[Surgical treatment of aortic valve stenosis].
Explore the source record for details and available documents.
Aortic Valve↗
SEARCH · PubMed Health
Results for “AORTIC VALVE STENOSIS”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
[Surgical treatment of isolated aortic valve stenosis].
Explore the source record for details and available documents.
Aortic Valve↗
[On the operative treatment of aortic valve stenosis].
Explore the source record for details and available documents.
Aortic Valve Stenosis↗
[Transfemoral valvuloplasty in calcified aortic valve stenosis].
In a 55 year old male patient and a 67 year old woman with calcified aortic valve stenosis, a valvuloplasty was performed via the femoral approach using a large-lumen balloon catheter. The 55 year old patient, who had undergone an aortocoronary bypass operation some years ago, displayed the symptoms of a cardiogenic shock. A surgical intervention would have entailed an additional risk. In the second case, there was a raised risk for the operation in view of a coronary two-vessel disease and with regard to the patient's age. By filling the balloon catheter placed in the aortic valve, the pressure gradient could be reduced from 100 mm Hg to 40 mm Hg, and in the second case from 95 mm Hg to 45 mm Hg. The slight aortic insufficiency which had been previously present in the two cases did not increase appreciably. The symptoms of cardiogenic shock disappeared, and there was a distinct clinical improvement. Valvuloplasty is evidently a possible method of treatment (even if it is palliative) in calcified aortic valve stenosis.
Aged↗
Treatment of congenital aortic valve stenosis: impact of the Ross operation.
GOAL: To evaluate the impact of the Ross operation, recently (1997) introduced in our unit, for the treatment of patients with congenital aortic valve stenosis. METHODS: The period from January 1997 to December 2000 was compared with the previous 5 years (1992-96). Thirty-seven children (< 16 yrs) and 49 young adults (16-50 yrs) with congenital aortic valve stenosis underwent one of these treatments: percutaneous balloon dilatation (PBD), aortic valve commissurotomy, aortic valve replacement and the Ross operation. The Ross operation was performed in 16 patients, mean age 24.5 yrs (range 9-46 yrs) with a bicuspid stenotic aortic valve, 7/10 adults with calcifications, 2/10 adults with previous aortic valve commissurotomy, 4/6 children with aortic regurgitation following PBD, and 1/6 children who had had a previous aortic valve replacement with a prosthetic valve and aortic root enlargement. RESULTS: PBD was followed by death in two neonates (fibroelastosis); all other children survived PBD. Although there were no deaths, PBD in adults was recently abandoned, owing to unfavourable results. Aortic valve commissurotomy showed good results in children (no deaths). Aortic valve replacement, although associated with good results (no deaths), has been recently abandoned in children in favour of the Ross operation. Over a mean follow-up of 16 months (2-40 months) all patients are asymptomatic following Ross operation, with no echocardiographic evidence of aortic valve regurgitation in 10/16 patients and with trivial regurgitation in 6/16 patients. CONCLUSIONS: The approach now for children and young adults with congenital aortic valve stenosis should be as follows: (1) PBD is the first choice in neonates and infants; (2) Aortic valve commissurotomy is the first choice for children, neonates and infants after failed PBD; (3) The Ross operation is increasingly used in children after failed PBD and in young adults, even with a calcified aortic valve.
Adolescent↗
Angiogenic activation of valvular endothelial cells in aortic valve stenosis.
Here, we demonstrate the angiogenic response of valvular endothelial cells to aortic valve (AV) stenosis using a new ex vivo model of aortic leaflets. Histological analysis revealed neovascularization within the cusps of stenotic but not of non-stenotic aortic valves. Correspondingly, the number of capillary-like outgrowth in 3D collagen gel was significantly higher in stenotic than in non-stenotic valves. Capillary-like sprouting was developed significantly faster in stenotic than in non-stenotic valves. New capillary sprouts from stenotic aortic valves exhibited the endothelial cell markers CD31, CD34 and von-Willebrand factor (vWF) as well as carcinoembryonic antigen cell adhesion molecule-1 (CEACAM1), Tie-2 and angiogenesis inhibitor endostatin. Western blot analyses revealed a significant increase of CEACAM1 and endostatin in stenotic aortic valve tissue. Electron microscopic examinations demonstrate that these capillary-like tubes are formed by endothelial cells containing Weibel-Palade bodies. Remarkably, inter-endothelial junctions are established and basement membrane material is partially deposited on the basal side of the endothelial tubes. Our data demonstrate the capillary-like sprout formation from aortic valves and suggest a role of angiogenesis in the pathogenesis of aortic valve stenosis. These data provide new insights into the mechanisms of valvular disorders and open new perspectives for prevention and early treatment of calcified aortic stenosis.
Aged↗
Absolute assessment of aortic valve stenosis by planimetry using cardiovascular magnetic resonance imaging: comparison with transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterisation.
OBJECTIVE: The aims of this study were to investigate absolute assessment of aortic valve area (AVA), before surgery for aortic stenosis, using cardiovascular magnetic resonance (CMR) in comparison with transesophageal echocardiography (TEE) and with effective AVA indirectly obtained by routine techniques i.e. transthoracic echocardiography (TTE) and cardiac catheterisation. MATERIALS AND METHODS: Absolute AVA planimetry was performed by TEE and CMR steady state free precession sequences obtained through the aortic valvular plane. Effective AVA was calculated by the continuity equation in TTE and by cardiac catheterisation (Gorlin formula). RESULTS: Thirty-nine patients with aortic valve stenosis, mean age 71.7 +/- 7.6 years, with a mean AVA of 0.93 +/- 0.31 cm2 as measured by TEE, were enrolled in the study. Mean differences were: between CMR and TEE planimetry: d = 0.01 +/- 0.14 cm2, between CMR and cardiac catheterisation: d = 0.05 +/- 0.13 cm2, between CMR and TTE: d = 0.10 +/- 0.17 cm2, between TTE and TEE: d = 0.10 +/- 0.18 cm2, between TTE and cardiac catheterisation: d = 0.06 +/- 0.16 cm2, and between TEE and cardiac catheterisation: d = 0.07 +/- 0.13 cm2. Mean intraobserver and interobserver differences of CMR planimetry were d = 0.02 +/- 0.07 cm2 and d = 0.03 +/- 0.14 cm2, respectively. CONCLUSION: CMR planimetry of the AVA is a noninvasive and reproducible technique to evaluate stenotic aortic valves and can be used as an alternative to echocardiography or cardiac catheterisation.
Aged↗
[Percutaneous transluminal valvuloplasty in aortic valve stenosis in children].
Percutaneous transluminal balloon valvuloplasty has been used in children since 1983 to treat tight aortic valve stenosis. Although more than 100 cases have been published, its indications compared with those of surgical valvulotomy have not yet been clearly defined. Twelve patients with tight aortic valve stenosis underwent transluminal balloon valvuloplasty: 3 were infants whose ages ranged from 1 month and 24 days to 3 months and 23 days (mean 80 +/- 13.7 days), and 9 were children aged from 4 to 17 years (mean 10.44 +/- 4.61 years). Aortic regurgitation grade I (5) or grade III (1) was present in 6 cases. An 8-year old child had previously undergone surgical aortic valvulotomy simultaneously with repair of aortic coarctation. Other associated malformations were congenital grade III mitral regurgitation in 1 case and Turner's syndrome in 1 case. Dilatation was performed with one or two successive balloons in 11 patients and with two balloons concomitantly in 1 patient. The diameter of the balloon (or the sum of those of the two balloons) was 77 to 112 percent of the diameter of the aortic annulus, but in one case this figure rose to 119 percent after failure of dilatation with a smaller balloon. One infant died at the end of the dilatation, due to perforation of the left ventricle. Another infant developed inferior myocardial infarction which followed a favourable course and left minimal sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)
Aortic Valve Stenosis↗
Successful balloon aortic valvotomy in a child with a pulmonary hypertensive duct and aortic valve stenosis.
A ten year old boy with pulmonary hypertension and a ductus arteriosus had severe aortic valve stenosis relieved by balloon aortic valvotomy. Subsequent aortic regurgitation was mild. This procedure avoided open heart operation, which would have been hazardous in this patient.
Angioplasty, Balloon↗
Spontaneous calcific cerebral emboli from calcified aortic valve stenosis.
Calcific cerebral emboli (CE) are a rare complication of calcified aortic valve stenosis (CAS). These emboli usually result from diagnostic manoeuvres (e.g. left heart catheterization) or from therapeutic procedures (e.g. heart valve surgery). Spontaneous calcific emboli are exceptional. We present the cases of two subjects known to have CAS who presented with acute neurological disorders suggesting strokes. In both subjects CT scans of the skull and brain provided a diagnosis of spontaneous CE by showing calcium-dense dots located on vessels or within the cerebral parenchyma. Additional examinations enabled us to determine the origin (heart or carotid artery) of these emboli. The finding of spontaneous cerebral CE is a very strong argument in favour of surgical valve replacement in these patients.
Adult↗
[Should all cases of aortic valve stenosis be surgically treated?].
Aortic stenosis is a condition in which progression accelerates with the onset of warning symptoms such as angina pectoris, syncope and heart failure. Surgery must be scheduled as quickly as possible in all such symptomatic patients, even in the presence of concomitant coronary disease, or of left ventricular failure. Aortic valve surgery is possible in the elderly, with a higher operative risk, but with the benefit of a symptomatic improvement identical to that seen in younger individuals, and a prolongation of life expectancy. Surgery is often considered in asymptomatic patients because of the fear of sudden death. In actual fact, sudden death not preceded by other symptoms is rare and the aim of surveillance must be to identify high-risk patients to whom surgery may be offered: poor exercise tolerance in a cautiously administered exercise test, abnormal ventricular function by echocardiography, or the existence of arrhythmias, which are also a severity factor, whether atrial or ventricular. The number of completely asymptomatic cases among patients with tight aortic stenosis is relatively slight, having been evaluated at 5%. It is in these asymptomatic patients, when they are young, that it is possible to delay surgery until the onset of a first symptom.
Age Factors↗
Ultrasound assessment of internal carotid disease candidates to endovascular carotid stenting and cardiac surgery is inaccurate in patients with severe aortic valve stenosis.
PURPOSE: The association of internal carotid artery disease (ICAD) with aortic valve stenosis (AVS) constitutes a very high-risk clinical occurrence in which combined surgery may increase the operative risks and carotid stenting before or after cardiac surgery may be a valuable option. Unfortunately, in patients with AVS, the evaluation of carotid arteries by Doppler ultrasound (DUS) may be inaccurate. The present retrospective study is aimed to evaluate the pitfalls of DUS and the role of carotid angiography before carotid stenting in evaluating ICAD in patients with AVS. METHODS: We analyzed the clinical, hemodynamic, and angiographic findings of 200 patients with moderate to severe AVS (5.5% of 3600 patients underwent cardiac catheterization; mean age, 68.5+/-10.6 years) investigated in our institution over the past 2 years. Patients with moderate to severe AVS, candidates to open cardiac surgery, underwent carotid ultrasonography to assess ICAD and complete left and right catheterization with coronary artery angiography, and in case of doubtful carotid artery sonography, the patients underwent also carotid artery angiography at the time of complete cardiac catheterization before confirming the indication to carotid stenting or combined surgery. RESULTS: Seventy patients with moderate to severe AVS and doubtful carotid ultrasonography underwent coincident carotid angiography. Reasons for suboptimal Doppler ultrasonographic examination are related to the anatomical or to the difficult evaluation of Doppler flow due to hemodynamic influences of AVS. On carotid angiography, 20 patients (28.5%, male/female, 8/12; mean age, 72.1+/-5.1 years) were diagnosed to have critical stenosis of one (16 patients) or both (4 patients) internal carotid arteries; in five patients, a significant ICAD was not diagnosed by DUS, whereas in seven patients, the stenosis was underestimated by DUS (mean luminal narrowing, 58+/-12.7% vs. 76.7+/-19.3%, P<.03), and in the other eight patients, DUS overestimated ICAD (77+/-12% vs. 62+/- 13.4%, P<.02). Out of this group, six patients underwent successful carotid stenting, six combined surgical treatments, and eight underwent simple cardiac surgery. CONCLUSIONS: Doppler ultrasound may be inconclusive in evaluating ICAD in patients with moderate to severe AVS candidates to cardiac surgery and endovascular carotid stenting. Carotid angiography may be proposed at the time of cardiac catheterization in patients with inconclusive DUS examination.
Aged↗
[Aortic valve stenosis. Surgical treatment in children].
OBJECTIVES: The results of aortic commissurotomy, as the first step in the treatment of aortic valve stenosis in children, have been estimated after a medium-term follow-up. MATERIAL AND METHODS: Twenty-two patients were operated at a mean age of 7.3 +/- 3.6 years of age. Surgery was performed under cardiopulmonary bypass and moderate hypothermia. Twenty patients underwent cardiac catheterization (the systolic gradient pressure was 67.9 +/- 24.7 mmHg and the end diastolic pressure was 17 +/- 7.1 mmHg). We evaluated 10 patients with Doppler flow echocardiography (the valvular area was 0.8 +/- 0.2 cm2/m2). After surgery, we made a follow-up of 8.6 +/- 5.4 years. RESULTS: The aortic valve was bicuspid in 13 cases and tricuspid in 9 cases. There was no mortality. Before the age of 7, 7 patients developed restenosis. The mean pressure gradient was 92.5 +/- 16.6 mmHg, so six of them underwent valvuloplasty and the other one was operated with an aortic valvulated homograft. The pressure gradient, which was estimated in 20 patients, was lowered to 43.5 +/- 17.5 mmHg and the aortic area was increased to 2.4 cm2/m2. Six patients had a pressure gradient above 40 mmHg. Six patients had previous aortic regurgitation and this reappeared in 3 patients after valvulotomy. At this time, 12 patients have aortic regurgitation, being mild in 9 patients, mild to moderate in 1 and moderate in 2 patients. CONCLUSION: Valvulotomy is a palliative therapeutic method. We had no mortality. Restenosis appeared in 7 patients, before the age of seven years, and it can be easily corrected. The aortic regurgitation is usually mild. Valve replacement can be avoided in childhood.
Adolescent↗
Aortic valve debridement by ultrasonic surgical aspirator in degenerative, aortic valve stenosis: follow-up with Doppler echocardiography.
OBJECTIVE: Recently there has been an emphasis on reconstructing diseases native valves as an alternative to prosthetic valve replacement. Whereas; the surgical repair of aortic valve stenosis has been always problematic. This study was performed to estimate the clinical results after aortic valve debridement using ultrasonic energy. METHODS: Between 1990-1994 26 patients underwent ultrasonic aortic valve decalcification. There were 15 females and 11 males, the age was in average 74 years. As a concomitant diagnosis 88% patients (23) had mostly mild, aortic valve insufficiency, 16 (61%) had coronary artery disease and 11 (42%) had mild mitral valve incompetence. All of the patients were operated with cardiopulmonary bypass using moderate hypothermia, cardioplegical arrest and topical cooling for myocardial protection. The calcifications were removed tangentially using Cavitron Ultrasonic Surgical Aspirator. (CUSA), CAVITRON, USA. Leaflet perforation and/or unsatisfactory valve closure have been indications for aortic valve replacement. RESULTS: Two operative death (8%) have occurred and six patients have died in the further course (follow-up mean 17 months ranging from 4 to 61 months). Postoperative Doppler-Echocardiography results taken directly after surgery and then again 17 months later (n = 18) showed a decrease of peak and mean gradients across the aortic valve three and two times respectively (p < 0.001). 17 months after debridement we observed a mild rise in both gradients (by peak gradient p < 0.05). Directly postoperative, the aortic valve area increased doubly and decreased 17 months later slight, but it was still statistically significant in comparison with our preoperative data (p < 0.001). Follow-up echocardiography demonstrated late onset of moderate aortic valve insufficiency in 6 patients. The classification of New York Heart Association was improved in 13 (72%) survivors after 17 months. CONCLUSIONS: Ultrasonic debridement of aortic valve stenosis allows precise and energy-controlled removal of calcium, increased doubly the valve area and decreased of peak and mean gradients statistically significant. The advantages of preserving the native aortic valve in elderly patients are relative good arguments; although a longer follow-up is necessary to establish this procedure.
Aged↗
[A study of predictive factors of the operative risk in the surgery of aortic valve stenosis in aged patients].
Aortic stenosis, the most extensive form of valvular disease in elderly subjects, has become very common because of demographic reasons in industrialised countries. The operative risk in patients over 70 years of age is significantly higher. The progressive rise in age of patients referred for surgery justifies this analysis of predictive factors of operative mortality. Between 1976 and February 1993, out of 2871 aortic valve replacements, 675 (278 men and 397 women) patients were over 75 years of age and were included in this study. The average age was 78.5 +/- 3 years. Associated pathology was present in 226 patients. A bioprosthesis was chosen in 632 cases (93.6%). An associated surgical procedure was required in 133 cases. The operative mortality was 12.4 +/- 1.3% (84 deaths). Longitudinal analysis was performed for 4 successive periods to assess the outcome of the study population over the 17 years. A statistical study was made of 50 variables and multivariate analysis showed age (p < 0.0001), left ventricular failure (p < 0.0001), non sinus rhythm (p < 0.0005) and emergency procedures (p < 0.02) to be independent preoperative predictive factors of mortality. In order to reduce this risk, the authors recommend early surgical referral to avoid emergency procedures and cardiac failure, and increased efforts of myocardial protection during cardiopulmonary bypass. Despite the risk, surgery is the only radical treatment of aortic stenosis, including elderly patients.
Age Factors↗
Aortic valve replacement in patients with aortic valve stenosis improves myocardial metabolism and diastolic function.
PURPOSE: To evaluate whether functional and metabolic changes recover after aortic valve replacement (AVR). MATERIALS AND METHODS: Eighteen men with aortic valve stenosis (mean pressure gradient +/- SD, 79.9 mm Hg +/- 15.1) underwent magnetic resonance (MR) imaging and phosphorus 31 MR spectroscopy. In nine patients who underwent AVR, MR imaging and spectroscopy were repeated 40 weeks +/- 12 after AVR. Ten age-matched healthy men were control subjects. RESULTS: Before AVR, the myocardial phosphocreatine (PCr)-to-adenosine triphosphate (ATP) ratio in the 18 patients was 1.24 +/- 0.17 and 1.43 +/- 0.14 in the control group (P <.01). In nine patients who underwent follow-up MR spectroscopy, the ratio increased from 1.28 +/- 0.17 to 1.47 +/- 0.14 (P <.05) following AVR. Before AVR, early acceleration peak corrected for cardiac output was (0.043 +/- 0.008) x 10(-3) sec(-1) in patients and (0.081 +/- 0.033) x 10(-3) sec(-1) in the control group (P <.05). After 40 weeks +/- 12, the mean early acceleration peak corrected for cardiac output in the nine patients increased significantly to (0.055 +/- 0.006) x 10(-3) sec(-1) (P <.05), although it was still significantly lower than that of the control group (P <.05). Before AVR, a significant correlation was found between the myocardial PCr-ATP ratio and left ventricular diastolic function (n = 18; P <.05). CONCLUSION: Severe aortic valve stenosis leads to a decreased myocardial PCr-ATP ratio and impairment of left ventricular diastolic function; following AVR, the ratio normalizes completely, whereas function improves significantly. There is an association between altered myocardial high-energy phosphate metabolism and impaired left ventricular diastolic function.
Adenosine Triphosphate↗
(Percutaneous) retrograde left ventricular catheterization in aortic valve stenosis.
Explore the source record for details and available documents.
Aortic Valve Stenosis↗
Mechanics of pulsus alternans in aortic valve stenosis.
Explore the source record for details and available documents.
Aortic Valve Stenosis↗