Degenerative aortic stenosis is the most prevalent aortic valve disease in western countries. Ageing processes and increased life expectancy of the population increase the prevalence of this valvular heart disease.w1 Surgical aortic valve replacement is the first therapeutic option for patients with severe symptomatic aortic stenosis. However, in selected subgroups of patients, the operative risk may outweigh the clinical benefits of surgery. Older age, severe left ventricular systolic dysfunction, and associated comorbidities such as neurological diseases are the main determinants of non-referral for surgery in almost 30% of patients with severe symptomatic aortic stenosis.w2. Technological advances in the field of percutaneous cardiovascular interventions have favoured the development of less invasive therapeutic strategies. The emerging transcatheter aortic valve implantation (TAVI) techniques have been shown to be a feasible alternative to surgical aortic valve replacement.w3 To date, ,40 ...
Transcatheter aortic valve implantation is being established as an alternative treatment for some patients with symptomatic severe aortic stenosis who are not considered suitable for surgical aortic valve replacement because of prohibitive surgical risk.1-3 One of the potential complications is complete atrioventricular block requiring definitive pacemaker implantation. This complication occurs in 4% to 5% with the Edwards-Sapiens prosthesis (Edwards Lifesciences, Irvine, Calif),1 and in ,30% with the CoreValve system (Medtronic CV, Luxembourg),3 but it also occurs in 5% of patients after percutaneous aortic valvuloplasty4 or surgical aortic valve replacement.5. The cause of complete atrioventricular block after transcatheter aortic valve implantation is unknown. Apart from traumatic lesions produced by aortic valve prosthesis expansion, ischemia of the conduction pathways resulting from insufficient myocardial protection might play a role. Here, necropsy findings in a patient with complete ...
Surgical Aortic Valve Replacement (SAVR) vs Transcatheter Aortic Valve Implantation (TAVI): Results Comparison for Prosthesis-Patient Mismatch (PPM) - adjusted outcomes, including mortality, heart failure (HF) rehospitalization, stroke, and quality of life, at 1 year Reporter: Aviva Lev-Ari, PhD, RN J Am Coll Cardiol. 2018 Sep 18. pii: S0735-1097(18)38287-1. doi: 10.1016/j.jacc.2018.09.001. [Epub ahead of print] Prosthesis-Patient […]…
Routine predeployment balloon aortic valvuloplasty (BAV) has historically been considered an essential part of the transcatheter aortic valve replacement (TAVR) procedure, ensuring unimpeded delivery of the prosthetic valve across the stenotic aortic valve, optimal valve expansion, and hemodynamic stability during valve deployment. This was particularly pertinent for first‐generation valves with very large profiles (22‐F and 24‐F Edwards Sapien valve [Edwards Lifesciences, Irvine, CA]1 and 24‐F Medtronic CoreValve [Medtronic, Dublin, Ireland]2), for which valve crossing was often challenging. However, its continued role as a routine adjunct given more advanced delivery systems with lower profiles (14‐F to 16‐F for the Edwards S3 and Medtronic Evolut R valves) and improved trackability remains uncertain. Routine predeployment BAV for every TAVR might not be necessary, especially as operators strive to minimize TAVR‐related risks. A tailored approach to predeployment BAV for specific ...
Objectives The aim of this study was to evaluate clinical outcome after CoreValve implantation in patients (pts) with low-gradient aortic stenosis (LGAS). We were especially interested in the 30 days mortality and in longterm outcome in respect to the presence or absence of contractile reserve (CR) evaluated by low dose dobutamine stessechocardiography (LDSE). Background Pts with LGAS have a considerable high operative mortality, especially if pts show no CR during LDSE. Percutaneous aortic valve repair (TAVI) is a new emerging technology for interventional treatment of severe aortic valve stenosis in surgical high-risk patients and offers a less invasive approach in these pts. Hence one might speculate that TAVI represents a promising treatment for these patients. Methods From April 2010 to february 2012 in total 165 patients (age 80.6 +0.8 years ) with high perioperative risk (log Euroscore , 20%) underwent TAVI at our hospital using the CoreValve Revalving system (26/29/31mm) in local ...
A 78-year-old woman with chest discomfort and progressive exertional dyspnea was admitted to our center. Transthoracic echocardiography (TTE) suggested severe aortic stenosis (AS) (mean pressure gradient 70 mm Hg; peak jet velocity 5.4 m/s) and moderate aortic regurgitation (AR). Left ventricular ejection fraction was 64%. Bicuspidy of the aortic valve and aneurysmal dilation of the ascending aorta (56 mm in diameter) were noted on TTE. She was declined for surgery on account of high operative risk (logistic EuroSCORE 31.67%) after consultations by the heart team, thus she was evaluated for transcatheter aortic valve implantation (TAVI). Coronary angiogram showed the absence of significant coronary lesions. Three-dimensional computed tomographic angiography (CTA) confirmed the bicuspidy (Fig. 1A) and measured the diameter of the ascending aorta at 53 mm (Fig. 1B); the annulus was elliptical with a long-axis diameter of 25.6 mm and a short-axis diameter of 19.5 mm. TAVI was conducted in a hybrid ...
To analyze our experience with percutaneous aortic balloon valvuloplasty in newborn infants with aortic stenosis, emphasizing the extraordinary importance of myocardial perfusion. Over a 10-year-period, 21 neonates underwent percutaneous aortic balloon valvuloplasty. Age ranged from 2 to 27 days, weight ranged from 2.2 to 4.1 kg and 19 were males. All patients presented with congestive heart failure that could not be treated clinically. The onset of symptoms in the first week of life occurred in 9 patients considered as having critical aortic stenosis. Severe aortic stenosis occurred in 12 patients with the onset of symptoms in the second week of life. Mortality reached 100% in the patients with critical aortic stenosis. The procedure was considered effective in the 12 patients with severe aortic stenosis. Vascular complications included the loss of pulse in 12 patients and rupture of the femoral artery in 2 patients. Cardiac complications included acute aortic regurgitation in 2 patients and ...
TY - JOUR. T1 - Correlation between calcific aortic stenosis diagnosed by two‐dimensional echocardiography and cardiac catheterization. AU - Nair, C. K.. AU - Aronow, W. S.. AU - Sketch, M. H.. AU - Mohiuddin, S. M.. AU - Stokke, K.. AU - Ryschon, K.. PY - 1984/1/1. Y1 - 1984/1/1. N2 - This retrospective study correlates the severity of calcific aortic stenosis determined by two-dimensional (2-D) echocardiography with the aortic valve area determined by catheterization in 57 patients. Aortic valve leaflet calcification was diagnosed by cineangiography in 50 (88%) of 57 patients and by 2-D echo in 57 (100%) of 57 patients (p. AB - This retrospective study correlates the severity of calcific aortic stenosis determined by two-dimensional (2-D) echocardiography with the aortic valve area determined by catheterization in 57 patients. Aortic valve leaflet calcification was diagnosed by cineangiography in 50 (88%) of 57 patients and by 2-D echo in 57 (100%) of 57 patients (p. UR - ...
TY - JOUR. T1 - Prognostic value of pre-procedural left ventricular strain for clinical events after transcatheter aortic valve implantation. AU - Suzuki-Eguchi, Noriko. AU - Murata, Mitsushige. AU - Itabashi, Yuji. AU - Shirakawa, Kosuke. AU - Fukuda, Memori. AU - Endo, Jin. AU - Tsuruta, Hikaru. AU - Arai, Takahide. AU - Hayashida, Kentaro. AU - Shimizu, Hideyuki. AU - Fukuda, Keiichi. PY - 2018/10/1. Y1 - 2018/10/1. N2 - Background Transcatheter aortic valve implantation (TAVI) is an alternative therapy for surgically highrisk patients with severe aortic stenosis (AS). Although TAVI improves survival of patients with severe AS, the mechanism of this effect remains to be clarified. We investigated the effects of TAVI on left ventricular (LV) function and identified the predictive parameters for cardiac events after TAVI. Methods and results We studied 128 patients with severe symptomatic AS who underwent TAVI. Echocardiographic assessments were performed before and after TAVI. In addition to ...
Aortic valve replacement (AVR) has been the mainstay of treatment of symptomatic severe aortic stenosis (AS). The role of transcatheter aortic valve implantation (TAVI; also known as transcatheter aortic valve replacement or TAVR) as an alternative t
TY - JOUR. T1 - Combined spinal-epidural anesthesia for lumbar discectomy in a patient with asymptomatic severe aortic stenosis -a case report-. AU - Kim, Young Sung. AU - Park, Ji Hye. AU - Lee, Shin Young. AU - Lim, Byung Gun. AU - Kim, Heezoo. AU - Lee, Il Ok. AU - Kong, Myounghoon. PY - 2014/1/1. Y1 - 2014/1/1. N2 - The use of neuraxial anesthesia has traditionally been contraindicated in patients with severe aortic stenosis. However, general anesthesia can be riskier than neuraxial anesthesia for severe aortic stenosis patients undergoing spinal surgeries in the prone position as this can cause a major reduction in cardiac output secondary to diminished preload. In addition, general anesthesia, muscle relaxation, and positive-pressure ventilation can decrease venous return and reduce vascular tone, further compromising cardiac output. Combined spinal-epidural anesthesia with closely monitored, careful titration of the local anesthetic dose can be an efficient and safe anesthetic method for ...
Aortic Valve Stenosis Aortic Valve Stenosis is the narrowing or obstruction of the hearts aortic valve. The aorta is a large artery that originates in the
In patients with asymptomatic aortic stenosis (AS), the prognostic value of reduced left ventricular (LV) ejection fraction is well known. Consequently, there is class I indication for surgery in these patients when LV ejection fraction ,50%. However, there is growing evidences suggesting that subclinical LV dysfunction, and more particularly longitudinal myocardial dysfunction, may be a powerful early predictor of outcome, even when LV ejection is still preserved. In asymptomatic AS patients with LV ejection fraction ,50%, a reduced LV global longitudinal strain, as assessed using speckle tracking imaging with transthoracic echocardiography, may be an accurate marker to identify early subclinical LV dysfunction and thus, to improve the risk stratification, the management and the timing of surgery. Several mono-centric observational small studies recently reported results emphasizing the role of LV global longitudinal strain in AS patients. Therefore, a meta-analysis may be conducted and may ...
The purpose of the study is to investigate the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with severe, symptomatic Aortic Stenosis (AS) at intermediate surgical risk by randomizing patients to either Surgical Aortic Valve Replacement (SAVR) or TAVI with the Medtronic CoreValve® System.. Single Arm: The purpose of this trial is to evaluate the safety and effectiveness of transcatheter aortic valve implementation (TAVI) in patients with sever symptomatic Aortic Stenosis (AS) at intermediate surgical risk with TAVI. This is a non-randomized phase of the pivotal clinical trial. ...
Background-The prognostic importance of left ventricular (LV) mass in nonsevere asymptomatic aortic stenosis has not been documented in a large prospective study.. Methods and Results-Cox regression analysis was used to assess the impact of echocardiographic LV mass on rate of major cardiovascular events in 1656 patients (mean age, 67 years; 39.6% women) with mild-to-moderate asymptomatic aortic stenosis participating in the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study. Patients were followed during 4.3 years of randomized treatment with combined simvastatin 40 mg and ezetimibe 10 mg daily or placebo. At baseline, LV mass index was 45.9+14.9 g/m2.7, and peak aortic jet velocity was 3.09+0.54 m/s. During follow-up, 558 major cardiovascular events occurred. In Cox regression analyses, 1 SD (15 g/m2.7) higher baseline LV mass index predicted increases in hazards of 12% for major cardiovascular events, 28% for ischemic cardiovascular events, 34% for cardiovascular mortality, and 23% for ...
Mack MJ, Leon MB, Smith CR, et al; PARTNER 1 trial investigators. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015 Mar 15. Epub ahead of print. 25788234 ...
As life expectancy has increased, so has the prevalence of heart valve disease, including a type called aortic valve stenosis. Now a minimally invasive procedure called TAVR is providing an alternative to open-heart surgery for treating the condition.
The hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR). TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported. This is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals. Seven observational
Aortic valve stenosis is a defect that narrows or obstructs the aortic valve opening, making it difficult for the heart to pump blood into the aorta. This may not have symptoms initially, but it can worsen over time. Typically the aortic valve has three cusps (tricuspid aortic valve), but some people are born with an aortic valve that has two cusps (bicuspid aortic valve).. ...
Transcatheter Aortic Valve Implantation has become an alternative treatment for elderly patients with severe aortic stenosis at risk of surgical aortic valve replacement
Introduction: Aortic valve stenosis imposes a pressure overload on the left ventricle. Congestive heart failure is one of the complications which can appear, even years after the operation. The main questions are: why do patients still develop heart failure? Which types of congestive heart failure can be expected? Which factors related to it are known? Methods: A literature search was performed with the terms aortic valve disease/replacement AND heart failure. Some secondary references derived from their reference list were also included. The study design of the selected papers differed considerably. Therefore, the analysis is descriptive and concerns factors which can be related to congestive heart failure. Furthermore, surrogate outcomes are ejection fraction, hypertrophy, long axis ventricular function, torsion, left atrial indices, pressures in the left sided heart and in the pulmonary circulation as well as a number of other echocardiographic parameters. Results: It has become clear that ...
ABSTRACT: The optimal treatment for coronary artery disease in patients who are candidates for percutaneous aortic valve implantation (PAVI) remains unclear. The operating team should take into consideration that the symptoms of ischemic heart disease could be identical to those of severe aortic stenosis and that performing percutaneous coronary intervention (PCI) in these frail patients prior to, or following PAVI, is not trivial. We describe a patient with severe aortic stenosis and significant coronary artery disease who was treated during the same interventional session: PCI that was followed immediately by PAVI. We review the different treatment strategies for patients who are candidates for PAVI and have coronary artery disease, discuss the relative advantages of each approach, and propose an algorithm for their treatment. _______________________________________________. J INVASIVE CARDIOL 2009;21:E237-E241. Key words: PaceC elevation. Calcific aortic stenosis is associated with ...
TY - JOUR. T1 - Severe aortic stenosis in patients 60 years of age or older. T2 - left ventricular function and 10-year survival after valve replacement.. AU - Murphy, Edward. AU - Lawson, R. M.. AU - Starr, Albert. AU - Rahimtoola, S. H.. PY - 1981/8. Y1 - 1981/8. N2 - From 1962-1977, 99 patients, mean age 65 +/- 0.5 years (range 60-81 years) underwent valve replacement for severe calcific aortic valve stenosis. Ninety-three percent of the patients were in New York Heart Association functional class III or IV. The aortic valve gradient was 76 +/- 3 mm Hg and the aortic valve area index was 0.34 +/- 0.01 cm2/m2. Left ventricular systolic pressure was 207 +/- 4 mm Hg, cardiac index was 2.5 +/- 0.1 l/min/m2, left ventricular ejection fraction was 0.57 +/- 0.02 and left ventricular end-diastolic volume index was 108 +/- 60 ml/m2; left ventricular ejection fraction and end-diastolic volume were normal in 63% of the patients. The operative mortality was 16%. Mean follow-up is 55 +/- 4 months. Using ...
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 ...
The importance of bleeding and its sequelae have been increasingly recognised by interventional cardiologists. We are undertaking increasingly complex percutaneous interventions, performed upon higher-risk patients, who are more elderly with a greater range of comorbidities,1 and using multiple anticoagulant pharmacotherapies,2 which may all increase susceptibility to bleeding. The advent of transcatheter aortic valve implantation (TAVI) has allowed cardiologists and surgeons to offer treatment for aortic valve disease to a similarly high-risk cohort of patients. The PARTNER randomised trial having demonstrated a survival benefit,3 the challenge is now to improve the safety profile of the procedure, and addressing the risk of bleeding is paramount to this.. Borz et al4 present data from a single centre using the Edwards bioprosthesis (Edwards Lifesciences, Irvine, California, USA). They report notable bleeding and life-threatening bleeding (LTB) rates of 27.6% and 13.2%, respectively. Their ...
This story was written by Nish Patel, MD, FACC, Albany Associates in Cardiology, a member of St. Peters Health Partners Medical Associates.]. In its upcoming February 27 print edition, The New England Journal of Medicine is set to publish a study that shows patients who underwent minimally invasive transcatheter aortic valve replacement (TAVR) surgery had similar clinical outcomes as patients who had traditional open-heart surgery.. The five-year study compared long-term outcomes of TAVR versus open-heart approaches to treating aortic valve stenosis. According to the American Heart Association, nearly 1.5 million people in the U.S. have aortic valve stenosis, which, if left untreated, often results in heart failure or death.. Aortic valve stenosis is a narrowing or hardening of the aortic valve most often caused by calcium buildup on the heart valve flaps. When the valve cannot fully open, less oxygen-rich blood flows to the body. This forces the heart to work harder to pump blood, and ...
Aortic Valve Stenosis: A pathological constriction that can occur above (supravalvular stenosis), below (subvalvular stenosis), or at the AORTIC VALVE. It is characterized by restricted outflow from the LEFT VENTRICLE into the AORTA.
Peak left ventricular pressure during balloon inflation was measured in 20 patients who underwent balloon valvuloplasty for severe aortic stenosis to define the determinants of ventricular pressure development in response to increased loading conditions. The peak left ventricular pressure ranged from 150 ± 5 to 386 ± 22 mm Hg (mean ± Sl), was reproducible in each patient with each balloon inflation (mean coefficient of variation 7.8%) and correlated with concurrent echocardiographic measurements of ejection fraction (r = 0.89, p = 0.0001) and mass/volume ratio in systole (r = 0.91, p = 0.0001) or diastole (r = 0.88, p = 0.0001). Thirteen patients with class II or more severe congestive heart failure had lower values for peak left ventricular pressure than did those without failure (225 ± 46 versus 305 ± 45 mm Hg, p = 0.002), whereas no difference in rest left ventricular systolic pressure was seen between the two groups. The measurement of peak left ventricular pressure was inversely ...
Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve allows blood to flow from the hearts lower left chamber into the aorta.
Only recently was the first data from the GARY Registry published. The GARY registry is a nationwide complete survey of patients with aortic valve stenosis undergoing invasive procedures including surgical (AVR), catheter-based (TAVI) transfemoral, catheter-based (TAVI) transapical procedures, and valvuloplasty. The aim of this unique registry initiated by cardiologists and heart surgeons together is to evaluate catheter-based procedures in comparison to surgical aortic valve replacement. In detail, the registry will allow for the development of criteria for adequate patient selection for the best treatment modality. From 01/01/2011 to 31/12/2011, 13,860 patients were included of whom 6,523 received SAVR without CABG, 3,462 SAVR with CABG, 2,694 transvascular TAVI, and 1,181 transapical TAVI. Outcome parameters are available for 1 year and show a continuous increase in mortality after hospital discharge, predominately in high-risk groups. In low and intermediate risk groups, surgical AVR without ...
PURPOSE: We sought to determine the accuracy of multislice spiral computed tomography (MSCT) for assessing of aortic valve stenosis and to establish threshold values of the planimetric aortic valve orifice area (AVA) that best separate between differ
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Aortic stenosis patients with left ventricular dysfunction are at increased risk for morbidity and mortality following surgical aortic valve replacement. There are few published data regarding the outcomes of patients with severe aortic stenosis and
Thirty adult patients with aortic stenosis had Doppler echocardiography within 1 day of cardiac catheterization. Noninvasive measurement of the mean transaortic pressure gradient was calculated by applying the simplified Bernoulli equation to the continuous wave Doppler transaortic velocity recording. Stroke volume was measured noninvasively by multiplying the systolic velocity integral of flow in the left ventricular outflow tract (obtained by pulsed Doppler ultrasonography) by the cross-sectional area of the left ventricular outflow tract (measured by two-dimensional echocardiography). Non-invasive measurement of aortic valve area was calculated by two methods. In method 1, the Gorlin equation was applied using Doppler-derived mean pressure gradient, cardiac output and systolic ejection period. Method 2 used the continuity equation. These noninvasive measurements were compared with invasive measurements using linear regression analysis, and mean pressure gradients correlated well (r = 0.92). ...
Predilatation has been historically considered a mandatory step before transcatheter aortic valve implantation (TAVI) since it facilitates valve crossing and prosthesis delivery, ensures optimal valve expansion and improves hemodynamic stability during valve deployment.
Background: The availability of transcatheter aortic valve replacement (TAVR) has expanded the proportion of patients with severe aortic stenosis (AS) who are candidates for valve replacement. Nevertheless, many patients decline or are not candidates for TAVR or surgical replacement, and their prognosis and risk factors for mortality are incompletely understood.. Methods: We examined 148 patients with severe AS referred for TAVR, but not treated with an aortic valve procedure, and with complete echocardiography and at least 3 months of follow-up. We determined all-cause mortality using the social security death index, and compared patient characteristics and echocardiography findings between survivors and non-survivors.. Results: Mean age was 78.9±10.4 years, and 53.4% were male. Mean follow-up was 10.3±8.7 months, and death occurred in 63 (42.6%) of patients. Mean follow-up for survivors was 14.4±8.6 months, and mean time to death was 4.7±5.2 months. Cumulative survival was 55.7% and 47.2% ...
Your aortic valve plays a key role in getting oxygen-rich blood to your body. Aortic valve stenosis is a common and serious heart problem when the valve doesnt open fully. Learn about what causes it and how it can be treated.
Aortic valve stenosis is a narrowing of the aortic valve that can stop blood from flowing properly out of the heart. Learn more from Boston Childrens Hospital.
TY - JOUR. T1 - Critical aortic stenosis in the first month of life. T2 - Surgical results in 26 infants. AU - Karl, Tom R.. AU - Sano, Shunji. AU - Brawn, William J.. AU - Mee, Roger B B. PY - 1990. Y1 - 1990. N2 - Between 1980 and 1989, 26 infants aged less than 1 month underwent open aortic valvotomy for critical aortic stenosis. All had congestive heart failure requiring inotropic agents (58%), ventilation (42%), and/or prostaglandin E1 (35%) preoperatively. Nine patients with isolated aortic stenosis had an operative mortality of 0%, whereas 17 patients with other anatomical lesions had a 47% mortality (p ,0.01). Univariate analysis failed to identify additional risk factors other than year of operation (p ,0.05). There were four late deaths, three probably related to arrhythmia (actuarial survival at 113 months = 0.53). Two patients have required late reoperation; neither required valve replacement.. AB - Between 1980 and 1989, 26 infants aged less than 1 month underwent open aortic ...
This is the first study to investigate the incidence and magnitude of pressure recovery in a large cohort of prospectively recruited patients with asymptomatic AS. The findings demonstrate that clinically important pressure recovery is present in a significant number of asymptomatic patients with AS and a transvalvular velocity of 2.5 to 4.0 m/s. As expected from experimental data (1,2,17) and confirmed in small clinical studies (18–20), the absolute magnitude of pressure recovery was greater in subjects with higher transvalvular velocities and more severe AS. However, the functional significance of pressure recovery was proportionately larger in patients with a lower degree of stenosis, confirming results in previous experimental and invasive studies (17,19).. Based on the present results, a substantial number of asymptomatic AS patients are likely to be misclassified as having severe AS if pressure recovery is not taken into account. Compared with previously published smaller studies ...
Aortic stenosis affects 3% of persons older than 65 years. Although survival in asymptomatic patients is comparable to that in age- and sex-matched control patients, it decreases rapidly after symptoms appear. During the asymptomatic latent period, left ventricular hypertrophy and atrial augmentation of preload compensate for the increase in afterload caused by aortic stenosis. As the disease worsens, these compensatory mechanisms become inadequate, leading to symptoms of heart failure, angina, or syncope. Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. Watchful waiting is recommended for most asymptomatic patients. However, select patients may also benefit from aortic valve replacement before the onset of symptoms. Surgical valve replacement is the standard of care for patients at low to moderate surgical risk. Transcatheter aortic valve replacement may be considered in patients at high or prohibitive surgical risk.
Hi all,Im 50 years old, male, have a calcified aortic valve stenosis, bicuspid by birth, LVH, slightly insufficiency and slightly ST segment abnormal...
Question - Have moderate aortic stenosis as a result of BAV, pain in chest. What can be inferred from EKG results?. Ask a Doctor about diagnosis, treatment and medication for Aortic valve stenosis, Ask a Cardiologist
Approximately 40% of patients with aortic stenosis (AS) show discordant Doppler-echocardiographic parameters with aortic valve area (AVA) <1 cm2 and/or index iAVA <0.6 cm2/m2 (consistent with severe AS) and the mean gradient (MG) <40 mmHg, consistent with mild/moderate AS. Accurate diagnosis of true severe low flow low gradient AS versus pseudo-severe aortic stenosis is important for prognosis and optimal timing for intervention. Doppler echocardiography using intravenous low dose dobutamine challenge is widely used for differentiating pseudo-severe from true severe aortic stenosis. However, relying on echocardiography alone may have limitations in accurate diagnosis. Reliable diagnosis using echocardiography is dependent on multiple factors like the angle of interrogation of the aortic jet, the assumption that the LVOT area is circular in cross section, optimal echo windows, the presence of underlying subclinical coronary artery disease prior to dobutamine challenge etc. In this chapter, we
Herrmann et al. (18), in a post-hoc analysis of the PARTNER trial, were the first and only group to date to compare clinical outcomes of patients with low ejection fraction (,50%), low-gradient (,40 mm Hg) severe AS (AVA ,0.8 cm2 or indexed AVA ,0.5 cm2·m−2) according to treatment modality. The investigators found that TAVR improved 2-year survival compared with MT (PARTNER B cohort) and revealed for the first time that LEF-LG severe AS patients undergoing TAVR and SAVR had similar clinical outcomes at 2 years (PARTNER A cohort) (18). However, this study was limited by the fact that the PARTNER trial systematically excluded all patients with CAD requiring revascularization and an LVEF ,20%, and no follow-up echocardiography was reported (18). However, previous studies have shown that 66% to 69% of LEF-LG severe AS patients have concomitant CAD, and 60% to 62% of LEF-LG severe AS patients undergoing SAVR also undergo concomitant CABG (4,6). The present study provides "real-world" clinical ...
The prognosis and treatment of patients with low-flow (LF) severe aortic stenosis are controversial.The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with severe aortic stenosis to medical management versus transcatheter aortic valve replacement (TAVR; inoperable cohort) and surgical aortic valve replacement versus TAVR (high-risk cohort). Among 971 patients with evaluable echocardiograms (92%), LF (stroke volume index =35 mL/m(2)) was observed in 530 (55%); LF and low ejection fraction (,50%) in 225 (23%); and LF, low ejection fraction, and low mean gradient (,40 mm Hg) in 147 (15%). Two-year mortality was significantly higher in patients with LF compared with those with normal stroke volume index (47% versus 34%; hazard ratio, 1.5; 95% confidence interval, 1.25-1.89; P=0.006). In the inoperable cohort, patients with LF had higher mortality than those with normal flow, but both groups improved with TAVR (46% versus 76% with LF and 38% versus 53% with normal flow; ...
in European Heart Journal - Cardiovascular Imaging (2016). AIMS: The objective assessment of maximal exercise capacity (MEC) using peak oxygen consumption (VO2) measurement may be helpful in the management of asymptomatic aortic stenosis (AS) patients. However ... [more ▼]. AIMS: The objective assessment of maximal exercise capacity (MEC) using peak oxygen consumption (VO2) measurement may be helpful in the management of asymptomatic aortic stenosis (AS) patients. However, the relationship between left ventricular (LV) function and MEC has been relatively unexplored. We aimed to identify which echocardiographic parameters of LV systolic function can predict MEC in asymptomatic AS. METHODS AND RESULTS: Asymptomatic patients with moderate to severe AS (n = 44, aortic valve area ,1.5 cm2, 66 +/- 13 years, 75% of men) and preserved LV ejection fraction (LVEF , 50%) were prospectively referred for resting echocardiography and cardiopulmonary exercise test. LV longitudinal strain (LS) of each ...
Sclerosis and calcification of the aortic valvular cusps are the ultimate pathological changes which lead to aortic stenosis. These morphological changes thicken and harden the cusps, resulting in poor opening of the aortic valve, and thus stenosis of the aortic valve outlet. Chronic hemodynamic shear forces and turbulent flow across these cusps are likely the root cause of progressive sclerosis and thickening. In individuals with anatomically normal aortic valves, such changes may take years to result in sclerotic and calcific pathology and thus disease manifests late in life, if ever. However, in individuals with preexisting aortic valvular deformities which enhance shear forces and turbulence, pathological progression is accelerated and disease may manifest much earlier in life. Below we discuss the most common etiologies that lead to aortic stenosis ...
There is a distinct need for more minimally-invasive therapies that provide direct access to the diseased aortic valve," said John Liddicoat, senior vice president, Medtronic, and president of the Medtronic Structural Heart Business. "Transapical valve delivery can be a valuable alternative for cardiac surgeons, who will want to consider various approaches for patients who are at high risk for open-heart surgery or patients suffering from conditions - such as peripheral artery disease - that can make other transcatheter procedures less suitable.". ...