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PubMed1988

[Doppler echocardiography in the evaluation of the results of balloon catheter valvuloplasty in aortic valve stenosis].

This study was undertaken to assess the diagnostic value of Doppler echocardiographic methods for determination of the mean pressure gradient and valve orifice area in the evaluation of the results of balloon valvuloplasty (PTVP) in aortic stenosis by comparison with invasively-determined measurements. In 16 patients with aortic valve stenosis, eight men and eight women, mean age 64 +/- 10 years, Doppler echocardiographic studies were performed one day before and after PTVP. The mean pressure gradient was calculated with the aid of the modified Bernoulli equation and the aortic valve orifice area with the continuity equation. After PTVP, on comparison of Doppler echocardiographic and invasively-determined pressure gradients, there was no significant correlation (n = 16, y = 0.3x + 18.7, r = 0.36, SEE = 9.3 mm Hg) (Figure 2). Prior to PTVP the two methods correlated reasonably well with each other (n = 16, y = 0.6x + 7.7, r = 0.54, SEE = 17.8 mm Hg) (Figure 2). On comparison of the Doppler echocardiographic and invasively-determined aortic valve orifice area, both after and before PTVP, there were significant linear correlations (n = 8, y = 0.41x + 0.41, r = 0.73, SEE = 0.12 cm2 and n = 14, y = 0.71x + 0.17, r = 0.86, SEE = 0.10 cm2, respectively) (Figure 4). Correspondingly, there was close agreement between the change in absolute aortic valve orifice areas determined invasively (0.18 +/- 0.15 cm2) and noninvasively (0.15 +/- 0.10 cm2, n = 8).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Clinical and Doppler echocardiographic follow-up after percutaneous balloon valvuloplasty for aortic valve stenosis.

Percutaneous balloon valvuloplasty has been shown to increase the aortic orifice area and to improve clinical symptoms. However, there are only few data concerning long-term results after balloon valvuloplasty. In this study, 36 patients (11 men, 25 women, mean age 75 +/- 8 years) were followed after balloon valvuloplasty for a period of up to 18 months by means of clinical parameters and repeated Doppler echocardiographic measurements after 1, 3, 6, 12 and 18 months. Invasive measurements revealed a decrease of the systolic peak gradient from 78 +/- 24 to 38 +/- 13 mm Hg (p less than 0.001), and an increase in the aortic orifice area from 0.58 +/- 0.23 to 0.93 +/- 0.2 cm2 (p less than 0.001). The Doppler echocardiographic approach revealed that the maximal instantaneous gradient decreased from 96 +/- 26 to 67 +/- 22 mm Hg (p less than 0.001). The aortic orifice area increased from 0.49 +/- 0.16 to 0.73 +/- 0.21 cm2 (p less than 0.001). Three patients (8%) died in the hospital. After hospital discharge, 16 patients (44%) died and 8 patients (22%) underwent successful aortic valve replacement after a mean follow-up of 8 +/- 6 months. Nine patients (25%) were alive after a follow-up period of 18 months. Seven of these (19%) remained clinically improved. During follow-up, the Doppler echocardiographic results revealed a continuous trend toward the preprocedural severity of the aortic valve stenosis. Progression of restenosis assessed by Doppler echocardiographic measurements was accelerated in the group of patients who subsequently died or underwent repeat balloon valvuloplasty or aortic valve replacement.

Aged↗
PubMed2005

Bicuspid aortic valve stenosis with single coronary artery.

A 56-year-old female with congestive heart failure was transferred to our institution. Aortography demonstrated aortic valve stenosis (AS) with a congenitally bicuspid valve and dilatation of the ascending aorta. Preoperative coronary angiography showed a left single coronary artery. Replacement of the aortic valve and ascending aorta was performed. She had an uneventful postoperative course. We report the case of aortic bicuspid valve stenosis with single coronary artery as an extremely rare congenital cardiac anomaly combination.

Aorta↗
PubMed2000

Proteolysis of von Willebrand factor and shear stress-induced platelet aggregation in patients with aortic valve stenosis.

BACKGROUND: Excessive bleeding may complicate congenital cardiac defects. To explain the pathogenesis of this abnormality, we evaluated selected parameters of primary hemostasis in patients with aortic valve stenosis before and after corrective surgery. METHODS AND RESULTS: We examined shear-induced platelet aggregation with the filter aggregometer test and von Willebrand factor (vWF) structure by evaluating the multimeric distribution and extent of subunit proteolysis. The platelet count was reduced before corrective surgery, and shear-induced platelet aggregation was impaired. Moreover, vWF multimers of higher molecular mass were decreased, and proteolytic subunit fragments were increased. After correction of the cardiac defect, all of these parameters returned to normal. CONCLUSIONS: Alterations of vWF and platelet function may contribute to the bleeding diathesis in patients with aortic valve stenosis. Improvement after corrective surgery suggests that the passage of blood through a stenosed aortic valve may result in shear forces that induce vWF interaction with platelets in the circulation and, in turn, trigger platelet clearance, vWF degradation, and the impairment of primary hemostasis.

Adult↗
PubMedDate not supplied

Stepwise Inoue balloon catheter valvuloplasty for congenital aortic valve stenosis: comparison with standard balloon catheter technique.

Experience with stepwise balloon dilatation of congenital aortic valve stenosis using the new Inoue balloon catheter in 16 patients (aged 12 +/- 4.6 years; group II) is presented. Results are compared with those obtained in 15 patients (10 +/- 6 years; group I) in whom standard balloon catheters were used. The procedure resulted in a similar transvalvar gradient reduction in both groups (83 +/- 25 to 34 +/- 14 mmHg in group I versus 84 +/- 21 to 28 +/- 10 mmHg in group II). Significant aortic incompetence occurred in three patients from group I and in four from group II. There was no difference in the average increase in AR grade between the groups. At follow-up (group I, 24 +/- 13 months; group II, 7 +/- 3 months) there was no significant change in transaortic gradient or aortic incompetence. Balloon aortic valvuloplasty for congenital aortic stenosis carries a risk of aortic incompetence. Stepwise dilatation of the stenosis does not prevent this complication. The Inoue balloon catheter offers technical advantages.

Aortic Valve Insufficiency↗
PubMed2006

Type I and type III collagen synthesis and composition in the valve matrix in aortic valve stenosis.

Changes in the collagenous matrix may contribute to the pathogenesis and progression of human aortic valve stenosis (AS). To evaluate the significance of collagen I and III in the pathogenesis of AS, we studied their synthesis in diseased valves. Type I and type III collagen mRNA expression and the immunohistochemical localization of the collagen antigens were studied from 36 AS and 2 normal aortic valves. The concentrations of propeptides and telopeptide structure of type I (PINP, PICP, and ICTP) and those of III collagens (PIIINP and IIINTP) were measured by radioimmunoassays in soluble tissue extracts and trypsin-solubilized calcified and non-calcified matrices of 11 AS and 24 healthy aortic valves of different ages. The synthesis of type I collagen, localized in the myofibroblasts adjacent to calcified nodules, was two- to three-fold in the AS samples compared to the controls. The proportion of collagen in the total protein fraction was 90% in the healthy valves, 50% in the non-calcified matrix, and 10% in the calcified matrix of AS valves. In the calcified valves, the ICTP content was six-fold compared to the age-matched controls and two-fold compared to the young control group. In the controls, the amount of ICTP in type I collagen decreased with age (r=-0.908, p<0.001) and was replaced by other cross-linked C-telopeptide structure. The concentration of type III collagen decreased during aging (r=-0.753, p<0.001). The decrease in total collagen content, despite the increase in type I collagen synthesis indicates an increase in collagen turnover in AS. The calcification of the aortic valves is accompanied by increased amount of ICTP in type I collagen.

Adolescent↗
PubMed1984

Severe aortic-valve stenosis unmasked by amateur running.

Three men aged 35, 55, and 60 years had asymptomatic underlying aortic-valve stenosis unmasked by amateur running or jogging. All three men underwent aortic-valve replacement and two of the three have resumed mild exercise programs. Congenitally abnormal aortic valves were found in two of the three patients. Amateur exercise may uncover an underlying cardiovascular abnormality perhaps sooner than might be apparent without exercise.

Adult↗
PubMed1993

Assessing the severity of aortic valve stenosis by spectral analysis of cardiac murmurs (spectral vibrocardiography). Part I: Technical aspects.

Assessing the severity of aortic stenosis remains an important clinical problem. The turbulent pressure fluctuations generated by the confined jet down-stream of the stenotic valve produce vibrations in the aortic wall. These vibrations are transmitted through the chest to the skin surface, where they can be measured as systolic ejection murmurs. The purpose of the present study was to find the relationship between the severity of aortic valve stenosis and the frequency content of the precordial systolic murmurs, and to evaluate the transthoracic attenuation of murmurs and its variation from patient to patient. Twenty-four patients with clinical signs of aortic stenosis underwent cardiac catheterization to measure the peak transvalvular pressure difference. The mean energy density spectrum of the measured systolic precordial murmurs was calculated and the murmur energy ratio between 100-500 Hz and 20-500 Hz was correlated to the transvalvular pressure difference. The inter-individual variability of the transthoracic attenuation was evaluated by calculating the transthoracic transfer function from simultaneous measurements of precordial vibrations at the second right intercostal space and intravascular recordings of high frequency pressure fluctuations in the ascending aorta. The transvalvular pressure difference and the square root of the murmur energy ratio correlated well (r = 0.81, SEE = 27 mmHg). In the frequency range from 10-500 Hz the transthoracic transfer function could be modelled by a low-pass filter function with a low frequency attenuation of 36 +/- 7.7 dB (mean +/- SD), a corner frequency of 26 +/- 12 Hz and an attenuation slope of -29 +/- 7.9 dB/decade. Spectral analysis of systolic murmurs might be an attractive non-invasive addition to the array of techniques already in use for assessing the severity of aortic stenosis. It is a simple and cost effective technique, and requires less skill and time for data analysis than conventional methods.

Adult↗
PubMed1997

[A surgical case of aortic valve stenosis associated with systemic lupus erythematosus].

A 46-year-old woman was hospitalized for aortic valve stenosis (AS) associated with systemic lupus erythematosus (SLE) on April 12, 1996. She had a syncopal episode six months before admission. She was found to have thrombocytopenia, and was diagnosed with SLE by further examination. Irregular genital bleeding was also seen on admission while her SLE was being controlled with steroid therapy. Aortic valve replacement was performed after the steroids had been reduced to avoid excessive bleeding. The aortic valve was the bicuspid with raphe. There was much calcification on the cusps and the annulus, but there were no degenerative changes. The postoperative course was uneventful, and her SLE has been in remission two years after the operation. The management of steroid therapy for SLE patients complicated with cardiovascular disease is discussed.

Aortic Valve Stenosis↗
PubMed1988

[Long-term results of transluminal valvuloplasty in calcified aortic valve stenosis].

Transluminal valvuloplasty (TVP) was attempted in 11 patients, aged 38-82 years, with calcified aortic valve stenosis (AS). The transvalvular systolic pressure gradient was reduced from a mean of 91 +/- 28 to 44 +/-30 mm Hg. Two patients had needed an emergency with decompensated AS in cardiogenic shock, died during the operation, another died of the consequences of an endocarditis. One patient had an inadequate TVP: a renewed TVP was subsequently performed at another hospital, followed by an operation for severe aortic regurgitation produced by the second TVP. In four patients left-heart catheterization 3-12 months post-dilation demonstrated considerable restenosis. One patient was significantly improved clinically (but no angiography had as yet been performed) four months after the TVP. Doppler echocardiography in this patient, too, demonstrated renewed increase in transvalvular pressure gradient. The results demonstrate that, because of the high rate of recurrence, TVP is at present only rarely indicated for calcified AS.

Adult↗
PubMed2006

A medical therapy for aortic valve sclerosis and aortic valve stenosis? Rationale of the ASSIST study (Asymptomatic aortic Sclerosis/Stenosis: Influence of STatins): a large, observational, prospective, multicenter study of the Italian Society of Cardiovascular Echography.

Progression of sclerosis and stenosis is substantially unpredictable in the individual patient: in some cases it is very slow, in others it is accelerated. In addition, different patterns of progression (linear and non-linear) are possible. It has been suggested that the aortic valve lesion can be considered a form within the spectrum of the same atherosclerotic disease. In this context it seemed reasonable to hypothesize that targeted medical therapy could retard the progression of the disease. In particular HMG-CoA reductase inhibitors (statins) and angiotensin-converting enzyme inhibitors have been tested. The first experimental and clinical studies are now available, even though they are not conclusive to date. Large, prospective, randomized trials are ideally needed, but they are quite difficult, if not even impossible, to realize in practice. The ASSIST study (Asymptomatic aortic Sclerosis/Stenosis: Influence of STatins) of the Italian Society of Cardiovascular Echography aims to create a large, prospective, observational investigation, involving many centers of echocardiography and thousands of patients, in order to provide from the real clinical world at least some of the answers to this unsolved question.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1999

Aortic valve stenosis with left ventricular outflow tract pressure gradient.

A 61-year-old man was diagnosed with severe aortic valve stenosis with left ventricular outflow tract pressure gradient due to systolic anterior movement of the mitral valve and a large poststenotic dilation of the ascending aorta. He underwent successful aortic root replacement and concomitant septal myectomy.

Aorta↗