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Valvular Aortic Stenosis (valvular aortic + stenosis)

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Medical Sciences	100%

Selected Abstracts

5 DIAGNOSTIC PITFALLS IN THE ECHOCARDIOGRAPHIC EVALUATION OF HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (HOCM) REFERRED FOR CATHETER INTERVENTIONAL THERAPY

ECHOCARDIOGRAPHY, Issue 1 2004
G. Beer
Introduction: Generally, the diagnosis of typical HOCM with subaortic obstruction and a dynamic pressure gradient across the left ventricular outflow tract is made by noninvasive diagnostic procedures with great certainty by employing transthoracic (TTE) and/or transoesophageal (TEE) echocardiography. However, in patients with asymmetric septal hypertrophy pitfalls in echocardiographic examination may arise from several additional diseases as described in casuistic reports. To date systematic investigations in patients referred for catheter interventional therapy of HOCM are lacking. Patients and Methods: Therefore we investigated for the first time in a systematic study 200 symptomatic patients. (180 consecutive and 20 nonconsecutive patients; functional class 3 or 4 according to NYHA) with HOCM who were referred for this new catheter interventional therapy. In all patients TTE, bicycle exercise Doppler echocardiography and multiplane TEE were performed. Results: In 4 of 180 consecutive patients. (2.2%) discrete subvalvular membranous aortic stenosis (DSAS) (3 female patients and 1 male patient; age 20 to 58 years; mean septal diameter 19 mm; Sam-like motion in all 4 patients) was made. In all cases the diagnosis could be confirmed by surgical treatment. TEE evaluation was of crucial importance with demonstration of a typical subvalvular membrane that was situated a few millimeters below the aortic valve. In all cases a typical asymmetric septal hypertrophy mimicking HOCM was seen. Additionally, in 2 patients there was a conincidence of severe symptomatic valvular aortic stenosis and HOCM and in 1 patient a tunnel type of subvalvular aortic stenosis was present. Conclusion: These results show the potential pitfalls in echocardiographic diagnosis of HOCM. Especially, the frequency of DSAS in symptomatic patients referred for HOCM is unexpectedly high (2.2%). Especially in patients in whom TTE is of insufficient quality, investigation employing multiplane TEE with careful evaluation of the small poststenotic subvalvular area in HOCM is of crucial importance. This is of special significance prior to catheter interventional therapy, because in these patients surgical treatment is mandatory. [source]

Auscultation and echocardiographic findings in Bull Terriers with and without polycystic kidney disease

AUSTRALIAN VETERINARY JOURNAL, Issue 5 2005
CA O'LEARY
Objective To investigate a possible association between Bull Terrier polycystic kidney disease (BTPKD) and cardiac disease, to determine the prevalence of mitral valve disease (MVD) and left ventricular outflow tract obstruction (LVOTO) in the Australian Bull Terrier population, and to compare auscultation and echocardiography in detection of cardiac disease in Bull Terriers. Design Ninety-nine Bull Terriers, ranging in age from 8 weeks to 13 years and 11 months were auscultated and examined using renal ultrasonography; 86 were also examined using echocardiography. The prevalence and severity of heart defects in dogs with BTPKD was compared with that in dogs without BTPKD. Results Nineteen of these 99 dogs were diagnosed with BTPKD. Forty-two percent of Bull Terriers with BTPKD and 28% of those without BTPKD had murmurs characteristic of mitral regurgitation or LVOTO. How recently an animal was descended from an ancestor with BTPKD was associated with presence (P = 0.008) and loudness of a murmur (P = 0.009). Overall, echocardiography detected MVD in 39% of Bull Terriers, with increased prevalence in older animals (P = 0.003). Mitral stenosis was found in eight cases. Fifty-three percent of dogs in this study had evidence of LVOTO, with obstruction consisting of a complex of lesions including dynamic or fixed subvalvular LVOTO, significantly narrowed left ventricular outflow tract or valvular aortic stenosis. Dogs with BTPKD, or those descended from dogs with BTPKD, were more likely to have MVD (P = 0.006), and while LVOTO was not more common in these dogs, if they did have LVOTO, they were more likely to have severe obstruction than dogs with no ancestors with BTPKD (analysed in three ways P = 0.028 to 0.001). In this study, 46% of Bull Terriers without a murmur or arrhythmia had cardiac disease detected on echocardiographic examination. Conclusion Cardiac disease, especially MVD and LVOTO, was common in Bull Terriers in this study, and those with BTPKD had an increased risk of cardiac abnormalities. Auscultation did not detect a significant number of Bull Terriers with cardiac disease. [source]

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]

Transcatheter closure of an atrial septal defect in a newborn with aortic stenosis

ACTA PAEDIATRICA, Issue 3 2009
Albrecht Beitzke
Abstract Aim: A newborn with valvular aortic stenosis and a 5 mm atrial septal defect (ASD) underwent emergency aortic valvotomy. The small left ventricle of the newborn with signs of fibroelastosis showed good function but a reduced compliance and caused a large left to right shunt at atrial level. Methods and Results: As the patient became respirator-dependant the ASD was interventionally closed with an 18 mm Amplatzer® PFO occluder. The patient could be weaned from the ventilator within two days and had an uneventful recovery. Conclusion: Interventional closure of an ASD is possible even in the newborn period and should be considered as an alternative to surgery. [source]