type A Aortic Dissection After Transcatheter Aortic Valve Replacement With a Medtronic CoreValve.

    Science.gov (United States)

    Berfield, Kathleen K S; Sweet, Matthew P; McCabe, James M; Reisman, Mark; Mackensen, G Burkhard; Mokadam, Nahush A; Dean, Larry S; Smith, Jason W

    2015-10-01

    Transcatheter aortic valve replacement is being used with increasing frequency in patients with severe aortic stenosis who are otherwise deemed to be at high surgical risk. Aortic dissection is a rare complication of transcatheter aortic valve replacement and poses a unique management dilemma. We describe the treatment of an acute Stanford type A aortic dissection after transcatheter aortic valve replacement with a modified thoracic endovascular stent graft in a 95-year-old woman. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Aortic valve surgery - minimally invasive

    Science.gov (United States)

    ... Saunders; 2012:chap 61. Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, Bonow ... A.M. Editorial team. Related MedlinePlus Health Topics Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  7. Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status

    Science.gov (United States)

    Misenheimer, Jacob A.; Ramaraj, Radhakrishnan

    2017-01-01

    Aortic stenosis is the most common valvular heart disease in the developed world. About 7% of the population over age 65 years suffers from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is dismal without valve replacement. Even though the American College of Cardiology recommends aortic valve replacement to treat this condition as a class I recommendation, approximately one third of these patients over the age of 75 years are not referred for surgery. Typically, this is from concern about prohibitive surgical risk associated with patient frailty, comorbidities, age, and severe left ventricular dysfunction. The advent in France of transcatheter aortic valve replacement has raised the hope in the United States for an alternative, less invasive treatment for aortic stenosis. Two recent trials—the Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve (Partner) and the CoreValve US Pivotal—have established transcatheter aortic valve replacement as the preferred approach in patients who are at high or prohibitive surgical risk. The more recently published Partner 2 trial has shown the feasibility of transcatheter aortic valve replacement in intermediate-surgical-risk patients as well. With a profile that promises easier use and better valve performance and delivery, newer-generation valves have shown their potential for further improvement in safety profile and overall outcomes. We review the history and status of this topic. PMID:28265210

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

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1980-06-01

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

  9. Apyrexic Brucella melitensis aortic valve endocarditis.

    Science.gov (United States)

    al-Mudallal, D S; Mousa, A R; Marafie, A A

    1989-10-01

    The case of a young shepherd with Brucella melitensis aortic valve endocarditis is presented. His illness ran an afebrile course and was also complicated by disseminated intravascular coagulation (DIC), nephritis, hepatitis and peritonitis, all of which responded well to supportive measures and a combination of tetracycline, trimethoprim-sulphamethoxazole and amikacin sulphate. The fact that even the most severe case of brucellosis can present without fever is stressed.

  10. Quantitative image analysis for planning of aortic valve replacement

    NARCIS (Netherlands)

    Elattar, M.A.I.M.

    2016-01-01

    Aortic stenosis is the most common and frequent cause of sudden death among all valvular heart diseases. Symptomatic aortic stenosis is considered to be a fatal disease if left untreated. Aortic valve replacement is the mainstay of treatment of symptomatic aortic stenosis. Traditional treatment of s

  11. Quantitative image analysis for planning of aortic valve replacement

    NARCIS (Netherlands)

    Elattar, M.A.I.M.

    2016-01-01

    Aortic stenosis is the most common and frequent cause of sudden death among all valvular heart diseases. Symptomatic aortic stenosis is considered to be a fatal disease if left untreated. Aortic valve replacement is the mainstay of treatment of symptomatic aortic stenosis. Traditional treatment of

  12. [Redo Aortic and Mitral Valve Replacement by Manouguian's Procedure for Active Prosthetic Valve Infection].

    Science.gov (United States)

    Kunitomo, Ryuji; Okamoto, Ken; Moriyama, Shuji; Sakaguchi, Hisashi; Tazume, Hirokazu; Yoshinaga, Takashi; Kawasuji, Michio

    2016-03-01

    The damage to the intervalvular fibrous trigone (IVFT) by infective endocarditis makes combined aortic and mitral valve replacement difficult. We performed Manouguian's double valve replacement for such a case and obtained a good result. A 81-year-old male underwent emergency operation due to active prosthetic valve endocarditis. He had a history of receiving combined aortic and mitral valve replacement because of active infective endocarditis at the age of 74 and redo aortic valve replacement 3 years after that. The infectious lesion extended from the mitral annulus to the IVFT and the aortic annulus, and it caused the prosthetic valve detachment from the aortic annulus. Manouguian's double valve replacement was required for radical resection and reconstruction of the IVFT. No recurrent infection or paravalvular leakage was observed during 49months follow up period. Manouguian's procedure is useful for complete resection of the infected IVFT and makes combined aortic and mitral valve replacement safer.

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

    Directory of Open Access Journals (Sweden)

    Sarika Katiyar

    2015-01-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    outcome was the composite rate of death from any cause, stroke, or myocardial infarction (MI) at 1 year. RESULTS: A total of 280 patients were randomized at 3 Nordic centers. Mean age was 79.1 years, and 81.8% were considered low-risk patients. In the intention-to-treat population, no significant...... difference in the primary endpoint was found (13.1% vs. 16.3%; p = 0.43 for superiority). The result did not change in the as-treated population. No difference in the rate of cardiovascular death or prosthesis reintervention was found. Compared with SAVR-treated patients, TAVR-treated patients had more......BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an option in certain high-risk surgical patients with severe aortic valve stenosis. It is unknown whether TAVR can be safely introduced to lower-risk patients. OBJECTIVES: The NOTION (Nordic Aortic Valve Intervention Trial) randomized...

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  16. Balloon aortic valvuloplasty as a bridge to aortic valve replacement in a patient with severe calcific aortic stenosis.

    Science.gov (United States)

    Swinkels, B M; Jaarsma, W; Wely, L Relik-van; van Swieten, H A; Ernst, J M P G; Plokker, H W M

    2003-03-01

    This case report describes a patient with severe calcific aortic stenosis who was initially considered inoperable because of a very poor left ventricular function and severe pulmonary hypertension. After balloon aortic valvuloplasty, the clinical and haemodynamic status of the patient improved to such an extent that subsequent aortic valve replacement was considered possible and eventually proved to be successful. Balloon aortic valvuloplasty has value as a potential bridge to aortic valve replacement when the risks for surgery are considered to be too high.

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

    Directory of Open Access Journals (Sweden)

    Ismail El-Hamamsy

    2010-01-01

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

  18. Transcatheter aortic valve replacement for bicuspid aortic stenosis 13years post heart transplant.

    Science.gov (United States)

    Julien, Maureen B; Desai, Nimesh; Brozena, Susan; Herrmann, Howard C

    2016-12-16

    Despite the widespread use of transcatheter aortic valve replacement (TAVR) for moderate and high-risk patients with severe aortic stenosis, it is utilized less frequently in patients with bicuspid aortic valves (BAV). Orthotopic heart transplant (OHT) donors tend to be younger and may have undiagnosed BAV. We present a case of successful TAVR in a patient with BAV thirteen years after OHT.

  19. Giant Aortic Pseudoaneurysm with Stanford Type A Aortic Dissection after Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Mertay Boran

    2012-01-01

    Full Text Available Giant pseudoaneurysm of the ascending aorta is a rare but dreadful complication occurring several months or years after aortic surgery. Thoracic aortic aneurysms tend to be asymptomatic and were previously often diagnosed only after a complication such as dissection or rupture. We present a rare case of giant ascending aneurysm with Stanford type A aortic dissection occurring 6 years after aortic valve replacement and also illustrate the potential dimensions the ascending aorta may reach by a pseudoaneurysm and dissection after AVR.

  20. Valve Replacement with a Sutureless Aortic Prosthesis in a Patient with Concomitant Mitral Valve Disease and Severe Aortic Root Calcification.

    Science.gov (United States)

    Lio, Antonio; Scafuri, Antonio; Nicolò, Francesca; Chiariello, Luigi

    2016-04-01

    Aortic valve replacement with concomitant mitral valve surgery in the presence of severe aortic root calcification is technically difficult, with long cardiopulmonary bypass and aortic cross-clamp times. We performed sutureless aortic valve replacement and mitral valve annuloplasty in a 68-year-old man who had severe aortic stenosis and moderate-to-severe mitral regurgitation. Intraoperatively, we found severe calcification of the aortic root. We approached the aortic valve through a transverse aortotomy, performed in a higher position than usual, and we replaced the valve with a Sorin Perceval S sutureless prosthesis. In addition, we performed mitral annuloplasty with use of an open rigid ring. The aortic cross-clamp time was 63 minutes, and the cardiopulmonary bypass time was 83 minutes. No paravalvular leakage of the aortic prosthesis was detected 30 days postoperatively. Our case shows that the Perceval S sutureless bioprosthesis can be safely implanted in patients with aortic root calcification, even when mitral valve disease needs surgical correction.

  1. Hesr2 knockout mice develop aortic valve disease with advancing age.

    Science.gov (United States)

    Kokubo, Hiroki; Miyagawa-Tomita, Sachiko; Nakashima, Yasumi; Kume, Tsutomu; Yoshizumi, Masao; Nakanishi, Toshio; Saga, Yumiko

    2013-03-01

    Acquired heart diseases, such as valve disease, are major causes of human morbidity and mortality. However, the pathological mechanisms underlying these diseases are largely unknown. Our aim is to identify the role of the hairy and enhancer of split-related (Hesr)-2 gene in the adult heart. Echocardiography detected heart dysfunctions indicative of aortic valve anomalies, stenosis, and regurgitation, in ≈59% of >12-month-old Hesr2 knockout survivor mice. Morphological and histological analyses revealed thickened semilunar valves with increased fibrotic areas, indicating that sclerotic degeneration of valves is the main cause of aortic valve disease. The expression of osteogenic genes, such as osteopontin and sclerostin, were upregulated in the mutants, and the overexpression of sclerostin in endothelial cells resulted in thickened semilunar valves with increased fibrotic areas, similar to that seen in the Hesr2 knockout mice, suggesting that Hesr2 can regulate osteogenic gene expression in valves. Reduced left ventricular function, which may be caused by increased ventricular interstitial fibrosis, and enlarged myocardial cell size without ventricular wall thickening were found in both aortic valve stenosis/regurgitation-positive (33%) and aortic valve stenosis/regurgitation-negative (38%) subpopulations in 12-month-old survivor mice. Dilated left ventricular internal dimensions were specifically detected in the aortic valve stenosis/regurgitation-positive subpopulation, thus suggesting that the degeneration of cardiomyocytes is influenced by irregular hemodynamics. These data revealed that survivor mice lacking the Hesr2 gene exhibit fibrosis in the aortic valve and ventricle in adulthood, thus suggesting that Hesr2 plays an important role in maintaining the homeostasis of the aortic valve and ventricle.

  2. [Surgical technique of aortic valve replacement for small aortic annulus in elderly patients].

    Science.gov (United States)

    Hata, T; Fujiwara, K; Furukawa, H; Tsushima, Y; Yoshitaka, H; Kuinose, M; Minami, H; Ishida, A; Tamura, K; Totsugawa, T; Kanemitsu, H; Ozawa, M

    2006-04-01

    Recent reports have shown that aortic valve replacement in elderly patients over 65 years with atherosclerotic aortic stenosis and a small aortic annulus is possible by using a small sized bioprosthesis (Carpentier-Edwards pericardial valve). Here we present out surgical technique. Firstly, the native calcified aortic valve was removed completely to gain total exposure of the surrounding aortic root and sinus of Valsalva like Bentall procedure. Secondly, a small sized bioprosthesis was implanted with intermittent noneverting mattress 2-0 sutures with spaghetti and small polytetrafluoroethylene (PTFE) felt. Aortic annulus is the dilated by inserting Hegar dilator sizing from 25 to 27 mm. Therefore, aortic valve replacement for small aortic annulus in intra- or supra-annular position should be easily accomplished. Good surgical results and hemodynamic state were achieved in 25 consecutive cases using this technique.

  3. Possible Subclinical Leaflet Thrombosis in Bioprosthetic Aortic Valves

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  4. Awake transapical aortic valve implantation using thoracic epidural anesthesia.

    Science.gov (United States)

    Mukherjee, Chirojit; Walther, Thomas; Borger, Michael Andrew; Kempfert, Joerg; Schuler, Gerhard; Mohr, Friedrich Wilhelm; Ender, Joerg

    2009-09-01

    Transapical aortic valve implantation is a minimally invasive, beating-heart procedure that normally requires a general anesthetic. We herein report an 85-year-old patient with impaired pulmonary function who underwent successful transapical aortic valve implantation while awake, using a thoracic epidural anesthetic.

  5. Simulation for transthoracic echocardiography of aortic valve

    Science.gov (United States)

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

    Chodór, Piotr; Wilczek, Krzysztof; Przybylski, Roman; Świątkowski, Andrzej; Głowacki, Jan; Kalarus, Zbigniew; Zembala, Marian

    2015-01-01

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

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

    OpenAIRE

    Chodór, Piotr; Wilczek, Krzysztof; Przybylski, Roman; Świątkowski, Andrzej; Głowacki, Jan; Kalarus, Zbigniew; Zembala, Marian

    2015-01-01

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

  9. [Aortic valve replacement as an independent predictive factor for later development of aortic dissection].

    Science.gov (United States)

    von Kodolitsch, Y; Simic, O; Bregenzer, T; Dresler, C; Haverich, A; Nienaber, C A

    1998-08-01

    Dissection of the ascending aorta (type A) following later after aortic valve replacement has been described with increasing frequency. This study analyzes the role of aortic valve replacement for the evolution of late dissection. In a series of 80 consecutive patients with type A dissection, a previous aortic valve replacement had been performed in 12 cases (15%). In addition to arterial hypertension (p syndrome (p factor for type A dissection. Dissection occurred 3 +/- 4 years after aortic valve replacement with a clinical and anatomical profile similar to classic dissection as proven by comparison to a group of 62 patients with classic dissection associated with arterial hypertension or Marfan syndrome. With 75% and 66%, respectively, 30 day and 1 year survival of patients with dissection following later after aortic valve replacement was similar to patients with classic type A dissection. Extensive thinning and/or fragility (p associated with a high risk for late dissection; this finding was substantiated by comparison to a control group of 10 consecutive patients with a similarly dilated aortic root but no dissection. Type and diameter of valve prostheses, cross-clamp time, NYHA functional class, and left ventricular ejection fraction were unrelated to late dissection. Previous aortic valve replacement is an independent predisposing factor for a dissection of the ascending aorta later. At the time of aortic valve replacement, prophylactic replacement or wrapping of the ascending aorta should be considered in patients with a thinned/fragile aortic wall even without a markedly dilated aortic root.

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

    Science.gov (United States)

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

    1989-01-01

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

  11. Aortic valve surgery: what is the future?

    Science.gov (United States)

    Hudorović, Narcis

    2008-04-01

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

  12. Transcatheter aortic valve replacement: techniques, complications, and bailout strategies.

    Science.gov (United States)

    Singh, Vikas; Macon, Conrad J; Scot Shaw, Eric; Londoño, Juan C; Martinez, Claudia A

    2013-09-01

    Transcatheter aortic valve replacement has emerged as an alternative option for inoperable or very high-risk patients with severe aortic stenosis-however, there are serious complications associated with the procedure, such as patient mortality, stroke, conduction disturbances, paravalvular regurgitation, and vascular concerns. Our review focuses on the most common complications related to transcatheter aortic valve replacement procedures and potential bailout strategies and techniques.

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

    Science.gov (United States)

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

    2004-03-01

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

  14. Percutaneous implantation of CoreValve aortic prostheses in patients with a mechanical mitral valve.

    Science.gov (United States)

    Bruschi, Giuseppe; De Marco, Federico; Oreglia, Jacopo; Colombo, Paola; Fratto, Pasquale; Lullo, Francesca; Paino, Roberto; Frigerio, Maria; Martinelli, Luigi; Klugmann, Silvio

    2009-11-01

    Concerns exist in the field of transcatheter aortic valve implantation regarding the treatment of patients with mechanical mitral valve for possible interference between the percutaneous aortic valve and the mechanical mitral prosthesis. We report our experience with percutaneous aortic valve implantation in 4 patients with severe aortic stenosis, previously operated on for mitral valve replacement with a mechanical prosthesis. All patients underwent uneventful percutaneous retrograde CoreValve implantation (CoreValve Inc, Irvine, CA). No deformation of the nitinol tubing of the prostheses (ie, neither distortion nor malfunction of the mechanical valve in the mitral position) occurred in any of the patients. All patients are alive and asymptomatic at a mean follow-up of 171 days.

  15. Surgical treatment of infective endocarditis with aortic and tricuspid valve involvement using cryopreserved aortic and mitral valve allografts.

    Science.gov (United States)

    Ostrovsky, Yury; Spirydonau, Siarhei; Shchatsinka, Mikalai; Shket, Aliaksandr

    2015-05-01

    Surgical treatment of infective and prosthetic endocarditis using allografts gives good results. Aortic allograft implantation is a common technique, while tricuspid valve replacement with a mitral allograft is very rare. Multiple valve disease in case of infective endocarditis is a surgical challenge as such patients are usually in a grave condition and results of surgical treatment are often unsatisfactory. In this article we describe a clinical case of successful surgical treatment in a patient with active infective endocarditis of aortic and tricuspid valve, complicated by an aortic-right ventricular fistula. The aortic valve and ascending aorta were replaced with a cryopreserved aortic allograft; the tricuspid valve was replaced with a cryopreserved mitral allograft. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. When operable patients become inoperable: conversion of a surgical aortic valve replacement into transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Olsen, Lene Kjaer; Arendrup, Henrik; Engstrøm, Thomas

    2009-01-01

    Transcatheter aortic valve implantation (TAVI) is a relatively new treatment option for inoperable patients with severe aortic stenosis (AS). This case describes how a planned conventional surgical aortic valve replacement (AVR) on a 73-year-old woman was successfully converted to a TAVI procedure....... On extracorporal circulation it was reconized that the aortic annulus, the coronary ostiae and the proximal part of the ascending aorta were severely calcified making valve implantation impossible. Surgical closure without valve substitution was estimated to be associated with a high risk of mortality due......, and the prosthesis was sutured to the ascending aorta. With some manipulation of the prosthesis it was possible to suture the aorta circumferentially around the fully expanded upper part of the prosthesis. Post-procedurally the patient recovered successfully, with improved function capacity, aortic valve area...

  17. Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm.

    Science.gov (United States)

    Tomsic, Anton; Li, Wilson W L; van Paridon, Marieke; Bindraban, Navin R; de Mol, Bas A J M

    2016-08-01

    Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature.

  18. Aortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future? †

    Science.gov (United States)

    Shrestha, Malakh; Maeding, Ilona; Höffler, Klaus; Koigeldiyev, Nurbol; Marsch, Georg; Siemeni, Thierry; Fleissner, Felix; Haverich, Axel

    2013-01-01

    OBJECTIVES Aortic valve replacement (AVR) in geriatric patients (>75 years) with small aortic roots is a challenge. Patient–prosthesis mismatch and the long cross-clamp time necessary for stentless valves or root enlargement are matters of concern. We compared the results of AVR with sutureless valves (Sorin Perceval), against those with conventional biological valves. METHODS Between April 2007 and December 2012, 120 isolated AVRs were performed in patients with a small annulus (<22 mm) at our centre. In 70 patients (68 females, age 77.4 ± 5.5 years), conventional valves (C group) and in 50 patients (47 females, age 79.8 ± 4.5 years), sutureless valves (P group) were implanted. The Logistic EuroSCORE of the C group was 16.7 ± 10.4 and that of the P group 20.4 ± 10.7, (P = 0.054). Minimal-access surgery was performed in 4.3% (3/70) patients in the C group and 72% (36/50) patients in the P group. RESULTS The cardiopulmonary bypass (CPB) and cross-clamp times of the C group were 75.3 ± 23 and 50.3 ± 14.2 min vs 58.7 ± 20.9 and 30.1 ± 9 min in the P group, (P < 0.001). In the C group, two annulus enlargements were performed. Thirty-day mortality was 4.3% (n = 3) in the C group and 0 in the P group, (n.s.). At follow-up (up to 5 years), mortalities were 17.4% (n = 12) in the C group and 14% (n = 7) in the P group, (n.s.). CONCLUSIONS This study highlights the advantages of sutureless valves for geriatric patients with small aortic roots reflected by shorter cross-clamp and CPB times, even though most of these patients were operated on via a minimally invasive access. Moreover, due to the absence of a sewing ring, these valves are also almost stentless, with greater effective orifice area (EOA) for any given size. This may potentially result in better haemodynamics even without the root enlargement. This is of advantage, as several studies have shown that aortic root enlargement can significantly increase the risks of AVR. Moreover, as seen in this series

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

    Science.gov (United States)

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

    2014-04-01

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

  20. Aortic valve replacement in familial hypercholesterolemia: not an ordinary procedure.

    Science.gov (United States)

    Muretti, Mirko; Massi, Francesco; Coradduzza, Enrico; Portoghese, Michele

    2015-04-28

    Familial hypercholesterolemia is an inherited disorder with incidences of approximately 1:500 and 1:1,000,000 in heterozygous and homozygous form respectively. Affected patients usually show early coronary artery disease and severe aortic root calcification, despite optimization of therapy. We report a case of a 64-year-old woman affected by heterozygous familial hypercholesterolemia which presented dyspnea and anginal symptoms due to a severely calcified aortic root causing valve stenosis and narrowed sinotubular junction. Aortic valve replacement and aortic root enlargement were performed using the Manougian procedure. Even for experiences surgeons, this surgery could prove challenging for this group of patients due to aggressive degenerative tissue calcification of the aortic root, which often presents an extremely calcified aortic valve with a small annulus associated to a narrowed sinotubular junction.

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

    Directory of Open Access Journals (Sweden)

    Katie L. Losenno

    2012-01-01

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

  2. Aortic and Mitral Valve Replacement Through a Single Transverse Aortotomy: A Useful Approach in Difficult Mitral Valve Exposure

    OpenAIRE

    Carmichael, Michael J.; Cooley, Denton A.; Favor, Arsenio S.

    1983-01-01

    Replacement of the mitral valve through a standard vertical left atriotomy in patients requiring both aortic and mitral valve replacement can be very difficult. This is especially true in patients who have undergone previous median sternotomy. Replacement of the mitral valve through the aortic root after excision of the aortic valve is described in two case reports. This is a convenient approach when traditional exposure of the mitral valve is impractical in patients requiring double valve re...

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

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    To evaluate the diagnostic accuracy of aortic valve area (AVA) assessment with 320-detector Computed Tomography (MDCT) compared to transthoracic echocardiography (TTE) in a population with mild to severe aortic valve stenosis. AVA was estimated in 169 patients by planimetry on MDCT images (AVAMDCT......) and by the continuity equation with TTE (AVATTE). To generate a reference AVA (AVAREF) we used the stroke volume from MDCT divided by the velocity time integral from CW Doppler by TTE (according to the continuity equation: stroke volume in LVOT = stroke volume passing the aortic valve). AVAREF was used as the reference...

  5. Replacing the valve restoring the flow: Effects of transcatheter aortic valve implantation

    NARCIS (Netherlands)

    Wiegerinck, E.M.A.

    2016-01-01

    When conventional surgery is not an option due to high surgical risk, transcatheter aortic valve implantation (TAVI) is a firmly established alternative and an effective and safe treatment option in this patient population. This thesis focuses on treatment of aortic valve stenosis by TAVI. The aim i

  6. Aortic valve replacement for aortic stenosis with a small aortic annulus in a patient having Werner's syndrome and liver cirrhosis.

    Science.gov (United States)

    Sogawa, M; Kasuya, S; Yamamoto, K; Koshika, M; Oguma, F; Hayashi, J

    2001-12-01

    Werner's syndrome is a rare genetic disease characterized by premature aging and scleroderma-like involvement of the skin. We report a case of aortic valve replacement for severely calcified aortic valve stenosis with a small annulus in a patient suffering from Werner's syndrome and liver cirrhosis

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Science.gov (United States)

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

    2013-05-01

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

  9. [Calcified aortic valve disease: association with atherosclerosis].

    Science.gov (United States)

    Toro, Rocío; Mangas, Alipio; Gómez, Francisco

    2011-05-14

    Calcified aortic valve disease (CAVD) is a prevalent condition, affecting 25% of people older than 65 years. CAVD and atherosclerosis share common risk factors and pathogenic mechanisms. Nevertheless, they present different pathologic lesions. The main factors involved in the pathogenesis of CAVD are genetic predisposition, the process of valvular calcification, deposition of lipoproteins, and chronic inflammation. Studies have suggested a potential benefit from early treatment with angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, and particularly with statins. Observational studies on risk factors for the CAVD, and randomized clinical trials on primary and secondary prevention in subjects with high risk for the disease, would be necessary to improve the clinical management of CAVD. Copyright © 2009 Elsevier España, S.L. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-11-15

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

  11. Midterm Results of Aortic Valve Replacement with Cryopreserved Homografts

    Directory of Open Access Journals (Sweden)

    Emre Özker

    2012-06-01

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

  12. Anesthetic management of transcatheter aortic valve implantation

    Directory of Open Access Journals (Sweden)

    Annalisa Franco

    2012-01-01

    Full Text Available Transcatheter aortic valve implantation (TAVI is an emergent technique for high-risk patients with aortic stenosis. TAVI poses significant challenges about its management because of the procedure itself and the population who undergo the implantation. Two devices are currently available and marketed in Europe and several other technologies are being developed. The retrograde transfemoral approach is the most popular procedure; nevertheless, it may not be feasible in patients with significant aortic or ileo-femoral arterial disease. Alternatives include a transaxillary approach, transapical approach, open surgical access to the retroperitoneal iliac artery and the ascending aorta. A complementary approach using both devices and alternative routes tailored to the anatomy and the comorbidities of the single patient is a main component for the successful implementation of a TAVI program. Anesthetic strategies vary in different centers. Local anesthesia or general anesthesia are both valid alternatives and can be applied according to the patient′s characteristics and procedural instances. General anesthesia offers many advantages, mainly regarding the possibility of an early diagnosis and treatment of possible complications through the use of transesophageal echocardiography. However, after the initial experiences, many groups began to employ, routinely, sedation plus local anesthesia for TAVI, and their procedural and periprocedural success demonstrates that it is feasible. TAVI is burdened with potential important complications: vascular injuries, arrhythmias, renal impairment, neurological complications, cardiac tamponade, prosthesis malpositioning and embolization and left main coronary artery occlusion. The aim of this work is to review the anesthetic management of TAVI based on the available literature.

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

    Science.gov (United States)

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

    2010-02-01

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

  14. Concomitant aortic valve replacement and myocardial revascularization.

    Science.gov (United States)

    Craver, J M; Jones, E L; Hatcher, C R; Farmer, J H

    1977-01-01

    Twenty-six consecutive patients underwent combined aortic valve replacement and myocardial revascularization at the Emory University Affiliated Hospitals between May, 1973 and March, 1976. Acute myocardial infarction resulted in two operative deaths (8%). There have been four late deaths, all Class IV preoperative. The age range was 37 to 79 years with an average age of 60. Preoperatively all patients were Class IV or late Class III. Twenty-three patients had symptoms of angina pectoris; congestive heart failure was evident in 56%. Postoperatively, 70% are now Class 1 or II. Single coronary bypass was performed in 16 patients, double in 6, and triple in three. Double bypass plus mitral valve replacement was required in two with aneurysmectomy in one. The rate of intraoperative infarction was 27% for the series but only 7% in the last year. The methods of intraoperative myocardial preservation and the technical approach for the operative procedures were variable. Results with each method are correlated, and currently preferred techniques are presented and discussed. Best results were obtained in patients who presented early in their symptomatic course with isolated proximal coronary lesions and good renoff vessels. Excellent results could be achieved despite advanced age of patients, requirement for multiple bypass grafts, and correction of other associated cardiac lesions. Poorest results were obtained when long-standing ventricular failure was combined with poor vessels distal to coronary stenoses. PMID:860881

  15. Patient outcome and valve performance following a second aortic valve homograft replacement.

    Science.gov (United States)

    Hasnat, K; Birks, E J; Liddicoat, J; Hon, J K; Edwards, S; Glennon, S; Yacoub, M H

    1999-11-09

    Homograft valves offer many advantages; however, there is concern about their use in second aortic valve replacement because of the complexity of the procedure and the possibility of accelerated degeneration. One hundred and forty-four patients underwent a second aortic homograft replacement between 1973 and 1997 (mean follow-up 6.5+/-5 years, range 1 to 20 years). Eighty-three were male, and 61 were female, aged 17 to 77 years, mean 49.0 years. All patients had undergone previous aortic valve replacement with a homograft. The indication for reoperation was aortic regurgitation in 75 patients (52.1%), aortic stenosis in 28 (19.4%), and mixed aortic valve disease in 41 (28.5%). Root replacement was performed in 54 patients (38%) and subcoronary in 90 (62.5%). Early mortality was 3.4%. The actuarial survival rate was 93% and 82% at 5 and 10 years, respectively. Freedom from tissue degeneration was 96% and 80% at 5 and 10 years, respectively, and freedom from reoperation was 97% and 82% at 5 and 10 years, respectively. This study shows that a second aortic valve homograft replacement results in good early and long-term survival. Accelerated degeneration does not occur. Left ventricular performance is improved, and earlier surgery could further improve outcome, indicating that an aortic homograft is a safe, durable option for patients requiring a second aortic valve replacement.

  16. Mitral annular calcification in patients undergoing aortic valve replacement for aortic valve stenosis.

    Science.gov (United States)

    Takami, Yoshiyuki; Tajima, Kazuyoshi

    2016-02-01

    Limited data exis t on clinical relevance of aortic valve stenosis (AVS) and mitral annular calcification (MAC), although with similar pathophysiologic basis. We sought to reveal the prevalence of MAC and its clinical features in the patients undergoing aortic valve replacement (AVR) for AVS. We reviewed 106 consecutive patients who underwent isolated AVR from 2004 to 2010. Before AVR, CT scans were performed to identify MAC, whose severity was graded on a scale of 0-4, with grade 0 denoting no MAC and grade 4 indicating severe MAC. Echocardiography was performed before AVR and at follow-up over 2 years after AVR. MAC was identified in 56 patients with grade 1 (30 %), 2 (39 %), 3 (18 %), and 4 (13 %), respectively. Patients with MAC presented older age (72 ± 8 versus 66 ± 11 years), higher rate of dialysis-dependent renal failure (43 versus 4 %), and less frequency of bicuspid aortic valve (9 versus 36 %), when compared to those without MAC. No significant differences were seen in short- and mid-term mortality after AVR between the groups. In patients with MAC, progression of neither mitral regurgitation nor stenosis was observed at follow-up of 53 ± 23 months for 102 survivors, although the transmitral flow velocities were higher than in those without MAC. In conclusion, MAC represented 53 % of the patients undergoing isolated AVR for AVS, usually appeared in dialysis-dependent elder patients with tricuspid AVS. MAC does not affect adversely upon the survival, without progression of mitral valve disease, at least within 2 years after AVR.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-06-15

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

  18. "Killer coronary artery" and aortic valve stenosis: A tricky case.

    Science.gov (United States)

    Nader, Joseph; Labont, Béatris Alina; Houpe, David; Caus, Thierry

    2015-11-01

    Anomalous origin of the left main coronary artery from the right coronary sinus is rarely diagnosed in elderly patients. We report such an anomaly in a 75-year-old lady presenting with chest pain and syncope. Preoperative screening revealed that her aortic valve was moderately stenotic. The patient underwent a successful unroofing procedure combined with aortic valve replacement. The outcome was uncomplicated and the patient remained asymptomatic at one year postoperatively. © The Author(s) 2014.

  19. Aortic valve replacement in a patient with severe hemophilia.

    Science.gov (United States)

    Gasparović, Hrvoje; Zupancic-Salek, Silva; Brida, Vojtjeh; Dulić, Grgur; Jelić, Ivan

    2007-03-01

    Hemophilia A is an inherited bleeding disorder characterized by factor VIII deficiency. The basis for insufficient hemostasis lies within inadequate amplification of factor Xa production with the undersupplied factor VIII. We report on a young patient with critical aortic stenosis bearing all the clinical stigmata of severe hemophilia, in whom aortic valve replacement was performed with a tissue valve in order to avoid the need for long term anticoagulation.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-07-15

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

  1. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease

    NARCIS (Netherlands)

    Yap, Sing-Chien; Drenthen, Willem; Pieper, Petronella G.; Moons, Philip; Mulder, Barbara J. M.; Klieverik, Loes M.; Vliegen, Hubert W.; van Dijk, Arie P. J.; Meijboom, Folkert J.; Roos-Hesselink, Jolien W.

    Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  2. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease.

    NARCIS (Netherlands)

    Yap, S.C.; Drenthen, W.; Pieper, P.G.; Moons, P.; Mulder, B.J.M.; Klieverik, L.M.; Vliegen, H.W.; Dijk, A.P.J. van; Meijboom, F.J.; Roos-Hesselink, J.W.

    2007-01-01

    BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  3. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease

    NARCIS (Netherlands)

    Yap, Sing-Chien; Drenthen, Willem; Pieper, Petronella G.; Moons, Philip; Mulder, Barbara J. M.; Klieverik, Loes M.; Vliegen, Hubert W.; van Dijk, Arie P. J.; Meijboom, Folkert J.; Roos-Hesselink, Jolien W.

    2007-01-01

    Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve replacem

  4. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease.

    NARCIS (Netherlands)

    Yap, S.C.; Drenthen, W.; Pieper, P.G.; Moons, P.; Mulder, B.J.M.; Klieverik, L.M.; Vliegen, H.W.; Dijk, A.P.J. van; Meijboom, F.J.; Roos-Hesselink, J.W.

    2007-01-01

    BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve replacem

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

    DEFF Research Database (Denmark)

    Aagaard, Jan; Geha, Alexander S.

    2007-01-01

    BACKGROUND AND AIM OF THE STUDY: The CarboMedics Top Hat supra-annular aortic valve allows a one-size (and often two-size) increase over the standard intra-annular valve. This advantage should minimize the risk of patient-prosthesis mismatch, where the effective prosthetic valve orifice area...

  6. Transcatheter Aortic Valve Replacement Versus Aortic Valve Bypass: A Comparison of Outcomes and Economics.

    Science.gov (United States)

    Brown, John W; Boyd, Jack H; Patel, Parth M; Baker, Mary L; Syed, Amjad; Ladowski, Joe; Corvera, Joel

    2016-01-01

    Transcatheter aortic valve replacement (TAVR) is currently offered to patients who are high-risk candidates for conventional surgical aortic valve replacement. For the past 37 years, off-pump aortic valve bypass (AVB) has been used in elderly patients at our center for this similarly high-risk group. Although TAVR and AVB were offered to similar patients at our center, comparisons of clinical outcomes and hospital economics for each strategy were not reported. We reviewed the clinical and financial records of 53 consecutive AVB procedures performed since 2008 with the records of 51 consecutive TAVR procedures performed since 2012. Data included demographics, hemodynamics, The Society of Thoracic Surgeons (STS) risk score, extent of coronary disease, and ventricular function. Follow-up was 100% in both groups. Hospital financial information for both cohorts was obtained. Mean risk score for the TAVR group was 10.1% versus 17.6% for AVB group (p < 0.001). Kaplan-Meier hospital rates of 3- and 6-month survival and of 1-year survival were 88%, 86%, 81%, and 61% and 89%, 83%, 83%, and 70% for the TAVR and AVB groups, respectively (p = 0.781). Two patients who had undergone TAVR had a procedure-related stroke. The one stroke in an AVB recipient was late and not procedure related. At discharge, mild and moderate perivalvular and central aortic insufficiency were present in 31% and 16% of TAVR recipients, respectively; no AVB valve leaked. Transvalvular gradients were reduced to less than 10 mm Hg in both groups. The average hospital length of stay for the AVB-treated patients was 13 days, and it was 9 days for the TAVR-treated patients. Median hospital charges were $253,000 for TAVR and $158,000 for AVB. Mean payment to the hospital was $65,000 (TAVR) versus $64,000 (AVB), and the mean positive contribution margin (profit) to the hospital was $14,000 for TAVR versus $29,000 for AVB. TAVR and AVB relieve aortic stenosis and have similar and acceptable procedural mortality

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

    Science.gov (United States)

    Vesely, I; Menkis, A; Campbell, G

    1990-10-01

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

  8. Aortenklappeninsuffizienz – Operationsindikationen und Möglichkeiten der Aortenklappenrekonstruktion // Aortic Regurgitation – Aortic Valve Repair

    Directory of Open Access Journals (Sweden)

    Schachner T

    2015-01-01

    Full Text Available Aortic valve repair for aortic regurgitation has evolved at dedicated centres. It is a valuable alternative to aortic valve replacement and offers good long term results. Tricuspid, as well as bicuspid aortic valves, are suitable for repair. These techniques of aortic valve repair can be combined with reconstruction of concomitant aneurysmal disease of the ascending aorta or the sinus valsalvae. In particular, younger patients can benefit from a life without oral anticoagulation. p bKurzfassung: /bDie Aortenklappenrekonstruktion bei bestehender Aortenklappeninsuffizienz hat sich in spezialisierten Zentren zu einer guten Behandlungsalternative zum Aortenklappenersatz entwickelt. Es können sowohl bikuspide als auch trikuspide Aortenklappen rekonstruiert werden. Bei Vorliegen eines Aortenaneurysmas können Techniken der Aortenklappenrekonstruktion mit dem Ersatz von Aorta ascendens oder Sinus valsalvae kombiniert werden. In spezialisierten Zentren können gute Langzeitergebnisse erzielt werden, die vor allem jüngeren Patienten ein Leben ohne orale Antikoagulation ermöglichen.

  9. The role of collagen cross-links in biomechanical behavior of human aortic heart valve leaflets - Relevance for tissue engineering

    NARCIS (Netherlands)

    Balguid, A.; Rubbens, M.P.; Mol, A.; Bank, R.A.; Bogers, A.J.J.C.; Kats, J.P. van; Mol, B.A.J.M. de; Baaijens, F.P.T.; Bouten, C.V.C.

    2007-01-01

    A major challenge in tissue engineering of functional heart valves is to determine and mimic the dominant tissue structures that regulate heart valve function and in vivo survival. In native heart valves, the anisotropic matrix architecture assures sustained and adequate functioning under

  10. PERFORMING TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH CAROTID STENOSIS

    Directory of Open Access Journals (Sweden)

    Veselin Valkov

    2016-07-01

    Full Text Available The management of carotid artery disease in patients with severe aortic stenosis referred for transcatheter aortic valve implantation is challenging. By reviewing the very limited amount of literature we will try to answer the question should we perform carotid revascularization before or after the TAVI procedure.

  11. Recently patented transcatheter aortic valves in clinical trials.

    Science.gov (United States)

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

    2013-12-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  13. Ramipril retards development of aortic valve stenosis in a rabbit model: mechanistic considerations.

    Science.gov (United States)

    Ngo, Doan Tm; Stafford, Irene; Sverdlov, Aaron L; Qi, Weier; Wuttke, Ronald D; Zhang, Yuan; Kelly, Darren J; Weedon, Helen; Smith, Malcolm D; Kennedy, Jennifer A; Horowitz, John D

    2011-02-01

    Aortic valve stenosis (AVS) is associated with significant cardiovascular morbidity and mortality. To date, no therapeutic modality has been shown to be effective in retarding AVS progression. We evaluated the effect of angiotensin-converting enzyme inhibition with ramipril on disease progression in a recently developed rabbit model of AVS. The effects of 8 weeks of treatment with either vitamin D₂ at 25,000 IU for 4 days a week alone or in combination with ramipril (0.5 mg·kg⁻¹) on aortic valve structure and function were examined in New Zealand white rabbits. Echocardiographic aortic valve backscatter (AV(BS)) and aortic valve:outflow tract flow velocity ratio were utilized to quantify changes in valve structure and function. Treatment with ramipril significantly reduced AV(BS) and improved aortic valve :outflow tract flow velocity ratio. The intravalvular content of the pro-oxidant thioredoxin-interacting protein was decreased significantly with ramipril treatment. Endothelial function, as measured by asymmetric dimethylarginine concentrations and vascular responses to ACh, was improved significantly with ramipril treatment. Ramipril retards the development of AVS, reduces valvular thioredoxin-interacting protein accumulation and limits endothelial dysfunction in this animal model. These findings provide important insights into the mechanisms of AVS development and an impetus for future human studies of AVS retardation using an angiotensin-converting enzyme inhibitor. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  14. Surgical aortic-valve replacement with a transcatheter implant.

    Science.gov (United States)

    Nowell, Justin L; Dewhurst, Alex; van Besouw, Jean-Pierre; Jahangiri, Marjan

    2011-04-01

    We describe a bailout procedure when surgical aortic-valve replacement was not possible due to severe calcification of the ascending aorta and the root and a very small annulus. A 21-mm CoreValve Revalving prosthesis was inserted via the aortotomy in the presence of a mitral prosthesis.

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

    Science.gov (United States)

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

    2015-05-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  17. 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

  18. Image-guided transapical aortic valve implantation: sensorless tracking of stenotic valve landmarks in live fluoroscopic images.

    Science.gov (United States)

    Merk, Denis R; Karar, Mohamed Esmail; Chalopin, Claire; Holzhey, David; Falk, Volkmar; Mohr, Friedrich W; Burgert, Oliver

    2011-07-01

    Aortic valve stenosis is one of the most frequently acquired valvular heart diseases, accounting for almost 70% of valvular cardiac surgery. Transapical transcatheter aortic valve implantation has recently become a suitable minimally invasive technique for high-risk and elderly patients with severe aortic stenosis. In this article, we aim to automatically define a target area of valve implantation, namely, the area between the coronary ostia and the lowest points of two aortic valve cusps. Therefore, we present a new image-based tracking method of these aortic landmarks to assist in the placement of aortic valve prosthesis under live 2D fluoroscopy guidance. We propose a rigid intensity-based image registration technique for tracking valve landmarks in 2D fluoroscopic image sequences, based on a real-time alignment of a contrast image including the initialized manual valve landmarks to each image of sequence. The contrast image is automatically detected to visualize aortic valve features when the aortic root is filled with a contrast agent. Our registration-based tracking method has been retrospectively applied to 10 fluoroscopic image sequences from routine transapical aortic valve implantation procedures. Most of all tested fluoroscopic images showed a successful tracking of valve landmarks, especially for the images without contrast agent injections. A new intraoperative image-based method has been developed for tracking aortic valve landmarks in live 2D fluoroscopic images to assist transapical aortic valve implantations and to increase the overall safety of surgery as well.

  19. Aortic valve replacement for Libman-Sacks endocarditis

    Science.gov (United States)

    Keenan, Jack B; Janardhanan, Rajesh; Larsen, Brandon T; Khalpey, Zain

    2016-01-01

    A 24-year-old man with systemic lupus erythematosus and antiphospholipid syndrome complicated by lupus nephritis presented with acute limb ischaemia secondary to an embolus. Following embolectomy, the patient underwent a transthoracic echocardiogram which revealed a large vegetation on all three cusps of the aortic valve. The patient was taken for an urgent aortic valve replacement with a mechanical valve. Cultures of one cusp remained sterile. Histopathological examination of the remaining two cusps revealed sterile fibrin-rich thrombotic vegetations characteristic of non-bacterial thrombotic endocarditis. PMID:27702929

  20. Particle Image Velocimetry studies of bicuspid aortic valve hemodynamics

    Science.gov (United States)

    Saikrishnan, Neelakantan; Yap, Choon-Hwai; Yoganathan, Ajit P.

    2010-11-01

    Bicuspid aortic valves (BAVs) are a congenital anomaly of the aortic valve with two fused leaflets, affecting about 1-2% of the population. BAV patients have much higher incidence of valve calcification & aortic dilatation, which may be related to altered mechanical forces from BAV hemodynamics. This study aims to characterize BAV hemodynamics using Particle Image Velocimetry(PIV). BAV models are constructed from normal explanted porcine aortic valves by suturing two leaflets together. The valves are mounted in an acrylic chamber with two sinuses & tested in a pulsatile flow loop at physiological conditions. 2D PIV is performed to obtain flow fields in three planes downstream of the valve. The stenosed BAV causes an eccentric jet, resulting in a very strong vortex in the normal sinus. The bicuspid sinus vortex appears much weaker, but more unstable. Unsteady oscillatory shear stresses are also observed, which have been associated with adverse biological response; characterization of the hemodynamics of BAVs will provide the first step to understanding these processes better. Results from multiple BAV models of varying levels of stenosis will be presented & higher stenosis corresponded to stronger jets & increased aortic wall shear stresses.

  1. Reoperation on aortic disease in patients with previous aortic valve surgery

    Institute of Scientific and Technical Information of China (English)

    SUN Xiao-gang; ZHANG Liang; YU Cun-tao; QIAN Xiang-yang; CHANG Qian

    2013-01-01

    Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Methods Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012,and the mean interval time of re-intervention to aortic disease was 6 years ((6.0± 3.8) years).The secondary aortic surgery included aortic root replacement (14 cases),ascending aorta replacement (10 cases),aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases),and total thoracoabdominal aorta replacement (2 cases).All these patients have received outpatient re-exams or follow-up by phone calls.Results After the initial aortic valve replacement,patients suffered from aortic dissection (25 cases,53%),ascending aortic aneurysm (12 cases,26%) or aortic root aneurysm (10 cases,21%).Diameter in ascending aorta increased (5.2±7.1) mm per year and aortic sinus (3.3±3.1) mm per year.The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P<0.05).All 47 patients have received reoperation on aorta.One patient died in operating room because aortic dissection seriously involved right coronary artery.Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction.All patients were followed up,the mean survival time was (97.25±17.63) months,95% confidence interval was 55.24-73.33 months.Eight cases were died during follow-up and five-year survival rate was 83%.Conclusion To reduce the aortic adverse events after first aortic valve surgery,it is necessary to actively treat and strictly

  2. The stretch responsive microRNA miR-148a-3p is a novel repressor of IKBKB, NF-κB signaling, and inflammatory gene expression in human aortic valve cells

    Science.gov (United States)

    Patel, Vishal; Carrion, Katrina; Hollands, Andrew; Hinton, Andrew; Gallegos, Thomas; Dyo, Jeffrey; Sasik, Roman; Leire, Emma; Hardiman, Gary; Mohamed, Salah A.; Nigam, Sanjay; King, Charles C.; Nizet, Victor; Nigam, Vishal

    2015-01-01

    Bicuspid aortic valves calcify at a significantly higher rate than normal aortic valves, a process that involves increased inflammation. Because we have previously found that bicuspid aortic valve experience greater stretch, we investigated the potential connection between stretch and inflammation in human aortic valve interstitial cells (AVICs). Microarray, quantitative PCR (qPCR), and protein assays performed on AVICs exposed to cyclic stretch showed that stretch was sufficient to increase expression of interleukin and metalloproteinase family members by more than 1.5-fold. Conditioned medium from stretched AVICs was sufficient to activate leukocytes. microRNA sequencing and qPCR experiments demonstrated that miR-148a-3p was repressed in both stretched AVICs (43% repression) and, as a clinical correlate, human bicuspid aortic valves (63% reduction). miR-148a-3p was found to be a novel repressor of IKBKB based on data from qPCR, luciferase, and Western blot experiments. Furthermore, increasing miR-148a-3p levels in AVICs was sufficient to decrease NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) signaling and NF-κB target gene expression. Our data demonstrate that stretch-mediated activation of inflammatory pathways is at least partly the result of stretch-repression of miR-148a-3p and a consequent failure to repress IKBKB. To our knowledge, we are the first to report that cyclic stretch of human AVICs activates inflammatory genes in a tissue-autonomous manner via a microRNA that regulates a central inflammatory pathway.—Patel, V., Carrion, K., Hollands, A., Hinton, A., Gallegos, T., Dyo, J., Sasik, R., Leire, E., Hardiman, G., Mohamed, S. A., Nigam, S., King, C. C., Nizet, V., Nigam V. The stretch responsive microRNA miR-148a-3p is a novel repressor of IKBKB, NF-κB signaling, and inflammatory gene expression in human aortic valve cells. PMID:25630970

  3. Fulminant diffuse systemic sclerosis following aortic valve replacement.

    Science.gov (United States)

    Marasovic-Krstulovic, Daniela; Jurisic, Zrinka; Perkovic, Dijana; Aljinovic, Jure; Martinovic-Kaliterna, Dusanka

    2014-06-01

    We present a case of fulminant diffuse systemic sclerosis (dSSc) developed after the aortic valve replacement followed by fatal congestive heart failure within the 6 months from the initial symptoms. A 61-year-old male developed rapidly progressive diffuse systemic sclerosis following aortic valve replacement due to stenosis of bicuspid aortic valve. He presented with diarrhoea, weight loss, mialgia and arthralgia after cardiac surgery. Heart failure, due to myocardial fibrosis, was noted as a cause of death. We hypothesize that artificial materials like the ones used in mechanical valves or silicon materials in breast implants may induce fulminant course of pre-existing systemic sclerosis or create a new onset in predisposed individual.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic...... valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter-based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR.......An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic...

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

    OpenAIRE

    Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-01-01

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

  6. [Evaluation of aortic valve replacement involving small severely calcified aortic annulus in elderly patients].

    Science.gov (United States)

    Iwahashi, M; Nishimura, Y; Hiramatsu, K; Komori, S; Shibata, M; Yuzaki, M; Okamura, Y

    2006-04-01

    We performed aortic valve replacement in 24 patients aged over 70 with small calcified valves. The surgical management of such patients remains controversial as the extensive calcification compromises implantation. Hence, we used an ultrasonic debridement instrument to remove calcium and selected a small prosthesis with the largest possible orifice without enlargement of the aortic annulus. Echocardiography showed significant reductions in left ventricular mass index compared with preoperative values. Early and mid-term prognosis has been relatively good.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  8. Computerized intraoperative calculation of instantaneous prosthetic aortic valve area.

    Science.gov (United States)

    DiSesa, V J; Lachman, P; Collins, J J; Cohn, L H

    1988-01-01

    Improved assessment of valve area is essential to understanding the performance of prosthetic valves. The authors studied six patients undergoing aortic valve replacement using mechanical (ME) or porcine (PO) prostheses. Instantaneous cardiac output (CO) (L/min) was measured in the aorta using an ultrasonic flow probe. Left ventricular and aortic pressures (mmHg) were measured using Millar catheters. Data were analyzed using an IBM PC-AT. Valve area (cm2) was determined using Gorlin's formula (AG) and a new formula for instantaneous area derived mathematically and using a theoretic constant. AG, mean (AI) and peak (Apk) instantaneous areas were compared to geometric measures of area (Aactual) in vitro. Peak instantaneous area correlates best with measured area. Intraoperative assessment using the ultrasonic flow probe and computer analysis is helpful in understanding the dynamic properties of prosthetic valves in vivo.

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

    Science.gov (United States)

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

    2014-08-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-02-01

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

  12. Aortic valve reconstruction with use of pericardial leaflets in adults with bicuspid aortic valve disease: early and midterm outcomes.

    Science.gov (United States)

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

    2014-12-01

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

  13. Impact of chronic obstructive pulmonary disease on survival and symptoms of severe aortic valve stenosis

    DEFF Research Database (Denmark)

    Poulsen, Mikael K; Dahl, Jordi S; Kjeldsen, Bo J;

    2015-01-01

    BACKGROUND: As patients with severe aortic valve stenosis (AS) develop symptoms their survival decreases rapidly, if treated conservatively. Transcatheter aortic valve implantation (TAVI) has been introduced as a less invasive treatment alternative, especially in inoperable patients, who often have...

  14. Ascending aortic wall cohesion: comparison of bicuspid and tricuspid valves.

    Science.gov (United States)

    Benedik, Jaroslav; Pilarczyk, Kevin; Wendt, Daniel; Indruch, Jiri; Flek, Radek; Tsagakis, Konstantinos; Alaeddine, Savvas; Jakob, Heinz

    2012-01-01

    Objectives. Bicuspid aortic valve (AV) represents the most common form of congenital AV malformation, which is frequently associated with pathologies of the ascending aorta. We compared the mechanical properties of the aortic wall between patients with bicuspid and tricuspid AV using a new custom-made device mimicking transversal aortic wall shear stress. Methods. Between 03/2010 and 07/2011, 190 consecutive patients undergoing open aortic valve replacement at our institution were prospectively enrolled, presenting either with a bicuspid (group 1, n = 44) or a tricuspid (group 2, n = 146) AV. Aortic wall specimen were examined with the "dissectometer" resulting in nine specific aortic-wall parameters derived from tensile strength curves (TSC). Results. Patients with a bicuspid AV showed significantly more calcified valves (43.2% versus 15.8%, P group (P = 0.003, P = 0.02, P = 0.01). We found no difference in the aortic wall cohesion between both groups as revealed by shear stress testing (P = 0.72, P = 0.40, P = 0.41). Conclusion. We observed no differences of TSC in patients presenting with tricuspid or bicuspid AVs. These results may allow us to assume that the morphology of the AV and the pathology of the ascending aorta are independent.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    DEFF Research Database (Denmark)

    Henein, Michael; Hällgren, Peter; Holmgren, Anders

    2015-01-01

    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...

  17. Automated 3-dimensional aortic annular assessment by multidetector computed tomography in transcatheter aortic valve implantation.

    Science.gov (United States)

    Watanabe, Yusuke; Morice, Marie-Claude; Bouvier, Erik; Leong, Tora; Hayashida, Kentaro; Lefèvre, Thierry; Hovasse, Thomas; Romano, Mauro; Chevalier, Bernard; Donzeau-Gouge, Patrick; Farge, Arnaud; Cormier, Bertrand; Garot, Philippe

    2013-09-01

    This study sought to evaluate the accuracy, reproducibility, and predictive value for post-procedural aortic regurgitation (AR) of an automated multidetector computed tomography (MDCT) post-processing imaging software, 3mensio Valves (version 5.1.sp1, 3mensio Medical Imaging BV, the Netherlands), in the assessment of patients undergoing transcatheter aortic valve implantation (TAVI). Accurate pre-operative aortic annulus measurements are crucial for patients undergoing TAVI. One hundred five patients undergoing MDCT screening before TAVI were evaluated. Aortic annular measurement was compared between automated 3mensio Valves software and manual data post-processing software on a dedicated workstation; we analyzed the discrimination value of annulus measurement for post-procedural AR in 44 recipients of a self-expanding valve. The automated 3mensio Valves software showed good concordance with manual MDCT measurements as demonstrated by Bland-Altman analysis. The automated software provided equally good reproducibility as manual measurement, especially for measurement of aortic annulus area (intraobserver intraclass correlation coefficients 0.98 vs. 0.97, interobserver 0.98 vs. 0.95). In 44 patients after implantation of a self-expanding valve, the valve diameter/CT-measured geometric mean annulus diameter ratio by automated 3mensio Valves software showed moderate and better discrimination ability in predicting post-procedural AR compared with manual measurement (p = 0.12, area under the curve 0.77, 95% confidence interval: 0.63 to 0.91, area under the curve 0.68, 95% confidence interval: 0.50 to 0.86, respectively). The automated 3mensio Valves software demonstrated reliable, reproducible aortic annulus measurement and better predictive value for post-procedural AR, suggesting important clinical implications for pre-operative assessment of patients undergoing TAVI. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights

  18. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Ming Li

    2012-01-01

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

  19. Spontaneous Thrombosis of a Bicuspid Aortic valve due to Primary Antiphospholipid Syndrome

    Directory of Open Access Journals (Sweden)

    Sarah Farrell

    2010-08-01

    Full Text Available We present the case of a 51-year-old man who was admitted as an emergency with spontaneous thrombosis of the aortic valve and ascending aorta. At operation he was found to have a congenitally bicuspid aortic valve and subsequent investigation revealed primary antiphospholipid syndrome. He underwent successful removal of the thrombus combined with mechanical replacement of the aortic valve.

  20. Aortic valve reconstruction with autologous pericardium for dialysis patients.

    Science.gov (United States)

    Kawase, Isamu; Ozaki, Shigeyuki; Yamashita, Hiromasa; Uchida, Shin; Nozawa, Yukinari; Matsuyama, Takayoshi; Takatoh, Mikio; Hagiwara, So

    2013-06-01

    This study aimed to report on original aortic valve reconstruction for patients on dialysis. Aortic valve reconstruction has been performed on 404 cases from April 2007 through September 2011. Among them, 54 cases on haemodialysis were retrospectively studied. Forty-seven patients had aortic stenosis, 5 had aortic regurgitation (AR), and 2 had infective endocarditis. Mean age was 70.2 ± 8.5 years. There were 35 males and 19 females. There were 27 primary aortic valve reconstructions, 11 with CABG, 6 with ascending aortic replacement, 5 with mitral valve repair and 4 with maze. First, in the procedure, harvested pericardium was treated with 0.6% glutaraldehyde solution. After resecting the cusps, we measured the distance between commissures with original sizing instrument. Then, the pericardium was trimmed with the original template. Three cusps were sutured to each annulus. Peak pressure gradient averaged to 66.0 ± 28.2 mmHg preoperatively, and decreased to 23.4 ± 10.7, 13.8 ± 5.5 and 13.3 ± 2.3 mmHg, 1 week, 1 year, and 3 years after the operation, respectively. No calcification was detected with echocardiographic follow-up. Recurrence of AR was not recorded with the mean follow-up of 847 days except for 1 case reoperated on for infective endocarditis 2.5 years after the operation. Three hospital deaths were recorded due to non-cardiac causes. Other patients were in good condition. There was no thromboembolic event. Medium-term results are excellent. Since warfarin for dialysis patients becomes problematic, a postoperative warfarin-free status is desirable. Aortic valve reconstruction can provide patients with a better quality of life without warfarin.

  1. Aortic valve reconstruction with autologous pericardium for dialysis patients†

    Science.gov (United States)

    Kawase, Isamu; Ozaki, Shigeyuki; Yamashita, Hiromasa; Uchida, Shin; Nozawa, Yukinari; Matsuyama, Takayoshi; Takatoh, Mikio; Hagiwara, So

    2013-01-01

    OBJECTIVES This study aimed to report on original aortic valve reconstruction for patients on dialysis. METHODS Aortic valve reconstruction has been performed on 404 cases from April 2007 through September 2011. Among them, 54 cases on haemodialysis were retrospectively studied. Forty-seven patients had aortic stenosis, 5 had aortic regurgitation (AR), and 2 had infective endocarditis. Mean age was 70.2 ± 8.5 years. There were 35 males and 19 females. There were 27 primary aortic valve reconstructions, 11 with CABG, 6 with ascending aortic replacement, 5 with mitral valve repair and 4 with maze. First, in the procedure, harvested pericardium was treated with 0.6% glutaraldehyde solution. After resecting the cusps, we measured the distance between commissures with original sizing instrument. Then, the pericardium was trimmed with the original template. Three cusps were sutured to each annulus. RESULTS Peak pressure gradient averaged to 66.0 ± 28.2 mmHg preoperatively, and decreased to 23.4 ± 10.7, 13.8 ± 5.5 and 13.3 ± 2.3 mmHg, 1 week, 1 year, and 3 years after the operation, respectively. No calcification was detected with echocardiographic follow-up. Recurrence of AR was not recorded with the mean follow-up of 847 days except for 1 case reoperated on for infective endocarditis 2.5 years after the operation. Three hospital deaths were recorded due to non-cardiac causes. Other patients were in good condition. There was no thromboembolic event. CONCLUSIONS Medium-term results are excellent. Since warfarin for dialysis patients becomes problematic, a postoperative warfarin-free status is desirable. Aortic valve reconstruction can provide patients with a better quality of life without warfarin. PMID:23427312

  2. Perceval S aortic valve implantation in an achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    Nikolaos G Baikoussis

    2016-01-01

    Full Text Available Despite cardiovascular disease in patients with dwarfism is not rare; there is a lack of reports referring to cardiac interventions in such patients. Dwarfism may be due to achondroplasia or hormonal growth disorders. We present a 58-year-old woman with episodes of dyspnea for several months. She underwent on transthoracic echocardiography, and she diagnosed with severe aortic valve stenosis. She referred to our department for surgical treatment of this finding. In accordance of her anthropometric characteristics and her very small aortic annulus, we had the dilemma of prosthesis selection. We decided to implant a stentless valve to optimize her effective orifice area. Our aim is to present the successful Perceval S valve implantation and the descriptions of the problems coming across in operating on these special patients. To our knowledge, this is the first case patient in which a Perceval S valve is implanted according to the international bibliography.

  3. A Quantitative Study of Simulated Bicuspid Aortic Valves

    Science.gov (United States)

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

    2010-11-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  5. Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation

    Energy Technology Data Exchange (ETDEWEB)

    Stolzmann, Paul; Desbiolles, Lotus; Scheffel, Hans; Leschka, Sebastian; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Knight, Joseph; Kurtcuoglu, Vartan; Poulikakos, Dimos [Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich (Switzerland); Maier, Willibald [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); Plass, Andre [University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland)

    2009-06-15

    Detailed knowledge of aortic root geometry is a prerequisite to anticipate complications of transcatheter aortic valve (TAV) implantation. We determined coronary ostial locations and aortic root dimensions in patients with aortic stenosis (AS) and compared these values with normal subjects using computed tomography (CT). One hundred consecutive patients with severe tricuspid AS and 100 consecutive patients without valvular pathology (referred to as the controls) undergoing cardiac dual-source CT were included. Distances from the aortic annulus (AA) to the left coronary ostium (LCO), right coronary ostium (RCO), the height of the left coronary sinus (HLS), right coronary sinus (HRS), and aortic root dimensions [diameters of AA, sinus of Valsalva (SV), and sino-tubular junction(STJ)] were measured. LCO and RCO were 14.9 {+-} 3.2 mm (8.2-25.9) and 16.8 {+-} 3.6 mm (12.0-25.7) in the controls, 15.5 {+-} 2.9 mm (8.8-24.3) and 17.3 {+-} 3.6 mm (7.3-26.0) in patients with AS. Controls and patients with AS had similar values for LCO (P = 0.18), RCO (P = 0.33) and HLS (P = 0.88), whereas HRS (P < 0.05) was significantly larger in patients with AS. AA (r = 0.55,P < 0.001), SV (r = 0.54,P < 0.001), and STJ (r = 0.52,P < 0.001) significantly correlated with the body surface area in the controls; whereas no correlation was found in patients with AS. Patients with AS had significantly larger AA (P < 0.01) and STJ (P < 0.01) diameters when compared with the controls. In patients with severe tricuspid AS, coronary ostial locations were similar to the controls, but a transverse remodelling of the aortic root was recognized. Owing to the large distribution of ostial locations and the dilatation of the aortic root, CT is recommended before TAV implantation in each patient. (orig.)

  6. Percutaneous balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation: a narrative review.

    Science.gov (United States)

    Keeble, Thomas R; Khokhar, Arif; Akhtar, Mohammed Majid; Mathur, Anthony; Weerackody, Roshan; Kennon, Simon

    2016-01-01

    The role of percutaneous balloon aortic valvuloplasty (BAV) in the management of severe symptomatic aortic stenosis has come under the spotlight following the development of the transcatheter aortic valve implantation (TAVI) technique. Previous indications for BAV were limited to symptom palliation and as a bridge to definitive therapy for patients undergoing conventional surgical aortic valve replacement (AVR). In the TAVI era, BAV may also be undertaken to assess the 'therapeutic response' of a reduction in aortic gradient in borderline patients often with multiple comorbidities, to assess symptomatic improvement prior to consideration of definitive TAVI intervention. This narrative review aims to update the reader on the current indications and practical techniques involved in undertaking a BAV procedure. In addition, a summary of the haemodynamic and clinical outcomes, as well as the frequently encountered procedural complications is presented for BAV procedures conducted during both the pre-TAVI and post-TAVI era.

  7. Carotid artery access for transcatheter aortic valve replacement.

    Science.gov (United States)

    Guyton, Robert A; Block, Peter C; Thourani, Vinod H; Lerakis, Stamatios; Babaliaros, Vasilis

    2013-10-01

    We report three patients who had successful transcatheter aortic valve replacement (TAVR) via carotid artery access. None were candidates for thoracotomy (including minimal access incisions) and had no other vascular access sites that would accommodate the transcatheter valve sheath. Antegrade carotid perfusion and retrograde insertion of the delivery sheath maintained cerebral blood flow without sequelae. Carotid access for TAVR is an option for unusual patients without other access. Copyright © 2012 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2016-06-01

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

  9. [New technique of concomitant replacement of the aortic valve and the ascending aorta with enlargement of the aortic annulus for congenital bicuspid aortic valve].

    Science.gov (United States)

    Takahara, Shingo; Fukasawa, Manabu; Kawahara, Yu; Suzuki, Kotaro; Kobayashi, Yuriko

    2012-12-01

    Congenital bicuspid aortic valve (BAV) is one of the most common congenital heart diseases, with a high incidence of associated valvular lesions and aortic abnormalities including aortic stenosis( AS), aortic regurgitation, aortic dilatation, and aortic dissection. Patients with BAV and AS often have a small aortic annulus. We encountered a case of BAV in which a 51-year-old woman with severe AS having a small aortic annulus and a dilated ascending aorta required surgical intervention. We performed the surgery using new technique that involved concomitant replacement of the aortic valve and the ascending aorta with enlargement of the aortic annulus using a single uniquely-shaped graft to avoid prosthesis patient mismatch. We trimmed the proximal end of the straight graft in shape of 2 teardrops hanging on it to fit the cut annulus. It requires only a single suture line to replace the ascending aorta and enlarge the aortic annulus, which entails a decreased risk of bleeding during surgery. We believe that it could be applicable to many cases requiring concomitant surgery.

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

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

  11. Non-infectious Pseudoaneurysm of Ascending Aorta Following Redo-Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Nozari Younes

    2009-05-01

    Full Text Available A 46 year old man had been undergone Aortic valve replacement (AVR due to mechanical aortic valve endocarditis two month ago. He was referred to Imam Khomeini hospital because of dyspnea since two weeks ago. Echocardiography showed the false aneurysm, with an area of flow beyond the lumen of the aorta. This patient underwent reoperation, the previously implanted aortic valve was removed, meticulous debridement was performed in aortic valve annulus and adjacent part of the ascending aorta, and aortic valve and root replacement were performed.

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

    Energy Technology Data Exchange (ETDEWEB)

    Schuhbaeck, Annika, E-mail: annika.schuhbaeck@uk-erlangen.de [Department of Cardiology, University of Erlangen, Erlangen (Germany); Weingartner, Christina [Department of Cardiology, University of Gießen, Giessen (Germany); Arnold, Martin; Schmid, Jasmin; Pflederer, Tobias; Marwan, Mohamed [Department of Cardiology, University of Erlangen, Erlangen (Germany); Rixe, Johannes; Nef, Holger [Department of Cardiology, University of Gießen, Giessen (Germany); Schneider, Christian [Department of Radiology, University of Gießen, Giessen (Germany); Lell, Michael; Uder, Michael [Department of Radiology, University of Erlangen, Erlangen (Germany); Ensminger, Stephan [Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen (Germany); Feyrer, Richard; Weyand, Michael [Department of Cardiothoracic Surgery, University of Erlangen, Erlangen (Germany); Achenbach, Stephan [Department of Cardiology, University of Erlangen, Erlangen (Germany)

    2015-07-15

    Highlights: • Post-implant geometry of catheter-based aortic valve prostheses is influenced by aortic valve calcification. • Balloon-expandable prostheses are more circular as compared to self-expanding prostheses. • The impact of post-implant geometry on valve function needs to be investigated. - Abstract: Introduction: The geometry of the aortic annulus and implanted transcatheter aortic valve prosthesis might influence valve function. We investigated the influence of valve type and aortic valve calcification on post-implant geometry of catheter-based aortic valve prostheses. Methods: Eighty consecutive patients with severe aortic valve stenosis (mean age 82 ± 6 years) underwent computed tomography before and after TAVI. Aortic annulus diameters were determined. Influence of prosthesis type and degree of aortic valve calcification on post-implant eccentricity were analysed. Results: Aortic annulus eccentricity was reduced in patients after TAVI (0.21 ± 0.06 vs. 0.08 ± 0.06, p < 0.0001). Post-TAVI eccentricity was significantly lower in 65 patients following implantation of a balloon-expandable prosthesis as compared to 15 patients who received a self-expanding prosthesis (0.06 ± 0.05 vs. 0.15 ± 0.07, p < 0.0001), even though the extent of aortic valve calcification was not different. After TAVI, patients with a higher calcium amount retained a significantly higher eccentricity compared to patients with lower amounts of calcium. Conclusions: Patients undergoing TAVI with a balloon-expandable prosthesis show a more circular shape of the implanted prosthesis as compared to patients with a self-expanding prosthesis. Eccentricity of the deployed prosthesis is affected by the extent of aortic valve calcification.

  13. TCT-670 Optimal Transcatheter Heart Valve Sizing in Aortic Valve in Valve Implantation: Insights from the Valve in Valve International Data (VIVID) Registry

    DEFF Research Database (Denmark)

    Alnasser, Sami; Cheema, Asim N; Horlick, Eric

    2016-01-01

    Background: Optimal transcatheter heart valve (THV) sizing is crucial to optimize procedural outcomes. Larger THV oversizing is shown to decrease paravalvular leakage post transcatheter aortic valve replacement but its role in Valve in Valve implantation (ViV) is not well established. Methods...... group received a larger THV (25.5± 1.4 mm vs. 23.3 ± 1.0 mm, pimplantation, the oversized group achieved a larger EOA (1.54±0.4cm2 vs. 1.37± 0.5cm2, p...V implantation was associated with favorable post-implant EOA and gradient but a higher risk of aortic insufficiency and THV re-intervention. Further exploration within various THV and surgical valve types at different degree of THV oversizing is planned....

  14. Guidelines for sizing pericardium for aortic valve leaflet grafts

    Science.gov (United States)

    Hammer, Peter E.; del Nido, Pedro J.

    2013-01-01

    Surgical repair of the aortic valve using leaflet grafts made from pericardium has been shown to be a viable option, particularly in children, in whom valve replacement has strong disadvantages. We present guidelines for sizing treated autologous pericardium to fabricate a leaflet graft for single leaflet replacement. Both our clinical experience and experimental evidence indicate that effective repairs are best achieved using a semicircular graft with diameter 10–15% greater than the sinotubular junction diameter in diastole. We also provide a simple formula to allow adjusting these guidelines to account for variation in valve geometry and tissue properties. PMID:23816114

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

    Institute of Scientific and Technical Information of China (English)

    Hakan Erkan; kr elik; Engin Hatem; Mustafa Tark Aa; Levent Korkmaz; Teyyar Gkdeniz; Ahmet arAykan; Ezgi Kalaycolu; Faruk Boyac; mer Faruk rakolu

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Computational Model of Aortic Valve Surgical Repair using Grafted Pericardium

    Science.gov (United States)

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

    2012-01-01

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

  18. Aortic valve disease : novel imaging insights from diagnosis to therapy

    NARCIS (Netherlands)

    Ewe, See Hooi

    2016-01-01

    The general introduction of this thesis outlines the epidemiology and the impact of aortic valve disease in the western world. The thesis further discusses the current and future role of advanced cardiac imaging modalities, using 3D echocardiography and speckle tracking echocardiography strain imagi

  19. Ruptured aortic valve cusp: a complication of the Heimlich maneuver.

    Science.gov (United States)

    Chapman, J H; Menapace, F J; Howell, R R

    1983-07-01

    A case of traumatic rupture of the aortic valve as a complication of the Heimlich maneuver is presented. Conformation was made by comparative echocardiographic studies available from three months before and immediately following the incident. The patient refused surgical intervention and died one month later with severe congestive heart failure despite vigorous medical therapy.

  20. Bicuspid aortic valve hemodynamics: a fluid-structure interaction study

    Science.gov (United States)

    Chandra, Santanu; Seaman, Clara; Sucosky, Philippe

    2011-11-01

    The bicuspid aortic valve (BAV) is a congenital defect in which the aortic valve forms with two leaflets instead of three. While calcific aortic valve disease (CAVD) also develops in the normal tricuspid aortic valve (TAV), its progression in the BAV is more rapid. Although studies have suggested a mechano-potential root for the disease, the native BAV hemodynamics remains largely unknown. This study aimed at characterizing BAV hemodynamics and quantifying the degree of wall-shear stress (WSS) abnormality on BAV leaflets. Fluid-structure interaction models validated with particle-image velocimetry were designed to predict the flow and leaflet dynamics in idealized TAV and BAV anatomies. Valvular function was quantified in terms of the effective orifice area. The regional leaflet WSS was characterized in terms of oscillatory shear index, temporal shear magnitude and temporal shear gradient. The predictions indicate the intrinsic degree of stenosis of the BAV anatomy, reveal drastic differences in shear stress magnitude and pulsatility on BAV and TAV leaflets and confirm the side- and site-specificity of the leaflet WSS. Given the ability of abnormal fluid shear stress to trigger valvular inflammation, these results support the existence of a mechano-etiology of CAVD in the BAV.

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

    Science.gov (United States)

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

    2006-09-01

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

  2. Transcatheter aortic valve implantation in patients with severe aortic valve stenosis and large aortic annulus, using the self-expanding 31-mm Medtronic CoreValve prosthesis: first clinical experience.

    Science.gov (United States)

    Nijhoff, Freek; Agostoni, Pierfrancesco; Amrane, Hafid; Latib, Azeem; Testa, Luca; Oreglia, Jacopo A; De Marco, Federico; Samim, Mariam; Bedogni, Francesco; Maisano, Francesco; Bruschi, Giuseppe; Colombo, Antonio; Van Boven, Ad J; Stella, Pieter R

    2014-08-01

    With the introduction of the 31-mm Medtronic CoreValve prosthesis, patients with large aortic annulus have become eligible for transcatheter aortic valve implantation. The aim of this study was to evaluate the feasibility, efficacy, and safety of transcatheter aortic valve implantation using the 31-mm Medtronic CoreValve in patients with severe aortic valve stenosis and large aortic annulus. Five institutions in the Netherlands and Italy participated in a retrospective multicenter registry. Clinical, procedural, and imaging data of patients treated with the 31-mm Medtronic CoreValve were retrospectively collected in accordance with the Valve Academic Research Consortium-2 criteria. Between August 2011 and November 2012, 47 patients (44 men, mean age 77.6 ± 8.9 years) received the 31-mm Medtronic CoreValve prosthesis for severe aortic stenosis. Device success (correct positioning of a single valve with intended performance and no all-cause 30-day mortality) was achieved in 31 patients (66.0%). Reasons for failing the device success criteria were significant prosthetic aortic regurgitation in 3 patients (6.4%), second valve implantation in 10 patients (21.2%) (8 cases of malpositioning with high-grade aortic regurgitation, 1 acute valve dislocation, and 1 delayed valve dislocation), 1 of whom died intrahospital, and in-hospital mortality in a further 3 patients (6.4%). Peak and mean transaortic gradients decreased significantly (P Medtronic CoreValve seemed to be challenging, even in experienced hands. If the prosthesis is properly implanted, it offers adequate valve hemodynamics and proper functioning. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  3. Transcatheter aortic valve replacement (TAVR): access planning and strategies.

    Science.gov (United States)

    Ramlawi, Basel; Anaya-Ayala, Javier E; Reardon, Michael J

    2012-01-01

    Transcatheter aortic valve replacement (TAVR) has proven to be a viable tool for the high-surgical-risk population with severe aortic valve stenosis. Vascular access complications are not uncommon with TAVR and may increase early and late mortality. Avoiding these serious complications is the goal. With experience and careful screening, we are now able to risk-stratify patients who may be at increased risk of vascular complications. While the traditional iliofemoral access site remains the most common for TAVR, alternate access sites that have proven to be viable and safe alternatives include the transapical, direct-aortic, and subclavian techniques. TAVR teams should be familiar and comfortable with these approaches as each of them has its own advantages and weaknesses. The best option is usually one in which the procedure is tailored to the patient. The present review examines our current access planning and strategies for TAVR.

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

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-08-01

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

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

    Science.gov (United States)

    Kunihara, Takashi

    2016-02-01

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

  6. Acute Right Coronary Ostial Stenosis during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Sarwar Umran

    2012-01-01

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

  7. Successful Thrombolysis of Aortic Prosthetic Valve Thrombosis ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    Standard surgical treatment using cardiopulmonary bypass carries high maternal and fetal ... 35-year-old female patient presented in the first trimester of pregnancy with PVT at aortic position. .... to a greater risk than thrombolytic therapy does,.

  8. Raloxifene attenuates Gas6 and apoptosis in experimental aortic valve disease in renal failure

    Science.gov (United States)

    Abedat, Suzan; Beeri, Ronen; Valitsky, Michael; Daher, Sameh; Kott-Gutkowski, Miriam; Gal-Moscovici, Anca; Sosna, Jacob; Rajamannan, Nalini M.; Lotan, Chaim

    2011-01-01

    Renal failure is associated with aortic valve calcification. Using our rat model of uremia-induced reversible aortic valve calcification, we assessed the role of apoptosis and survival pathways in that disease. We also explored the effects of raloxifene, an estrogen receptor modulator, on valvular calcification. Gene array analysis was performed in aortic valves obtained from three groups of rats (n = 7 rats/group): calcified valves obtained from rats fed with uremic diet, valves after calcification resolution following diet cessation, and control. In addition, four groups of rats (n = 10 rats/group) were used to evaluate the effect of raloxifene in aortic valve calcification: three groups as mentioned above and a fourth group fed with the uremic diet that also received daily raloxifene. Evaluation included imaging, histology, and antigen expression analysis. Gene array results showed that the majority of the altered expressed genes were in diet group valves. Most apoptosis-related genes were changed in a proapoptotic direction in calcified valves. Apoptosis and decreases in several survival pathways were confirmed in calcified valves. Resolution of aortic valve calcification was accompanied by decreased apoptosis and upregulation of survival pathways. Imaging and histology demonstrated that raloxifene significantly decreased aortic valve calcification. In conclusion, downregulation of several survival pathways and apoptosis are involved in the pathogenesis of aortic valve calcification. The beneficial effect of raloxifene in valve calcification is related to apoptosis modulation. This novel observation is important for developing remedies for aortic valve calcification in patients with renal failure. PMID:21335463

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

    Science.gov (United States)

    Wilczek, Krzysztof; Pres, Damian; Krajewski, Adam; Poloński, Lech; Zembala, Marian; Gąsior, Mariusz

    2015-01-01

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

  10. Transaortic aortic valve replacement using the Edwards Sapien-XT Valve and the Medtronic CoreValve: initial experience.

    Science.gov (United States)

    Spargias, Konstantinos; Bouboulis, Nikolaos; Halapas, Antonios; Chrissoheris, Michael; Skardoutsos, Spyridon; Nikolaou, Joulia; Tsolakis, Apostolos; Mourmouris, Christos; Pattakos, Stratis

    2014-01-01

    Transcatheter aortic valve replacement (TAVR) is now an established treatment for certain patients with severe aortic valve stenosis (AS). However, as the number of patients screened for TAVR increases, many are found to have absolutely no option for peripheral artery access. Transaortic valve replacement (TAoVR) has been proposed as a new alternative route in patients deemed unsuitable for conventional approaches. We present our first series of TAoVR cases using the Edwards Sapien-XT and the Medtronic CoreValve prostheses. Twenty-five (25) symptomatic patients (mean age 78 ± 8 years, mean logistic EuroSCORE I 25 ± 11%) with severe AS underwent TAoVR using the Sapien-XT valve (10 patients) or the CoreValve (15 patients). The mean fluoroscopy time was 15.6 ± 4.2 minutes, the mean time in the intensive care unit was 1.9 ± 1.0 days, and the mean hospital stay was 6.4 ± 1.6 days. The mean effective aortic valve area increased (from 0.68 ± 0.15 cm(2) to 1.82 ± 0.34 cm(2), pMedtronic CoreValve prosthesis demonstrated that it could be performed safely, resulting in substantial acute echocardiographic and early clinical improvement.

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

    Directory of Open Access Journals (Sweden)

    Taylan Adademir

    2014-03-01

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

  12. Minimally invasive aortic valve replacement - pros and cons of keyhole aortic surgery.

    Science.gov (United States)

    Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-06-01

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

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

    Science.gov (United States)

    Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    XIA Dongdong; BAI Jing

    2006-01-01

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

  15. 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.

  16. Aortic valve stenosis: non-invasive preoperative evaluation using 64-slice CT angiography.

    Science.gov (United States)

    Ciolina, F; Sedati, P; Zaccagna, F; Galea, N; Noce, V; Miraldi, F; Cavarretta, E; Francone, M; Carbone, I

    2015-10-01

    In patients affected by aortic valve stenosis (AS) it is mandatory to rule out coronary artery disease (CAD). The role of retrospectively ECG-gated 64-slice CT angiography (64-SCTA) was assessed in patients with AS referred for surgical valve replacement. Forty-two patients with AS underwent ECG-gated 64-SCTA of thoracic aorta, including the heart and coronary arteries, before surgical valve replacement. Images were evaluated by two independent readers and compared with surgical findings in terms of aortic valve calcification grading, valvular morphology, aortic valve annulus and sino-tubular junction diameters, and valvular area planimetry. Quantitative evaluation of cusps opening was also performed. Finally, the presence of CAD, thoracic aortic aneurysm and left ventricle hypertrophy were assessed. Visualization of the aortic valve without motion artefacts was possible in 38 patients (90.5%). Valvular morphology was correctly assessed in all cases (100%). 64-SCTA correctly determined aortic valve calcification grading and the aortic valve annulus and sinotubular junction diameters in 100% of cases. The aortic valve planimetric area was assessed in 38 cases (90.5%). Ascending aortic aneurysms requiring surgical replacement were detected in 12 patients (28.6%). Significant left ventricle hypertrophy was found in 30 patients (71%). Preoperative evaluation of patients undergoing surgical replacement for AS with 64-SCTA is feasible. 64-SCTA can rule out CAD and evaluate the status of the aortic valve and thoracic aorta in the same examination, obtaining relevant information for surgical planning.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  18. Sex-Related Discordance Between Aortic Valve Calcification and Hemodynamic Severity of Aortic Stenosis: Is Valvular Fibrosis the Explanation?

    Science.gov (United States)

    Simard, Louis; Côté, Nancy; Dagenais, François; Mathieu, Patrick; Couture, Christian; Trahan, Sylvain; Bossé, Yohan; Mohammadi, Siamak; Pagé, Sylvain; Joubert, Philippe; Clavel, Marie-Annick

    2017-02-17

    Calcific aortic stenosis (AS) is characterized by calcium deposition in valve leaflets. However, women present lower aortic valve calcification loads than men for the same AS hemodynamic severity. We, thus, aimed to assess sex differences in aortic valve fibrocalcific remodeling. One hundred and twenty-five patients underwent Doppler echocardiography and multidetector computed tomography within 3 months before aortic valve replacement. Explanted stenotic tricuspid aortic valves were weighed, and fibrosis degree was determined. Sixty-four men and 39 women were frequency matched for age, body mass index, hypertension, renal disease, diabetes mellitus, and AS severity. Mean age (75±9 years), mean gradient (41±18 mm Hg), and indexed aortic valve area (0.41±0.12 cm(2)/m(2)) were similar between men and women (all P≥0.18). Median aortic valve calcification (1973 [1124-3490] Agatston units) and mean valve weight (2.36±0.99 g) were lower in women compared with men (both Pvalve calcification density correlated better with valve weight in men (r(2)=0.57; Pvalve calcification density, and aortic annulus diameter, female sex was an independent risk factor for higher fibrosis score in AS valves (P=0.003). Picrosirius red staining of explanted valves showed greater amount of collagen fibers (P=0.01), and Masson trichrome staining revealed a greater proportion of dense connective tissue (P=0.02) in women compared with men. In this series of patients with tricuspid aortic valve and similar AS severity, women have less valvular calcification but more fibrosis compared with men. These findings suggest that the pathophysiology of AS and thus potential targets for drug development may be different according to sex. © 2016 American Heart Association, Inc.

  19. Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study.

    Science.gov (United States)

    Sturla, Francesco; Ronzoni, Mattia; Vitali, Mattia; Dimasi, Annalisa; Vismara, Riccardo; Preston-Maher, Georgia; Burriesci, Gaetano; Votta, Emiliano; Redaelli, Alberto

    2016-08-16

    Transcatheter aortic valve implantation (TAVI) can treat symptomatic patients with calcific aortic stenosis. However, the severity and distribution of the calcification of valve leaflets can impair the TAVI efficacy. Here we tackle this issue from a biomechanical standpoint, by finite element simulation of a widely adopted balloon-expandable TAVI in three models representing the aortic root with different scenarios of calcific aortic stenosis. We developed a modeling approach realistically accounting for aortic root pressurization and complex anatomy, detailed calcification patterns, and for the actual stent deployment through balloon-expansion. Numerical results highlighted the dependency on the specific calcification pattern of the "dog-boning" of the stent. Also, local stent distortions were associated with leaflet calcifications, and led to localized gaps between the TAVI stent and the aortic tissues, with potential implications in terms of paravalvular leakage. High stresses were found on calcium deposits, which may be a risk factor for stroke; their magnitude and the extent of the affected regions substantially increased for the case of an "arc-shaped" calcification, running from commissure to commissure. Moreover, high stresses due to the interaction between the aortic wall and the leaflet calcifications were computed in the annular region, suggesting an increased risk for annular damage. Our analyses suggest a relation between the alteration of the stresses in the native anatomical components and prosthetic implant with the presence and distribution of relevant calcifications. This alteration is dependent on the patient-specific features of the calcific aortic stenosis and may be a relevant indicator of suboptimal TAVI results.

  20. High pacing rates for management of aortic insufficiency after balloon aortic valvuloplasty or transcatheter aortic valve replacement.

    Science.gov (United States)

    Ali, Omar; Salinger, Michael H; Levisay, Justin P; Feldman, Ted

    2014-01-01

    Aortic insufficiency (AI) after transcatheter aortic valve replacement (TAVR) is difficult to manage when associated with congestive heart failure. AI after balloon aortic valvuloplasty (BAV) may be catastrophic, especially in patients who are not candidates for TAVR. We describe the use of urgent temporary pacing, followed by permanent pacing, to increase the heart rate to diminish diastolic filling time for the short term management of AI after BAV or TAVR. The strategy is particularly useful in patients who already have permanent pacemakers, which are common in this population.

  1. Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time.

    Science.gov (United States)

    Gersak, Borut; Sutlic, Zeljko

    2002-01-01

    the selected high risk patients or to minimize the deleterious effects of cardiopulmonary bypass (CPB) on the overall postoperative performance [Calafiore 1996, Tasdemir 1998]. Due to the fact, that the cardiac muscle should be protected at most during the cardiac arrest, retrograde blood cardioplegia was successfully introduced [Buckberg 1990], and more - the warm cardioplegia is being used recently [Kawasuji 1997]. The natural status of the human heart is the beating status, so it is reasonable to try to perform the operations on the beating heart. This has been done recently with the MID - CAB and OP - CAB (off-pump CABG) operations [Tasdemir 1998]. The retrograde warm blood cardioplegia has therefore led us to the premise, that with retrograde oxygenated blood perfusion it would be possible to achieve the operations on the beating heart even in the open heart surgery, such as aortic and/or mitral valve surgery. All will agree that the most damaging effect of the cardioplegia is the reperfusion injury [Allen 1997], and it is obvious that with the technique of retrograde continuous oxygenated blood perfusion this effect will be canceled. In this article, we would like to show the how-to technique for the operations on the beating heart in the case of operations on the aortic valve replacement (AVR) with mitral valve repair (MVR) or replacement MVR and with/without concomitant coronary artery bypass (CABG) surgery. The tricuspid valve repair (PTV) is normally done on the beating heart and there it is realized what problems or technical difficulties may arise during procedures on the mitral valve: the walls of the ventricles are not flattened and the exposure of the mitral valve is challenging task. Furthermore, the free walls of the ventricles with interventricular septum are in the state of the tonus, so every force applied to better expose the aortic or mitral valve is not acceptable

  2. Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices.

    Science.gov (United States)

    Pal, Jay D; McCabe, James M; Dardas, Todd; Aldea, Gabriel S; Mokadam, Nahush A

    2016-10-01

    The development of new aortic insufficiency after a period of support with a left ventricular assist device can result in progressive heart failure symptoms. Transcatheter aortic valve repair can be an effective treatment in selected patients, but the lack of aortic valve calcification can result in unstable prostheses or paravalvular leak. We describe a technique of deploying a self-expanding CoreValve (Medtronic, Minneapolis, MN, USA) into the aortic annulus, followed by a balloon-expandable SAPIEN-3 (Edwards, Irvine, CA, USA).

  3. RAGE deficiency alleviates aortic valve calcification in ApoE(-/-) mice via the inhibition of endoplasmic reticulum stress.

    Science.gov (United States)

    Wang, Bo; Cai, Zhejun; Liu, Baoqing; Liu, Zongtao; Zhou, Xianming; Dong, Nianguo; Li, Fei

    2017-03-01

    Receptor for advanced glycation end products (RAGE) and endoplasmic reticulum (ER) stress have been shown to be involved in calcific aortic valve disease (CAVD). However, the association between RAGE and ER stress remains unknown in the pathogenesis of CAVD. The current study aims to test the hypothesis that RAGE deficiency alleviates aortic valve calcification via the inhibition of ER stress. Up-regulation of RAGE and ER stress markers in calcified human aortic valves were confirmed by immunoblotting. Aortic valve calcification was evaluated in atherosclerotic prone ApoE(-/-) mice or in mice with dual deficiencies of ApoE and RAGE (ApoE(-/-)RAGE(-/-)) fed with high cholesterol diet for 24weeks. Echocardiography and histological examination show that genetic deficiency of RAGE attenuates aortic valve calcification in ApoE(-/-) mice. Meanwhile, RAGE deficiency inhibited the osteogenic signaling and ER stress activation as well as suppressed macrophage infiltration in vivo. Cultured human aortic valve interstitial cells (AVICs) were treated with high molecular group box 1 protein (HMGB1) as in vitro model. We found that HMGB1 induced osteoblastic differentiation and calcification through RAGE/ER stress. Furthermore, Sox9 up-regulation and intranuclear translocation mediated the pro-osteogenic effect of HMGB1 on AVICs. RAGE or ER stress knockdown reduced the up-regulation of monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-α (TNF-α) in human AVICs exposed to HMGB1.These novel findings demonstrate that RAGE deficiency protects against aortic valve calcification in high cholesterol diet-fed ApoE(-/-) mice via inhibition of ER stress. HMGB1 induces AVIC osteoblastic differentiation and calcification through RAGE/ER stress/Sox9 pathway. Copyright © 2016. Published by Elsevier B.V.

  4. Risk Factors for Late Aortic Valve Dysfunction After the David V Valve-Sparing Root Replacement.

    Science.gov (United States)

    Esaki, Jiro; Leshnower, Bradley G; Binongo, Jose N; Lasanajak, Yi; McPherson, LaRonica; Guyton, Robert A; Chen, Edward P

    2017-06-29

    Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. However, late aortic valve dysfunction requiring reoperation remains a primary concern of this procedure. This study examines risk factors for late aortic insufficiency (AI) and aortic stenosis (AS) after David V VSRR. A retrospective review from 2005 to 2015 at a US academic center identified 282 patients who underwent VSRR. Cox proportional hazards regression analysis was used to identify risk factors for late AI and AS after VSRR. The mean age was 46.4 years. Sixty-four patients (22.7%) had bicuspid valves, and 41 patients (14.5%) had Marfan syndrome. The incidence of reoperations was 27 (9.6%), and 42 cases (14.9%) presented with acute type A dissection. Operative mortality was 8 (2.8%). Seven-year survival was 90.9%. Seven-year cumulative incidence of reoperation, greater than 2+ AI and greater than moderate AS were 3.1%, 2.2%, and 0.8%, respectively. Multivariable analysis showed aortic root size 55 mm or larger (hazard ratio 3.44, 95% confidence interval: 1.27 to 9.29, p = 0.01) to be a risk factor for late AI whereas bicuspid valve (hazard ratio 16.07, 95% confidence interval: 3.12 to 82.68, p = 0.001) and cusp repair were found to be risk factors (hazard ratio 5.91, 95% confidence interval: 1.17 to 29.86, p = 0.03) for late AS. Valve-sparing root replacement can be performed with low operative risk and good overall long-term survival even in complex clinical settings. Durable valve function can be expected; however, aortic root size 55 cm or more, bicuspid valve anatomy, and cusp repair represent independent risk factors for late aortic valve dysfunction after these procedures. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-06-24

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

  6. Comparison of complete versus incomplete stent frame expansion after transcatheter aortic valve implantation with Medtronic CoreValve bioprosthesis.

    Science.gov (United States)

    Jilaihawi, Hasan; Chin, Derek; Spyt, Tomasz; Jeilan, Mohamed; Vasa-Nicotera, Mariuca; Mohamed, Noor; Bence, Johan; Logtens, Elaine; Kovac, Jan

    2011-06-15

    We sought to determine the significance of incomplete stent frame expansion after transcatheter aortic valve implantation with the Medtronic-CoreValve device. Incomplete coronary stent expansion is a well-described phenomenon. Transcatheter valves are mounted on stents; however, the incidence of incomplete stent expansion after transcatheter aortic valve implantation, its sequelae and predictors are poorly elucidated. The 18Fr CoreValve revalving system was used to treat anatomically and clinically suitable patients with severe calcific aortic stenosis. The postdeployment stent dimensions were measured on fluoroscopic images at multiple levels of the stent frame. Incomplete expansion at each was defined as Medtronic-CoreValve at a single center from January 2007 to December 2008. For the inflow portion, incomplete expansion was seen in 54% of patients and was unrelated to the aortic valve area, peak or mean aortic valve gradients, or measures of aortic regurgitation, although it was paradoxically associated with a lower incidence of prosthesis-patient mismatch. Incomplete expansion of the constrained portion was seen in 62% of the patients and displayed a trend toward a greater incidence of aortic regurgitation grade 2 or greater, although this was rare. Incomplete expansion of the Medtronic CoreValve stent frame is common. For the most part, valvular hemodynamic function was satisfactory, regardless of the degree of expansion of the stent frame that carries it and a strategy of reluctant postdilation in the context of incomplete stent frame expansion was supported. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Aortic Valve Replacement in Young Adults

    NARCIS (Netherlands)

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

    2007-01-01

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

  8. Do all critical aortic stenosis with chest pain need aortic valve replacement? A case report

    Directory of Open Access Journals (Sweden)

    Munish Sharma

    2016-11-01

    Full Text Available Aortic valve replacement (AVR remains the cornerstone of treatment for symptomatic critical aortic stenosis (AS. It is a Class I indication that symptomatic patients with critical AS undergo either surgical or transcatheter aortic valve replacement (TAVR. We present a patient with critical AS and new angina that was managed successfully with percutaneous coronary intervention (PCI of the Right coronary artery. Physicians should consider that not all patients with critical AS and angina necessarily require AVR. Concomitant pathology leading to the symptoms should be carefully ruled out. This leads to a less invasive, cost effective care plan especially in patients with advanced age and comorbidities for which any type of surgical valvular intervention may pose high risk.

  9. Prosthetic valve endocarditis 7 months after transcatheter aortic valve implantation diagnosed with 3D TEE.

    Science.gov (United States)

    Sarı, Cenk; Durmaz, Tahir; Karaduman, Bilge Duran; Keleş, Telat; Bayram, Hüseyin; Baştuğ, Serdal; Özen, Mehmet Burak; Bayram, Nihal Akar; Bilen, Emine; Ayhan, Hüseyin; Kasapkara, Hacı Ahmet; Bozkurt, Engin

    2016-01-01

    Transcatheter aortic valve implantation (TAVI) was introduced as an alternative treatment for patients with severe symptomatic aortic stenosis for whom surgery would be high-risk. Prosthetic aortic valve endocarditis is a serious complication of surgical AVR (SAVR) with high morbidity and mortality. According to recent cases, post-TAVI prosthetic valve endocarditis (PVE) seems to occur very rarely. We present the case of a 75-year-old woman who underwent TAVI (Edwards Saphien XT) with an uneventful postoperative stay. She was diagnosed with endocarditis using three dimensional (3D) echocardiography on the TAVI device 7 months later and she subsequently underwent surgical aortic valve replacement. Little experience of the interpretation of transoesophageal echocardiography (TEE) and the clinical course and effectiveness of treatment strategies in post-TAVI endocarditis exists. We report a case of PVE in a TAVI patient which was diagnosed with three-dimensional transoesophageal echocardiography (3DTEE). Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

  10. Transcatheter Aortic Valve Replacement in a Patient With a Previous Bioprosthetic Mitral Valve Replacement: Report of a Delayed Fatal Interaction.

    Science.gov (United States)

    Poulin, Frédéric; Lamarche, Yoan; Le, Van Hoai Viet; Doucet, Michel; Roméo, Philippe; Généreux, Philippe

    2016-02-01

    We report on a man with bioprosthetic mitral valve perforation who presented late after transcatheter aortic valve replacement with a balloon-expandable transcatheter heart valve (THV). The protrusion of the commissural strut of the bioprosthetic mitral valve coupled with the low implanted THV resulted in repetitive trauma leading to rupture of a mitral leaflet. Potential preventive strategies are discussed. This case illustrates the importance of preprocedural imaging screening and cautious THV deployment in patients with a bioprosthetic mitral valve.

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

    Science.gov (United States)

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

    1998-12-01

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

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

    Science.gov (United States)

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

    2015-04-01

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

  13. Relation of thoracic aortic and aortic valve calcium to coronary artery calcium and risk assessment.

    Science.gov (United States)

    Wong, Nathan D; Sciammarella, Maria; Arad, Yadon; Miranda-Peats, Romalisa; Polk, Donna; Hachamovich, Rory; Friedman, John; Hayes, Sean; Daniell, Anthony; Berman, Daniel S

    2003-10-15

    Aortic calcium, aortic valve calcium (AVC), and coronary artery calcium (CAC) have been associated with cardiovascular event risk. We examined the prevalence of thoracic aortic calcium (TAC) and AVC in relation to the presence and extent of CAC, cardiovascular risk factors, and estimated risk of coronary heart disease (CHD). In 2,740 persons without known CHD aged 20 to 79 years, CAC was assessed by electron beam- or multidetector-computed tomography. We determined the prevalence of TAC and AVC in relation to CAC, CHD risk factors, and predicted 10-year risk of CHD. A close correspondence of TAC and AVC was observed with CAC. TAC and AVC increased with age; by the eighth decade of life, the prevalence of TAC was similar to that of CAC (>80%), and 36% of men and 24% of women had AVC. Age, male gender, and low-density lipoprotein cholesterol were directly related to the likelihood of CAC, TAC, and AVC; higher diastolic blood pressure and cigarette smoking additionally predicted CAC. Body mass index and higher systolic and lower diastolic blood pressures were also related to TAC, and higher body mass index and lower diastolic blood pressure were related to AVC. Calculated risk of CHD increased with the presence of AVC and TAC across levels of CAC. TAC and AVC provided incremental value over CAC in association with the 10-year calculated risk of CHD. If longitudinal studies show an incremental value of aortic and aortic valve calcium over that of CAC for prediction of cardiovascular events, future guidelines for risk assessment incorporating CAC assessment may additionally incorporate the measurement of aortic and/or aortic valve calcium.

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

    Directory of Open Access Journals (Sweden)

    Ender Sener

    2013-10-01

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

  15. [Dehiscence of the Pericardial Patch, after Surgical Treatment of Active Infective Aortic Valve Endocarditis with Reconstruction of the Aortic Annulus Using a Glutaraldehyde-treated Autologous Pericardium].

    Science.gov (United States)

    Yoshida, Kazufumi; Fukunaga, Naoto; Koizumi, Shigeki; Nishiya, Kenta; Matsuda, Yasuhiro; Ishigami, Masanosuke; Nagasawa, Atsushi; Sakata, Ryuzo; Koyama, Tadaaki

    2017-03-01

    A 50-year-old man was admitted with fever and chill sensation 6 months ago. Transthoracic echocardiography (TTE) showed left and right coronary cusp prolapses and a thickened tissue of the aortic curtain. Congestive heart failure due to active infective aortic valve endocarditis was diagnosed, and he underwent aortic valve replacement. The aortic annulus was reconstructed using a glutaraldehydetreated autologous pericardium. Six months after surgery, TTE showed severe aortic regurgitation and saccular change in the aortic annulus. Transesophageal echocargiography showed some echo free space from left to noncoronary cusp and abnormal movement of the prosthetic valve annulus. Intraoperative examination showed dehiscence of the pericardial patch from the aortic wall, but no finding of infection. Aortic valve rereplacement was performed with reconstruction of the aortic annulus using a bovine pericardium. To prevent the dehiscence of the pericardial patch from the aortic wall, sutures fixing the prosthetic valve were passed from outside of the aortic wall.

  16. Development of Aortic Valve Disease in Familial Hypercholesterolemic Swine: Implications for Elucidating Disease Etiology.

    Science.gov (United States)

    Porras, Ana M; Shanmuganayagam, Dhanansayan; Meudt, Jennifer J; Krueger, Christian G; Hacker, Timothy A; Rahko, Peter S; Reed, Jess D; Masters, Kristyn S

    2015-10-27

    Familial hypercholesterolemia (FH) is a prevalent hereditary disease associated with increased atherosclerosis and calcific aortic valve disease (CAVD). However, in both FH and non-FH individuals, the role of hypercholesterolemia in the development of CAVD is poorly understood. This study used Rapacz FH (RFH) swine, an established model of human FH, to investigate the role of hypercholesterolemia alone in the initiation and progression of CAVD. The valves of RFH swine have not previously been examined. Aortic valve leaflets were isolated from wild-type (0.25- and 1-year-old) and RFH (0.25-, 1-, 2-, and 3-year-old) swine. Adult RFH animals exhibited numerous hallmarks of early CAVD. Significant leaflet thickening was found in adult RFH swine, accompanied by extensive extracellular matrix remodeling, including proteoglycan enrichment, collagen disorganization, and elastin fragmentation. Increased lipid oxidation and infiltration of macrophages were also evident in adult RFH swine. Intracardiac echocardiography revealed mild aortic valve sclerosis in some of the adult RFH animals, but unimpaired valve function. Microarray analysis of valves from adult versus juvenile RFH animals revealed significant upregulation of inflammation-related genes, as well as several commonalities with atherosclerosis and overlap with human CAVD. Adult RFH swine exhibited several hallmarks of early human CAVD, suggesting potential for these animals to help elucidate CAVD etiology in both FH and non-FH individuals. The development of advanced atherosclerotic lesions, but only early-stage CAVD, in RFH swine supports the hypothesis of an initial shared disease process, with additional stimulation necessary for further progression of CAVD. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  17. Late Paravalvular Aortic Regurgitation: Migration of the Valve or Late Recoil?

    Science.gov (United States)

    Karimi, Ashkan; Pourafshar, Negiin; Park, Ki E; Choi, Calvin Y; Mogali, Kiran; Stinson, Wade W; Manning, Eddie W; Bavry, Anthony A

    2017-01-02

    A 79-year-old man underwent trans-catheter aortic valve replacement for symptomatic severe aortic stenosis with a 26-mm Edwards SAPIEN XT valve. Immediately after valve deployment there was moderate amount of paravalvular leak. Post-dilation was performed with an additional 2 cc of volume, and the paravalvular leak was reduced to trace. Nine months later, trans-thoracic echocardiography revealed moderate to severe paravalvular leak and possible aortic migration of the valve. The patient was brought back for the treatment of the paravalvular leak which was suspected to be due to valve migration. However, fluoroscopy and trans-esophageal echocardiography showed good valve position. Measurement of late valve recoil in the Coplanar view using cine-angiographic analysis software showed that the lower third of the valve had the greatest late recoil (-1.74 mm, 6.55%), which presumably accounted for the progression of the paravalvular leak. Valve-in-valve trans-catheter aortic valve replacement was performed with a 26-mm SAPIEN 3 valve and the paravalvular leak was reduced to trace. This case displays late recoil as a likely mechanism for development of paravalvular leak after SAPIEN XT valve implantation. Our case illustrates that late recoil needs to be systematically evaluated in future studies, especially when trans-catheter aortic valve replacement is being expanded to lower risk and younger patients for whom the longevity and long-term performance of these valves is of critical importance.

  18. Successful treatment by transcatheter aortic valve implantation of severe aortic regurgitation in a patient with ascending aorta prosthesis.

    Science.gov (United States)

    Rossi, Marco Luciano; Bocchi, Roberto; Barbaro, Cristina; Pagnotta, Paolo; Mennuni, Marco; Zavalloni, Dennis; Gasparini, Gabriele; Presbitero, Patrizia

    2013-05-01

    Severe aortic regurgitation (AR), when intervention is required, is managed by surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) has shown non-inferiority to SAVR and superiority to medical management. TAVR could be a valid "off label" option to treat severe AR for patients unsuitable for SAVR due to their high surgical risk. Among aortic pathologies leading to severe AR, those involving the aortic root are considered as high risk procedures and thus prohibit TAVR. For these reasons TAVR is not an option for severe AR due to concomitant aortic root dilatation and degeneration. We report a successful case of TAVR for severe AR due to dilatation of degenerated tract of aortic root.

  19. Three-year outcomes after transcatheter aortic valve implantation with the CoreValve prosthesis.

    Science.gov (United States)

    Gotzmann, Michael; Czauderna, Anna; Hehnen, Tobias; Aweimer, Assem; Lind, Alexander; Kloppe, Axel; Bösche, Leif; Mügge, Andreas; Ewers, Aydan

    2014-08-15

    There is little known about the long-term results of the CoreValve prosthesis. The aim of this study was to assess the 3-year clinical and hemodynamic outcomes of the CoreValve prosthesis. One hundred fifty consecutive patients with severe aortic stenosis successfully underwent transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis. The primary study end point was death from any cause after TAVI. The secondary end points were defined as (1) cardiovascular death and (2) prosthesis-related mortality and morbidity. At 1 to 3 years, all-cause mortality rates were 25%, 32%, and 41%, respectively, and cardiovascular mortality rates were 14%, 21%, and 27%, respectively. Before TAVI, 95% of patients were in New York Heart Association class III or IV. Of the surviving patients, rates of New York Heart Association class III or IV at 1 to 3 years were 33%, 39%, and 38%, respectively. There was an annual decrease of the valve area of approximately 0.1 cm². Aortic restenosis occurred in 2 patients. Moderate or severe aortic regurgitation (AR) occurred in 15% of patients immediately after TAVI. Twenty patients (13%) had a slight worsening of AR within 3 years. New severe AR did not occur. The incidence of prosthesis-related endocarditis was 0.66% per year. Overall, 7 patients (incidence of 1.5% per year) had a clinically relevant problem of the prosthesis. In conclusion, TAVI with the CoreValve prosthesis had favorable effects on symptoms and outcomes even after 3 years. These results are clouded by side effects, such as AR and prosthesis-related mortality and morbidity.

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

    Directory of Open Access Journals (Sweden)

    Nasrien E Ibrahim

    2015-01-01

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

  1. The Perceval S Aortic Valve Implantation in Patients with Porcelain Aorta; is this Ideal Option?

    Science.gov (United States)

    Baikoussis, Nikolaos G; Dedeilias, Panagiotis; Prappa, Efstathia; Argiriou, Michalis

    2017-01-01

    We would like to present in this paper a patient with severe aortic valve stenosis referred to our department for surgical aortic valve replacement. In this patient, it was intraoperatively detected an unexpected heavily calcified porcelain ascending aorta. We present the treatment options in this situation, the difficulties affronted intraoperatively, the significance of the preoperative chest computed tomography scan and the use of the Perceval S aortic valve as ideal bioprosthesis implantation. This is a self-expanding, self-anchoring, and sutureless valve with a wide indication in all patients requiring aortic bioprosthesis. PMID:28074827

  2. Correction of aortic regurgitation after transcatheter aortic valve implantation of the Medtronic CoreValveTM prosthesis due to a too-low implantation, using transcatheter repositioning.

    Science.gov (United States)

    Zahn, Ralf; Schiele, Rudolf; Kilkowski, Caroline; Klein, Bärbel; Zeymer, Uwe; Werling, Christiane; Lehmann, Andreas; Gerckens, Ulrich; Saggau, Werner

    2011-01-01

    Transcatheter aortic valve implantation (TAVI) has been introduced for the treatment of severe symptomatic aortic stenosis in patients not suitable for surgical valve replacement. However, a potential problem of TAVI is the development of severe aortic insufficiency after valve implantation due to a too-low implantation of the valve. Since August 2008, a total of 33 TAVI procedures using the 18 Fr Medtronic CoreValve ReValving system has been performed at the authors' institution. Severe post-implantation aortic regurgitation occurred in three patients (9%), due to a too-low implantation. Two of these patients underwent a catheter-based repositioning of the valve using a standard snare; the third patient declined any further intervention. Both repositioning procedures were uneventful, with no significant residual regurgitation. Severe aortic regurgitation after TAVI with the Medtronic CoreValve system is not uncommon. If the valve is implanted too low, a catheter-based valve repositioning may be the method of choice to resolve the problem.

  3. Quality and Safety in Health Care, Part XXX: Transcatheter Aortic Valve Therapy.

    Science.gov (United States)

    Harolds, Jay A

    2017-08-12

    Initially, the transcatheter aortic valve replacement procedure was approved only for patients with aortic stenosis that was both severe and symptomatic who either also had too high a risk of aortic valve replacement surgery to have the surgery or who had a high risk for the surgery. Between the years 2012 and 2015, the death rate at 30 days declined from an initial rate of 7.5% to 4.6%. There has also been more use of the transfemoral approach over the years. In 2016, the transcatheter aortic valve replacement was approved for patients with aortic stenosis at intermediate risk of surgery.

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

    NARCIS (Netherlands)

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

    2007-01-01

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

  5. Midterm evaluation of hemodynamics of the Top Hat supraannular aortic valve

    DEFF Research Database (Denmark)

    Aagaard, Jan; Nissen, Henrik; Geha, Alexander S

    2010-01-01

    The CarboMedics Top Hat supraannular aortic valve provides an orifice-to-annulus ratio of 1:1 in most patients, and enhances patient outcomes. This study compared the midterm echocardiographic parameters of 52 patients undergoing aortic valve replacement with a Top Hat valve with those in other...... measurements were compared in 38 patients with aortic valve stenosis. Hemodynamic data were comparable to those of other studies, but the Top Hat prosthesis implanted was significantly larger (by a mean of 3.29 mm) than the valve size indicated using an intraannular valve sizer in 48 patients. Mean effective...... orifice area improved significantly from 0.73 cm(2) preoperatively to 2.04 cm(2) postoperatively. In patients with preoperative aortic valve stenosis, postoperative mean peak gradient was significantly reduced. The larger orifice-to-annulus ratio of the Top Hat valve improved hemodynamic parameters...

  6. Prosthetic Aortic Valve Fixation Study: 48 Replacement Valves Analyzed Using Digital Pressure Mapping.

    Science.gov (United States)

    Lee, Candice Y; Wong, Joshua K; Ross, Ronald E; Liu, David C; Khabbaz, Kamal R; Martellaro, Angelo J; Gorea, Heather R; Sauer, Jude S; Knight, Peter A

    Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures. Simulating open and minimally invasive access, 4 surgeons, blinded to data acquisition, each secured 12 valves using manual knot-tying (hand-tied [HT] or knot-pusher [KP]) or automated titanium fasteners (TFs). Real-time pressure measurements and times were recorded. Two-dimensional (2D) and 3D pressure maps were generated for all valves. Pressures less than 80 mm Hg were considered at risk for PVL. Pressures under each knot (intrasuture) fell less than 80 mm Hg for 12 of 144 manual knots (5/144 HT, 7/144 KP) versus 0 of 288 TF (P valves; 17 of 48 HT, 25 of 48 KP, and 12 of 96 TF for 12 × 4-mm valves; and 15 of 36 HT, 17 of 36 KP, and 9 and 72 TF for 9 × 6-mm valves; P manual versus TF. Annular areas with pressures less than 80 mm Hg ranged from 0% of the sewing-ring area (all open TF) to 31% (12 × 4 mm, KP). The average time per manual knot, 46 seconds (HT, 31 seconds; KP, 61 seconds), was greater than TF, 14 seconds (P valve replacement. This research encourages continued exploration of technical factors in optimizing prosthetic valve security.

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

    Science.gov (United States)

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

    2016-06-01

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

  8. Fracturing mechanics before valve-in-valve therapy of small aortic bioprosthetic heart valves

    DEFF Research Database (Denmark)

    Johansen, Peter; Engholt, Henrik; Tang, Mariann

    2017-01-01

    AIMS: Patients with degraded bioprosthetic heart valves (BHV) who are not candidates for valve replacement may benefit from transcatheter valve-in-valve (VIV) therapy. However, at smaller sized surgical BHV the resultant orifice may become too narrow. To overcome this, the valve frame can be frac...

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

    Directory of Open Access Journals (Sweden)

    Dias Altamiro Ribeiro

    2001-01-01

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

  10. Enlargement of the aortic annulus during aortic valve replacement: a review.

    Science.gov (United States)

    Bortolotti, Uberto; Celiento, Michele; Milano, Aldo D

    2014-01-01

    The main goal of aortic valve replacement (AVR) is to obtain relief from the fixed left ventricular (LV) obstruction by replacing the aortic valve with a prosthesis, either mechanical or biological, of adequate size. Most currently available prostheses provide satisfactory hemodynamic performance, but small-sized prostheses may be associated with high transvalvular gradients and suboptimal effective orifice area that result in prosthesis-patient mismatch (PPM), and thus are far from ideal for use in young, active patients. The avoidance of PPM is advisable as it has been repeatedly associated with increased mortality, decreased exercise tolerance and an impaired regression of LV hypertrophy after AVR for severe aortic stenosis. Enlargement of the aortic annulus (EAA) has proved to be a valuable method to prevent PPM in the presence of a diminutive aortic root. This review outlines the various techniques described for EAA, presenting technical details, long-term results and major procedure-related complications, and discussing the current role of EAA in patients requiring AVR.

  11. Aortic allografts in treatment of aortic valve and ascending aorta prosthetic endocarditis

    Directory of Open Access Journals (Sweden)

    S.V. Spiridonov

    2017-03-01

    Full Text Available The aim – to assess short- and long-term results of aortic root replacement using aortic allografts in patients with prosthetic endocarditis. Materials and methods. Since February 2009 until June 2016 aortic valve and ascending aorta replacement using aortic allografts was performed in 26 patients with prosthetic endocarditis. In 50 % of cases at initial operation aortic valve replacement was performed, in another 50 % of cases – aortic valve and ascending aorta replacement. Echocardiography was performed 10 days, 3, 6 and 12 months, 2, 3 and 5 years after surgery. Analysis of long-term results included all cases of deaths, prosthesis-related complications and recurrence of endocarditis. Results. 30-day mortality was 23.1 %. Extracorporeal membranous oxygenation (ECMO was used only in 5 patients (19.2 %. Four patients were weaned from ECMO. We did not observe any allograft-related complications. During follow-up period there were no cases of reoperation due to structural allograft failure. Relapse of infection occurred in 1 patient (3.8 % four years after the operation and led to lethal outcome. Conclusion. Reoperations using allografts are an effective surgical treatment of prosthetic endocarditis. In majority of cases prosthetic endocarditis was caused by gram-positive cocci (Staphylococcus. In 84.6 % of cases it was associated with destruction of paravalvular structures and abscesses formation. Heart failure was a causative factor of different complications in these patients, which required ECMO in 19.2 % of patients. In 80 % of cases patients were weaned from ECMO. Allografts using for the treatment of prosthetic endocarditis is associated with high resistance to infection and with a significant rate of freedom from recurrence of endocarditis within 3 years after surgery.

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  13. Role of transesophageal echocardiography in percutaneous aortic valve replacement with the CoreValve Revalving system.

    Science.gov (United States)

    Berry, Colin; Oukerraj, Latifa; Asgar, Anita; Lamarche, Yoan; Marcheix, Bertrand; Denault, André Y; Laborde, Jean-Claude; Cartier, Raymond; Ducharme, Anique; Bonan, Raoul; Basmadjian, Arsène J

    2008-09-01

    Percutaneous aortic valve replacement (PAVR) is an emerging therapy for nonsurgical patients with severe aortic stenosis (AS). We examined the role of transesophageal echocardiography (TEE) in PAVR. TEE was used initially to assess the native valve and aortic root, and served as a guide during PAVR. Following prosthetic valve deployment, TEE was used to assess valve function. Eleven patients aged 82 +/- 10 years with NYHA III-IV underwent PAVR. Periprocedural TEE gave immediate information on prosthetic position and function, LV function, mitral regurgitation, pericardium, and thoracic aorta anatomy. There was excellent visual agreement between fluoroscopic and TEE images of prosthetic positioning and deployment. TEE facilitated the detection and management of procedure-related complications. Compared with pre-PAVR, AV area (0.56 +/- 0.19 cm(2) vs. 1.3 +/- 0.4 cm(2); P < 0.001) and LVEF (49 +/- 17% vs. 56 +/- 11%; P < 0.001) increased. TEE provides key anatomical and functional information, and serves as a diagnostic guide for complications, which may arise during PAVR.

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

    Science.gov (United States)

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

    2014-12-01

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

  15. Aortic Valve Replacement: Treatment by Sternotomy versus Minimally Invasive Approach

    Directory of Open Access Journals (Sweden)

    Renata Tosoni Rodrigues Ferreira

    Full Text Available Abstract Objective: To compare the results of aortic valve replacement with access by sternotomy or minimally invasive approach. Methods: Retrospective analysis of medical records of 37 patients undergoing aortic valve replacement by sternotomy or minimally invasive approach, with emphasis on the comparison of time of cardiopulmonary bypass and aortic clamping, volume of surgical bleeding, time of mechanical ventilation, need for blood transfusion, incidence of atrial fibrillation, length of stay in intensive care unit, time of hospital discharge, short-term mortality and presence of surgical wound infection. Results: Sternotomy was used in 22 patients and minimally invasive surgery in 15 patients. The minimally invasive approach had significantly higher time values of cardiopulmonary bypass (114.3±23.9 versus 86.7±19.8min.; P=0.003, aortic clamping (87.4±19.2 versus 61.4±12.9 min.; P<0.001 and mechanical ventilation (287.3±138.9 versus 153.9±118.6 min.; P=0.003. No difference was found in outcomes surgical bleeding volume, need for blood transfusion, incidence of atrial fibrillation, length of stay in intensive care unit and time of hospital discharge. No cases of short-term mortality or surgical wound infection were documented. Conclusion: The less invasive approach presented with longer times of cardiopulmonary bypass, aortic clamping and mechanical ventilation than sternotomy, however without prejudice to the length of stay in intensive care unit, time of hospital discharge and morbidity.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    Background:Conventional treatment for patients with severe symptomatic aortic stenosis is surgical aortic valve replacement (SAVR), but transcatheter aortic valve implantation (TAVI) has become a reliable alternative in high-risk patients.Aims:The aim of our study was to describe the post-operati......, predominantly continuous and at rest. We recommend the development of an evidence-based pathway to address the immediate post-operative issues in TAVI patients. Non-pharmacological interventions to prevent pain and promote sleep need to be explored.......-operative patient response to TAVI on the evening of the procedure and the following day before discharge from the coronary care unit. A secondary aim was to compare responses of patients younger and older than 80 years of age.Methods:A prospective, comparative observational study triangulating nurse assessment...... and structured interviews on a cohort of 54 Danish patients: 28/26 male/female, 26/28 younger/older than 80. Mean age in the younger/older group was 73/85 years.Results:After TAVI pain was experienced by 47 (87%) patients; 29 (62%) were restricted by pain, and 24 (44%) had discomfort at the femoral insertion...

  17. Feature identification for image-guided transcatheter aortic valve implantation

    Science.gov (United States)

    Lang, Pencilla; Rajchl, Martin; McLeod, A. Jonathan; Chu, Michael W.; Peters, Terry M.

    2012-02-01

    Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to open-heart surgery, and is critically dependent on imaging for accurate placement of the new valve. Augmented image-guidance for TAVI can be provided by registering together intra-operative transesophageal echo (TEE) ultrasound and a model derived from pre-operative CT. Automatic contour delineation on TEE images of the aortic root is required for real-time registration. This study develops an algorithm to automatically extract contours on simultaneous cross-plane short-axis and long-axis (XPlane) TEE views, and register these features to a 3D pre-operative model. A continuous max-flow approach is used to segment the aortic root, followed by analysis of curvature to select appropriate contours for use in registration. Results demonstrate a mean contour boundary distance error of 1.3 and 2.8mm for the short and long-axis views respectively, and a mean target registration error of 5.9mm. Real-time image guidance has the potential to increase accuracy and reduce complications in TAVI.

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

    Directory of Open Access Journals (Sweden)

    Lisa J Martin

    2011-09-01

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

  19. Association of warfarin therapy duration after bioprosthetic aortic valve replacement with risk of mortality, thromboembolic complications, and bleeding

    DEFF Research Database (Denmark)

    Mérie, Charlotte; Køber, Lars; Skov Olsen, Peter

    2012-01-01

    The need for anticoagulation after surgical aortic valve replacement (AVR) with biological prostheses is not well examined.......The need for anticoagulation after surgical aortic valve replacement (AVR) with biological prostheses is not well examined....

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-04-01

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

  1. [Surgical treatment of traumatic rupture of the aortic valve with dove-coo murmur--case report].

    Science.gov (United States)

    Shigemitsu, O; Hadama, T; Mori, Y; Miyamoto, S; Sako, H; Uchida, Y

    1995-03-01

    Aortic regurgitation due to traumatic rupture of the aortic valve with dove-coo murmur is rare. A 71-year-old man was admitted for cardiac failure due to aortic regurgitation with dove-coo murmur, 4 years after the traffic accident. The aortic valve replacement was performed and his postoperative course was good. The aortic valve was tricuspid valve with the tear in the left side of right coronary cusp, and the size of the tear was 7 mm. The aortic valve was not recognized the findings of inflammatory or rheumatic change in the pathological study.

  2. No clinical effect of prosthesis-patient mismatch after transcatheter versus surgical aortic valve replacement in intermediate- and low-risk patients with severe aortic valve stenosis at mid-term follow-up

    DEFF Research Database (Denmark)

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

    2016-01-01

    OBJECTIVES: Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) for severe aortic valve stenosis (AVS) is common, but less common after transcatheter aortic valve replacement (TAVR) in patients considered at high risk for death after surgery. The objectives of this st...

  3. Computed tomography assessment for transcatheter aortic valve in valve implantation: The vancouver approach to predict anatomical risk for coronary obstruction and other considerations.

    Science.gov (United States)

    Blanke, Philipp; Soon, Jeanette; Dvir, Danny; Park, Jong K; Naoum, Christopher; Kueh, Shaw-Hua; Wood, David A; Norgaard, Bjarne L; Selvakumar, Kapilan; Ye, Jian; Cheung, Anson; Webb, John G; Leipsic, Jonathon

    Valve-in-valve implantation of a transcatheter heart valve into a failed bioprosthetic heart valve has emerged as a treatment alternative to repeat conventional surgery. This requires careful pre-procedural assessment using non-invasive imaging to identify patients at risk for procedure related adverse events, such as ostial coronary occlusion. Herein we report how to comprehensively assess aortic root anatomy using computed tomography prior to transcatheter valve implantation for failed bioprosthetic aortic valves.

  4. Aortic valve replacement with concomitant annular enlargement for small aortic annulus of less than 19 mm.

    Science.gov (United States)

    Takakura, H; Sasaki, T; Hashimoto, K; Hachiya, T; Onoguchi, K; Oshiumi, M; Takeuchi, S

    2000-06-01

    Three female patients with aortic stenosis associated with a severely small annulus underwent aortic valve replacement. In intraoperative measurements, a 19-mm obtulator could not pass through the aortic annulus in each case. We therefore concluded that it would be difficult to implant an appropriate-sized prosthesis in a routine fashion, so we performed an annular enlargement in a modified Nicks procedure. By using a wide teardrop-shaped patch for enlargement and slightly tilting insertion of a prosthesis, a 21 mm bileaflet mechanical prosthesis could be inserted into the enlarged annulus. Despite being a simpler method than other enlarging procedures, a two- or three-sizes larger prosthesis than the native annulus can be inserted with relative ease. Thus, the use of a 19 mm mechanical prosthesis may be avoidable in most adult cases.

  5. Effect of permanent pacemaker on mortality after transcatheter aortic valve replacement

    DEFF Research Database (Denmark)

    Engborg, Jonathan; Riechel-Sarup, Casper; Gerke, Oke

    2017-01-01

    OBJECTIVES: Transcatheter aortic valve implantation (TAVI) is an established treatment for high-grade aortic valve stenosis in patients found unfit for open heart surgery. The method may cause cardiac conduction disorders requiring permanent pacemaker (PPM) implantation, and the long-term effect...

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

    Directory of Open Access Journals (Sweden)

    Masmoudi Sayda

    2000-01-01

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

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

    Science.gov (United States)

    Dimarakis, Ioannis; Grant, Stuart; Kadir, Isaac

    2013-06-01

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

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

    Science.gov (United States)

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

    2013-06-01

    Computational fluid dynamics (CFD) simulations quantifying thoracic aortic flow patterns have not included disturbances from the aortic valve (AoV). 80% of patients with aortic coarctation (CoA) have a bicuspid aortic valve (BAV) which may cause adverse flow patterns contributing to morbidity. Our objectives were to develop a method to account for the AoV in CFD simulations, and quantify its impact on local hemodynamics. The method developed facilitates segmentation of the AoV, spatiotemporal interpolation of segments, and anatomic positioning of segments at the CFD model inlet. The AoV was included in CFD model examples of a normal (tricuspid AoV) and a post-surgical CoA patient (BAV). Velocity, turbulent kinetic energy (TKE), time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) results were compared to equivalent simulations using a plug inlet profile. The plug inlet greatly underestimated TKE for both examples. TAWSS differences extended throughout the thoracic aorta for the CoA BAV, but were limited to the arch for the normal example. OSI differences existed mainly in the ascending aorta for both cases. The impact of AoV can now be included with CFD simulations to identify regions of deleterious hemodynamics thereby advancing simulations of the thoracic aorta one step closer to reality. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  9. [Long-term results of conventional aortic valve replacement for small aortic annulus].

    Science.gov (United States)

    Miura, Y; Miyairi, T; Kitamura, T; Kigawa, I; Fukuda, S

    2006-04-01

    We studied cardiac function, clinical outcome and quality of life (QOL) long after aortic valve replacement for pure aortic stenosis. Forty-four patients in small group [St. Jude Medical (SJM) 17 HP, 19 A], and 69 patients in non-small group (19 HP, 21 A, 23 A) operated on from 1984 to 2004 were enrolled in this study. We assessed the clinical data, aortic pressure gradient, left ventricular mass index (LVMI), and ejection fraction (EF) by preoperative and postoperative echocardiography. Moreover to evaluate QOL after the operation, we performed SF-36 used for the evaluation of health and QOL worldwide. Mean follow-up is 7.1 +/- 4.8 years in small group, and 6.8 +/- 4.6 years in non-small group. There were 2 hospital deaths in small group, and 1 in non-small group. The actual survival rate at 10-year were 89.2% in small group, and 85.6% in non-small group. There was no significant difference in hospital mortality, LVMI, long-term survival rate, and the scores of SF-36 between the 2 groups. The use of small sized prosthetic valves in patients with small aortic annulus might be justified when there is no patient-prosthesis mismatch.

  10. File list: DNS.CDV.50.AllAg.Aortic_valve_endothelial_cells [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  1. File list: Unc.CDV.50.AllAg.Aortic_valve_endothelial_cells [Chip-atlas[Archive

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  2. Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Ramamurthy Senthil

    2010-01-01

    Full Text Available Abstract Background Congenital Bicuspid Aortic Valve (BAV is a significant risk factor for serious complications including valve dysfunction, aortic dilatation, dissection, and sudden death. Clinical tools for identification and monitoring of BAV patients at high risk for development of aortic dilatation, an early complication, are not available. Methods This paper reports an investigation in 18 pediatric BAV patients and 10 normal controls of links between abnormal blood flow patterns in the ascending aorta and aortic dilatation using velocity-encoded cardiovascular magnetic resonance. Blood flow patterns were quantitatively expressed in the angle between systolic left ventricular outflow and the aortic root channel axis, and also correlated with known biochemical markers of vessel wall disease. Results The data confirm larger ascending aortas in BAV patients than in controls, and show more angled LV outflow in BAV (17.54 ± 0.87 degrees than controls (10.01 ± 1.29 (p = 0.01. Significant correlation of systolic LV outflow jet angles with dilatation was found at different levels of the aorta in BAV patients STJ: r = 0.386 (N = 18, p = 0.048, AAO: r = 0.536 (N = 18, p = 0.022, and stronger correlation was found with patients and controls combined into one population: SOV: r = 0.405 (N = 28, p = 0.033, STJ: r = 0.562 (N = 28, p = 0.002, and AAO r = 0.645 (N = 28, p Conclusions The results of this study provide new insights into the pathophysiological processes underlying aortic dilatation in BAV patients. These results show a possible path towards the development of clinical risk stratification protocols in order to reduce morbidity and mortality for this common congenital heart defect.

  3. Simultaneous aortic and tricuspid valve rupture after fall injury

    Science.gov (United States)

    Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

    2013-01-01

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

  4. Multimodality Imaging of a Giant Aortic Valve Papillary Fibroelastoma

    Directory of Open Access Journals (Sweden)

    Nowell M. Fine

    2013-01-01

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

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

    Science.gov (United States)

    Jenny, Benjamin E; Almanaseer, Yassar

    2014-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2015-10-01

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

  7. [Surgical treatment of traumatic rupture of the bicuspid aortic valve; report of a case].

    Science.gov (United States)

    Fujimoto, K; Okamoto, H; Tamenishi, A; Niimi, T

    2002-07-01

    A 27-year-old man was injured during a motocross game. He was suffered from dyspnea, orthopnea, and hemoptysis. The to-and-fro murmur was noticed 3 days after the accident and then the patient was admitted to our hospital. Echocardiography revealed severe aortic regurgitation. Computerized tomography also showed severe pulmonary contusions. Seventeen days after the accident the aortic valve replacement was performed. The aortic valve was anterior-posterior type bicuspid valve (fusion of right coronary cusp and light coronary cusp) and the tear was detected in the anterior cusp. The postoperative course was uneventful. Rupture of the aortic valve due to a blunt chest trauma is rare and reported in 20 cases previously in Japan. This case is the second report of traumatic rupture of the bicuspid aortic valve.

  8. Mechanosensitive microRNA-181b Regulates Aortic Valve Endothelial Matrix Degradation by Targeting TIMP3.

    Science.gov (United States)

    Heath, Jack M; Fernandez Esmerats, Joan; Khambouneheuang, Lucky; Kumar, Sandeep; Simmons, Rachel; Jo, Hanjoong

    2017-02-24

    Calcific aortic valve disease (CAVD) is a major cause of morbidity in the aging population, but the underlying mechanisms of its progression remain poorly understood. Aortic valve calcification preferentially occurs on the fibrosa, which is subjected to disturbed flow. The side-specific progression of the disease is characterized by inflammation, calcific lesions, and extracellular matrix (ECM) degradation. Here, we explored the role of mechanosensitive microRNA-181b and its downstream targets in human aortic valve endothelial cells (HAVECs). Mechanistically, miR-181b is upregulated in OS and fibrosa, and it targets TIMP3, SIRT1, and GATA6, correlated with increased gelatinase/MMP activity. Overexpression of miR-181b led to decreased TIMP3 and exacerbated MMP activity as shown by gelatinase assay, and miR-181b inhibition decreased gelatinase activity through the repression of TIMP3 levels. Luciferase assay showed specific binding of miR-181b to the TIMP3 gene. Overexpression of miR-181b in HAVECs subjected to either LS or OS increased MMP activity, and miR-181b inhibition abrogated shear-sensitive MMP activity. These studies suggest that targeting this shear-dependent miRNA may provide a novel noninvasive treatment for CAVD.

  9. Calcific aortic valve damage as a risk factor for cardiovascular events.

    Science.gov (United States)

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

    2012-10-01

    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.

  10. Dynamic heart phantom with functional mitral and aortic valves

    Science.gov (United States)

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

    2015-03-01

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

  11. Morphology of the bicuspid aortic valve and elasticity of the adjacent aorta in children.

    Science.gov (United States)

    Pees, Christiane; Michel-Behnke, Ina

    2012-11-01

    Bicuspid aortic valve (BAV) is a common congenital malformation with the known sequela of ascending aortic dilation. The morphology of the BAV and the elasticity of the adjacent ascending aorta appear to influence the outcome. We prospectively examined 48 pediatric patients with an isolated, native BAV for the morphology and size of the aortic valve, aortic root, sinotubular junction, and ascending aorta and their elasticity indexes. A cohort of 48 matching subjects with tricuspid aortic valves was investigated as controls. A comparison of the aortic valve subtypes showed normal-size aortic dimensions in the tricuspid aortic valves. In contrast, in the BAVs, the ascending aorta and aortic valve itself tended to dilate with age and aortic elasticity deteriorated. In the BAVs, the stiffness was significantly greater (4.43 ± 1.82 vs 3.43 ± 0.81 in the tricuspid aortic valves; p = 0.001). The distensibility indexes decreased inversely in the BAVs (6.57 ± 2.83 vs 7.84 ± 2.04 cm(2) × dynes(-1) × 10(-6), p = 0.013; and 53.5 ± 26.0 versus 64.3 ± 17.9 kPa(-1) × 10(-3), p = 0.020). The anteroposterior-oriented phenotype of BAVs showed significantly stiffer and less distensible elasticity even after correction for congenital valve dysfunction, which was more frequent in the left-right-oriented phenotype. In conclusion, the morphology of the BAV seems to play a major role in the outcome of BAV disease, although the left-right phenotype is more prone to congenital valve dysfunction, the anteroposterior phenotype showed worse elasticity quality.

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

    Science.gov (United States)

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

    2015-03-01

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

  13. Cutting precision in a novel aortic valve resection tool. Research in progress.

    Science.gov (United States)

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

    2009-10-01

    We recently demonstrated the first in-vitro cutting results of a minimal-invasive aortic valve resection tool. The current study was designed to assess the cutting accuracy of this new device improved by the implementation of a linear motor-based propulsion unit. Native aortic valves of isolated swine hearts (valve diameter 17.8+/-0.9 mm, mean+/-S.D.) were artificially stenosed and calcified (n=7). Subsequently, valves were resected by the use of a new aortic valve resection tool. The cutting process was performed by fitting the instrument with foldable Nitinol cutting blades (diameter 15 mm) and two software-operated linear motors combined with separated manual rotation. Aortic valve area was measured pre- and postprocedure by software-guided binary area calculation. Aortic valve residue has been determined and the grade of accuracy has been assessed via calculating the average midpoint of the neoannulus. Furthermore, radial deviation of concentricity was calculated and cutting time was measured. Aortic valve resection was successful in all cases and nearly all leaflets (2.5+/-0.4) with a weight of 0.22+/-0.12 g were cut. Aortic valve area increased significantly (0.3+/-0.1 cm(2) vs. 1.1+/-0.2 cm(2), Pvalve by the aortic valve resection tool. Nearly all leaflets were cut and a small rim was left within the annulus, hence providing an ideal 'landing zone' for the new prosthesis. Nevertheless, the aortic valve resection tool should be enhanced by adding a centering mechanism, thus achieving a more precise cutting process in order to avoid secondary damage.

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

    DEFF Research Database (Denmark)

    Lund, Ole; Dorup, Inge; Emmertsen, Kristian

    2005-01-01

    OBJECTIVES: Size mismatch and impaired left ventricular function have been shown to determine the hemodynamic function of the standard St. Jude bileaflet disc valve early after aortic valve replacement (AVR). We aimed to analyse St. Jude valve hemodynamic function and its clinical impact in the s......OBJECTIVES: Size mismatch and impaired left ventricular function have been shown to determine the hemodynamic function of the standard St. Jude bileaflet disc valve early after aortic valve replacement (AVR). We aimed to analyse St. Jude valve hemodynamic function and its clinical impact...... in the survivors of a prospective series 10 years after AVR for aortic stenosis. DESIGN: Forty-three survivors aged 32-90 years from a prospective series attended a follow-up study with Doppler echo and radionuclide cardiography 10 years after AVR for aortic stenosis. Six patients with significant left sided valve......Hg. In a multilinear regression analysis GOA indexed for LVEDD, hypertension, and LVEF were independently related to peak gradient. CONCLUSION: High gradients of the standard St. Jude bileaflet disc valve 10 years after AVR was primarily related to systemic hypertension and mismatch between valve and left ventricular...

  15. Appropriate patient selection or health care rationing? Lessons from surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves I trial.

    Science.gov (United States)

    Szeto, Wilson Y; Svensson, Lars G; Rajeswaran, Jeevanantham; Ehrlinger, John; Suri, Rakesh M; Smith, Craig R; Mack, Michael; Miller, D Craig; McCarthy, Patrick M; Bavaria, Joseph E; Cohn, Lawrence H; Corso, Paul J; Guyton, Robert A; Thourani, Vinod H; Lytle, Bruce W; Williams, Mathew R; Webb, John G; Kapadia, Samir; Tuzcu, E Murat; Cohen, David J; Schaff, Hartzell V; Leon, Martin B; Blackstone, Eugene H

    2015-09-01

    The study objectives were to (1) compare the safety of high-risk surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves (PARTNER) I trial with Society of Thoracic Surgeons national benchmarks; (2) reference intermediate-term survival to that of the US population; and (3) identify subsets of patients for whom aortic valve replacement may be futile, with no survival benefit compared with therapy without aortic valve replacement. From May 2007 to October 2009, 699 patients with high surgical risk, aged 84 ± 6.3 years, were randomized in PARTNER-IA; 313 patients underwent surgical aortic valve replacement. Median follow-up was 2.8 years. Survival for therapy without aortic valve replacement used 181 PARTNER-IB patients. Operative mortality was 10.5% (expected 9.3%), stroke 2.6% (expected 3.5%), renal failure 5.8% (expected 12%), sternal wound infection 0.64% (expected 0.33%), and prolonged length of stay 26% (expected 18%). However, calibration of observed events in this relatively small sample was poor. Survival at 1, 2, 3, and 4 years was 75%, 68%, 57%, and 44%, respectively, lower than 90%, 81%, 73%, and 65%, respectively, in the US population, but higher than 53%, 32%, 21%, and 14%, respectively, in patients without aortic valve replacement. Risk factors for death included smaller body mass index, lower albumin, history of cancer, and prosthesis-patient mismatch. Within this high-risk aortic valve replacement group, only the 8% of patients with the poorest risk profiles had estimated 1-year survival less than that of similar patients treated without aortic valve replacement. PARTNER selection criteria for surgical aortic valve replacement, with a few caveats, may be more appropriate, realistic indications for surgery than those of the past, reflecting contemporary surgical management of severe aortic stenosis in high-risk patients at experienced sites. Copyright © 2015 The American Association for Thoracic Surgery. Published by

  16. Comparison of outcomes and presentation in men-versus-women with bicuspid aortic valves undergoing aortic valve replacement.

    Science.gov (United States)

    Andrei, Adin-Cristian; Yadlapati, Ajay; Malaisrie, S Chris; Puthumana, Jyothy J; Li, Zhi; Rigolin, Vera H; Mendelson, Marla; Clennon, Colleen; Kruse, Jane; Fedak, Paul W M; Thomas, James D; Higgins, Jennifer A; Rinewalt, Daniel; Bonow, Robert O; McCarthy, Patrick M

    2015-07-15

    Gender disparities in short- and long-term outcomes have been documented in cardiac and valvular heart surgery. However, there is a paucity of data regarding these differences in the bicuspid aortic valve (BAV) population. The aim of this study was to examine gender-specific differences in short- and long-term outcomes after surgical aortic valve (AV) replacement in patients with BAV. A retrospective analysis was performed in 628 consecutive patients with BAV who underwent AV surgery from April 2004 to December 2013. To reduce bias when comparing outcomes by gender, propensity score matching obtained on the basis of potential confounders was used. Women with BAV who underwent AV surgery presented with more advanced age (mean 60.7 ± 13.8 vs 56.3 ± 13.6 years, p <0.001) and less aortic regurgitation (29% vs 44%, p <0.001) and had a higher risk for in-hospital mortality (mean Ambler score 3.4 ± 4.4 vs 2.5 ± 4.0, p = 0.015). After propensity score matching, women received more blood products postoperatively (48% vs 34%, p = 0.028) and had more prolonged postoperative lengths of stay (median 5 days [interquartile range 5 to 7] vs 5 days [interquartile range 4 to 6], p = 0.027). Operative, discharge, and 30-day mortality and overall survival were not significantly different. In conclusion, women with BAV who underwent AV surgery were older, presented with less aortic regurgitation, and had increased co-morbidities, lending higher operative risk. Although women received more blood products and had significantly longer lengths of stay, short- and long-term outcomes were similar.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    INTRODUCTION: Preoperative anemia is common in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and has been linked to a poorer outcome--including a higher 1-year mortality. The aim of this study was to investigate the impact of successful TAVI...

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  19. Traumatic rupture of Ionescu-Shiley aortic valve after the Heimlich maneuver.

    Science.gov (United States)

    Passik, C S; Ackermann, D M; Piehler, J M; Edwards, W D

    1987-05-01

    A 74-year-old woman who had undergone aortic valve replacement with an Ionescu-Shiley bioprosthesis was evaluated and treated because aortic insufficiency developed after the application of the Heimlich maneuver. Pathologic examination of the explanted valve disclosed a cuspid perforation and an adjacent tear of a second cusp at its insertion into the valve strut. Patients with unexplained acute prosthetic insufficiency should be questioned as to whether the Heimlich maneuver has been previously performed.

  20. Practical update on imaging and transcatheter aortic valve implantation

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-11-01

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

  2. Design of Bioprosthetic Aortic Valves using biaxial test data.

    Science.gov (United States)

    Dabiri, Y; Paulson, K; Tyberg, J; Ronsky, J; Ali, I; Di Martino, E; Narine, K

    2015-01-01

    Bioprosthetic Aortic Valves (BAVs) do not have the serious limitations of mechanical aortic valves in terms of thrombosis. However, the lifetime of BAVs is too short, often requiring repeated surgeries. The lifetime of BAVs might be improved by using computer simulations of the structural behavior of the leaflets. The goal of this study was to develop a numerical model applicable to the optimization of durability of BAVs. The constitutive equations were derived using biaxial tensile tests. Using a Fung model, stress and strain data were computed from biaxial test data. SolidWorks was used to develop the geometry of the leaflets, and ABAQUS finite element software package was used for finite element calculations. Results showed the model is consistent with experimental observations. Reaction forces computed by the model corresponded with experimental measurements when the biaxial test was simulated. As well, the location of maximum stresses corresponded to the locations of frequent tearing of BAV leaflets. Results suggest that BAV design can be optimized with respect to durability.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-10-15

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

  4. Extra-coronary calcification (aortic valve calcification, mitral annular calcification, aortic valve ring calcification and thoracic aortic calcification) in HIV seropositive and seronegative men: Multicenter AIDS Cohort Study.

    OpenAIRE

    Rezaeian, P.; Miller, PE; Haberlen, SA; Razipour, A; Bahrami, H; Castillo, R.; Witt, MD; Kingsley, L; Palella, FJ; Nakanishi, R; Matsumoto, S.; Alani, A; Jacobson, LP; Post, WS; Budoff, MJ

    2016-01-01

    Previous studies have demonstrated an association between HIV infection and coronary artery disease (CAD); little is known about potential associations between HIV infection and extra-coronary calcification (ECC).We analyzed 621 HIV infected (HIV+) and 384 HIV uninfected (HIV-) men from the Multicenter AIDS Cohort Study who underwent non-contrast computed tomography (CT) from 2010-2013. Agatston scores were calculated for mitral annular calcification (MAC), aortic valve calcification (AVC), a...

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Left atrial volume in patients with asymptomatic aortic valve stenosis (the Simvastatin and Ezetimibe in Aortic Stenosis study)

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Egstrup, K.; Wachtell, K.

    2008-01-01

    Left atrial (LA) size is known to increase with persistently increased left ventricular (LV) filling pressure. We therefore hypothesized that LA volume might reflect the severity of aortic valve stenosis (AS). Transthoracic echocardiography was performed in 1,758 patients with asymptomatic...... AS (transaortic Doppler velocity > or =2.5 and Aortic Stenosis (SEAS) study. LA volume was measured in end-systole in the apical 4-chamber view in 1,503 patients (85%), and aortic valve area (AVA) was estimated by the continuity equation and indexed by body surface...

  7. Valve morphology effect in aortic coarctation flow using realistic silicon models and magnetic resonance imaging

    Science.gov (United States)

    Marrufo, Oscar; Solis-Najera, Sergio; Pibarot, Philippe; Kadem, Lyes; Kesharvarz-Motamed, Zahra; Rodriguez, Alfredo O.; Garcia, Julio

    2014-11-01

    Aortic valve morphology and phenotype may alter the aortic wall structure and its normal flow hemodynamics. However, the relationship between altered flow patterns and progression of wall pathology is often not fully understood in patients with aortic coartation and needs larger experimental work. In this study, we introduced a compatible experimental setup with magnetic resonance imaging (MRI) using a realistic aortic coarctation (AoCo) silicon model which can replicate physiological flow conditions (pressure, flow-wave, and systemic load). We evaluated the aortic valve hemodynamics of a normal tricuspid valve and a stenotic bicuspid valve using valve effective orifice area (EOA), peak and mean transvalvular pressure gradient (TPG). AoCo severity was assessed by the AoCo pressure gradient. For the tricuspid valve we obtained an EOA = 1.89 cm2, a peak TPG = 10 mmHg, and a mean TPG = 5 mmHg. For the bicuspid valve we obtained an EOA = 1.03 cm2, a peak TPG = 37 mmHg and a mean TPG = 13 mmHg. Furthermore, AoCo with tricuspid valve led to a peak AoCo pressure gradient (PG) = 11 mmHg and a mean PG = 5 mmHg. AoCo with bicuspid valve led to a peak PG = 6 mmHg and a mean PG = 3 mmHg. Aortic flow reattachment was more evident in presence of bicuspid valve and helical flow was present in all cases. This study showed that silicon prototyping in combination with MRI velocity measurements could successfully be used to assess hemodynamic effects of aortic valve morphology in aortic coarctation flow.

  8. Automatic aorta segmentation and valve landmark detection in C-arm CT for transcatheter aortic valve implantation.

    Science.gov (United States)

    Zheng, Yefeng; John, Matthias; Liao, Rui; Nöttling, Alois; Boese, Jan; Kempfert, Jörg; Walther, Thomas; Brockmann, Gernot; Comaniciu, Dorin

    2012-12-01

    Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure to treat severe aortic valve stenosis. As an emerging imaging technique, C-arm computed tomography (CT) plays a more and more important role in TAVI on both pre-operative surgical planning (e.g., providing 3-D valve measurements) and intra-operative guidance (e.g., determining a proper C-arm angulation). Automatic aorta segmentation and aortic valve landmark detection in a C-arm CT volume facilitate the seamless integration of C-arm CT into the TAVI workflow and improve the patient care. In this paper, we present a part-based aorta segmentation approach, which can handle structural variation of the aorta in case that the aortic arch and descending aorta are missing in the volume. The whole aorta model is split into four parts: aortic root, ascending aorta, aortic arch, and descending aorta. Discriminative learning is applied to train a detector for each part separately to exploit the rich domain knowledge embedded in an expert-annotated dataset. Eight important aortic valve landmarks (three hinges, three commissures, and two coronary ostia) are also detected automatically with an efficient hierarchical approach. Our approach is robust under all kinds of variations observed in a real clinical setting, including changes in the field-of-view, contrast agent injection, scan timing, and aortic valve regurgitation. Taking about 1.1 s to process a volume, it is also computationally efficient. Under the guidance of the automatically extracted patient-specific aorta model, the physicians can properly determine the C-arm angulation and deploy the prosthetic valve. Promising outcomes have been achieved in real clinical applications.

  9. Outcomes for Transcatheter Aortic Valve Replacement in Nonagenarians.

    Science.gov (United States)

    Kayatta, Michael O; Thourani, Vinod H; Jensen, Hanna A; Condado, Jose C; Sarin, Eric L; Kilgo, Patrick D; Devireddy, Chandan M; Leshnower, Bradley G; Mavromatis, Kreton; Li, Chun; Guyton, Robert A; Stewart, James P; Simone, Amy; Keegan, Patricia; Block, Peter; Lerakis, Stamatios; Babaliaros, Vasilis C

    2015-10-01

    Transcatheter aortic valve replacement (TAVR) may offer extreme-aged patients a treatment alternative to surgical aortic valve replacement (SAVR). The objective of this study was to describe outcomes of TAVR in nonagenarians using transfemoral and alternative access techniques. In a retrospective review, we found 95 nonagenarians who underwent TAVR from September 2007 through February 2014 at Emory University using a balloon expandable valve: transfemoral (n = 66), transapical (n = 14), transaortic (n = 14), and transcarotid (n = 1). Morbidity and 30-day and midterm mortality were assessed. Kaplan-Meier plots were used to determine midterm survival rates. The mean age of the patients was 91.8 ± 1.8 years, and 49 (52%) were female. Postoperative morbidity included 1 patient (1%) each with stroke, myocardial infarction, pneumonia, and renal failure. The mean postoperative length of stay was 6.8 ± 5.1 days for all patients. Overall 30-day mortality was 3.2%, much less than The Society of Thoracic Surgeons predicted risk of mortality of 14.5% ± 7.3%. There were no deaths in the transfemoral patients, but there were 2 transapical deaths (14.3%) and 1 transaortic death (7.1%). The Kaplan-Meier estimate of median survival was 2.6 years. Extreme-aged nonagenarian patients may have excellent outcomes from TAVR at 30-day and midterm follow-up. Alternative access TAVR is associated with higher morbidity and mortality than transfemoral TAVR. Referral for TAVR of nonagenarians should not be precluded based on age alone. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Gabor Erdoes

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

  11. [Aortic Valve Replacement after Balloon Valvuloplasty for Aortic Valve Stenosis in a Dialysis Patient with Cardiogenic Shock;Report of a Case].

    Science.gov (United States)

    Takamatsu, Masanori; Hirotani, Takashi; Ohtsubo, Satoshi; Saito, Sumikatsu; Takeuchi, Shigeyuki; Hasegawa, Tasuku; Endo, Ayaka; Yamasaki, Yu; Hayashida, Kentaro

    2015-06-01

    A 67-year-old man on chronic hemodialysis was admitted with worsening congestive heart failure due to critical aortic stenosis. Echocardiography showed severe aortic stenosis with a valve area of 0.67 cm2 and an ejection fraction of 0.31. Cardiac catheterization revealed severe pulmonary hypertension with pulmonary artery pressures of 62/32 mmHg. In the middle of cardiac catheterization, the systolic pressure declined to 60 mmHg due to cardiogenic shock. Dopamine hydrochloride and dobutamine hydrochloride infusions were necessary to maintain a systolic pressure greater than 80 mmHg. Balloon aortic valvuloplasty was urgently performed. The patient's symptoms rapidly resolved except for angina on exertion. One month later, elective aortic valve replacement was performed. The postoperative course was uneventful and the he was discharged on the 60th postoperative day. A follow-up echocardiogram 6 months postoperatively revealed normal prosthetic valve function and an ejection fraction of 0.6.

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

    DEFF Research Database (Denmark)

    Linke, Axel; Wenaweser, Peter; Gerckens, Ulrich

    2014-01-01

    AIM: Transcatheter aortic valve implantation has become an alternative to surgery in higher risk patients with symptomatic aortic stenosis. The aim of the ADVANCE study was to evaluate outcomes following implantation of a self-expanding transcatheter aortic valve system in a fully monitored, multi......-centre 'real-world' patient population in highly experienced centres. METHODS AND RESULTS: Patients with severe aortic stenosis at a higher surgical risk in whom implantation of the CoreValve System was decided by the Heart Team were included. Endpoints were a composite of major adverse cardiovascular......Valve System with low mortality and stroke rates in higher risk real-world patients with severe aortic stenosis....

  13. Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function.

    NARCIS (Netherlands)

    Delgado, V.; Ng, A.C.; Veire, N.R. van de; Kley, F. van der; Schuijf, J.D.; Tops, L.F.; Weger, A. de; Tavilla, G.; Roos, A. de; Kroft, L.J.; Schalij, M.J.; Bax, J.J.

    2010-01-01

    AIMS: Aortic regurgitation after transcatheter aortic valve implantation (TAVI) is one of the most frequent complications. However, the underlying mechanisms of this complication remain unclear. The present evaluation studied the anatomic and morphological features of the aortic valve annulus that m

  14. Early impact of aortic wrapping on patients undergoing aortic valve replacement with mild to moderate ascending aorta dilatation

    Directory of Open Access Journals (Sweden)

    Sosnowski Andrzej

    2010-08-01

    Full Text Available Abstract Background The management of mild to moderate dilatation of the ascending aorta of less than 5 cm is controversial, particularly when concomitant surgical correction of aortic valve is required. We investigate the impact of a simple method of aorta reduction using Dacron graft wrapping during aortic valve replacement on the rest of the aorta. Methods We studied 14 patients who had ascending aorta dilatation of 4-5 cm before undergoing aortic wrapping during their aortic valve replacement and compared with their post-operative imaging within a month. Results The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within 4 weeks after surgery from 44.7 ± 2.6 to 33.6 ± 3.9 mm (p Conclusions Reduction of ascending aortic dilatation by wrapping with a Dacron graft in this preliminary study is associated with favourable early reversed aortic remodelling. This supports the hypothesis that correction of mild-moderate dilatation of the ascending aorta with Dacron wrapping at the time of aortic valve surgery may prevent the progression of the dilatation, although the long-term study on a larger population is needed to confirm its benefits.

  15. Successful implantation of a second-generation aortic valve in severe aortic regurgitation secondary to a traumatic cusp lesion

    Energy Technology Data Exchange (ETDEWEB)

    Mangieri, Antonio [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); Latib, Azeem, E-mail: info@emocolumbus.it [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); EMO-GVM Centro Cuore Columbus, Milan (Italy); Aurelio, Andrea [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); Figini, Filippo [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); EMO-GVM Centro Cuore Columbus, Milan (Italy); Agricola, Eustachio; Rosa, Isabella; Stella, Stefano; Spagnolo, Pietro; Castiglioni, Alessandro [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); Colombo, Antonio [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); EMO-GVM Centro Cuore Columbus, Milan (Italy)

    2015-10-15

    A 67-year-old man with a dilated cardiomyopathy and severe aortic regurgitation (AR) secondary to a traumatic cusp lesion was referred to our institution because of progressive worsening of dyspnea. After formal discussion in the heart team, the patient was scheduled for TAVI (transcatheter aortic valve implantation). The pre procedural computed tomography scan revealed a minimum amount of calcium on the aortic valve and low position of coronary ostia. The TAVI procedure was performed with the implantation of a fully retrievable and repositionable aortic valve prosthesis (Direct Flow 29 mm, Direct Flow Medical, Santa Rosa, California) with an excellent result and no paravalvular leak. The TAVI devices designed for the treatment of calcific aortic stenosis have numerous limitations for the treatment of pure AR such as the risk of residual AR, the lack of repositionability and retrievability, and the need for valve- in-valve implantation. We believe that treatment of selected cases of pure AR with the Direct Flow valve is feasible and takes advantage of the retrievability of the prosthesis.

  16. Differential cell-matrix responses in hypoxia-stimulated aortic versus mitral valves.

    Science.gov (United States)

    Sapp, Matthew C; Krishnamurthy, Varun K; Puperi, Daniel S; Bhatnagar, Saheba; Fatora, Gabrielle; Mutyala, Neelesh; Grande-Allen, K Jane

    2016-12-01

    Tissue oxygenation often plays a significant role in disease and is an essential design consideration for tissue engineering. Here, oxygen diffusion profiles of porcine aortic and mitral valve leaflets were determined using an oxygen diffusion chamber in conjunction with computational models. Results from these studies revealed the differences between aortic and mitral valve leaflet diffusion profiles and suggested that diffusion alone was insufficient for normal oxygen delivery in mitral valves. During fibrotic valve disease, leaflet thickening due to abnormal extracellular matrix is likely to reduce regional oxygen availability. To assess the impact of low oxygen levels on valve behaviour, whole leaflet organ cultures were created to induce leaflet hypoxia. These studies revealed a loss of layer stratification and elevated levels of hypoxia inducible factor 1-alpha in both aortic and mitral valve hypoxic groups. Mitral valves also exhibited altered expression of angiogenic factors in response to low oxygen environments when compared with normoxic groups. Hypoxia affected aortic and mitral valves differently, and mitral valves appeared to show a stenotic, rheumatic phenotype accompanied by significant cell death. These results indicate that hypoxia could be a factor in mid to late valve disease progression, especially with the reduction in chondromodulin-1 expression shown by hypoxic mitral valves. © 2016 The Author(s).

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    analysis and coronary angiography by MDCT. The combined endpoint was indication for aortic valve replacement (AVR) and sudden cardiac death. During a median follow-up of 2.3 years (interquartile range 1.7-3.6) 43 patients (41%) met the endpoint of indication for AVR. The basal (13.4 ± 3.1% vs. 15.7 ± 3.......1%) and mid-ventricular segments (14.9 ± 2.7% vs. 16.2 ± 2.9%) were significantly reduced, but with sparing of the apical segments, in patients who later underwent AVR. In various multivariable Cox regression models, including only BLS, but not GLS, remained an independent predictor of AVR. CONCLUSION......: In contrast to GLS, reduced BLS is a significant predictor of future AVR in asymptomatic patients with aortic stenosis, independently of clinical characteristics, conventional echocardiographic measures, and coronary pathology....

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    In hypertension, angiotensin receptor blockers can augment regression of left ventricular (LV) hypertrophy. It is not known whether this also is the case after aortic valve replacement (AVR) for severe aortic stenosis (AS). To test the hypothesis that treatment with candesartan in addition...... to conventional treatment is able to augment LV and left atrial (LA) reverse remodeling in patients with AS undergoing AVR, we studied 114 patients scheduled for AVR. Patients were randomized to treatment with candesartan 32 mg 1 time/day or conventional therapy immediately after AVR. Patients were followed...... E/e' ratio or B-type natriuretic peptide. In conclusion, angiotensin receptor blockade with candesartan after AVR in patients with AS is associated with augmented reverse LV and LA remodeling compared to conventional management....

  20. Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)

    DEFF Research Database (Denmark)

    Nielsen, O. W.; Sajadieh, A.; Sabbah, M.

    2016-01-01

    BACKGROUND: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal. METHODS: A total of 1767 patients with asymptomatic aortic...... stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate...... to 69 mm Hg taken as reference. Low systolic and diastolic BPs increased risk in patients with moderate aortic stenosis. With a time-varying systolic BP from 130 to 139 mm Hg used as reference, mortality was increased for systolic BP ≥160 mm Hg (HR, 1.7; P=0.033) and BP of 120 to 129 mm Hg (HR, 1.6; P=0...

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

    Science.gov (United States)

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

    2014-09-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  3. Complete Resolution of a Large Bicuspid Aortic Valve Thrombus with Anticoagulation in Primary Antiphospholipid Syndrome

    Directory of Open Access Journals (Sweden)

    Rayan Jo Rachwan

    2017-09-01

    Full Text Available Native aortic valve thrombosis in primary antiphospholipid syndrome (APLS is a rare entity. We describe a 38-year-old man who presented with neurological symptoms and a cardiac murmur. Transthoracic echocardiography detected a large bicuspid aortic valve thrombus. Laboratory evaluation showed the presence of antiphospholipid antibodies. Anticoagulation was started, and serial echocardiographic studies showed complete resolution of the aortic valve vegetation after 4 months. The patient improved clinically and had no residual symptoms. This report and review of the literature suggests that vegetations in APLS can be treated successfully with conservative treatment, regardless of their size.

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

    OpenAIRE

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

    2012-01-01

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

  5. Asymptomatic papillary fibroelastoma of the Aortic valve in a young woman - a case report

    Directory of Open Access Journals (Sweden)

    Pitsis Antonis

    2009-09-01

    Full Text Available Abstract Echocardiography represents an invaluable diagnostic tool for the detection of intracardiac masses while simultaneously provides information about their size, location, mobility and attachment site as well as the presence and extent of any consequent hemodynamic derangement. A 29-year-old asymptomatic young woman with incidental transthoracic echocardiographic (TTE discovery of an aortic valve mass is presented. The 2-dimensional TTE showed a mobile, pedunculated mass, attached by a thin stalk to the aortic surface of the right coronary aortic cusp at the junction of its base with the anterior aortic wall. The importance of valve sparing tumour resection even in asymptomatic patients is emphasised.

  6. The development of transcatheter aortic valve replacement in the USA.

    Science.gov (United States)

    Dvir, Danny; Barbash, Israel M; Ben-Dor, Itsik; Okubagzi, Petros; Satler, Lowell F; Waksman, Ron; Pichard, Augusto D

    2012-03-01

    The penetration rate of devices in general, and in transcatheter aortic valve replacement (TAVR) specifically, is significantly delayed in the United States of America (USA) compared with in Europe. This is mostly due to the mission statement of the regulatory agencies in the USA, which requires very rigorous clinical testing of a device prior to its approval. The USA had a major role in the development and evaluation of this technology and USA research has enabled clinicians inside and outside of the USA to conduct a concise scientifically based assessment of the performance of TAVR devices in terms of safety and efficacy. In the following review, we provide data on the development of TAVR in the USA, revealing the critical role the USA has played in this extraordinary process.

  7. First-in-man transcatheter aortic valve implantation of a 20-mm Edwards SAPIEN XT valve: one step forward for the treatment of patients with severe aortic stenosis and small aortic annulus.

    Science.gov (United States)

    Rodés-Cabau, Josep; DeLarochellière, Robert; Dumont, Eric

    2012-04-01

    We present the case of an 85-year-old woman diagnosed with severe aortic stenosis, porcelain aorta, and a small aortic annulus (17.3 mm), who underwent successful transfemoral transcatheter aortic valve implantation (TAVI) with a 20-mm Edwards SAPIEN XT valve using the NovaFlex+ delivery system. At 1-month follow-up the patient was in NYHA functional class I, and Doppler echocardiography showed a mean residual gradient of 15 mm Hg and trivial paravalvular aortic regurgitation. This case, which shows for the first time the feasibility of TAVI with a 20-mm valve, opens a new avenue for the challenging treatment of patients with aortic stenosis and a small aortic annulus.

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

    Science.gov (United States)

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

    2009-01-01

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

  9. Basal and Oxidative Stress–Induced Expression of Metallothionein Is Decreased in Ascending Aortic Aneurysms of Bicuspid Aortic Valve Patients

    Science.gov (United States)

    Phillippi, Julie A.; Klyachko, Ekaterina A.; Kenny, John P.; Eskay, Michael A.; Gorman, Robert C.; Gleason, Thomas G.

    2017-01-01

    Background Bicuspid aortic valve (BAV) is a heritable condition that has been linked by an unknown mechanism to a predisposition for ascending aortic aneurysm. Matrix metalloproteinases have been implicated in this predisposition. Metallothionein is a poorly characterized, metal-binding protein that regulates matrix metalloproteinases and is an antioxidant known to be upregulated under oxidative stress. Methods and Results To determine putative factors involved in the pathogenesis of aortic aneurysm in BAV patients, our first goal was to identify genes that are dysregulated in ascending aortic aneurysms of BAV patients compared with tricuspid aortic valve patients and nondiseased (control) donors. By microarray analysis (22 000 probe sets), 110 dysregulated genes were identified in BAV compared with tricuspid aortic valve patients and control donors; 8 were genes of the metallothionein family. Metallothionein gene expression and protein expression were significantly lower in aortic tissue and cultured aortic smooth muscle cells from BAV patients compared with control subjects. Matrix metalloproteinase-9 expression was increased in BAV aortic samples relative to controls. BAV aorta was more susceptible to oxidative stress, and induction of metallothionein under oxidative stress was reduced in BAV patients compared with control subjects. Conclusions These results demonstrate dysregulated metallothionein expression in ascending aortic smooth muscle cells of BAV patients that may contribute to an inadequate response to oxidative stress and provoke aneurysm formation. We hypothesize that metallothionein plays a pivotal role in the response of ascending aortic smooth muscle cells to oxidative stress cues normally involved in the maintenance of the extracellular matrix, including the regulation of matrix metalloproteinase expression. PMID:19398671

  10. Effect of pulmonary autograft transplantation in the surgical treatment of aortic valve disease

    Institute of Scientific and Technical Information of China (English)

    LI Wen-bin; LIU Hai-yan; ZHOU Qi-wen; XU Xiu-fang; ZHANG Jian-qun; SONG Shi-qiu; PENG Jin-feng; WANG Sheng-xun; LIU Wei; ZHOU Hai-po; WANG Zhu-heng

    2008-01-01

    Background Aortic root replacement with pulmonary autograft (Ross procedure) has the advantages of good haemodynamics and growth potential without the need for anticoagulation.In this study,we reviewed our expedence of the Ross procedure for patients with aortic valve disease.Methods From October 1994 to January 2005,42 Ross procedures were performed in our centre.There were 30 males and 12 females.The mean age was 28+15 years (range,5-56 years).Congenital heart disease (CHD) with aortic valve stenosis (AS) and/or aortic valve insufficiency (A1) in 40 cases including one associated with ventdcular septal defect (VSD),degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis (SBE) with A1 in 1 were studied.The diagnosis was made by ultracardiography (UCG) in all patients.The mean aortic valve annulus diameter (AVD) was (2.45±0.31) cm and pulmonary valve annulus diameter (MPVD) was (2.34±0.21) cm.All patients had normal pulmonary valves.The New York Heart Association (NYHA) function class was Ⅱ in 36 cases and Ⅲ in 6 cases.The operation was performed under moderate hypothermic cardiopulmonary bypass (CPB) with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft.Results There was no early hospital mortality.Postoperative UCG showed normal aortic valve function in all our patients.The mean gradient across the aortic valve was (6.11±0.12) mmHg.The left ventricular diastole diameter (LVDD)decreased significantly from (62±5) mm to (56±3) mm (P<0.001).The mean postoperative left ventricular ejective fraction (LVEF) was 0.49±0.23.All patients were in NYHA class Ⅰ-Ⅱ.Follow-up was completed in 38 cases for a mean period of 3.2 years (range 1-10 years).All survivors were in NYHA class Ⅰ with normal neo-aortic and pulmonary valve function.One patient died after secondary operation due to homograft fungal endocarditis 1 year after the Ross procedure.The cause of death was uncontrolled

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1991-09-01

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

  12. Association of diffuse idiopathic skeletal hyperostosis and aortic valve sclerosis

    Directory of Open Access Journals (Sweden)

    Alberto O. Orden

    2014-06-01

    Full Text Available The principal objective of this investigation was to analyze the association between diffuse idiopathic skeletal hyperostosis (DISH and the presence of aortic valve sclerosis (AVS. For this study we used results from 1000 consecutive outpatients (473 males, older than 50 years of age (average 67.6 years, that had been examined with Doppler echocardiogram and anterior and lateral chest radiographs. Overall, 195 patients (19.5% were diagnosed with DISH and 283 (28.3% with AVS. DISH was more prevalent than AVS in males (66.7% vs. 42.6%, p< 0.0001 and in older patients (73.6 ± 9 years vs. 66.1 ± 9 years, p < 0.0001. Furthermore, 55.4% of patients with dorsal DISH presented aortic sclerosis calcification vs. 21.7% of patients free of DISH (OR = 4.47; 95% CI = 3.22-6.21. The adjusted odds ratio (OR was calculated by sex and age resulting in 3.04 (95% CI = 2.12-4.36; p < .0001. A statistically significant association was found between DISH and AVS in accordance to age and sex. The biological plausibility of this association is based on similar risk factors, pathogenic mechanisms and vascular complications.

  13. Periprocedural considerations of transcatheter aortic valve implantation for anesthesiologists

    Directory of Open Access Journals (Sweden)

    Ata Hassani Afshar

    2016-06-01

    Full Text Available Transcatheter aortic valve replacement (TAVR is rapidly gaining popularity as a viable option in the management of patients with symptomatic aortic stenosis (AS and high risk for open surgical intervention. TAVR soon expanding its indications from "high-risk" group of patients to those with "intermediate-risk". As an anesthesiologist; understanding the procedure and the challenges inherent to it is of utmost importance, in order to implement optimal care for this generally frail population undergoing a rather novel procedure. Cardiac anesthesiologists generally play a pivotal role in the perioperative care of the patients, and therefore they should be fully familiar with the circumstances occurring surrounding the procedure. Along with increasing experience and technical developments for TAVR, the procedure time becomes shorter. Due to this improvement in the procedure time, more and more anesthesiologists feel comfortable in using monitored anesthesia care with moderate sedation for patients undergoing TAVR. A number of complications could arise during the procedure needing rapid diagnoses and occasionally conversion to general anesthesia. This review focuses on the periprocedural anesthetic considerations for TAVR.

  14. Bicuspid aortic valve hemodynamics does not promote remodeling in porcine aortic wall concavity

    Institute of Scientific and Technical Information of China (English)

    Samantha K Atkins; Alison N Moore; Philippe Sucosky

    2016-01-01

    AIM: To investigate the role of type-I left-right bicuspid aortic valve(LR-BAV) hemodynamic stresses in the remodeling of the thoracic ascending aorta(AA) concavity, in the absence of underlying genetic or structural defects.METHODS: Transient wall shear stress(WSS) profiles in the concavity of tricuspid aortic valve(TAV) and LR-BAV AAs were obtained computationally. Tissue specimens excised from the concavity of normal(nondilated) porcine AAs were subjected for 48 h to those stress environments using a shear stress bioreactor. Tissue remodeling was characterized in terms of matrix metalloproteinase(MMP) expression and activity via immunostaining and gelatin zymography.RESULTS: Immunostaining semi-quantification results indicated no significant difference in MMP-2 and MMP-9 expression between the tissue groups exposed to TAV and LR-BAV AA WSS(P = 0.80 and P = 0.19, respectively). Zymography densitometry revealed no difference in MMP-2 activity(total activity, active form and latent form) between the groups subjected to TAV AA and LR-BAV AA WSS(P = 0.08, P = 0.15 and P = 0.59, respectively).CONCLUSION: The hemodynamic stress environment present in the concavity of type-I LR-BAV AA does not cause any significant change in proteolytic enzyme expression and activity as compared to that present in the TAV AA.

  15. Automatic aorta segmentation and valve landmark detection in C-arm CT: application to aortic valve implantation.

    Science.gov (United States)

    Zheng, Yefeng; John, Matthias; Liao, Rui; Boese, Jan; Kirschstein, Uwe; Georgescu, Bogdan; Zhou, S Kevin; Kempfert, Jörg; Walther, Thomas; Brockmann, Gernot; Comaniciu, Dorin

    2010-01-01

    C-arm CT is an emerging imaging technique in transcatheter aortic valve implantation (TAVI) surgery. Automatic aorta segmentation and valve landmark detection in a C-arm CT volume has important applications in TAVI by providing valuable 3D measurements for surgery planning. Overlaying 3D segmentation onto 2D real time fluoroscopic images also provides critical visual guidance during the surgery. In this paper, we present a part-based aorta segmentation approach, which can handle aorta structure variation in case that the aortic arch and descending aorta are missing in the volume. The whole aorta model is split into four parts: aortic root, ascending aorta, aortic arch, and descending aorta. Discriminative learning is applied to train a detector for each part separately to exploit the rich domain knowledge embedded in an expert-annotated dataset. Eight important aortic valve landmarks (three aortic hinge points, three commissure points, and two coronary ostia) are also detected automatically in our system. Under the guidance of the detected landmarks, the physicians can deploy the prosthetic valve properly. Our approach is robust under variations of contrast agent. Taking about 1.4 seconds to process one volume, it is also computationally efficient.

  16. Uraemic hyperparathyroidism causes a reversible inflammatory process of aortic valve calcification in rats

    National Research Council Canada - National Science Library

    Shuvy, Mony; Abedat, Suzan; Beeri, Ronen; Danenberg, Haim D; Planer, David; Ben-Dov, Iddo Z; Meir, Karen; Sosna, Jacob; Lotan, Chaim

    2008-01-01

    Aims Renal failure is associated with aortic valve calcification (AVC). Our aim was to develop an animal model for exploring the pathophysiology and reversibility of AVC, utilizing rats with diet-induced kidney disease...

  17. ACE inhibition attenuates uremia-induced aortic valve thickening in a novel mouse model

    DEFF Research Database (Denmark)

    Simolin, Mikko A; Pedersen, Tanja X; Bro, Susanne

    2009-01-01

    BACKGROUND: We examined whether impaired renal function causes thickening of the aortic valve leaflets in hyperlipidemic apoE-knockout (apoE-/-) mice, and whether the putative effect on the aortic valves could be prevented by inhibiting the angiotensin-converting enzyme (ACE) with enalapril....... METHODS: Thickening of the aortic valve leaflets in apoE-/- mice was induced by producing mild or moderate chronic renal failure resulting from unilateral nephrectomy (1/2 NX, n = 18) or subtotal nephrectomy (5/6 NX, n = 22), respectively. Additionally, the 5/6 NX mice were randomized to no treatment (n...... treated with enalapril had significantly thinner leaflets than did the untreated 5/6 NX mice (P = 0.014). CONCLUSION: Moderate uremia causes thickening of the aortic valves in apoE-/- mice, which can be attenuated by ACE inhibition. The nephrectomized apoE-/- mouse constitutes a new model...

  18. Update: Cardiac Imaging (II). Transcatheter Aortic Valve Replacement: Advantages and Limitations of Different Cardiac Imaging Techniques.

    Science.gov (United States)

    Podlesnikar, Tomaz; Delgado, Victoria

    2016-03-01

    Transcatheter aortic valve replacement is an established therapy for patients with symptomatic severe aortic stenosis and contraindications or high risk for surgery. Advances in prostheses and delivery system designs and continuous advances in multimodality imaging, particularly the 3-dimensional techniques, have led to improved outcomes with significant reductions in the incidence of frequent complications such as paravalvular aortic regurgitation. In addition, data on prosthesis durability are accumulating. Multimodality imaging plays a central role in the selection of patients who are candidates for transcatheter aortic valve replacement, procedure planning and guidance, and follow-up of prosthesis function. The strengths and limitations of each imaging technique for transcatheter aortic valve replacement will be discussed in this update article. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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

    Science.gov (United States)

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

    2016-06-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    BACKGROUND: In patients referred for aortic valve replacement (AVR) a pre-surgical assessment of coronary artery disease is mandatory to determine the possible need for additional coronary artery bypass grafting. The diagnostic accuracy of coronary computed tomography angiography (coronary CTA......) was evaluated in patients with aortic valve stenosis referred for surgical AVR. METHODS: Between March 2008 and March 2010 a total of 181 consecutive patients were included. All patients underwent pre-surgical coronary CTA (64- or 320-detector CT scanner) and invasive coronary angiography (ICA). The analyses...... with disagreement between ICA and coronary CTA in univariate analysis. CONCLUSION: In patients with aortic valve stenosis referred for surgical AVR the diagnostic accuracy of coronary CTA to identify significant coronary artery disease is moderate. Coronary CTA may be used successfully in a subset of patients...

  1. Validation of the Valve Academic Research Consortium Bleeding Definition in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Stortecky, Stefan; Stefanini, Giulio G; Pilgrim, Thomas; Heg, Dik; Praz, Fabien; Luterbacher, Fabienne; Piccolo, Raffaele; Khattab, Ahmed A; Räber, Lorenz; Langhammer, Bettina; Huber, Christoph; Meier, Bernhard; Jüni, Peter; Wenaweser, Peter; Windecker, Stephan

    2015-09-25

    The Valve Academic Research Consortium (VARC) has proposed a standardized definition of bleeding in patients undergoing transcatheter aortic valve interventions (TAVI). The VARC bleeding definition has not been validated or compared to other established bleeding definitions so far. Thus, we aimed to investigate the impact of bleeding and compare the predictivity of VARC bleeding events with established bleeding definitions. Between August 2007 and April 2012, 489 consecutive patients with severe aortic stenosis were included into the Bern-TAVI-Registry. Every bleeding complication was adjudicated according to the definitions of VARC, BARC, TIMI, and GUSTO. Periprocedural blood loss was added to the definition of VARC, providing a modified VARC definition. A total of 152 bleeding events were observed during the index hospitalization. Bleeding severity according to VARC was associated with a gradual increase in mortality, which was comparable to the BARC, TIMI, GUSTO, and the modified VARC classifications. The predictive precision of a multivariable model for mortality at 30 days was significantly improved by adding the most serious bleeding of VARC (area under the curve [AUC], 0.773; 95% confidence interval [CI], 0.706 to 0.839), BARC (AUC, 0.776; 95% CI, 0.694 to 0.857), TIMI (AUC, 0.768; 95% CI, 0.692 to 0.844), and GUSTO (AUC, 0.791; 95% CI, 0.714 to 0.869), with the modified VARC definition resulting in the best predictivity (AUC, 0.814; 95% CI, 0.759 to 0.870). The VARC bleeding definition offers a severity stratification that is associated with a gradual increase in mortality and prognostic information comparable to established bleeding definitions. Adding the information of periprocedural blood loss to VARC may increase the sensitivity and the predictive power of this classification. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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

    Science.gov (United States)

    Lamelas, Joseph; LaPietra, Angelo

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  4. Validation of German Aortic Valve Score in a Multi-Surgeon Single Center

    Science.gov (United States)

    Kalender, Mehmet; Baysal, Ahmet Nihat; Karaca, Okay Guven; Boyacioglu, Kamil; Kayalar, Nihan

    2017-01-01

    Objective Risk assessment for operative mortality is mandatory for all cardiac operations. For some operation types such as aortic valve repair, EuroSCORE II overestimates the mortality rate and a new scoring system (German AV score) has been developed for a more accurate assessment of operative risk. In this study, we aimed to validate German Aortic Valve Score in our clinic in patients undergoing isolated aortic valve replacement. Methods A total of 35 patients who underwent isolated open aortic valve replacement between 2010 and 2013 were included. Patients with concomitant procedures and transcatheter aortic valve implantation were excluded. Patients' data were collected and analyzed retrospectively. Patients' risk scores EuroSCORE II were calculated online according to criteria described by EuroSCORE taskforce, Aortic Valve Scores were also calculated. Results The mean age of patients was 61.14±13.25 years (range 29-80 years). The number of female patients was 14 (40%) and body mass index of 25 (71.43%) patients was in range of 22-35. Mean German Aortic Valve Score was 1.05±0.96 (min: 0 max: 4.98) and mean EuroSCORE was 2.30±2.60 (min: 0.62, max: 2.30). The Aortic Valve Score scale showed better discriminative capacity (AUC 0.647, 95% CI 0.439-0.854). The goodness of fit was x2HL=16.63; P=0.436). EuroSCORE II scale had shown less discriminative capacity (AUC 0.397, 95% CI 0.200-0.597). The goodness of fit was good for both scales. The goodness of fit was x2HL=30.10; P=0.610. Conclusion In conclusion, German AV score applies to our population with high predictive accuracy and goodness of fit. PMID:28492787

  5. Validation of German Aortic Valve Score in a Multi-Surgeon Single Center

    Directory of Open Access Journals (Sweden)

    Mehmet Kalender

    Full Text Available Abstract OBJECTIVE: Risk assessment for operative mortality is mandatory for all cardiac operations. For some operation types such as aortic valve repair, EuroSCORE II overestimates the mortality rate and a new scoring system (German AV score has been developed for a more accurate assessment of operative risk. In this study, we aimed to validate German Aortic Valve Score in our clinic in patients undergoing isolated aortic valve replacement. METHODS: A total of 35 patients who underwent isolated open aortic valve replacement between 2010 and 2013 were included. Patients with concomitant procedures and transcatheter aortic valve implantation were excluded. Patients' data were collected and analyzed retrospectively. Patients' risk scores EuroSCORE II were calculated online according to criteria described by EuroSCORE taskforce, Aortic Valve Scores were also calculated. RESULTS: The mean age of patients was 61.14±13.25 years (range 29-80 years. The number of female patients was 14 (40% and body mass index of 25 (71.43% patients was in range of 22-35. Mean German Aortic Valve Score was 1.05±0.96 (min: 0 max: 4.98 and mean EuroSCORE was 2.30±2.60 (min: 0.62, max: 2.30. The Aortic Valve Score scale showed better discriminative capacity (AUC 0.647, 95% CI 0.439-0.854. The goodness of fit was x2HL=16.63; P=0.436. EuroSCORE II scale had shown less discriminative capacity (AUC 0.397, 95% CI 0.200-0.597. The goodness of fit was good for both scales. The goodness of fit was x2HL=30.10; P=0.610. CONCLUSION: In conclusion, German AV score applies to our population with high predictive accuracy and goodness of fit.

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

    Science.gov (United States)

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

    2012-01-01

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

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  8. Clinical and echocardiographic assessment of the Medtronic Advantage aortic valve prosthesis: the Scandinavian multicentre, prospective study

    DEFF Research Database (Denmark)

    Haaverstad, Rune; Vitale, Nicola; Karevold, Asbjørn

    2006-01-01

    OBJECTIVE: The aim of this report is the prospective, multicentre evaluation of clinical results and haemodynamic performance of the Medtronic Advantage aortic valve prosthesis. METHODS: From April 2001 to June 2003, 166 patients (male:female 125:41; mean (SD) age 61.8 (11.8) years) received...... echocardiography. CONCLUSIONS: Haemodynamic performance and early clinical results of Medtronic advantage in the aortic position were satisfactory and comparable with those of other bileaflet valves in current clinical use....

  9. Increased hsCRP is associated with higher risk of aortic valve replacement in patients with aortic stenosis

    DEFF Research Database (Denmark)

    Blyme, Adam; Asferg, Camilla; Nielsen, O. W.

    2016-01-01

    Objective To investigate relations between inflammation and aortic valve stenosis (AS) by measuring high-sensitivity C-reactive protein, at baseline (hsCRP(0)) and after 1year (hsCRP(1)) and exploring associations with aortic valve replacement (AVR). Design We examined 1423 patients from...... the Simvastatin and Ezetimibe in Aortic Stenosis study. Results During first year of treatment, hsCRP was reduced both in patients later receiving AVR (2.3 [0.9-4.9] to 1.8 [0.8-5.4] mg/l, p...) predicted later AVR (HR=1.17, paortic valve area (AVA) and other risk factors. A higher rate of AVR was observed in the group with high hsCRP(0) and an increase during the first year (AVR(highCRP0CRP1inc)=47.3% versus AVR(highCRP0CRP1dec)=27.5%, p

  10. Alternative transarterial access for CoreValve transcatheter aortic bioprosthesis implantation.

    Science.gov (United States)

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

    2015-05-01

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

  11. Automatic segmentation of the aortic root in CT angiography of candidate patients for transcatheter aortic valve implantation.

    Science.gov (United States)

    Elattar, M A; Wiegerinck, E M; Planken, R N; Vanbavel, E; van Assen, H C; Baan, J; Marquering, H A

    2014-07-01

    Transcatheter aortic valve implantation is a minimal-invasive intervention for implanting prosthetic valves in patients with aortic stenosis. Accurate automated sizing for planning and patient selection is expected to reduce adverse effects such as paravalvular leakage and stroke. Segmentation of the aortic root in CTA is pivotal to enable automated sizing and planning. We present a fully automated segmentation algorithm to extract the aortic root from CTA volumes consisting of a number of steps: first, the volume of interest is automatically detected, and the centerline through the ascending aorta and aortic root centerline are determined. Subsequently, high intensities due to calcifications are masked. Next, the aortic root is represented in cylindrical coordinates. Finally, the aortic root is segmented using 3D normalized cuts. The method was validated against manual delineations by calculating Dice coefficients and average distance error in 20 patients. The method successfully segmented the aortic root in all 20 cases. The mean Dice coefficient was 0.95 ± 0.03, and the mean radial absolute error was 0.74 ± 0.39 mm, where the interobserver Dice coefficient was 0.95 ± 0.03 and the mean error was 0.68 ± 0.34 mm. The proposed algorithm showed accurate results compared to manual segmentations.

  12. [A case report of aortic valvuloplasty by rasping technique for aortic stenosis with small annulus simultaneously performed with mitral valve replacement].

    Science.gov (United States)

    Taniyasu, N; Kou, E; Hiramatsu, T; Yokoyama, S; Takenaka, A; Ikawa, O

    1997-02-01

    The patient was a 48-year-old woman with aortic stenosis and regurgitation and mitral stenosis. Preoperative cardiac catheterization revealed LV-Ao pressure gradient of 30 mmHg and regurgitation of Sellers III. The aortic annulus was measured less than 19 mm. As operative findings, the aortic annulus seemed to be too small to be replaced with 19 mm prosthetic valve. Aortic valvuloplasty (AVP) with rasping technique was performed for the aortic valve and valve replacement was carried out for the mitral valve. After aortic declamping and occurring her beat, the transesophageal echocardiographic evaluation for AVP was effective. Postoperative course was uneventful. Postoperative cardiac catheterization have shown decreased transvalvular pressure gradient up to 10 mmHg and aortic regurgitation of Sellers I.

  13. Three-Dimensional Echocardiography of the Aortic Valve: Feasibility, Clinical Potential, and Limitations.

    Science.gov (United States)

    Kasprzak, Jaroslaw D.; Salustri, Alessandro; Roelandt, Jos R.T.C.; Ten Cate, Folkert J.

    1998-02-01

    OBJECTIVES: The purpose of our study was to assess the feasibility and potential clinical utility of three-dimensional echocardiography for evaluation of the aortic valve. BACKGROUND: The value of three-dimensional echocardiographic assessment of the aortic valve has not been established yet. METHODS: The study group comprised 32 patients (11 women, 21 men), mean age 56.1 (range 20-82). Seven morphologically normal valves, 5 homografts, 6 mechanical prostheses, and 14 valves of abnormal morphology were evaluated. Images were acquired during a routine multiplane transesophageal echocardiographic examination (rotational scan with 2 degrees interval, respiration, and electrocardiogram [ECG] gating) and postprocessed off-line. A selection of reconstructed cutplanes (anyplane mode) and volume-rendered three-dimensional views of aortic valve anatomy were analyzed by two observers and compared with two-dimensional echocardiography findings. RESULTS: The quality of reconstructions was scored excellent when permitting unrestricted assessment of aortic valve anatomy with optimized planimetric measurements (19 patients, 59%), adequate when aortic valve was partially visualized (7 patients, 22%), or inadequate when no assessment was possible (6 patients, 19%, including 5 with prosthetic valves). Three-dimensional echocardiography provided additional information in ten (31%) patients as compared with the two-dimensional echocardiographic findings. CONCLUSIONS: It can be concluded that three-dimensional echocardiographic reconstruction of the aortic valve is feasible, with excellent or adequate quality in 81% of patients, more frequently in native than in prosthetic valves, P < 0.05. Morphologic information additional to that provided by two-dimensional echocardiography is obtained in a significant proportion of patients.

  14. Rationale and design of the edwards SAPIEN-3 periprosthetic leakage evaluation versus medtronic corevalve in transfemoral aortic valve implantation (ELECT) trial : A randomised comparison of balloon-expandable versus self-expanding transcatheter aortic valve prostheses

    NARCIS (Netherlands)

    Abawi, M; Agostoni, Pierfrancesco|info:eu-repo/dai/nl/34169276X; Kooistra, N H M; Samim, M; Nijhoff, F; Voskuil, M|info:eu-repo/dai/nl/254745954; Nathoe, H|info:eu-repo/dai/nl/267961472; Doevendans, P A|info:eu-repo/dai/nl/164248366; Chamuleau, S A|info:eu-repo/dai/nl/236454161; Urgel, K; Hendrikse, J|info:eu-repo/dai/nl/266590268; Leiner, T; Abrahams, A C|info:eu-repo/dai/nl/344456374; van der Worp, B|info:eu-repo/dai/nl/189855010; Stella, P R|info:eu-repo/dai/nl/304814717

    2017-01-01

    Background and objectives Periprosthetic aortic regurgitation (PPR) after transcatheter aortic valve implantation (TAVI) remains an important issue associated with impaired long-term outcomes. The current randomised study aims to evaluate potential differences between the balloon-expandable Edwards

  15. Ross procedure in a child with Aspergillus endocarditis and bicuspid aortic valve.

    Science.gov (United States)

    Mitropoulos, Fotios A; Kanakis, Meletios A; Contrafouris, Constantinos; Laskari, Cleo; Rammos, Spyridon; Apostolidis, Christos; Azariadis, Prodromos; Chatzis, Andrew C

    2014-08-23

    The case is presented of a previously healthy infant with a known asymptomatic bicuspid aortic valve who developed fungal endocarditis. The patient underwent aortic root replacement with a pulmonary autograft (Ross procedure). Cultured operative material revealed Aspergillus infection. The patient had an excellent recovery and remained well one year later.

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

    Science.gov (United States)

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

    2013-01-01

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

  17. 3D bioprinting of heterogeneous aortic valve conduits with alginate/gelatin hydrogels.

    Science.gov (United States)

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

    2013-05-01

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

  18. Preliminary Evidence for Aortopathy and an X-Linked Parent-of-Origin Effect on Aortic Valve Malformation in a Mouse Model of Turner Syndrome

    Directory of Open Access Journals (Sweden)

    Robert B. Hinton

    2015-07-01

    Full Text Available Turner syndrome (TS, most frequently caused by X-monosomy (45,X, is characterized in part by cardiovascular abnormalities, including aortopathy and bicuspid aortic valve (BAV. There is a need for animal models that recapitulate the cardiovascular manifestations of TS. Extracellular matrix (ECM organization and morphometrics of the aortic valve and proximal aorta were examined in adult 39,XO mice (where the parental origin of the single X was paternal (39,XPO or maternal (39,XMO and 40,XX controls. Aortic valve morphology was normal (tricuspid in all of the 39,XPO and 40,XX mice studied, but abnormal (bicuspid or quadricuspid in 15% of 39,XMO mice. Smooth muscle cell orientation in the ascending aorta was abnormal in all 39,XPO and 39,XMO mice examined, but smooth muscle actin was decreased in 39,XMO mice only. Aortic dilation was present with reduced penetrance in 39,XO mice. The 39,XO mouse demonstrates aortopathy and an X-linked parent-of-origin effect on aortic valve malformation, and the candidate gene FAM9B is polymorphically expressed in control and diseased human aortic valves. The 39,XO mouse model may be valuable for examining the mechanisms underlying the cardiovascular findings in TS, and suggest there are important genetic modifiers on the X chromosome that modulate risk for nonsyndromic BAV and aortopathy.

  19. Aortic insufficiency

    Science.gov (United States)

    ... 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's Cecil ...

  20. [Discrete type subaortic stenosis disclosed by hemolytic anemia after aortic and mitral valve replacement].

    Science.gov (United States)

    Kawahara, Yu; Inage, Yuichi; Masaki, Naoki; Kobayashi, Yuriko; Jinbu, Ryota; Toyama, Shuji; Fukasawa, Manabu

    2014-03-01

    We report a case of discrete type subaortic stenosis disclosed by hemolytic anemia 7 years after aortic and mitral prosthetic valve replacement. A 53-year-old female complained of general fatigue, dyspnea, macrohematuria and hemolysis. She had undergone aortic valve replacement for non-coronary cusp perforation 15 years before, and mitral valve replacement and tricuspid annuloplasty 7 years before. Echocardiography showed mitral prosthetic valve regurgitation (III/IV degree) and symptomatic hemolysis might be caused by accelerated blood flow through the prosthetic valve. A mild aortic stenosis (peak flow verocity:3.73 m/s) was also pointed out. The redo double valve replacement was performed. Intraoperative findings showed discrete type subaortic stenosis due to extensive pannus formation, but that the previously implanted prosthetic valves were intact. The blood flow biased by the interference of the subaortic stenosis might have obstructed closure of the mitral prosthetic valve and caused mitral regurgitation. Postoperatively, hemolysis and mitral regurgitation were diminished, and aortic stenosis was improved.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND: In aortic valve stenosis (AS), the occurrence of heart failure symptoms does not always correlate with severity of valve stenosis and left ventricular (LV) function. Therefore, we tested the hypothesis that symptomatic patients with AS have impaired diastolic, longitudinal systolic fu...... for indices of AS severity. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00294775....

  2. Our new tornado-compatible aortic valve prosthesis: notable results of hydrodynamic testing and experimental trials

    Directory of Open Access Journals (Sweden)

    Leo A. Bockeria

    2014-05-01

    Full Text Available Aims A shortcoming common to all existing designs of mechanical cardiac valve prostheses is an increased trombogenicity caused, among other factors, by the lack of hydrodynamic compatibility between the luminal part of the prosthesis and the patterned blood flow. The aim of the study is to design and test our new mechanical aortic valve prosthesis to exclude life-long anticoagulation treatment. Materials and methods Standard hydrodynamic tests of the new prosthetic valve have been carried out for comparing with the other existing valve designs. A new method for the heart valve prosthesis testing in a tornado-like flow has been developed. The valve function has been verified in a swine excluding the anticoagulation treatment during the period of time exceeding six months. Results The significant advantage of the new prosthesis in the standard hydrodynamic tests has been demonstrated. The tests in the tornado-like flow have shown that only this prosthesis allows maintaining the pattern, the head and flow rate characteristics of the tornado-like jet. Upon implanting the new prosthesis in the aortic position in a swine, the good performance of the valve without anticoagulation therapy has been confirmed in the course of more than six months. Conclusion Obtained has been the evidence of the merits of the new mechanical aortic valve owing to the due consideration of the hydrodynamic peculiarities of the aortic blood flow and the creation of the design providing the proper hydrodynamic compatibility.

  3. Surgical technique: establishing a pre-clinical large animal model to test aortic valve leaflet substitute

    Science.gov (United States)

    Knirsch, Walter; Cesarovic, Niko; Krüger, Bernard; Schmiady, Martin; Frauenfelder, Thomas; Frese, Laura; Dave, Hitendu; Hoerstrup, Simon Philipp; Hübler, Michael

    2016-01-01

    To overcome current limitations of valve substitutes and tissue substitutes the technology of tissue engineering (TE) continues to offer new perspectives in congenital cardiac surgery. We report our experiences and results implanting a decellularized TE patch in nine sheep in orthotropic position as aortic valve leaflet substitute. Establishing the animal model, feasibility, cardiopulmonary bypass issues and operative technique are highlighted. PMID:28149571

  4. Immediate results of aortic valve reconstruction by using autologous pericardium (Ozaki procedure

    Directory of Open Access Journals (Sweden)

    Е. В. Россейкин

    2016-11-01

    Full Text Available Aim. The study was designed to compare the immediate echocardiographic characteristics of aortic valve reconstruction by using autologous pericardium and the method proposed in 2007 by Shigeyuki Ozaki, as well as aortic valve replacement by means of frame-mounted biological prostheses Medtronic HANCOCK®II T505 CINCH® II and the Carpentier-Edwards PERIMOUNT.Methods. Over a period from January 2014 to February 2016, 76 patients underwent aortic valve replacement by means of frame-mounted biological prostheses Medtronic HANCOCK®II T505 CINCH® II (n=41 and Carpentier-Edwards PERIMOUNT (n=35 at our hospital. 20 patients underwent the Ozaki procedure. These three groups of patients were assigned to the study. Demographic and preoperative indicators of patients from all three groups were homogeneous (р>0.05. The evaluation of the aortic valves replaced was carried out by echocardiography.Results. Echocardiography was performed before the procedure and in the early postoperative period. Statistical analysis using ANOVA showed significantly lower values of the aortic valve pressure gradient (p<0.001 and larger effective orifice area and indexed effective orifice area of the valve (p<0.001 in the group of the Ozaki procedure.Conclusion. According to echocardiography data, in the immediate postoperative period the Ozaki procedure is associated with lower mean and peak gradients of pressure on the aortic valve and larger effective orifice area and indexed effective orifice area of the valve, as compared with the frame-mounted biological aortic prostheses Medtronic HANCOCK®II T505 CINCH® II and the Carpentier-Edwards PERIMOUNT.Received 27 May 2016. Accepted 24 June 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest.

  5. Immediate results of aortic valve reconstruction by using autologous pericardium (Ozaki procedure

    Directory of Open Access Journals (Sweden)

    Е. В. Россейкин

    2016-08-01

    Full Text Available Aim: The study was designed to compare the immediate echocardiographic characteristics of aortic valve reconstruction by using autologous pericardium and the method proposed in 2007 by Shigeyuki Ozaki, as well as aortic valve replacement by means of frame-mounted biological prostheses Medtronic HANCOCK®II T505 CINCH® II and the Carpentier-Edwards PERIMOUNT.Methods: Over a period from January 2014 to February 2016, 76 patients underwent aortic valve replacement by means of frame-mounted biological prostheses Medtronic HANCOCK®II T505 CINCH® II (n=41 and Carpentier-Edwards PERIMOUNT (n=35 at our hospital. 20 patients underwent the Ozaki procedure. These three groups of patients were assigned to the study. Demographic and preoperative indicators of patients from all three groups were homogeneous (р>0.05. The evaluation of the aortic valves replaced was carried out by echocardiography.Results: Echocardiography was performed before the procedure and in the early postoperative period. Statistical analysis using ANOVA showed significantly lower values of the aortic valve pressure gradient (p<0.001 and larger effective orifice area and indexed effective orifice area of the valve (p<0.001 in the group of the Ozaki procedure.Conclusion: According to echocardiography data, in the immediate postoperative period the Ozaki procedure is associated with lower mean and peak gradients of pressure on the aortic valve and larger effective orifice area and indexed effective orifice area of the valve, as compared with the frame-mounted biological aortic prostheses Medtronic HANCOCK®II T505 CINCH® II and the Carpentier-Edwards PERIMOUNT.FundingThe study had no sponsorship.Conflict of interestThe authors declare no conflict of interest.

  6. Five-year follow-up after transcatheter aortic valve implantation for symptomatic aortic stenosis.

    Science.gov (United States)

    Zahn, Ralf; Werner, Nicolas; Gerckens, Ulrich; Linke, Axel; Sievert, Horst; Kahlert, Philipp; Hambrecht, Rainer; Sack, Stefan; Abdel-Wahab, Mohamed; Hoffmann, Ellen; Zeymer, Uwe; Schneider, Steffen

    2017-07-06

    Transcatheter aortic valve implantation (TAVI) has been implemented into the care of elderly patients suffering from severe symptomatic aortic stenosis. However, data on long-term follow-up are sparse and predictors of long-term mortality need to be evaluated to better select patients. Therefore, we aimed to analyse predictors of 5-year mortality after TAVI. We analysed data from the German Transcatheter Aortic Valve Interventions-Registry. Each of the 27 participating hospitals agreed to include all consecutive TAVI patients at their institution. Out of 1444 patients treated with TAVI, 1378 patients had a follow-up of at least 4.5 years (completeness 95.4%). Endpoint for this analysis was 5-year survival. Cox regression analysis was used to determine risk factors associated with this endpoint. Patients who died were compared with survivors. The two groups showed multiple differences in patient characteristics, indications for interventions, preinterventional, as well as interventional characteristics and postinterventional events. Calculated 1-year mortality was 21.8% and 5-year mortality 59.1%. A higher logistic EuroScore was associated with a lower 5-year survival, being 45.5% in patients with a logistic EuroScore of 40%. Cox proportional hazard analysis revealed the following independent predictors of 5-year mortality: female gender (HR (HR)=0.66, 95% CI 0.56 to 0.77, pyear) (HR=1.02, 95% CI 1.01 to 1.03, p=0.006), prior myocardial infarction (HR=1.29, 95% CI 1.07 to 1.57, p=0.009), urgent TAVI (HR=1.25, 95% CI 1.04 to 51, p=0.020) and diabetes mellitus (HR=1.20, 95% CI 1.02 to 1.40, p=0.024). These data from the early TAVI experience show a 5-year mortality of 59.1%. Some of the predictors of 5-year mortality seem to be modifiable, such as residual aortic regurgitation, type of TAVI access route and concomitant mitral regurgitation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved

  7. CPB-assisted aortic valve replacement in a pregnant 27-year-old with endocarditis.

    Science.gov (United States)

    Marcoux, J; Rosin, M; Mycyk, T

    2009-09-01

    A 27-year-old, G(3)P( 2)A(0) female with acute Staph aureus (SA) endocarditis successfully underwent CPB-assisted aortic valve replacement with a bioprosthetic aortic valve at 22 weeks' gestation. This patient's presentation of acute endocarditis complicated by septic shock, congestive heart failure, severe aortic insufficiency, multiple septic embolic events and borderline renal failure appeared on the daunting background of chronic heavy tobacco usage, hepatitis C positivity, long-term IV drug abuse and a pregnancy into its twenty-second week. Optimal treatment strategies implemented for both mother and fetus throughout the perioperative period contributed to a successful outcome for both.

  8. Severe non-valve-related hemolytic anemia following aortic root replacement.

    Science.gov (United States)

    Stanger, Olaf; Hammerer, Matthias; Datz, Lidwina

    2010-12-01

    Aortic interposition grafting combined with aortic root replacement (conduit) is widely performed to manage thoracic aortic aneurysms. Intravascular hemolysis without clinical significance is occasionally observed as a complication after prosthetic valve replacement. Symptomatic lysis of red blood cells (RBCs) is rare and primarily attributed to mechanical damage as result of high shear stress, turbulent flow, and physical interaction. We report a case of severe hemolytic anemia shortly after mechanical conduit implantation. The RBC damage was not related to the valve prosthesis and resolved completely after replacement of a section of the kinked Dacron tube graft to correct a fold.

  9. Simulation of self expanding transcatheter aortic valve in a realistic aortic root: implications of deployment geometry on leaflet deformation.

    Science.gov (United States)

    Gunning, Paul S; Vaughan, Ted J; McNamara, Laoise M

    2014-09-01

    Self expanding Transcatheter Aortic Valve Replacements (TAVR) can conform to the geometry of the aortic annulus and the calcified leaflet complex, which may result in leaflet distortion and altered leaflet kinematics, but such changes have not yet been characterized. In this study we developed a computational model to investigate the deployment of a self expanding TAVR in a realistic aortic root model derived from multi-slice computed tomography (MSCT) images. We simulated TAVR crimping/deployment in realistic and idealized aortic root models, followed by diastolic loading of the TAVR leaflets in its final deployed configuration. The TAVR deployed in a realistic aortic root had increased peak loading in the commissural region of the leaflets compared to TAVRs under idealized circular deployment conditions (2.97 vs. 1.52 MPa). Furthermore, orientation of the TAVR in the asymmetric aortic annulus such that the commissures of the TAVR are aligned with the native valve commissures minimized the effect of TAVR stent distortion on peak stresses in the TAVR leaflets (2.97 vs. 2.35 MPa). We propose that preoperative planning of the orientation of the TAVR in the aortic root annulus might minimize the impact of potential stent distortion on leaflet function and may in turn increase long term leaflet durability.

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

    Directory of Open Access Journals (Sweden)

    Hallowell Gayle D

    2013-01-01

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

  11. Balloon-expanding stent and delivery system for transcatheter aortic valve implantation:An animal study

    Institute of Scientific and Technical Information of China (English)

    Xiang Chen; Fei-Yu Wang; Guo-Jun Chu; Yu-Feng Zhu; Hong-Wen Tan; Xian-Xian Zhao; Yong-Wen Qin; Jun-Bo Ge

    2015-01-01

    Objective: To evaluate the feasibility and satefy of transcatheter aortic valve implantation in animals by using a new balloon-expanding valved stent. Methods: The balloon-expandable stent is made from cobalt-based alloy material and designed with a tubular, slotted structure. Fresh bovine pericardium was treated, sutured and fixed on the balloon-expandable stent. Ten healthy sheep (five males and five females), weighing an average of (25.16 ± 1.83) kg, were selected to undergo transcatheter implantation of the valve stents. The function of the valve stent was evaluated by angiography, echocardiography, and histology six months after the procedure. Results: Of the ten experimental sheep, two sheep died during the operation because the higher position of the artificial valve affected the opening of the coronary artery. We successfully implanted the aortic valve stent in other eight sheep;however, one sheep died of heart failure two weeks after the operation due to the lower position of the valve stent. The valve stents were implanted in the desired position in seven sheep. Ascending aortic angiographic and autoptic findings immediately after the operation confirmed the satisfactory location and function of the valved stent. Echocardiography, angiography, and histology at six post-operative months confirmed the satisfactory location and function of the valve stent. Conclusion: We successfully implanted our new valve stent as a replacement of native aortic valve via the transcatheter route with satisfactory outcome. Copyright © 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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

    Science.gov (United States)

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

    2016-01-01

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

  13. 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.

  14. Double valve replacement for acute spontaneous left chordal rupture secondary to chronic aortic incompetence

    Directory of Open Access Journals (Sweden)

    McLenachan Jim

    2006-10-01

    Full Text Available Abstract A 54 years old male with undiagnosed chronic calcific degenerative aortic valve incompetence presented with acute left anterior chordae tendinae rupture resulting in severe left heart failure and cardiogenic shock. He was successfully treated with emergency double valve replacement using mechanical valves. The pathogenesis of acute rupture of the anterior chordae tendinae, without any evidence of infective endocarditis or ischemic heart disease seems to have been attrition of the subvalvular mitral apparatus by the chronic regurgitant jet of aortic incompetence with chronic volume overload. We review the literature with specific focus on the occurrence of this unusual event.

  15. Robotic excision of aortic valve papillary fibroelastoma and concomitant Maze procedure

    Directory of Open Access Journals (Sweden)

    Edward T Murphy

    2012-12-01

    Full Text Available Cardiothoracic surgeons have utilized the surgical robot to provide a minimally invasive approach to a number of intracardiac operations, including tumor resection, valve repair, and ablation of atrial arrhythmia. We report the case of a 58 year-old woman who was found to have a mobile mass on her aortic valve during evaluation of atrial fibrillation. Both of these conditions were addressed when she underwent a combined robotic biatrial Maze procedure and excision of the mass, which proved to be a papillary fibroelastoma of the aortic valve.

  16. ACE inhibition attenuates uremia-induced aortic valve thickening in a novel mouse model

    Directory of Open Access Journals (Sweden)

    Mäyränpää Mikko I

    2009-03-01

    Full Text Available Abstract Background We examined whether impaired renal function causes thickening of the aortic valve leaflets in hyperlipidemic apoE-knockout (apoE-/- mice, and whether the putative effect on the aortic valves could be prevented by inhibiting the angiotensin-converting enzyme (ACE with enalapril. Methods Thickening of the aortic valve leaflets in apoE-/- mice was induced by producing mild or moderate chronic renal failure resulting from unilateral nephrectomy (1/2 NX, n = 18 or subtotal nephrectomy (5/6 NX, n = 22, respectively. Additionally, the 5/6 NX mice were randomized to no treatment (n = 8 or enalapril treatment (n = 13. The maximal thickness of each leaflet was measured from histological sections of the aortic roots. Results Leaflet thickness was significantly greater in the 5/6 NX mice than in the 1/2 NX mice (P = 0.030 or the unoperated mice (P = 0.003. The 5/6 NX mice treated with enalapril had significantly thinner leaflets than did the untreated 5/6 NX mice (P = 0.014. Conclusion Moderate uremia causes thickening of the aortic valves in apoE-/- mice, which can be attenuated by ACE inhibition. The nephrectomized apoE-/- mouse constitutes a new model for investigating the mechanisms of uremia-induced aortic valve disease, and also provides an opportunity to study its pharmacologic prevention.

  17. Paradoxical low flow aortic valve stenosis: incidence, evaluation, and clinical significance.

    Science.gov (United States)

    Clavel, Marie-Annick; Pibarot, Philippe; Dumesnil, Jean G

    2014-01-01

    Paradoxical low-flow (PLF) aortic stenosis is defined by a stroke volume index <35 ml/m(2) despite the presence of preserved LV ejection fraction (≥ 50 %). This entity is typically characterized by pronounced LV concentric remodeling with small LV cavity, impaired LV filling, increased arterial load, and reduced LV longitudinal shortening. Patients with PLF also have a worse prognosis compared to patients with normal flow. Because of the low flow state, these patients often have a low gradient despite the presence of severe stenosis, thus leading to discordant AS grading (i.e., aortic valve area < 1.0 cm(2) but mean gradient < 40 mmHg) and thus uncertainty about the indication of aortic valve replacement. Stress echocardiography and aortic valve calcium score by computed tomography may be helpful to differentiate true from pseudo severe stenosis and thereby guide therapeutic management in these patients. Aortic valve replacement improves outcomes in patients with PLF low gradient AS having evidence of severe stenosis. Transcatheter aortic valve replacement may provide an interesting alternative to surgery in these patients.

  18. Candidate gene resequencing in a large bicuspid aortic valve-associated thoracic aortic aneurysm cohort: SMAD6 as an important contributor

    NARCIS (Netherlands)

    E. Gillis (Elisabeth); Kumar, A.A. (Ajay A.); Luyckx, I. (Ilse); Preuss, C. (Christoph); Cannaerts, E. (Elyssa); Beek, G. (Gerarda van de); Wieschendorf, B. (Björn); Alaerts, M. (Maaike); Bolar, N. (Nikhita); G. Vandeweyer (Geert); Meester, J. (Josephina); Wünnemann, F. (Florian); Gould, R.A. (Russell A.); Zhurayev, R. (Rustam); Zerbino, D. (Dmytro); Mohamed, S.A. (Salah A.); Mital, S. (Seema); L. Mertens (Luc); Björck, H.M. (Hanna M.); A. Franco-Cereceda (Anders); A.S. McCallion (Andrew); L. van Laer (Lut); J.M.A. Verhagen (Judith ); I.M.B.H. van de Laar (Ingrid); M.W. Wessels (Marja); Messas, E. (Emmanuel); Goudot, G. (Guillaume); Nemcikova, M. (Michaela); Krebsova, A. (Alice); M.J.E. Kempers (Marlies); Salemink, S. (Simone); Duijnhouwer, T. (Toon); X. Jeunemaître (Xavier); Albuisson, J. (Juliette); P. Eriksson (Per); Andelfinger, G. (Gregor); H.C. Dietz (Harry ); Verstraeten, A. (Aline); B.L. Loeys (Bart)

    2017-01-01

    textabstractBicuspid aortic valve (BAV) is the most common congenital heart defect. Although many BAV patients remain asymptomatic, at least 20% develop thoracic aortic aneurysm (TAA). Historically, BAV-related TAA was considered as a hemodynamic consequence of the valve defect. Multiple lines of

  19. [The assessment of mechanical heart valves stenosis in adults after aortic valve replacement: the advantage of full-flow design of mechanical valve].

    Science.gov (United States)

    Bokeria, L A; Bokeria, O L; Fadeev, A A; Makhachev, O A; Kosareva, T I; Averina, I I

    2013-01-01

    The analysis of transprosthetic hemodynamics in adults after aortic valve replacement in the Bakoulev Center for Cardiovascular Surgery in 2007-2010 demonstrated the hemodynamic advantage of the concept of new full-flow mechanical aortic valve prosthesis "CorBeat". Having the same size of internal orifice and tissue annulus diameters, the values of transprosthetic parameters (peak and mean gradients, blood flow velocities) through "CorBeat" were close to physiological values of transvalvular native aortic parameters and had a tendency to be not dependent on the size of prosthesis (p = 0.63). In the article for the first time a morphometric database of geometric values of internal orifice area of normal native aortic valves in adults was used taking into account both the gender and the body surface area's of a patient. There was also used the standardized prosthesis size Z-score which represents the number of SDs by which the internal prosthesis area differs from the mean normal native aortic valve area for the patient's body surface area. The article emphasizes the need of the personal selection of the size and the type of prosthesis for any patient as well as the need for new design development of prosthetic heart valves.

  20. 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.

  1. 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.

  2. [Anesthetic management and experience in the transcatheter implantation of the CoreValve(®) self-expanding aortic valve].

    Science.gov (United States)

    Fernández Suárez, F E; del Valle Fernández, R; González Alvarez, A; Sánchez Lasheras, J; Fernández Sánchez, L; Argüelles Tamargo, L

    2013-10-01

    To analyze the experience and anesthetic management in the transcatheter implantation of the CoreValve(®) self-expanding aortic valve, in a university tertiary hospital. Observational analytical review of data incorporated into a prospectively maintained database of 142 patients diagnosed with severe aortic stenosis who underwent implantation of a CoreValve(®) aortic self-expanding aortic valve between December 2007 and December 2012. The mean age of patients was 82.5±6.1 years and the logistic EuroSCORE was 14.9±11.2. General anesthesia was used in 107 patients (75.3%), with local anesthesia with sedation in 35 (24.6%). Local anesthesia and sedation was associated with a lower requirement of vasoactive drugs (P=.003) during implantation. No statistically significant differences were found between the 2 anesthetic techniques in the duration of the procedure, hospital stay, or morbimortality. The success rate was 97.1%. The most common complication was conduction disorders that required implantation of a permanent pacemaker in 46 patients (32.3%). There was no intraoperative mortality, and all-cause mortality at 30 days was 6.3%, with a one-year survival estimated by the Kaplan-Meier of 83.1%. This study confirms that in patients with severe aortic stenosis and high surgical risk, transcatheter implantation of aortic valve is a safe and effective alternative. Both, general anesthesia and local anesthesia with sedation are valid options, depending on the experience of the team. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Patrick Horn

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

  4. 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.

  5. IMPROVED SEMI-AUTOMATED 4D-FLOW MRI ANALYSIS IN THE AORTA IN PATIENTS WITH CONGENITAL AORTIC VALVE ANOMALIES VS TRICUSPID AORTIC VALVES

    Science.gov (United States)

    Schnell, Susanne; Entezari, Pegah; Mahadewia, Riti J.; Malaisrie, S. Chris; McCarthy, Patrick M.; Collins, Jeremy D.; Carr, James; Markl, Michael

    2015-01-01

    Objective To systematically investigate a newly developed semi-automated workflow for the analysis of aortic 4D-flow MRI and its ability to detect hemodynamic differences in patients with congenitally altered aortic valve (CAV, bicuspid or quadricuspid valves) compared to tricuspid aortic valves (TAV). Methods 4D-flow MRI data were acquired in 20 aortic dilation patients (9 TAV, 11 CAV). A semi-automated workflow was evaluated regarding inter-observer variability, accuracy of net flow, regurgitant fraction and peak systolic velocity, and the ability to detect differences between cohorts. Results were compared to manual segmentation of vessel contours. Results Despite the significantly reduced analysis time a good inter-observer agreement was found for net flow and peak systolic velocity and moderate agreement for regurgitation. Significant differences in peak velocities in the descending aorta (P=0.014) could be detected. Conclusions 4D-flow MRI-based semi-automated analysis of aortic hemodynamics can be performed with good reproducibility and accuracy. PMID:26466113

  6. Transcatheter Aortic Valve Replacement Results in Improvement of Pulmonary Function in Patients With Severe Aortic Stenosis.

    Science.gov (United States)

    Gilmore, Richard C; Thourani, Vinod H; Jensen, Hanna A; Condado, Jose; Binongo, José Nilo G; Sarin, Eric L; Devireddy, Chandan M; Leshnower, Bradley; Mavromatis, Kreton; Syed, Amjad; Guyton, Robert A; Block, Peter C; Simone, Amy; Keegan, Patricia; Stewart, James; Rajaei, Mohammad; Kaebnick, Brian; Lerakis, Stamatios; Babaliaros, Vasilis C

    2015-12-01

    Chronic obstructive pulmonary disease (COPD) has been identified as a risk factor for morbidity and mortality after transcatheter aortic valve replacement (TAVR). We hypothesized that a portion of pulmonary dysfunction in patients with severe aortic stenosis may be of cardiac origin, and has potential to improve after TAVR. A retrospective analysis was made of consecutive TAVR patients from April 2008 to October 2014. Of patients who had pulmonary function testing and serum B-type natriuretic peptide data available before and after TAVR, 58 were found to have COPD (26 mild, 14 moderate, and 18 severe). Baseline variables and operative outcomes were explored along with changes in pulmonary function. Multiple regression analyses were performed to adjust for preoperative left ventricular ejection fraction and glomerular filtration rate. Comparison of pulmonary function testing before and after the procedure among all COPD categories showed a 10% improvement in forced vital capacity (95% confidence interval: 4% to 17%) and a 12% improvement in forced expiratory volume in 1 second (95% confidence interval: 6% to 19%). There was a 29% decrease in B-type natriuretic peptide after TAVR (95% confidence interval: -40% to -16%). An improvement of at least one COPD severity category was observed in 27% of patients with mild COPD, 64% of patients with moderate COPD, and 50% of patients with severe COPD. There was no 30-day mortality in any patient group. In patients with severe aortic stenosis, TAVR is associated with a significant improvement of pulmonary function and B-type natriuretic peptide. After TAVR, the reduction in COPD severity was most evident in patients with moderate and severe pulmonary dysfunction. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Aortic root to left-atrial fistula after aortic valve replacement: A rare complication and its intraoperative management

    Directory of Open Access Journals (Sweden)

    Tanveer Ahmad

    2014-01-01

    Full Text Available Aorto-atrial fistula is a rare complication of prosthetic aortic valve replacement (AVR and most of them have been diagnosed as a late complication. We present a case of this unusual complication after AVR. Intraoperative transoesophageal echocardiography identified and diagnosed this rare and potentially disastrous surgical complication and confirmed adequacy of its surgical repair.

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

    NARCIS (Netherlands)

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

    2007-01-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    AIM: Psoriasis is a chronic inflammatory disease associated with increased risk of cardiovascular disease including atherosclerosis. The pathogenesis of aortic valve stenosis (AS) also includes an inflammatory component. We therefore investigated the risk of AS in patients with psoriasis compared...... for analysis. During the study period, we identified 58 747 patients with mild psoriasis and 11 918 patients with severe psoriasis. The overall incidence rates for AS were 8.09, 16.07, and 20.08 per 10 000 person-years for the reference population (48 539 cases [mean follow-up 12.3 years]), mild psoriasis (509...... cases [mean follow-up 6.2 years]), and severe psoriasis (99 cases [mean follow-up 5.4 years]), respectively. Correspondingly, the fully adjusted IRRs for AS were markedly increased in patients with psoriasis with IRR 1.22 (95% confidence interval [CI] 1.12-1.33) and IRR 1.61 (CI 1.32-1.96) for subjects...

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

    CERN Document Server

    Wiens, Andrew D; Inan, Omer T

    2016-01-01

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

  11. [Ascending aorta replacement late after aortic valve replacement].

    Science.gov (United States)

    Hayashi, Yasunari; Ito, Toshiaki; Maekawa, Atsuo; Sawaki, Sadanari; Fujii, Genyo; Hoshino, Satoshi; Tokoro, Masayoshi; Yanagisawa, Junji

    2013-07-01

    Replacement of the asceding aorta is indicated in patients undergoing aortic valve replacement( AVR), if the diameter of the ascending aorta is greater than 5.0 cm. If the diameter of the asceding aorta is from 4.0 to 5.0 cm, it was arguable whether replacement of the ascending aorta should be performed. Nine patients who underwent reoperative ascending aorta replacement after AVR were reviewed retrospectively. Reoperation on the asending aorta replacement was performed 11.8±7.2 years (range 1y5m~23y3m) after AVR. Mean patient age was 69.9±6.3 (range 60~81). In 2 cases, reoperations were performed early year after AVR. Although ascending aorta was dilated at the 1st operation, replacement wasn't performed for the age and minimally invasive cardiac surgery (MICS). In 3 cases, reoperations were performed more than 10 years later. On these cases, ascending aorta aneurysm and dissection occurred with no pain and were pointed out by computed tomography(CT) or ultrasonic cardiogram(UCG). We think that patients with dilatation of the ascending aorta should undergo AVR and aorta replacement at the 1st operation regardness of age. It is important that patients who underwent AVR should undergo a regular checkup on the ascending aorta.

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

    Science.gov (United States)

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

    2015-12-15

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

  13. The course of very severe aortic stenosis due to bicuspid aortic valve calcinosis in a young man

    Directory of Open Access Journals (Sweden)

    Regina Jonkaitiene

    2015-05-01

    Full Text Available In the young patients with bicuspid aortic valve, manifestation of aortic stenosis (AS often remains silent. Asymptomatic very severe AS makes medical decisions challenging. For the better evaluation of AS severity and estimation the indications for the surgical treatment any stress test is preferable. We report a case history of a 46 year old male patient with successfully treated critical AS with severe heart failure (HF that demonstrates effectiveness of the surgical treatment. Successful aortic valve replacement (AVR was beneficial and guided to increase functional class, improve LV systolic function, normalization of the heart chambers, decreased pulmonary hypertension (PH, determined reversible left ventricle (LV hypertrophy. Summarizing our experience, we hypothesize that surgical treatment of this patient with asymptomatic very severe AS would be helpful in increasing quality of life and avoiding manifestation of AS with critical severe HF.

  14. Echocardiographic and electron beam tomographic assessment of stenosis in patients with aortic valve disease: Gradient versus valve area

    NARCIS (Netherlands)

    Piers, Lieuwe Hendrik; Dikkers, Riksta; Tio, R.A.; van den Berg, M.P.; Willems, Els; Oudkerk, M.; Zijlstra, F.

    2006-01-01

    Background. Transthoracic echocardiography (TTE) is routinely used to evaluate aortic valve stenosis. However, it does not give reliable results in every patient. There is growing interest in electron-beam tomography (EBT) as a noninvasive cardiac imaging technique. The usefulness of EBT to evaluate

  15. 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. 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. I

  16. Radiation dose of patients undergoing transcatheter aortic valve implantation: a comparison between Edwards SAPIEN XT and Medtronic CoreValve aortic valve prostheses.

    Science.gov (United States)

    Steinvil, Arie; Aviram, Galit; Konigstein, Maayan; Abramowitz, Yigal; Halkin, Amir; Arbel, Yaron; Ben-Gal, Yanai; Keren, Gad; Banai, Shmuel; Finkelstein, Ariel

    2013-10-01

    The relative radiation dose (RD) of patients undergoing transcatheter aortic valve implantation (TAVI) with either the Edwards Sapien XT (ESX) or the Medtronic CoreValve (MCV) prostheses has not been studied in depth. Our aim was to quantify RD in uncomplicated transfemoral TAVI with either prosthesis. We analyzed 248 consecutive patients undergoing uncomplicated transfemoral TAVI between March 2009 and September 2012, at a single tertiary care facility. Total air Kerma, cumulated dose area product (DAP), and fluoroscopy time were determined in each case. The ESX and MCV prostheses were implanted in 44 and 204 patients, respectively. Though mean fluoroscopy time was higher during ESX valve implantation, overall RD per total air Kerma and DAP was significantly higher during MCV implantation (P < 0.05 for both comparisons). By multivariate regression analyses, prosthesis type was an independent predictor of RD according to both total air Kerma and DAP (r(2) = 0. 498; P < 0.01 and r(2) = 0.363; P < 0.01, respectively). In uncomplicated transfemoral TAVI, RD is greater during MCV implantation than during ESX implantation. Copyright © 2013 Wiley Periodicals, Inc.

  17. Presence of B cells within aortic valves in patients with aortic stenosis: Relation to severity of the disease.

    Science.gov (United States)

    Natorska, Joanna; Marek, Grzegorz; Sadowski, Jerzy; Undas, Anetta

    2016-01-01

    Aortic stenosis (AS) shares several similarities with atherosclerosis. Recent reports showed that B cells are implicated in atherosclerosis progression through macrophage-B cells bidirectional interaction. We aimed to study the in loco presence of B cells within aortic valves and to determine its modulators. Thirty-seven patients with severe AS were studied. Immunohistochemistry was performed on valve leaflets using antibodies against CD20, B cell-activating factor of the tumor necrosis factor family receptor (BAFF-R) and CD68. Plasma inflammatory markers were also determined. The B cells were detected within aortic leaflets from 5 to 31/mm(2) (17.9±11.6/mm(2)). Double-staining showed that 27±13.5% of B cells express BAFF-R. There were positive correlations between the number of B cells and macrophages (r=0.45, p=0.018), and between macrophages and B cell-associated BAFF-R expression (r=0.66, p=0.002). The number of B cells was associated with the valve calcification (r=0.41, p=0.039), and with the maximum transvalvular gradient (r=0.63, p=0.02). The BAFF-R expression was positively correlated with maximum transvalvular gradient (r=0.39, p=0.031) and negatively with aortic valve area (r=-0.41, p=0.048). There were no correlations between the number of B cells and plasma markers. It might be hypothesized that, like in atherosclerosis, increasing number of B cells within aortic valves may accelerate inflammation and thus potentiate the progression of AS. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Schattke Sebastian

    2012-03-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  20. Anesthetic management for combined mitral valve replacement and aortic valve repair in a patient with osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Huang Jiapeng

    2011-01-01

    Full Text Available Osteogenesis imperfecta is a rare disorder of connective tissues and presents multiple challenges, including difficult airway, hyperthermia, coagulopathy and respiratory dysfunction, for anesthesiologists, especially during cardiac surgery. We present anesthetic management of a patient with osteogenesis impertecta during double valve surgery. Dexmedetomidine infusion minimized the risks of malignant hyperthermia. Glidescope and in-line stabilization facilitated endotracheal intubation and protected his oral structures and cervical spine. Transesophageal echocardiography (TEE diagnosed a flail A3 segment and redundant left coronary cusp causing mitral and aortic regurgitation. The mitral valve was replaced and the aortic valve repaired. Coagulopathy was corrected according to comprehensive coagulation analysis. Glidescope, dexmedetomidine, coagulation analysis and TEE could facilitate anesthetic management in these patients.

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

    Science.gov (United States)

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

    2013-01-01

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

  2. 3D printing based on cardiac CT assists anatomic visualization prior to transcatheter aortic valve replacement.

    Science.gov (United States)

    Ripley, Beth; Kelil, Tatiana; Cheezum, Michael K; Goncalves, Alexandra; Di Carli, Marcelo F; Rybicki, Frank J; Steigner, Mike; Mitsouras, Dimitrios; Blankstein, Ron

    2016-01-01

    3D printing is a promising technique that may have applications in medicine, and there is expanding interest in the use of patient-specific 3D models to guide surgical interventions. To determine the feasibility of using cardiac CT to print individual models of the aortic root complex for transcatheter aortic valve replacement (TAVR) planning as well as to determine the ability to predict paravalvular aortic regurgitation (PAR). This retrospective study included 16 patients (9 with PAR identified on blinded interpretation of post-procedure trans-thoracic echocardiography and 7 age, sex, and valve size-matched controls with no PAR). 3D printed models of the aortic root were created from pre-TAVR cardiac computed tomography data. These models were fitted with printed valves and predictions regarding post-implant PAR were made using a light transmission test. Aortic root 3D models were highly accurate, with excellent agreement between annulus measurements made on 3D models and those made on corresponding 2D data (mean difference of -0.34 mm, 95% limits of agreement: ± 1.3 mm). The 3D printed valve models were within 0.1 mm of their designed dimensions. Examination of the fit of valves within patient-specific aortic root models correctly predicted PAR in 6 of 9 patients (6 true positive, 3 false negative) and absence of PAR in 5 of 7 patients (5 true negative, 2 false positive). Pre-TAVR 3D-printing based on cardiac CT provides a unique patient-specific method to assess the physical interplay of the aortic root and implanted valves. With additional optimization, 3D models may complement traditional techniques used for predicting which patients are more likely to develop PAR. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  3. Aortic valve reconstruction using autologous pericardium for ages over 80 years.

    Science.gov (United States)

    Ozaki, Shigeyuki; Kawase, Isamu; Yamashita, Hiromasa; Uchida, Shin; Nozawa, Yukinari; Takatoh, Mikio; Hagiwara, So; Kiyohara, Nagaki

    2014-10-01

    We performed original aortic valve reconstruction using autologous pericardium; the feasibility for elderly patients is reviewed. From April 2007 through September 2011, aortic valve reconstruction was carried out in 86 patients over the age of 80 years. Twenty-seven patients were male and 59 were female. Mean age was 82.9 ± 2.5 years. Seventy-two patients had aortic stenosis and 14 had aortic regurgitation. Mean preoperative surgical annular diameter was 19.5 ± 2.5 mm. There were 80 (90.7%) cases of small aortic annulus. Mean preoperative logistic EuroSCORE was 22.9 ± 15.8. Isolated aortic valve reconstructions were performed in 51 patients. Concomitant procedures included coronary artery bypass grafting in 6, hemiarch aortic replacements in 6, 9 maze procedures, and some combinations. No conversion to valve replacement was required. Mean follow-up was 1243 days. There were 3 hospital deaths due to noncardiac causes. No reoperation was needed. Survival at 56 months was 87.0%. No thromboembolic event occurred. Echocardiography 3.5 years after surgery revealed an average peak pressure gradient of 14.6 ± 3.8 mm Hg. No moderate or severe regurgitation was recorded. Aortic valve reconstruction is feasible for patients older than 80 years, resulting in good hemodynamics and a better quality of life, without anticoagulation. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. Examination of periodontal pathogens in stenotic valve specimens and in whole blood samples in patients affected by aortic valve stenosis and chronic periodontitis.

    Science.gov (United States)

    Raffaelli, L; Santangelo, R; Falchetti, P; Galluccio, F; Luciani, N; Anselmi, A; Nowzari, H; Verdugo, F; Fadda, G; D'Addona, A

    2010-01-01

    Periodontitis may be a risk factor for atherosclerosis and coronary heart disease. The influence of periodontal pathogens in cardiovascular diseases needs further investigation. Therefore, the aims of this clinical study are: to test the presence of periodontal bacteria DNA in aortic valves and to assess the concomitant presence of the same periodontal bacteria DNA in whole blood samples in patients affected by aortic valve stenosis and chronic periodontitis. Nineteen consecutive patients (12 males and 7 females, age: 49-85 years) were enrolled in this study after having been subjected to a complete periodontal evaluation to confirm the diagnosis of chronic periodontitis. All patients were scheduled for aortic valve replacement surgery. After clinical and microbial periodontal examination, the aortic valve tissue specimens were obtained by excision during valve replacement surgery and the patients were subjected to the whole blood sampling before the surgery. The polymerase chain reaction technology was used to detect the putative periodontal pathogens Tannerella forshytia, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens and Treponema denticola. Neither the 19 aortic valve specimens nor the blood samples were positive for the genoma of the selected periodontal pathogens. The selected periodontal pathogens did not colonize the aortic valve of patients affected by stenosis and bacterial genoma was not present in whole blood samples. A high blood pressure at the aortic valve may prevent the adhesion and proliferation of bacterial colonies.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-06-01

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

  6. Pre-interventional assessment and calcification score of the aortic valve and annulus, with multi-detector CT, in transcatheter aortic valve implantation (TAVI using the Medtronic CoreValve

    Directory of Open Access Journals (Sweden)

    Antoinette Reinders

    2015-03-01

    Full Text Available Background: Transcatheter aortic valve implantation (TAVI provides an acceptable alternative for aortic valve replacement in the elderly, but needs accurate pre-procedural imaging to optimise intervention. Objectives: To evaluate an alternative manual aortic valve calcification scoring system with computed tomography, for patients undergoing TAVI. We hypothesise a correlation between the Free State aortic valve calcium computed tomography score (FACTS scoring system, valve plaque density and procedure-related complications. Methods: Twenty patients suitable for TAVI were selected according to standard international guidelines and received multimodality imaging prior to intervention. Images were reviewed by two reviewers who were blinded to each other’s scores. Where large inter-individual score variations existed, retraining was done and scores repeated, using a double-blinded method. Matched scores were included in the final analysis. Rosenhek calcification scores were used as a standard of reference. Results: The study comprised 9 (45% men and 11 (55% women, with a median age of 83.5 years. Median EuroSCORE was 15.5. FACTS scores ≥6 were associated with the presence of a paravalvular leak (p = 0.01. Procedure-related complications (left bundle branch block, repositioning of the valve and anaemia were seen in patients with plaques measuring ≥1000 HU (p = 0.07. Conclusion: The FACTS score and averaged valve plaque HU showed potential for predicting a paravalvular leak and procedure-related complications, and could be valuable in the future for optimising patient selection for TAVI.

  7. Acute obstruction by Pannus in patients with aortic medtronic-hall valves: 30 years of experience.

    Science.gov (United States)

    Ellensen, Vegard Skalstad; Andersen, Knut Sverre; Vitale, Nicola; Davidsen, Einar Skulstad; Segadal, Leidulf; Haaverstad, Rune

    2013-12-01

    Acute dysfunction of mechanical aortic valve prostheses is a life-threatening adverse event. Pannus overgrowth, which is fibroelastic hyperplasia originating from the periannular area, is one cause of dysfunction. The aim of this study was to determine the annual incidence of readmittance resulting from acute obstruction caused by pannus during 30 years of observation in patients with Medtronic-Hall aortic valve prostheses and to analyze the risk factors associated with pannus development. From 1982 to 2004, 1,187 patients in our department underwent aortic valve replacement with Medtronic-Hall mechanical monoleaflet valve prostheses. As of December 31, 2012, 27 of these patients (2.3%) had presented with acute valve dysfunction caused by pannus obstruction. The annual incidence of pannus was 0.7 per 1,000. The median time from the primary operation to prosthetic dysfunction was 11.1 years (range, 1.2 to 26.8 years). Of the 20 patients who underwent reoperation, 2 died. Seven patients died before reoperation. Women had a higher risk for the development of obstructing pannus, and patients with pannus obstruction were younger. Valve size was not an independent risk factor. Women and younger patients are at higher risk for pannus development. When acute dysfunction by pannus is suspected in a mechanical aortic valve, an immediate echocardiogram and an emergency aortic valve replacement should be carried out because of the potential of a fatal outcome. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Spontaneous retrograde dissection of the ascending aorta in a patient with a bicuspid aortic valve.

    Science.gov (United States)

    Akgullu, Cagdas; Hekim, Tolga; Eryilmaz, Ufuk; Kurtoğlu, Tünay; Gürcün, Uğur

    2013-06-23

    Bicuspid aortic valve (BAV) is a congenital anomaly associated with structural weakness of the aortic wall. Sudden onset of symptoms in patients with BAV, such as sudden severe back pain, and pulse inequality between the extremities or tension disparity should alert clinicians to acute aortic syndromes, as they require prompt diagnosis and management. Retrograde aortic dissection, which is a rare form of acute aortic syndrome, is an uncommon life-threatening entity and may produce atypical computed tomography (CT) or magnetic resonance imaging findings, leading to difficulty in diagnosis. We report on a 51-year-old male patient with BAV and spontaneous retrograde ascending aortic dissection. CT findings were confusing and the diagnosis was made via transoesophageal echocardiography. After the diagnosis, the patient was treated with a modified Bentall procedure. He did not have any complications and was stable four months after the operation.

  9. Vascular complications with transcatheter aortic valve implantation using the 18 Fr Medtronic CoreValve System: the Rotterdam experience.

    Science.gov (United States)

    Van Mieghem, Nicolas M; Nuis, Rutger-Jan; Piazza, Nicolo; Apostolos, Tzikas; Ligthart, Jurgen; Schultz, Carl; de Jaegere, Peter P; Serruys, Patrick W

    2010-01-01

    Transcatheter aortic valve implantation (TAVI) requires large bore catheters. Access site complications, therefore, can be a concern. The aim of this study is to present the 30-day incidence of major and minor vascular complications in patients treated with the third generation 18 Fr Medtronic CoreValve System. We prospectively evaluated the vascular complications occurring in all patients treated with the 18 Fr Medtronic CoreValve System between October 2006 and October 2009 in the Thoraxcenter using various proposed definitions. Ninety-nine consecutive patients were treated with TAVI using the 18 Fr Medtronic CoreValve System. Vascular events were encountered in 13 patients (13%), seven of these cases (54%) were related to incomplete arteriotomy closure with the Prostar device which is the default access closure technique in our centre. Depending on how major vascular complications were defined, the incidence varied from 4 to 13%. Blood transfusions in combination with surgical or percutaneous intervention were required in eight cases. Transcatheter aortic valve implantation with the 18 Fr Medtronic CoreValve System(R) has a 4 to 13% vascular complications' rate. More than half of the vascular events were due to incomplete Prostar arteriotomy closure, despite its use by experienced operators. Current percutaneous closure devices for these large arteriotomies seems suboptimal. Uniformity in how to define TAVI related vascular complications is needed.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-02-15

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

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

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Egstrup, Kenneth; Wachtell, Kristian

    2013-01-01

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

  12. Cardiologist and cardiac surgeon view on decision-making in prosthetic aortic valve selection: Does profession matter?

    NARCIS (Netherlands)

    N.M. Korteland; J. Kluin (Jolanda); R.J.M. Klautz (Robert); J.W. Roos-Hesselink (Jolien); M. Versteegh (Michel); A.J.J.C. Bogers (Ad); J.J.M. Takkenberg (Hanneke)

    2014-01-01

    textabstractAims Assess and compare among Dutch cardiothoracic surgeons and cardiologists: opinion on (1) patient involvement, (2) conveying risk in aortic valve selection, and (3) aortic valve preferences. Methods and results A survey among 117 cardiothoracic surgeons and cardiologists was conducte

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

    Directory of Open Access Journals (Sweden)

    Thyregod Hans Gustav

    2013-01-01

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

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

    Science.gov (United States)

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

    2014-02-01

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    Objectives: After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design: All adult patients with severe AVS referred to a large tertiary medical......%), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09-1.26; p obesity (OR = 4.69, 1.......51-13.77; p disease (COPD) (OR = 3.66, 1.21-10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease...

  16. Fluid-structure interaction modeling of aortic valve stenosis at different heart rates.

    Science.gov (United States)

    Bahraseman, Hamidreza Ghasemi; Languri, Ehsan Mohseni; Yahyapourjalaly, Niloofar; Espino, Daniel M

    2016-01-01

    This paper proposes a model to measure the cardiac output and stroke volume at different aortic stenosis severities using a fluid-structure interaction (FSI) simulation at rest and during exercise. The geometry of the aortic valve is generated using echocardiographic imaging. An Arbitrary Lagrangian-Eulerian mesh was generated in order to perform the FSI simulations. Pressure loads on ventricular and aortic sides were applied as boundary conditions. FSI modeling results for the increment rate of cardiac output and stroke volume to heart rate, were about 58.6% and -14%, respectively, at each different stenosis severity. The mean gradient of curves of cardiac output and stroke volume to stenosis severity were reduced by 57% and 48%, respectively, when stenosis severity varied from healthy to critical stenosis. Results of this paper confirm the promising potential of computational modeling capabilities for clinical diagnosis and measurements to predict stenosed aortic valve parameters including cardiac output and stroke volume at different heart rates.

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

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    Subrata Podder

    2015-01-01

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

  18. Effect of transcatheter aortic valve implantation on intraoperative left ventricular end-diastolic pressure.

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    Toyota, Kosaku; Ota, Takashi; Nagamine, Katsutoshi; Koide, Yasuhiro; Nomura, Takeshi; Yamanaka, Futoshi; Shishido, Koki; Tanaka, Masashi; Saito, Shigeru

    2016-12-01

    Transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis is a less invasive alternative to surgical aortic valve replacement. Despite this, careful anesthetic management, especially strict control of blood pressure and fluid management, is necessary. During TAVI, normalization of left ventricular afterload due to aortic balloon valvuloplasty and prosthetic valve deployment is expected to result in rapid improvement of systolic function and consequent improvement in diastolic function. However, the early effect of TAVI on left ventricular diastolic function is less clear. We hypothesized that TAVI induces a rapid decrease in left ventricular end-diastolic pressure (LVEDP) after valve deployment. This retrospective observational study included 71 patients who had undergone TAVI using the transfemoral approach with a balloon-expandable valve under general anesthesia. Intraoperative LVEDP was measured using an intracardiac catheter. The severity of residual aortic regurgitation (AR) was assessed using the Sellers criteria. The mean (SD) LVEDP was 17.8 (5.3) mmHg just before TAVI and increased significantly to 27.3 (8.2) mmHg immediately after prosthetic valve deployment (p < 0.0001). The change in LVEDP was 8.7 (8.6) mmHg in patients with low residual AR (Sellers ≤1) and 11.0 (7.1) mmHg in those with high residual AR (Sellers ≥2); however, this difference was not significant. No correlation was found between the LVEDP change and intraoperative fluid balance. In conclusion, LVEDP increased significantly in the early period after valve deployment during TAVI, regardless of residual AR severity. It was suggested that the tolerability of fluid load could be reduced at that time.

  19. Modern Use of Echocardiography in Transcatheter Aortic Valve Replacement: an Up-Date.

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    Caldararu, Cristina; Balanescu, Serban

    2016-12-01

    Echocardiography is the cornerstone in the diagnosis of any valvular heart disease. The accurate diagnosis of aortic stenosis, the left ventricle function and the other heart valves evaluation are currently done by ultrasound alone. Prosthetic valve choice and dimensions prior to implantation can be done solely by proper use of echocardiography. The emergence of new methods to cure aortic stenosis such as trans-catheter aortic valve replacement (TAVR) emphasized the diagnostic value of cardiac ultrasound. The usefulness of echocardiography in TAVR can be divided in the baseline assessment (common to patients treated by conventional surgery), intra-procedural guidance of valve deployment and post-procedural follow-up. In the baseline diagnostic work-up echocardiography should allow proper assessment of low-gradient severe aortic stenosis and especially of "low-flow, low-gradient" aortic stenosis, as far the benefit of any valve intervention in these cases may be overshadowed by persistent ventricular dysfunction. "Classic" TAVR is performed with a trans-esophageal echocardiography probe in place, but recently intracardiac echocardiography (ICE) was advocated to reduce the need for general anesthesia. "Minimalist TAVR approach" recommends no echo-guidance and valve implantation by angiography alone. Post-TAVR echo assessment should allow prompt recognition of early complications and the severity of para-valvular leaks. Long term follow-up by echocardiography assesses prosthetic valve function, left ventricular functional recovery and the impact of the procedure on associated conditions (mitral regurgitation, pulmonary hypertension or tricuspid regurgitation). This article emphasizes the role of the cardiologist with ultrasound skills in the assessment of patients addressed to TAVR.

  20. Primary Mitral Valve Regurgitation Outcome in Patients With Severe Aortic Stenosis 1 Year After Transcatheter Aortic Valve Implantation: Echocardiographic Evaluation.

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    Florentino, Thiago Marinho; Bihan, David Le; Abizaid, Alexandre Antonio Cunha; Cedro, Alexandre Vianna; Corrêa, Amably Pessoa; Santos, Alexandre Roginski Mendes Dos; Souza, Alexandre Costa; Bignoto, Tiago Costa; Sousa, José Eduardo Moraes Rego; Sousa, Amanda Guerra de Moraes Rego

    2017-07-10

    Mitral valve regurgitation (MR), present in up to 74% of the patients with severe aortic stenosis (AS), can be a negative prognostic factor when moderate or severe. The outcome of MR after percutaneous transcatheter aortic valve implantation (TAVI) and predictors associated with that outcome have not been well established in the literature. To assess the outcome of primary MR in patients submitted to TAVI and to identify associated factors. Observational study of patients with symptomatic severe AS submitted to TAVI from January 2009 to April 2015 at two specialized centers. Echocardiographic outcome was assessed with data collected before and 1 year after TAVI. Of the 91 patients with MR submitted to TAVI and followed up for at least 12 months, 67 (73.6%) had minimum/mild MR before the procedure and 24 (26.4%) had moderate/severe MR. Of those with minimum/mild MR, 62 (92.5%) had no change in the MR grade (p literatura. Avaliar a evolução da IM primária em pacientes submetidos ao TAVI e identificar fatores associados a essa evolução. Realizou-se um estudo observacional em pacientes com EA grave sintomática, submetidos ao TAVI no período de janeiro de 2009 a abril de 2015 em dois centros especializados. Foram avaliados desfechos ecocardiográficos com dados antes e 1 ano após a intervenção. Dos 91 pacientes com IM que realizaram TAVI e tinham acompanhamento de pelo menos 12 meses, 67 (73,6%) apresentavam IM mínima ou discreta antes da realização do procedimento e 24 (26,4%), IM moderada ou grave. Entre os com IM mínima ou discreta, 62 (92,5%) não apresentaram mudança no grau de refluxo (p < 0,001) e 5 (7,5%) tiveram piora. Entre os com IM moderada ou grave, 8 (33,3%) permaneceram na mesma classe e 16 (66,7%) tiveram melhora (p = 0,076). Pacientes com IM moderada ou grave que melhoraram o grau de insuficiência apresentavam menores valores de EuroSCORE II (p = 0,023) e STS morbidade (p = 0,027), quando comparados aos que continuaram na mesma classe

  1. Aortic valve debridement by ultrasonic surgical aspirator: a word of caution.

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    Craver, J M

    1990-05-01

    Aortic stenosis was relieved in 11 patients by ultrasonic debridement of the valve and annulus, while 102 other patients underwent valve replacement for aortic stenosis during 1988. Debridement was selectively applied based on findings of small annulus size (19 mm or less) and extensive calcification. Additional patient characteristics were mean transvalvular gradient of 78 mm Hg, advanced age, and marked left ventricular hypertrophy. Six patients had no residual gradient and 5 others a mean gradient less than 10 mm Hg. There were no complications related to the debridement process. Intraoperative transesophageal Doppler echocardiography demonstrated improved leaflet mobility and elimination of the gradient in all patients and elimination of associated valvular insufficiency in 2 patients. Follow-up echocardiography demonstrated late onset of new valvular regurgitation in 5 patients that was progressive and required reoperation in 3. Thickened, hardened, and retracted valve leaflets with loss of central coaptation were found in all 3 patients who underwent reoperation. Ultrasonic debridement can effectively relieve aortic stenosis, provide an excellent immediate hemodynamic result, and decrease operative time. However, the early occurrence of aortic insufficiency in a high percentage of patients makes it an unacceptable alternative to valve replacement, and the technique should be abandoned as a treatment for severe calcific aortic stenosis.

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

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    Keymel S

    2015-09-01

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

  3. [Aorta-associated complications after prosthetic repair of the aortic valve].

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    Bazylev, V V; Vachev, S A; Karnakhin, V A; Bartosh, F L; Rosseĭkin, E V

    2015-01-01

    The authors analyzed dependence between the presence of preoperative predictors of aorta-associated complications and risk for the development of these complications in the remote period after prosthetic repair of the aortic valve. The study included a total of 231 patients subjected to aortic valve prosthetic repair with no additional intervention on the root and ascending portion of the aorta. The follow up duration varied from 12 to 62 months. As predictors of the development of aorta-associated complications we examined such factors as the bicuspid structure of the aortic valve, dilatation of the aortic ascending portion relative to the upper border of the individually calculated norm, disordered configuration of the complex "aortic root - ascending portion of the aorta", resistant arterial hypertension, diabetes mellitus. Depending on the number of predictors for the development of aorta-associated complications the patients were subdivided into 2 groups: Group One consisting of 105 patients with two and more predictors of the development of aorta-associated complications, and Group Two comprising 126 patients with not more than one predictor of the development of aorta-associated complications. It was determined that in the first group of patients the total number of aorta-associated complications in the remote period after prosthetic repair of the aortic valve amounted to 25.7% (27 of 105 patients). The total number of aorta-associated complications in the second group amounted to 1.6% (2 of 126 patients). All detected aorta-associated complications were divided into "critical" and "noncritical". The critical complications were those the detection of which required performing a second operation in the patient: formation of an ascending aortic aneurysm and type A aortic dissection. To the "noncritical" aorta-associated complications belonged dilatation of the ascending portion of the aorta progressing at a rate of 2 mm/year. Resulting from the performed study

  4. Non-linear rotation-free shell finite-element models for aortic heart valves.

    Science.gov (United States)

    Gilmanov, Anvar; Stolarski, Henryk; Sotiropoulos, Fotis

    2017-01-04

    Hyperelastic material models have been incorporated in the rotation-free, large deformation, shell finite element (FE) formulation of (Stolarski et al., 2013) and applied to dynamic simulations of aortic heart valve. Two models used in the past in analysis of such problem i.e. the Saint-Venant and May-Newmann-Yin (MNY) material models have been considered and compared. Uniaxial tests for those constitutive equations were performed to verify the formulation and implementation of the models. The issue of leaflets interactions during the closing of the heart valve at the end of systole is considered. The critical role of using non-linear anisotropic model for proper dynamic response of the heart valve especially during the closing phase is demonstrated quantitatively. This work contributes an efficient FE framework for simulating biological tissues and paves the way for high-fidelity flow structure interaction simulations of native and bioprosthetic aortic heart valves. Copyright © 2016. Published by Elsevier Ltd.

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

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    M. Polastri

    2015-06-01

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

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

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

    2006-03-15

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

  7. Feasibility of transapical aortic valve replacement through a left ventricular apical diverticulum

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    Ferrari Enrico

    2013-01-01

    Full Text Available Abstract Transapical aortic valve replacement is an established technique performed in high-risk patients with symptomatic aortic valve stenosis and vascular disease contraindicating trans-vascular and trans-aortic procedures. The presence of a left ventricular apical diverticulum is a rare event and the treatment depends on dimensions and estimated risk of embolisation, rupture, or onset of ventricular arrhythmias. The diagnosis is based on standard cardiac imaging and symptoms are very rare. In this case report we illustrate our experience with a 81 years old female patient suffering from symptomatic aortic valve stenosis, respiratory disease, chronic renal failure and severe peripheral vascular disease (logistic euroscore: 42%, who successfully underwent a transapical 23 mm balloon-expandable stent-valve implantation through an apical diverticulum of the left ventricle. Intra-luminal thrombi were absent and during the same procedure were able to treat the valve disease and to successfully exclude the apical diverticulum without complications and through a mini thoracotomy. To the best of our knowledge, this is the first time that a transapical procedure is successfully performed through an apical diverticulum.

  8. Bicuspid aortic valve: a literature review and its impact on sport activity.

    Science.gov (United States)

    De Mozzi, Paola; Longo, Umile Giuseppe; Galanti, Giorgio; Maffulli, Nicola

    2008-01-01

    The bicuspid aortic valve (BAV) is the most common congenital cardiac malformation. A literature search was performed using the key words 'bicuspid aortic valve', 'pathophysiology', 'exercise' and 'training'. BAV is the result of a complex developmental process where several genes seem to lead to abnormal valvulogenesis. Complications associated with BAV include aortic stenosis (AS) and regurgitation, infective endocarditis and aortic dilation and dissection. Moreover, BAV may be associated with other cardiovascular anomalies, mainly aortic coarctation. There is greater awareness of BAV in the young population who practice sport, with an increasing interest on the impact of regular and competitive exercise on athletes with BAV. The early identification of BAV through pre-participation screening is of paramount importance, and the justification of the more appropriate diagnostic methods is still an area of debate. A normally functioning BAV usually does not represent a limit for practising sport. The stress of regular and intense exercise on an abnormal aortic valve may favour its early deterioration and accelerate the development of complications. Therefore, athletes with BAV warrant regular follow-up, which should include echocardiographic assessment at least every year. The eligibility for participation and ability to continue to practise competitive sports in athletes with BAV cannot be generalized, but needs to be individualized depending on age, severity of lesions and type of sport. Further studies are required to elucidate the impact of physical training and competitive sports on the natural course of the BAV.

  9. Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach

    Science.gov (United States)

    Cocchia, Rosangela; D’Andrea, Antonello; Conte, Marianna; Cavallaro, Massimo; Riegler, Lucia; Citro, Rodolfo; Sirignano, Cesare; Imbriaco, Massimo; Cappelli, Maurizio; Gregorio, Giovanni; Calabrò, Raffaele; Bossone, Eduardo

    2017-01-01

    Transcatheter aortic valve replacement (TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities should be preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. Ultrasounds represent the first line tool in evaluation of this patients giving detailed anatomic description of aortic valve complex and allowing estimating with enough reliability the hemodynamic entity of valvular stenosis. Angiography should be used to assess coronary involvement and plan a revascularization strategy before the implant. Multislice computed tomography play a central role as it can give anatomical details in order to choice the best fitting prosthesis, evaluate the morphology of the access path and detect other relevant comorbidities. Cardiovascular magnetic resonance and positron emission tomography are emergent modality helpful in aortic stenosis evaluation. The aim of this review is to give an overview on TAVR clinical and technical aspects essential for adequate selection.

  10. Aortic annulus dimension assessment by computed tomography for transcatheter aortic valve implantation: differences between systole and diastole.

    Science.gov (United States)

    Bertaso, Angela G; Wong, Dennis T L; Liew, Gary Y H; Cunnington, Michael S; Richardson, James D; Thomson, Viji S; Lorraine, Brett; Kourlis, George; Leech, Diana; Worthley, Matthew I; Worthley, Stephen G

    2012-12-01

    Accurate assessment of aortic annular dimensions is essential for successful transcatheter aortic valve implantation (TAVI). Annular dimensions are conventionally measured in mid-systole by multidetector computed tomography (MDCT), echocardiography and angiography. Significant differences in systolic and diastolic aortic annular dimensions have been demonstrated in cohorts without aortic stenosis (AS), but it is unknown whether similar dynamic variation in annular dimensions exists in patients with severe calcific AS in whom aortic compliance is likely to be substantially reduced. We investigated the variation in aortic annular dimensions between systole and diastole in patients with severe calcific AS. Patients with severe calcific AS referred for TAVI were evaluated by 128-slice MDCT. Aortic annular diameter was measured during diastole and systole in the modified coronal, modified sagittal, and basal ring planes (maximal, minimal and mean diameters). Differences between systole and diastole were analysed by paired t test. Fifty-nine patients were included in the analysis. Three of the five aortic dimensions measured increased significantly during systole. The largest change was a 0.75 mm (3.4%) mean increase in the minimal diameter of the basal ring during systole (p = 0.004). This corresponds closely to the modified sagittal view, which also increased by mean 0.42 mm (1.9%) during systole (p = 0.008). There was no significant change in the maximal diameter of the basal ring or the modified coronal view during systole (p > 0.05). There is a small magnitude but statistically significant difference in aortic annulus dimensions of patients with severe AS referred for TAVI when measured in diastole and systole. This small difference is unlikely to alter clinical decisions regarding prosthesis size or suitability for TAVI.

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

    Science.gov (United States)

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

    2015-11-01

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

  12. A roadmap to investigate the genetic basis of bicuspid aortic valve and its complications: insights from the International BAVCon (Bicuspid Aortic Valve Consortium).

    Science.gov (United States)

    Prakash, Siddharth K; Bossé, Yohan; Muehlschlegel, Jochen D; Michelena, Hector I; Limongelli, Giuseppe; Della Corte, Alessandro; Pluchinotta, Francesca R; Russo, Maria Giovanna; Evangelista, Artur; Benson, D Woodrow; Body, Simon C; Milewicz, Dianna M

    2014-08-26

    Bicuspid aortic valve (BAV) is the most common adult congenital heart defect and is found in 0.5% to 2.0% of the general population. The term "BAV" refers to a heterogeneous group of disorders characterized by diverse aortic valve malformations with associated aortopathy, congenital heart defects, and genetic syndromes. Even after decades of investigation, the genetic determinants of BAV and its complications remain largely undefined. Just as BAV phenotypes are highly variable, the genetic etiologies of BAV are equally diverse and vary from complex inheritance in families to sporadic cases without any evidence of inheritance. In this paper, the authors discuss current concepts in BAV genetics and propose a roadmap for unraveling unanswered questions about BAV through the integrated analysis of genetic and clinical data.

  13. Review of molecular and mechanical interactions in the aortic valve and aorta: implications for the shared pathogenesis of aortic valve disease and aortopathy.

    Science.gov (United States)

    Krishnamurthy, Varun K; Godby, Richard C; Liu, G R; Smith, J Michael; Hiratzka, Loren F; Narmoneva, Daria A; Hinton, Robert B

    2014-12-01

    Aortic valve disease (AVD) and aortopathy are associated with substantial morbidity and mortality, representing a significant cardiovascular healthcare burden worldwide. These mechanobiological structures are morphogenetically related and function in unison from embryonic development through mature adult tissue homeostasis, serving both coordinated and distinct roles. In addition to sharing common developmental origins, diseases of the aortic valve and proximal thoracic aorta often present together clinically. Current research efforts are focused on identifying etiologic factors and elucidating pathogenesis, including genetic predisposition, maladaptive cell-matrix remodeling processes, and hemodynamic and biomechanical perturbations. Here, we review the impact of these processes as they pertain to translational research efforts, emphasizing the overlapping relationship of these two disease processes. The successful application of new therapeutic strategies and novel tissue bioprostheses for AVD and/or aortopathy will require an understanding and integration of molecular and biomechanical processes for both diseases.

  14. Surgical repair of a pseudoaneurysm of the ascending aorta after aortic valve replacement

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    Almeida Rui Manuel Sequeira de

    2001-01-01

    Full Text Available We report the case of a patient with a pseudoaneurysm of the ascending aortic clinically diagnosed 5 months after surgical replacement of the aortic valve. Diagnosis was confirmed with the aid of two-dimensional echocardiography and helicoidal angiotomography. The corrective surgery, which consisted of a reinforced suture of the communication with the ascending aorta after opening and aspiration of the cavity of the pseudoaneurysm, was successfully performed through a complete sternotomy using extracorporeal circulation, femorofemoral cannulation, and moderate hypothermia, with no aortic clamping.

  15. Serial changes of hemodynamic performance with Medtronic Hall valve in aortic position.

    Science.gov (United States)

    Cho, Yang Hyun; Jeong, Dong Seop; Park, Pyo Won; Park, Kay-Hyun; Sung, Kiick; Kim, Wook Sung; Lee, Young Tak

    2011-02-01

    The aim of this study was to evaluate the long-term hemodynamic performance of the Medtronic Hall valve by analyzing serial changes in echocardiographic outcomes in aortic position. One hundred seventeen patients who underwent aortic valve replacement (AVR) using the Medtronic Hall valve between August 1997 and January 2004 were retrospectively studied. Fifty-five patients underwent isolated AVR (AVR group), and 62 patients underwent AVR and mitral valve replacement (double valve replacement group). Mean age was 51.2 ± 10.4 years (range, 26 to 67 years), and mean follow-up duration was 93.7 ± 25.6 months (913.6 patient-years; range, 17 to 140 months). Serial echocardiographic data were analyzed. Overall mortality was 12.8% (15 of 117), but no early mortality occurred. A greater than 15 mm Hg increment of aortic transprosthetic mean pressure gradient at last follow-up occurred in 13 patients (11.1%). Redo AVR was performed in 7 patients, 6 of whom had subaortic pannus ingrowths. Group cumulative survival rates at 10 years were similar (90.4%, AVR group versus 88.4%, double valve replacement group; p = 0.580), but the AVR group showed better adverse cardiac event-free survival at 10 years (80.1% versus 53.8%; p = 0.025). Multivariate analysis showed that double valve replacement and a small-sized valve (20 mm) significantly predicted the increment of aortic transprosthetic mean pressure gradient at last follow up greater than 15 mm Hg (p = 0.013; odds ratio, 13.9; p = 0.019; odds ratio, 4.2, respectively). The transprosthetic mean pressure gradient of the Medtronic Hall valve in the aortic position frequently increased as a function of time, and this increase was more common in patients who had undergone double valve replacement, especially in those implanted with a small valve. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Blood flow characteristics in the ascending aorta after TAVI compared to surgical aortic valve replacement.

    Science.gov (United States)

    Trauzeddel, Ralf Felix; Löbe, Ulrike; Barker, Alex J; Gelsinger, Carmen; Butter, Christian; Markl, Michael; Schulz-Menger, Jeanette; von Knobelsdorff-Brenkenhoff, Florian

    2016-03-01

    Ascending aortic blood flow characteristics are altered after aortic valve surgery, but the effect of transcatheter aortic valve implantation (TAVI) is unknown. Abnormal flow may be associated with aortic and cardiac remodeling. We analyzed blood flow characteristics in the ascending aorta after TAVI in comparison to conventional stented aortic bioprostheses (AVR) and healthy subjects using time-resolved three-dimensional flow-sensitive cardiovascular magnetic resonance imaging (4D-flow MRI). Seventeen patients with TAVI (Edwards Sapien XT), 12 with AVR and 9 healthy controls underwent 4D-flow MRI of the ascending aorta. Target parameters were: severity of vortical and helical flow pattern (semiquantitative grading from 0 = none to 3 = severe) and the local distribution of systolic wall shear stress (WSSsystole). AVR revealed significantly more extensive vortical and helical flow pattern than TAVI (p = 0.042 and p = 0.002) and controls (p flow than controls (p blood flow eccentricity (64.7 and 66.7%, respectively), whereas controls showed central blood flow (88.9%). TAVI and AVR exhibited an asymmetric distribution of WSSsystole in the mid-ascending aorta with local maxima at the right anterior aortic wall and local minima at the left posterior wall. In contrast, controls showed a symmetric distribution of WSSsystole along the aortic circumference. Blood flow was significantly altered in the ascending aorta after TAVI and AVR. Changes were similar regarding WSSsystole distribution, while TAVI resulted in less helical and vortical blood flow.

  17. Marked discrepancy in pressure gradient between Doppler and catheter examinations on Medtronic Mosaic valve in aortic position.

    Science.gov (United States)

    Ito, Toshiaki; Maekawa, Atsuo; Fujii, Genyo; Sawaki, Sadanari; Hoshino, Satoshi; Hayashi, Yasunari

    2012-12-01

    A 71-year-old woman underwent aortic valve replacement with 23 mm Medtronic Mosaic Ultra valve 4 years ago because of aortic stenosis. Although she had been asymptomatic since the operation, echocardiography showed 4 m/s of transprosthetic valve flow that implied early prosthetic valve failure. Catheter examination revealed that the mean transvalvular pressure gradient during systole was 15.1 mmHg on simultaneous pressure recording, and calculated valve area 1.82 cm(2). Her body surface area was 1.56 m(2). Prosthetic valve failure and prosthesis-patient mismatch were both denied. The discrepancy between Doppler study data and catheter data seemed to be due to fluid dynamical pressure recovery phenomenon. Net pressure difference between the left ventricle and the aorta may be significantly smaller than that estimated using Bernoulli's equation from transvalvular flow speed in some patients after aortic valve replacement.

  18. High-pitch dual-source CT angiography of the aortic valve-aortic root complex without ECG-synchronization

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    Karlo, Christoph; Leschka, Sebastian; Goetti, Robert Paul; Feuchtner, Gudrun; Desbiolles, Lotus; Stolzmann, Paul; Marincek, Borut; Baumueller, Stephan [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Plass, Andre; Falk, Volkmar [University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland); Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Massachusetts General Hospital, Harvard Medical School, Cardiac MR PET CT Group, Boston, MA (United States)

    2011-01-15

    To compare image quality and radiation dose of high-pitch computed tomography angiography(CTA) of the aortic valve-aortic root complex with and without prospective ECG-gating compared to a retrospectively ECG-gated standard-pitch acquisition. 120 patients(mean age 68 {+-} 13 years) were examined using a 128-slice dual-source CT system using prospectively ECG-gated high-pitch(group A; n = 40), non-ECG-gated high-pitch(group B; n = 40) or retrospectively ECG-gated standard-pitch(C; n = 40) acquisition techniques. Image quality of the aortic root, valve and ascending aorta including the coronary ostia was assessed by two independent readers. Image noise was measured, radiation dose estimates were calculated. Interobserver agreement was good({kappa} = 0.64-0.78). Image quality was diagnostic in 38/40 patients(group A), 37/40(B) and 38/40(C) with no significant difference in number of patients with diagnostic image quality among all groups (p = 0.56). Significantly more patients showed excellent image quality in group A compared to groups B and C(each, p < 0.01). Average image noise was significantly different between all groups(p < 0.05). Mean radiation dose estimates in groups A and B(each; 2.4 {+-} 0.3 mSv) were significantly lower compared to group C(17.5 {+-} 4.4 mSv; p < 0.01). High-pitch dual-source CTA provides diagnostic image quality of the aortic valve-aortic root complex even without ECG-gating at 86% less radiation dose when compared to a standard-pitch ECG-gated acquisition. (orig.)

  19. Influence of St. Jude medical valve in patients with aortic stenosis and small aortic annulus on cardiac function and late survival result.

    Science.gov (United States)

    Natsuaki, Masafumi; Itoh, Tsuyoshi; Okazaki, Yukio; Takarabe, Kyoumi; Furukawa, Koujirou; Rikitake, Kazuhisa; Ohtubo, Satoshi

    2002-10-01

    This clinical study analyzes our experience of postoperative cardiac function and long-term survival rate in patients with aortic stenosis and small-size St. Jude Medical (SJM) valve. Sixty-eight patients who underwent aortic valve replacement by SJM valve were divided into two groups by preoperative aortic annulus diameter. Group 1 consisted of 44 patients with small aortic annulus and small-size SJM valve (19 mm or 21 mm). In Group 1, small SJM standard valves were implanted in 16 patients, and small SJM Hemodynamic Plus (HP) valves were implanted in 28 patients. Group 2 consisted of 24 patients with large-size SJM standard valve (23 mm or larger). Preoperative left ventricular mass index, left ventricular dimension, the dimension of ascending aorta, and body surface area were significantly smaller in Group 1 than in Group 2. Average age at surgery was older in Group 1 than in Group 2. Effective orifice area index of the SJM valve measured by the manufacturer's data was smaller in Group 1 than in Group 2. Postoperative left ventricular mass indexes of Group 1 (standard valve or HP valve) and Group 2 significantly decreased in comparison with the preoperative mass indexes. Postoperative left ventricular ejection fraction and the peak ejection rate of Group 1 were not different from those of Group 2. The 10 year survival rate of Group 1 was 79%, and the rate of Group 2 was 77%. At 10 years after surgery, freedom from valve-related complication of Group 1 was 80%, and freedom from complication of Group 2 was 81%. Our results demonstrated that small-size SJM valve afforded satisfactory long-term survival rate and valve-related event-free rate for elderly patients with small body surface area and small aortic annulus.

  20. Blood flow competition after aortic valve bypass: an evaluation using computational fluid dynamics.

    Science.gov (United States)

    Kawahito, Koji; Kimura, Naoyuki; Komiya, Kenji; Nakamura, Masanori; Misawa, Yoshio

    2017-05-01

    Aortic valve bypass (AVB) (apico-aortic conduit) remains an effective surgical alternative for patients in whom surgical aortic valve replacement or transcatheter aortic valve implantation is not feasible. However, specific complications include thrombus formation, possibly caused by stagnation arising from flow competition between the antegrade and retrograde flow, but this has not been fully investigated. The aim of this study was to analyse flow characteristics after AVB and to elucidate mechanisms of intra-aortic thrombus using computational fluid dynamics (CFD). Flow simulation was performed on data obtained from a 73-year-old postoperative AVB patient. Three-dimensional cine phase-contrast magnetic resonance imaging at 3 Tesla was used to acquire flow data and to set up the simulation. The vascular geometry was reconstructed using computed tomography angiograms. Flow simulations were implemented at various ratios of the flow rate between the ascending aorta and the graft. Results were visualized by streamline and particle tracing. CFD demonstrated stagnation in the ascending aorta-arch when retrograde flow was dominant, indicating that the risk of thrombus formation exists in the ascending arch in cases with severe aortic stenosis and/or poor left ventricular function. Meanwhile, stagnation was observed in the proximal descending aorta when the antegrade and retrograde flow were equivalent, suggesting that the descending aorta is critical when aortic stenosis is not severe. Flow stagnation in the aorta which may cause thrombus was observed when retrograde flow was dominant and antegrade/retrograde flows were equivalent. Our results suggest that anticoagulants might be recommended even in patients who receive biological valves.

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

    Science.gov (United States)

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

    2012-12-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Rixe, Johannes; Schmitt, Joern; Neumann, Thomas; Hamm, Christian W.; Rolf, Andreas [Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim (Germany); University Hospital of Giessen and Marburg, Site Giessen, Department of Internal Medicine I (Cardiology, Angiology), Giessen (Germany); Schuhbaeck, Annika; Nef, Holger M.; Achenbach, Stephan [University Hospital of Giessen and Marburg, Site Giessen, Department of Internal Medicine I (Cardiology, Angiology), Giessen (Germany); Liebetrau, Christoph; Moellmann, Helge; Szardien, Sebastian; Brandt, Roland [Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim (Germany); Schneider, Christian; Krombach, Gabriele [University Hospital of Giessen and Marburg, Department of Radiology, Giessen (Germany)

    2012-12-15

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

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 4. Suture-less bio-prosthetic aortic valve replacement: Early clinical and hemodynamic outcome

    Directory of Open Access Journals (Sweden)

    A. Arifi

    2016-07-01

    Full Text Available Suture-less bio-prostheses (SBP are a recent addition in the surgical armamentarium in the surgical treatment of sever aortic valve disease that offer rapid deployment, shorter bypass & ischemic times and excellent hemodynamic performance even in small aortic annulus. We present our initial experience and short-term clinical and hemodynamic results with the use of suture-less bio-prostheses. Between May 2011 and August 2015, 61 patients, with mean age of 72.6 years and severe aortic stenosis underwent aortic valve replacement with a SBP. 28 were males and 19 were females. Mean euroSCORE was 11.5. 55% had coronary artery disease, 8.5% had severe mitral regurgitation and 6.4% had severe tricuspid regurgitation. Left ventricular dysfunction was present in 28% patients and 83% had elevated right ventricular systolic pressure. Average size of aortic annulus was 21.7 mm. 42.5% patients underwent isolated aortic valve replacement while 57.5% had concomitant procedures including coronary artery bypass grafting (25 patients. Average cross clamp time in isolated aortic valve replacement was 34 min and total bypass time was 46 min. Mean gradient across the prostheses was an average of 8.9 mmHg intra-operatively with 4.3% prevalence of mild para-prosthetic leak and 10.6% prevalence of mild prosthetic regurgitation. In-hospital mortality was 2.1% (1 patient. At follow-up, average mean trans-aortic gradients were 15 mmHg and prevalence of mild prosthetic and para-prosthetic leak was 10.5%. Average left ventricular diastolic dimensions changed from 4.93 mm pre-operatively to 4.42 mm post-operatively (p = 0.023 and left ventricular systolic dimensions changed from 3.39 mm pre-operatively to 3.05 mm post-operatively (p = 0.124. Use of suture-less bio-prosthesis for aortic valve replacement produces excellent hemodynamic results with low incidence of para-prosthetic leakage and prosthetic regurgitation. Persistent low trans-aortic gradients and

  5. Mast Cells Might Have a Protective Role against the Development of Calcification and Hyalinisation in Severe Aortic Valve Stenosis.

    Science.gov (United States)

    Milutinovic, A; Petrovič, D; Zorc, M; Vraspir Porenta, O; Arko, M; Pleskovič, A; Alibegovic, A; Zorc-Pleskovic, R

    2016-01-01

    Aortic valve stenosis is characterized by inflammation and extracellular matrix remodelling. The aim of this study was to analyse the impact of mast cells on the occurrence of histopathological changes of aortic valves in patients with severe grade, non-rheumatic degenerative aortic valve stenosis. Valve specimens were obtained from 38 patients undergoing valve replacement. The role of mast cells was analysed by dividing the specimens into two groups, characterized by the presence (group A, N = 13) or absence of mast cells (group B, N = 25). There were no significant differences in clinical data between the two groups. In group A, T cells and macrophages were present in all aortic valves, as compared to a significantly lower proportion of valves with T cells and macrophages in group B. Valves in group A were less often calcified and hyaline-degenerated than valves in group B. There were no changes in fibrosis between the two groups. We found a positive correlation between the presence of mast cells and macrophages/T cells, a negative correlation between the presence of mast cells and calcification/ hyaline degeneration, and no correlation between the presence of mast cells and fibrosis. There was also a negative correlation between the presence of macrophages/T cells and calcification. The linear regression model identified only the presence of mast cells as an independent negative prediction value for calcification. In conclusion, mast cells might have a protective role against the development of calcification and hyaline degeneration in severe grade, non-rheumatic aortic valve stenosis.

  6. Computational analysis of an aortic valve jet with Lagrangian coherent structures

    Science.gov (United States)

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

    2010-03-01

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

  7. Aortic valve sclerosis in mice deficient in endothelial nitric oxide synthase

    Science.gov (United States)

    El Accaoui, Ramzi N.; Gould, Sarah T.; Hajj, Georges P.; Chu, Yi; Davis, Melissa K.; Kraft, Diane C.; Lund, Donald D.; Brooks, Robert M.; Doshi, Hardik; Zimmerman, Kathy A.; Kutschke, William; Anseth, Kristi S.; Heistad, Donald D.

    2014-01-01

    Risk factors for fibrocalcific aortic valve disease (FCAVD) are associated with systemic decreases in bioavailability of endothelium-derived nitric oxide (EDNO). In patients with bicuspid aortic valve (BAV), vascular expression of endothelial nitric oxide synthase (eNOS) is decreased, and eNOS−/− mice have increased prevalence of BAV. The goal of this study was to test the hypotheses that EDNO attenuates profibrotic actions of valve interstitial cells (VICs) in vitro and that EDNO deficiency accelerates development of FCAVD in vivo. As a result of the study, coculture of VICs with aortic valve endothelial cells (vlvECs) significantly decreased VIC activation, a critical early phase of FCAVD. Inhibition of VIC activation by vlvECs was attenuated by NG-nitro-l-arginine methyl ester or indomethacin. Coculture with vlvECs attenuated VIC expression of matrix metalloproteinase-9, which depended on stiffness of the culture matrix. Coculture with vlvECs preferentially inhibited collagen-3, compared with collagen-1, gene expression. BAV occurred in 30% of eNOS−/− mice. At age 6 mo, collagen was increased in both bicuspid and trileaflet eNOS−/− aortic valves, compared with wild-type valves. At 18 mo, total collagen was similar in eNOS−/− and wild-type mice, but collagen-3 was preferentially increased in eNOS−/− mice. Calcification and apoptosis were significantly increased in BAV of eNOS−/− mice at ages 6 and 18 mo. Remarkably, these histological changes were not accompanied by physiologically significant valve stenosis or regurgitation. In conclusion, coculture with vlvECs inhibits specific profibrotic VIC processes. In vivo, eNOS deficiency produces fibrosis in both trileaflet and BAVs but produces calcification only in BAVs. PMID:24610917

  8. Porcine Tricuspid Valve Anatomy and Human Compatibility

    DEFF Research Database (Denmark)

    Waziri, Farhad; Lyager Nielsen, Sten; Hasenkam, J. Michael

    2016-01-01

    before clinical use. The study aim was to evaluate and compare the tricuspid valve anatomy of porcine and human hearts. METHODS: The anatomy of the tricuspid valve and the surrounding structures that affect the valve during a cardiac cycle were examined in detail in 100 fresh and 19 formalin...

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  10. Can postoperative mean transprosthetic pressure gradient predict survival after aortic valve replacement?

    NARCIS (Netherlands)

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

    In this study, we sought to determine the effect of the mean transprosthetic pressure gradient (TPG), measured at 6 weeks after aortic valve replacement (AVR) or AVR with coronary artery bypass grafting (CABG) on late all-cause mortality. Between January 1998 and March 2012, 2,276 patients (mean age

  11. Frequency and prognosis of new bundle branch block induced by surgical aortic valve replacement.

    NARCIS (Netherlands)

    Poels, T.T.; Houthuizen, P.; Garsse, L.A. van; Soliman Hamad, M.A.; Maessen, J.G.; Prinzen, F.W.; Straten, A.H. Van

    2015-01-01

    OBJECTIVES: Recently, transcatheter aortic valve implantation has been introduced, but one of its complications is left bundle branch block (LBBB), a conduction disturbance that has been associated with increased mortality. We investigated the incidence and fate of both right bundle branch block

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

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  13. Myocardial infarction with ventricular septal rupture complicating elective aortic valve replacement.

    Science.gov (United States)

    Milhous, J Gerrit-Jan; Heijmen, Robin H; Ball, Egbert T; Plokker, H W Thijs

    2006-07-01

    Herein is described the case of a 79-year-old woman who underwent elective aortic valve replacement. The procedure was complicated by a particulate embolism into the left anterior descending artery leading to a myocardial infarction, complicated by ventricular septal rupture. Subsequently, the patient was reoperated on and the septal defect closed successfully, with an uneventful recovery.

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    OBJECTIVES: The purpose of this study was to determine whether elevated lipoprotein(a) levels and corresponding LPA risk genotypes (rs10455872, rs3798220, kringle IV type 2 repeat polymorphism) prospectively associate with increased risk of aortic valve stenosis (AVS). BACKGROUND: The etiologic...

  16. Total left main coronary artery occlusion after aortic aneurysm repair and valve replacement.

    Science.gov (United States)

    DePace, N L; Lemole, G M; Wolf, N W; Dowinsky, S; Untereker, W; Spagna, P M

    1991-02-01

    A 38-year-old woman with complete occlusion of the left main coronary artery secondary to cannulation during aortic valve replacement is presented. The clinical course was characterized by progressive left ventricular dysfunction and congestive heart failure. Recognition of this potential problem when it occurs is important as to institute therapeutic measures which may interrupt a patient's progressive clinical deterioration.

  17. Giant Aneursym of the Ascending Aorta 37 Years after Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2013-04-01

    Full Text Available Giant ascending aorta aneurysms (AAA, which are larger than 10 cm, are rare. We hereby present the case of a giant AAA of about 13 cm, incidentally detected several years after aortic valve replacement and treated according to the Cabrol technique without postoperative complications. [Arch Clin Exp Surg 2013; 2(2.000: 129-131

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

    Directory of Open Access Journals (Sweden)

    Johan Petrini

    2016-06-01

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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  20. Protein-altering and regulatory genetic variants near GATA4 implicated in bicuspid aortic valve

    DEFF Research Database (Denmark)

    Yang, Bo; Zhou, Wei-Wu; Jiao, Jiao

    2017-01-01

    Bicuspid aortic valve (BAV) is a heritable congenital heart defect and an important risk factor for valvulopathy and aortopathy. Here we report a genome-wide association scan of 466 BAV cases and 4,660 age, sex and ethnicity-matched controls with replication in up to 1,326 cases and 8,103 control...