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Severe Aortic Stenosis (severe aortic + stenosis)

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Medical Sciences	100%

Selected Abstracts

Does Left Atrial Size Predict Mortality in Asymptomatic Patients with Severe Aortic Stenosis?

ECHOCARDIOGRAPHY, Issue 2 2010
Grace Casaclang-Verzosa M.D.
Background: We assessed the hypothesis that diastolic function represented by left atrial size determines the rate of development of symptoms and the risk of all-cause mortality in asymptomatic patients with severe aortic stenosis (AS). Methods: From a database of 622 asymptomatic patients with isolated severe AS (velocity by Doppler , 4 m/sec) followed for 5.4 ± 4 years, we reviewed the echocardiograms and evaluated Doppler echocardiographic indices of diastolic function. Prediction of symptom development and mortality by left atrial diameter with and without adjusting for clinical and echocardiographic parameters was performed using Cox proportional-hazards regression analysis. Results: The age was 71 ± 11 years and 317 (62%) patients were males. The aortic valve mean gradient was 46 ± 11 mmHg, and the Doppler-derived aortic valve area was 0.9 ± 0.2 cm2. During follow-up, symptoms developed in 233 (45%), valve surgery was performed in 290 (57%) and 138 (27%) died. Left atrial enlargement was significantly correlated with symptom development (P < 0.05) but the association diminished after adjusting for aortic valve area and peak velocity (P = 0.2). However, atrial diameter predicted death independent of age and gender (P = 0.007), comorbid conditions (P = 0.03), and AS severity and Doppler parameters of diastolic function (P = 0.002). Conclusion: Diastolic function, represented as left atrial diameter, is related to mortality in asymptomatic patients with severe AS. (ECHOCARDIOGRAPHY 2010;27:105-109) [source]

Surgical Techniques: Transcatheter Aortic Valve Implantation with "No Touch" of the Aortic Arch for the Treatment of Severe Aortic Stenosis Associated with Complex Aortic Atherosclerosis

JOURNAL OF CARDIAC SURGERY, Issue 5 2010
Rodrigo Bagur M.D.
[source]

Aortic Stenosis: Assessment of the Patient at Risk

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2007
KHUNG KEONG YEO M.B.B.S.
The true incidence of aortic stenosis among the general population is unknown but aortic sclerosis, its precursor, has been estimated to affect about 25% of people over age 65, while an estimated 3% of the population over age 75 have severe aortic stenosis. Severe aortic stenosis, when accompanied by symptoms of angina, syncope, or heart failure, is associated with high mortality rates. Two-dimensional and Doppler echocardiography are cornerstone tools for the evaluation and monitoring of aortic stenosis. Echocardiography helps identify the patient at risk of death and guide timing of aortic valve replacement. Other important diagnostic tools include cardiac catheterization, treadmill stress testing, and dobutamine stress echocardiography, although their use is limited to specific patient populations. Aortic valve replacement carries a significant operative risk of approximately 4.0%. However, risk of operative mortality varies according to comorbidities and disease presentation. There are many risk models that guide estimation of the risk of operative mortality. Understanding operative risk is important in patient care and the selection of patients for aortic valve replacement. [source]

Diagnostic Accuracy of Handheld Echocardiography for Evaluation of Aortic Stenosis

ECHOCARDIOGRAPHY, Issue 5 2010
Arnd Schaefer M.D.
Background: Symptomatic severe aortic stenosis is associated with increased mortality and morbidity. Early identification of these patients by echocardiography is crucial. We conducted this study to evaluate a handheld ultrasound device (HCU) in patients with suspected severe aortic stenosis (AS) in comparison to a standard echocardiography device (SE). Methods: A HCU (Vivid I; GE Healthcare) and a SE device (Philips iE 33) were used to evaluate 50 consecutive patients with suspected severe AS. Two consecutive echocardiographic studies were performed by two experienced and blinded examiners using HCU and SE device. AS was graded by mean transaortic pressure, aortic valve area (AVA), and indexed AVA (AVA adjusted for body surface area). Results: Mean difference for mean transaortic gradient, AVA and indexed AVA for the SE and HCU device were 1.28 mmHg (,0.70 to 3.26 mmHg), ,0.02 cm2 (,0.06 to 0.01 cm2), and ,0.01 cm2/m2 (,0.03 to 0.01 cm2/m2), respectively. Discrepancies between both devices were not associated with misinterpretation of the degree of AS. Conclusion: Our study demonstrates that HCU can be used to evaluate patients with suspected AS. (ECHOCARDIOGRAPHY 2010;27:481-486) [source]

Does Left Atrial Size Predict Mortality in Asymptomatic Patients with Severe Aortic Stenosis?

Impact of Valvular Calcification on the Diagnostic Accuracy of Transesophageal Echocardiography for the Detection of Congenital Aortic Valve Malformation

ECHOCARDIOGRAPHY, Issue 7 2007
Akash Makkar M.D.
Background: Degeneration of congenital bicuspid or unicuspid aortic valves can progress more rapidly than that of tricuspid valves, and an early diagnosis significantly impacts decision making and outcome. We hypothesized that the extent of valvular calcification would negatively influence the diagnostic accuracy of multiplane transesophageal echocardiography (TEE) for the diagnosis of congenital aortic valve disease. Methods: TEE was performed in 57 patients undergoing aortic valve replacement surgery for aortic stenosis (n = 46), pure regurgitation (n = 9), or significant regurgitation with less than severe aortic stenosis (n = 2). The degree of aortic valve calcification and the number of valve cusps were determined at surgery. Results: Surgical inspection confirmed 14 bicuspid and 43 tricuspid aortic valves. Sensitivity and specificity of TEE for the diagnosis of congenital aortic valve malformation was 93% (13/14) and 91% (39/43) (P = 0.0001), respectively. In patients with no or mild aortic valve calcification (n = 13), sensitivity and specificity of TEE for the diagnosis of congenitally malformed aortic valve was 100% (5/5) and 100% (8/8) (P = 0.001), respectively. In patients with moderate or marked aortic valve calcification (n = 44), sensitivity and specificity of TEE for the diagnosis of congenitally malformed aortic valve was 89% (8/9) and 89% (31/35) (P<0.0001), respectively. In this subgroup of 44 patients, there were four false-positive and one false-negative diagnoses due to valvular calcification. Conclusions: Although TEE is highly sensitive and specific for the detection of congenital aortic valve malformations, presence of moderate or marked calcification of the aortic valve may result in false positive and false negative diagnoses. [source]

Validation of the Peak to Mean Pressure Decrease Ratio as a New Method of Assessing Aortic Stenosis Using the Gorlin Formula and the Cardiovascular Magnetic Resonance-Based Hybrid Method

ECHOCARDIOGRAPHY, Issue 4 2007
Dariusch Haghi M.D.
Background: We sought to validate the recently introduced peak to mean pressure decrease ratio (PMPDR), using the Gorlin formula and a hybrid method which combines cardiovascular magnetic resonance (CMR)-derived stroke volume with transaortic Doppler measurements to calculate aortic valve area (AVA). Methods: Data analysis in 32 patients with severe (AVA <= 0.75 cm2) or moderate aortic stenosis who had prospectively been entered into our aortic stenosis database. Results: Gorlin-derived AVA was 0.61 ± 0.10 cm2 in severe and 0.92 ± 0.14 cm2 in moderate aortic stenosis (P < 0.01). Corresponding values for PMPRD were 1.61 ± 0.10 and 1.73 ± 0.18, respectively (P < 0.05). Sensitivity, specificity, positive and negative predictive values for PMPDR <1.5 to predict severe aortic stenosis were 0.12, 0.92, 0.67, and 0.44 as assessed by the Gorlin formula. Conclusions: Using the Gorlin formula as the reference standard, our study confirms results of a previously reported study on the performance of PMPDR for assessment of aortic stenosis. [source]

Fibrotic Aortic Stenosis in a Patient with Dwarfism

ECHOCARDIOGRAPHY, Issue 7 2000
Wen Ying Huang M.D.
In this report, we present an adult patient with dwarfism who had severe aortic stenosis with markedly thickened fibrotic valve leaflets without calcification. These findings were well demonstrated by both two- and three-dimensional transesophageal echocardiography and confirmed at surgery and by pathological examination. [source]

Aortic Valve Replacement with Simultaneous Chest Wall Reconstruction for Radiation-Induced Sarcoma

JOURNAL OF CARDIAC SURGERY, Issue 1 2008
Anand Sachithanandan A.F.R.C.S.I.
We describe a lady with previous mantle radiotherapy exposure, who developed a radiation-induced chest wall sarcoma. She underwent simultaneous aortic valve replacement (AVR) for severe aortic stenosis and excision of the sarcoma. Chest wall reconstruction was achieved with a composite marlex cement plate and a pedicled latissimus dorsi muscle flap. [source]

Aortic Stenosis: Assessment of the Patient at Risk

Treatment of severe valvular aortic stenosis and subvalvular discrete subaortic stenosis and septal hypertrophy with Percutaneous CoreValve Aortic Valve Implantation,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2010
Ariel Finkelstein MD
Abstract Background: Percutaneous Aortic Valve Implantation (PAVI) is a procedure gaining popularity and becoming more widely used for the treatment of patients with severe aortic stenosis who are at high risk for surgery. Here we show, for the first time, that a successful and complete elimination of both valvular and subvalvular pressure gradients can be achieved with a slight modification of the valve implantation technique. Methods and Results: A 91-year-old woman presented with shortness of breath at rest, effort angina, and pulmonary congestion. Echocardiography revealed calcified aortic stenosis with a peak gradient of 75 mm Hg accros the valve, and discrete subaortic stenosis (DSS) and marked hypertrophy of the basal septum with systolic anterior motion of the mitral valve (SAM). The intra ventricular gradient had a dynamic pattern across the DSS and the septal hypertrophy and measured 75 mm Hg. The total gradient across the left ventricular outflow (valvular and subvalvular) was 125 mmHg. PAVI with a 23 mm CoreValve was performed with an intentional lower positioning of the valve towards the LV outflow tract; so that the valve struts cover the subaortic membrane and part of the thickened basal septum. At the end of the procedure, the SAM disappeared, and the left ventricular ouflow was widely open. At 1 month follow up the patient was asymptomatic, no pressure gradient was measured between the LV apex and the aorta. Conclusions: This is the first report of successful treatment of severe valvular aortic stenosis and combined subvalvular aortic stenosis due to DSS and septal hypertrophy with SAM with percutaneous aortic valve implantation. © 2010 Wiley-Liss, Inc. [source]

Buddy balloon to deliver a percutaneous aortic valve device: A percutaneous shoehorn?,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2009
Imad Sheiban MD
Abstract Percutaneous aortic valve replacement is performed with increasing frequency in patients with severe aortic stenosis at prohibitive surgical risk. Currently available devices are however in their early development stage, and are thus quite bulky with a large profile, with ensuing difficulties in delivery of the device through a stenotic aortic valve. We report hereby a case in which we employed a buddy wire and balloon technique as a "shoehorn" to enable accurate delivery of a balloon-expandable aortic valve prosthesis from the transfemoral route. © 2009 Wiley-Liss, Inc. [source]

High-risk left main coronary stenting supported by percutaneous left ventricular assist device

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2005
Robert Francis Bonvini MD
Abstract Percutaneous left ventricular assist devices could nowadays offer a valid support to percutaneous coronary interventions even in very high risk patients. This case illustrates a successful distal left main coronary artery V-stenting supported by the Tandem Heart in a patient with severe left ventricular dysfunction, severe aortic stenosis, and refractory myocardial ischemia. © 2005 Wiley-Liss, Inc. [source]

Transcatheter Aortic Valve Replacement: A Potential Option for the Nonsurgical Patient

CLINICAL CARDIOLOGY, Issue 6 2009
Jigar H. Patel MD
With improved life expectancy, the incidence of aortic stenosis is rising. However, up to one-third of patients who require lifesaving surgical aortic valve replacement are denied surgery due to a high operative mortality rate. Such patients can only be treated with medical therapy or percutaneous aortic valvuloplasty, neither of which has been shown to improve mortality. With advances in interventional cardiology, transcatheter methods have been developed for aortic valve replacement. Clinical trials are investigating these devices in patients with severe aortic stenosis that have been denied surgery. Preliminary results from these trials suggest that transcatheter aortic valve replacement (TAVR) is not only feasible, but an effective way to improve symptoms. In this review, we describe the current technology and display available outcome data. Though technical challenges and operator learning curve limit optimal use of the current technology, continued experience and advancements in technology may one day make TAVR a viable alternative to traditional surgical aortic valve replacement. Copyright © 2009 Wiley Periodicals, Inc. [source]