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At least 55 records · Page 3Linked to original sources
PubMed2003

Progression of aortic valve stenosis: TGF-beta1 is present in calcified aortic valve cusps and promotes aortic valve interstitial cell calcification via apoptosis.

BACKGROUND: Aortic valve stenosis characteristically progresses due to cuspal calcification, often necessitating valve replacement surgery. The present study investigated the hypothesis that TGF-beta1, a cytokine that causes calcification of vascular smooth muscle cells in culture, initiates apoptosis of valvular interstitial cells as a mechanistic event in cuspal calcification. METHODS: Noncalcified and calcified human aortic valve cusps were obtained at autopsy or at the time of cardiac surgery. The distributions within cusps of TGF-beta1, latent-TGF-beta1-associated peptide, and TGF-beta receptors were studied using immunohistochemistry. The effects of TGF-beta1 on mechanistic events contributing to aortic valve calcification were also investigated using sheep aortic valve interstitial cell (SAVIC) cultures. RESULTS: Immunohistochemistry studies revealed that calcific aortic stenosis cusps characteristically contained within the extracellular matrix qualitatively higher levels of TGF-beta1 than noncalcified cusps. Noncalcified normal valves demonstrated only focal intracellular TGF-beta1. Addition of TGF-beta1 to SAVIC cultures led to a cascade of events, including: cellular migration, aggregation, formation of apoptotic-alkaline phosphatase enriched nodules, and calcification of these nodules. The time course of these events in the SAVIC culture system was rapid with nodule formation with apoptosis by 72 hours, and calcification after 7 days. Furthermore, ZVAD-FMK, an antiapoptosis agent (caspase inhibitor), significantly inhibited calcification and apoptosis induced by TGF-beta1, but had no effect on nodule formation. However, cytochalasin D, an actin-depolymerizing agent, inhibited nodule formation, but not calcification. CONCLUSIONS: TGF-beta1 is characteristically present within calcific aortic stenosis cusps, and mediates the calcification of aortic valve interstitial cells in culture through mechanisms involving apoptosis.

Aged↗
PubMed1999

[Risk of invasive diagnosis with retrograde catheterization of the left ventricle in patients with acquired aortic valve stenosis].

In patients with aortic valve stenosis, the determination of the transstenotic pressure gradient is usually performed by cardiac catheterization with retrograde passage of the aortic valve. The aim of this study was to determine retrospectively the risk of the invasive examination with retrograde catheterization of the left ventricle and predictors for an increased risk. From 1984 to 1995, 457 patients (63 +/- 11 years) with aortic stenosis were investigated in the Medizinische Klinik Tübingen. In 435 patients (95.2%), the retrograde catheterization of the left ventricle was successful; in 19 cases a transseptal left heart catheterization was performed, and in 3 patients an invasive determination of the pressure gradient was not assessed. Complications occurred in 39 patients (8.5%). 5 patients died due to the catherization procedure (mortality rate 1.1%), 2 of them as a consequence of perforation of the left ventricle, one patient of heart failure, one of myocardial infarction, and another of fulminant pulmonary embolism. Four procedures (0.9%) were complicated by cerebral embolism, in 3 patients a pericard tamponade occurred, and in one case caused by transseptal punction of the interatrial septum. The most complications were peripheral vascular problems in 19 patients (4.2%). Predictors for increased risk dur to retrograde catheterization were age > 70 years (p = 0.008) and aortic valve area < or = 0.7 cm2 (p = 0.02). patients with a doppler echocardiographic instantaneous pressure gradient > or = 70 mm Hg were more likely to sustain a complication (p = 0.04). The retrograde catheterization of a stenotic aortic valve was successful in most cases. In approximately 2% of patients, complications occurred which can be attributed directly to retrograde catheterization and with significant higher frequency in patients over 70 years and with severe stenosis. Especially in these cases, invasive determination of the gradient should not be performed if reliable doppler echocardiographic information is available.

Adult↗
PubMed2002

Transmural gradients of cardiac myofiber shortening in aortic valve stenosis patients using MRI tagging.

Aortic valve stenosis impairs subendocardial perfusion with a risk of irreversible subendocardial tissue damage. A likely precursor of damage is subendocardial contractile dysfunction, expressed by the parameter TransDif, which is defined as epicardial minus endocardial myofiber shortening, normalized to the mean value. With the use of magnetic resonance tagging in two short-axis slices of the left ventricle (LV), TransDif was derived from LV torsion and contraction during ejection. TransDif was determined in healthy volunteers (control, n = 9) and in patients with aortic valve stenosis before (AVSten, n = 9) and 3 mo after valve replacement (AVRepl, n = 7). In the control group, TransDif was 0.00 +/- 0.14 (mean +/- SD). In the AVSten group, TransDif increased to 0.96 +/- 0.62, suggesting impairment of subendocardial myofiber shortening. In the AVRepl group, TransDif decreased to 0.37 +/- 0.20 but was still elevated. In eight of nine AVSten patients, the TransDif value was elevated individually (P < 0.001), suggesting that the noninvasively determined parameter TransDif may provide important information in planning of treatment of aortic valve stenosis.

Aged↗
PubMed1990

[Percutaneous aortic valvuloplasty as a last resort in patients with critical aortic valve stenosis].

Emergency aortic valvuloplasty was performed as a last resort in 34 patients with an average age of 76 years with critical aortic stenosis in the terminal stages with congestive cardiac failure or cardiogenic shock. Emergency aortic valve replacement was considered to be too risky in these cases. The valve was dilated in all patients, resulting in a fall in mean peak-to-peak pressure gradients from 59 mmHg to 21 mmHg and an increase in valve surface area from 0.42 cm2 to 0.85 cm2. Significant improvement in myocardial function was observed immediately after the procedure with an increase of the cardiac index from 1.77 l/min/m2 to 2.07 l/min/m2 and of the ejection fraction from 28% to 35%. Complications were rare. There were no deaths or cerebrovascular accidents during the valvuloplasty procedure. Two patients died in hospital (6%) after the dilatation and two other patients who had persistent pulmonary oedema, underwent surgery; one died and the other had a good surgical result. A clear cut clinical improvement was obtained in the other 30 patients. The patients were followed up for an average of 15 +/- 7 months during which 15 died (50%), 6 +/- 5 months after dilatation. The other 15 survivors have a significant and unhoped for functional improvement. Three young patients later underwent surgical valve replacement in good clinical conditions with the same operative risk as that of standard candidates for aortic valve surgery. One other patient was operated on successfully during another relapse of cardiac failure. These results show that aortic valvuloplasty may be undertaken with a low risk even in the most critical clinical situations and that the procedure rapidly relieves the invalidating symptoms. It may be used as a bridge to surgery in patients with an unacceptable operative risk. The indications should be very flexible in young patients in terminal cardiac failure with cardiogenic shock or refractory pulmonary oedema.

Aged↗
PubMed1984

Echocardiography in the diagnosis and management of symptomatic aortic valve stenosis in infants.

Infants with severe aortic valve stenosis often are critically ill and require urgent surgical treatment. Currently, angiography is used at the time of cardiac catheterization to diagnose aortic valve stenosis. However, the use of this test may be hazardous in an unstable infant and may precipitate hemodynamic and clinical deterioration before surgery. Therefore, a noninvasive method of accurately making this diagnosis would be useful in that it would allow the risks of cardiac catheterization to be avoided. Between January 1982 and September 1983, 10 infants with critically severe aortic valve stenosis and intact ventricular septum were examined by echocardiography. There were no false-positive or negative results in this time period and several criteria for the noninvasive diagnosis of critical aortic valve stenosis were recognized. These included immobile aortic valve cusps and left ventricular hypertrophy with increased echo density of the left ventricular papillary muscles and mitral valve support apparatus. Patients without other aortic obstruction had poststenotic dilation of the ascending aorta, as evidenced by a ratio of the diameter of the ascending aorta to that of aortic valve anulus greater than 1.7. A disturbed Doppler velocity signal in the ascending aorta supported the presence of valvar stenosis. Nine patients underwent cardiac surgery and five survived. In five patients surgery was performed without angiographic examination. The correct diagnosis was made noninvasively in each, and four of the five patients survived surgery. Echocardiography was comparable to angiography in making the diagnosis and assessing the cardiovascular anatomic characteristics. Echocardiography could therefore replace angiography in selected infants with symptomatic aortic valve stenosis and should be routinely used in the evaluation of these patients.

Aortic Valve Stenosis↗
PubMed2005

The relation between homocysteine and calcific aortic valve stenosis.

BACKGROUND: In patients diagnosed with calcific aortic valve stenosis, cardiac risk factors are similar to those of coronary artery disease; homocysteine concentration is an independent risk factor for coronary artery disease. The aim of this study was to investigate the correlation between plasma homocysteine levels and aortic valve stenosis and the influence of homocysteine levels on the coexistence of coronary artery disease in patients with moderate to severe aortic valve stenosis. METHODS: Fifty-eight patients who had been diagnosed with moderate to severe aortic stenosis formed the test group of this study, and 47 healthy subjects without coronary artery disease or aortic valve stenosis formed the control group. The patients with aortic stenosis were divided into two groups according to the presence or absence of coronary artery disease in their coronary angiograms. After 12 h fasting venous blood samples were collected and total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides and homocysteine levels were measured and compared between the two groups. MEASUREMENTS AND RESULTS: The mean blood homocysteine level was 10.8 +/- 3.3 micromol/l in patients with aortic valve stenosis and 8.1 +/- 4.7 micromol/l in the control group; the difference between these levels was statistically insignificant. The patients with aortic valve stenosis had significantly higher levels of total cholesterol and hypertension and were more likely to have a positive family history for coronary artery disease. When the two subgroups of patients with aortic valve stenosis were compared, mean blood homocysteine levels were 13.2 +/- 3.1 and 8.3 +/- 2.2 micromol/l, respectively, showing significantly higher levels in the group with coronary artery disease. In this comparison patients with coronary artery disease were also found to have significantly higher levels of total cholesterol and LDL and they were more likely to be smokers. CONCLUSIONS: Although there was no relation between blood homocysteine levels and the existence of aortic valve stenosis, in cases with both coronary heart disease and aortic stenosis homocysteine levels were significantly higher than in the patients with pure aortic valve stenosis.

Age Factors↗
PubMed1994

Pathology of aortic valve stenosis and pure aortic regurgitation. A clinical morphologic assessment--Part I.

This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant aortic valves. Part I discusses stenotic aortic valves and Part II will discuss causes of purely regurgitant aortic valves. In over 95% of stenotic aortic valves, the etiology is one of three types: congenital (primarily bicuspid), degenerative, or rheumatic. Other rare causes of stenotic aortic valves include active infective endocarditis, homozygous type II hyperlipoproteinemia, and systemic lupus erythematosis. The causes of pure aortic regurgitation are multiple but can be separated into diseases affecting the valve (normal aorta) (infective endocarditis, congenital bicuspid, rheumatic, floppy), diseases affecting the walls of aorta (normal valve) (syphilis, Marfan's, dissection), disease affecting both aorta and valve (abnormal aorta, abnormal valve) (ankylosing spondylitis), and diseases affecting neither aorta nor valve (normal aorta, normal valve) (ventricular septal defect, systemic hypertension). Diseases affecting the aortic valve alone are the most common subgroup of conditions producing pure aortic valve regurgitation.

Adolescent↗
PubMed1994

Pathology of aortic valve stenosis and pure aortic regurgitation: a clinical morphologic assessment--Part II.

This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant aortic valves. Part I discussed stenotic aortic valves and Part II discusses causes of purely regurgitant aortic valves. In over 95% of stenotic aortic valves, the etiology is one of three types: congenital (primarily bicuspid), degenerative, and rheumatic. Other rare causes included active infective endocarditis, homozygous type II hyperlipoproteinemia, and systemic lupus erythematosis. The causes of pure aortic regurgitation are multiple but can be separated into diseases affecting the valve (normal aorta) (infective endocarditis, congenital bicuspid, rheumatic, floppy), diseases affecting the walls of aorta (normal valve) (syphilis, Marfan's dissection), disease affecting both aorta and valve (abnormal aorta, abnormal valve) (ankylosing spondylitis), and disease affecting neither aorta nor valve (normal aorta, normal valve) (ventricular septal defect, systemic hypertension). Diseases affecting the aortic valve alone are the most common subgroup of conditions producing purely regurgitant aortic valves.

Aortic Diseases↗
PubMed1977

Isolated aortic valve stenosis in the eighth decade.

Aortic valve stenosis was evaluated in 26 patients in the eighth decade of life, representing 20% of all patients referred for aortic valve stenosis. There were no clinical features which distinguished this older group from younger patients. Coronary artery disease was present in 46% of the older group, 30% in the younger. Angina pectoris or an infarction pattern on the electrocardiogram was not useful in predicting coronary artery disease in either group. A dominant left coronary circulation was more frequent (22%) in the younger than the older group. This was related to the higher incidence of congenitally deformed aortic valves (55%) found in the younger, compared in the advanced age group (5%). The surgical mortality in the younger and advanced age group was 8 and 20%, respectively. Mortality in both groups was related in more than half the patients to coronary artery disease.

Age Factors↗
PubMed1984

Transverse aortic wall tears in infants after balloon angioplasty for aortic valve stenosis: relation of aortic wall damage to diameter of inflated angioplasty balloon and aortic lumen in seven necropsy cases.

Aortic wall tears resulting from rupture of dilating balloons in infants undergoing transluminal balloon angioplasty have not been previously recognized. A 2 day old infant had percutaneous transluminal balloon angioplasty to dilate a stenotic aortic valve, and after multiple balloon inflations the balloon burst. The infant died 2 days after undergoing transluminal balloon angioplasty and at necropsy a circumferential, transverse aortic wall tear was found. To test the hypothesis that rupture of appropriately sized balloons results in similar aortic wall tears, six unfixed, intact infant aortas were subjected to transluminal balloon angioplasty at necropsy: two infants had balloon rupture with inflated balloon diameter similar to that of the aorta, two had balloon rupture with an undersized balloon and two had dilation with an oversized balloon. Transverse wall tears occurred in aortas with similar aortic and balloon diameters; no aortic wall damage occurred with rupture of undersized balloons, and aortic rupture resulted from the use of oversized balloons. Thus, intimal-medial tears in the infant aorta may result from balloon bursting during angioplasty when aortic and inflated balloon diameters are similar.

Angioplasty, Balloon↗