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PubMed1984

Coronary artery obstruction associated with congenital aortic valve disease.

Abnormal attachment of the aortic valve caused obstruction to left coronary arterial flow in a young girl, who presented with angina of effort. Aortic valve and root replacement resulted in the patient's effort tolerance returning to normal with resolution of the exercise electrocardiographic and angiographic abnormalities. This case emphasises the importance of an awareness of the existence of such defects and their amenability to surgical correction.

Adolescent↗
PubMed1999

Mortality and need for reoperation in patients with mild-to-moderate asymptomatic aortic valve disease undergoing coronary artery bypass graft alone.

BACKGROUND: Patients presenting for coronary artery bypass graft (CABG) surgery may have concurrent asymptomatic aortic stenosis (AS) or aortic insufficiency (AI). This retrospective study was performed to evaluate outcomes in patients with aortic valve disease undergoing CABG with or without aortic valve replacement (AVR). METHODS: Study groups included 414 patients undergoing combined AVR and CABG (AVR-CABG group) and 62 patients with asymptomatic mild-to-moderate AS, AI, or both undergoing CABG but not AVR (CABG group). End points included 30-day mortality rate, time to cardiac mortality, time to all-cause mortality, and time to aortic valve reoperation. Reoperation refers to surgery for replacement of the native aortic valve in the CABG group or replacement of the prosthetic aortic valve in the AVR-CABG group. Important patient characteristics affecting outcomes were determined by using Cox proportional-hazard analysis. These variables were then included in multivariable analyses by using logistic regression analysis and Cox proportional-hazard modeling to compare outcomes between each patient group. RESULTS: No difference was seen in any of the mortality end points between the CABG group and the AVR-CABG group after controlling for significant differences between the groups. However, the need for reoperation for AVR was significantly higher for the CABG group than the AVR-CABG group. For patients followed for up to 6 years, the estimated need for aortic valve reoperation was 24.3% in the CABG group versus 3% in the AVR-CABG group. CONCLUSION: On the basis of these results, patients with asymptomatic AS or AI should be considered for AVR at the time of CABG.

Aged↗
PubMedDate not supplied

Transient left ventricular pulsus alternans in severe aortic valve disease.

A 56-year-old man presented with severe aortic valve disease. Pulsus alternans was recorded in the left ventricle, apparently provoked by catheter placement through a stenotic aortic valve. This case illustrates that studies on left ventricular performance in severe aortic stenosis should be done with a transseptal catheter.

Aortic Valve Stenosis↗
PubMed1997

Factors influencing heart rate variability in patients with severe aortic valve disease.

BACKGROUND AND HYPOTHESIS: Heart rate variability (HRV) is an accepted tool for the assessment of cardiovascular autonomic tone. There are no sufficient data concerning its application to patients with severe aortic valve disease (AVD) requiring cardiac surgery. METHODS: It was the aim of this study to examine HRV and its physiologic correlates in patients with severe aortic valve disease requiring cardiac surgery. The correlates of time domain indices of HRV obtained from 24-h Holter electrocardiographic recordings were analyzed in 36 consecutive patients (23 men and 13 women, mean age 62 +/- 11 years) with AVD prior to cardiac surgery (aortic stenosis: 17 patients, aortic valve regurgitation: 3 patients, combined aortic valve disease: 16 patients). RESULTS: Low values of HRV were found in the entire study group: SDNN 96.8 +/- 30.9 ms, SDNNI 39.3 +/- 14.4 ms, SDANN 86 +/- 28.9 ms, and RMSSD 30 +/- 18.1 ms. In a univariate analysis, there was no significant correlation between the time domain measures of HRV and age, gender, medication, left ventricular ejection fraction, peak aortic pressure gradient, fraction of aortic valve regurgitation, and left ventricular mass assessed by echocardiography. Patients in advanced functional classes of heart failure [New York Heart Association (NYHA) III or IV] had significantly lower values for SDNN (83.8 +/- 33.6 vs. 107.3 +/- 24.7 ms; p < 0.05) and SDANN (72.7 +/- 29.4 vs. 96.6 +/- 24.3 ms; p < 0.05) than patients in NYHA class I or II. Reassessment of HRV 1 week after aortic valve replacement was performed in 17 patients and showed a significant further decrease of SDNN (102.4 +/- 29.7 vs. 61.5 +/- 23.5 ms; p < 0.001), SDNNI (40.7 +/- 13.6 vs. 23.4 +/- 12.4 ms; p < 0.001) and SDANN (91.8 +/- 29.2 vs. 54.2 +/- 22.8 ms; p < 0.001). CONCLUSION: Patients with AVD requiring cardiac surgery reveal reduced time domain indices of HRV. This observation is pronounced in patients with a progressed clinical class of heart failure, whereas hemodynamic and echocardiographic parameters seem to have no significant influence on HRV parameters in this population. In addition, there is evidence of a further reduction of HRV time domain indices 1 week after uncomplicated aortic valve replacement.

Aortic Valve↗
PubMed1992

Myocardial oxygen consumption in aortic valve disease with and without left ventricular dysfunction.

OBJECTIVE: To assess whether and to what extent myocardial oxygen consumption is modified by hypertrophy and alterations in contractility in patients with aortic valve disease and to evaluate the influence of regression of left ventricular hypertrophy and improvement of contractility on myocardial oxygen consumption after successful aortic valve replacement. DESIGN: A cohort analytical study to investigate the influence of the "explanatory" variables of myocardial oxygen consumption by multiple regression analysis. A comparison of myocardial oxygen consumption in preoperative patients with that after operation in a group with comparable severity of aortic valve disease before operation (analysis of covariance). PATIENTS: In six controls and in 43 patients with aortic valve disease and normal coronary arteries standard haemodynamic variables were measured, left ventricular biplane cineangiography performed, and coronary sinus blood flow measured by thermodilution. The patients were divided into three groups: 19 preoperative patients with normal ejection fraction (greater than or equal to 57%) (group 1); nine preoperative patients with reduced ejection fraction (less than 57%) (group 2); 16 postoperative patients (one with preoperative and postoperative measurements (group 3). Postoperative evaluation was performed 12-51 months after surgery. MAIN OUTCOME MEASUREMENTS: Myocardial oxygen consumption/100 g left ventricular muscle mass and its suspected "explanatory" variables--that is, peak systolic left ventricular circumferential wall stress, heart rate, contractility (assessed by left ventricular ejection fraction), and left ventricular muscle mass index. RESULTS: Multiple regression analysis showed that the product of peak systolic stress and heart rate (p less than 0.0001) and ejection fraction (p less than 0.03) were positively correlated with myocardial oxygen consumption/100 g and that left ventricular muscle mass index (p less than 0.002) was negatively correlated with myocardial oxygen consumption/100 g (r = 0.72; n = 50 measurements). Myocardial oxygen consumption per 100 g at a given stress-rate product was higher in the controls than in group 1 (hypertrophied ventricles with normal ejection fraction) and was also higher in group 1 than in group 2 (hypertrophied ventricles with reduced ejection fraction). In a subgroup of the postoperative patients with complete regression of hypertrophy and normalisation of contractility, myocardial oxygen consumption per 100 g at a given stress-rate product was indistinguishable from that in controls. CONCLUSIONS: When the actual stress-rate product was used as an index of overall left ventricular performance the results suggested that mechanical efficiency was increased in hypertrophied ventricles especially when contractility was decreased. These changes in mechanical efficiency seemed to be reversible during the postoperative course when muscle mass and contractility returned to normal.

Aged↗
PubMed1983

Functional limitation in aortic valve disease: superiority of bicycle test to symptom-rated appraisal?

The overall functional capacity in aortic valve disease was evaluated using the New York Heart Association criteria and symptom-limited bicycle ergometry in 80 patients who underwent cardiac catheterization. The correlations between exercise performance and resting cardiac haemodynamics and clinical class were poor. Similar exercise tolerance appeared to be associated with comparable resting left ventricular (LV) performance in each haemodynamic subgroup. Limitation in exercise tolerance in aortic stenosis (n = 25), as defined by peak work-load achieved and work-pulse index, together with an inability to raise systolic blood pressure during exercise, appeared to be associated not only with a more significant reduction in LV systolic pump function and compliance but also with greater LV dilatation. A lack of correlation between exercise performance and resting LV function was seen in patients with aortic regurgitation (n = 35); and, to large extent, in those with combined lesion (n = 20). The severity of the valvular lesion was not indicated by functional limitation in any of the subgroups, although greater systolic blood pressure during exercise appeared to reflect more significant valvular leakage in the combined lesion group. It is concluded that objective tests of exercise tolerance are to be preferred in monitoring the course of the disease and the therapy provided. Aortic regurgitation appears to cause as great a limitation in exercise tolerance as does aortic stenosis alone, but may not be associated with greater deterioration in LV function at a similar level of functional limitation. Pressure overload to the LV may explain the ability of impaired LV function to reflect the limitation in exercise tolerance in cases of aortic stenosis.

Adult↗
PubMed1994

[Cerebral circulation in patients with dilated cardiomyopathy and aortic valve diseases].

The present study was performed in order to investigate the effect of dilated cardiomyopathy and severe aortic valve disease on cerebral blood flow. Cerebral perfusion was determined in 39 healthy volunteers representing two control groups of different age (77.7 +/- 8.7; 79.7 +/- 8.1 ml/100 g/min), in 7 patients with dilated cardiomyopathy (64.0 +/- 4.7 ml/100 g/min), in 11 patients with severe aortic stenosis (71.1 +/- 14.8 ml/100 g/min), and in 6 patients with severe aortic regurgitation (54.6 +/- 5.8 ml/100 g/min). Regional cerebral blood flow was measured with the 133Xenon inhalation method. Cerebral blood flow in severe aortic regurgitation patients (p = 0.006) was markedly and significantly reduced versus controls, whereas in dilated cardiomyopathy patients (p = 0.197) and in patients with severe aortic stenosis (p = 0.111) cerebral blood flow was not significantly reduced. A chronic adaptation of cerebral blood flow to the profound reduction of cardiac output is assumed in dilated cardiomyopathy patients. The collapsing pulse and the maximal reduction of mean arterial blood pressure in severe aortic regurgitation patients cause the reduction of autoregulatory capacity of cerebral blood flow with subsequent decrease of brain perfusion. Measurement of cerebral blood flow appears to be suitable for evaluation of perfusion deficits due to cardiac abnormalities. It provides an additional parameter for estimating the indication of valve replacement in patients with aortic valve disease.

Adult↗
PubMed2006

[Diastolic heart failure in patients with aortic valve disease].

From March 2002 to August 2005, 53 patients with age between 30 and 86 underwent surgical treatment for aortic valve disease. Preoperative diastolic heart failure was observed in 15 cases (28.3%). Operative procedures consisted of aortic valve replacement (AVR) in 42 cases [AVR and mitral valve replacement (MVR) in 3], aortic valve plasty (AVP) in 2, and aortic root replacement in 4. Concomitant procedures included maze procedure in 2 cases, coronary artery bypass grafting (CABG) in 6, mitral valve surgery in 15, and tricuspid valve annuloplasty (TAP) in 8. There were 7 cases for patient-prosthesis mismatch (PPM) [13.2%]. There were 2 hospital deaths (both were low-output syndrome). Among the surgical survivors, there were 2 late cardiac-related complications (all cases were cardiac failure). There was no recurrence or re-operation. Although all cases had severe diastolic failure, their systolic function was almost normal. Our study suggested that in patients with aortic valve disease, not PPM but diastolic heart failure correlated strongly with postoperative event and survival.

Aged↗
PubMed1996

Aortic valve disease.

There have been several significant advances in our understanding of aortic valve disease over the past year. Recent studies suggest that "degenerative" valvular aortic stenosis is an active disease process rather than an inevitable consequence of aging. In the diagnostic evaluation of patients with aortic stenosis, detailed studies of the changes in valve area with changes in flow rate and the subaortic flow profile have been performed. In addition, the myocardial response to chronic pressure overload has been studied in further detail including gender differences in the response to chronic pressure overload. Aortic regurgitant severity can now be quantitated more precisely using simplified measures of regurgitant fraction based on Doppler and color flow imaging techniques. The optimal timing of surgical repair in chronic aortic regurgitation continues to be a topic of interest, with additional studies recommending surgical intervention prior to the development of an irreversible decrease in left ventricular contractility. Most importantly, two randomized trials of afterload reduction for preventing left ventricular dilation and symptom onset in aortic regurgitation have been performed, with the data supporting long-term afterload reduction in this patient group.

Aortic Valve Insufficiency↗
PubMed1976

Incidence and morphology of carotid shudders in aortic valve disease.

The incidence and morphology of shudders in carotid arterial pulse tracings were examined in 73 patients with aortic valve disease documented by cardiac catheterization. Two forms of carotid shudder were recorded: coarse and fine. Shudders were present in 67 per cent of patients with aortic stenosis, 48 per cent of patients with aortic insufficiency, and 57 per cent of patients with mixed aortic stenosis and insufficiency. No significant difference existed among these three groups of patients with respect to the over-all incidence of carotid shudders or with respect to the incidence of coarse or fine shudders. In patients with aortic insufficiency, stroke volume index (Fick) and phonocardiographic systolic ejection murmur amplitude were significantly greater (p less than 0.01, p less than 0.001, respectively) in those with coarse carotid shudders compared with those manifesting fine or absent shudders. Loud, flow-related, systolic ejection murmurs of aortic insufficiency are capable of producing radial vibrations in the aortic wall which are recorded as carotid shudders. The finding of a carotid shudder in a patient with aortic valve disease does not enable the physician to distinguish between stenosis, insufficiency, or mixed stenosis and insufficiency.

Adolescent↗