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At least 91 records · Page 5Linked to original sources
PubMed1989

Octogenarians with aortic stenosis. Outcome after aortic valve replacement.

To assess the outcome of aortic valve replacement for aortic stenosis in octogenarians, we retrospectively studied 64 patients, aged 80-89 years, who underwent aortic valve replacement for aortic stenosis from 1974 to 1987. Mean aortic valve gradient was 61 +/- 22 mm Hg, and valve area was 0.5 +/- 0.2 cm2. Concurrent coronary artery bypass grafting was performed in 29 patients, mitral valve replacement in two, and both procedures in two. Serious, comorbid, noncardiac conditions were infrequent. In-hospital mortality was 9.4%. Outcomes were classified as 1a) uncomplicated; 1b) complicated (technically complicated surgery, temporary encephalopathy, discharge to a rehabilitation facility, or some combination thereof) but with ultimately good results; or 2) unfavorable (death or permanent, severe neurological deficit). There were 28 (44%) patients in group 1a, 24 (38%) in group 1b, and 12 (19%) in group 2. Of 18 patients with preoperative left ventricular ejection fraction less than 50%, two (11%) were in group 2. Of 31 patients undergoing aortic valve replacement only, two (6%) were in group 2, compared with 10 of 33 (30%) patients who had concomitant coronary artery bypass grafting, mitral valve replacement, or both (p = 0.02). Late follow-up at 28 +/- 5 months revealed four cardiac and seven noncardiac deaths, with actuarial 1- and 5-year survival rates of 83 +/- 5% and 67 +/- 10%, respectively. With few exceptions, survivors were free of cardiac symptoms. Thus, short- and long-term outcomes after aortic valve replacement for aortic stenosis in otherwise healthy octogenarians is generally favorable, even in the presence of preoperative left ventricular systolic dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed2003

Anti-inflammatory effects of statins in patients with aortic stenosis.

BACKGROUND: Aortic stenosis is an inflammatory process, as evidenced by increased tissue expression and serum levels of various endothelial cellular adhesion molecules. Aortic stenosis and atherosclerosis have many risk factors in common, including hypercholesterolemia. In atherosclerosis, statins lower cholesterol and display some anti-inflammatory activity. We hypothesized that statins might also have anti-inflammatory effects in patients with aortic stenosis. METHODS: This observational cross-sectional study measured levels of cellular adhesion molecules in 129 patients (88 male, mean age 68) with aortic stenosis (mean echo gradient 49 mm Hg, range 22 to 112) and compared levels in patients already on statin therapy for primary or secondary prevention of coronary artery disease, to those not on treatment. Concomitant conditions included hypertension (47%), diabetes (10%), and ischemic heart disease (54%). A comparison group consisted of 45 patients with stable ischemic heart disease. RESULTS: Patients on statins (35) were more likely to have hypertension (62% vs 42%, P =.05), but no significant differences existed in sex, age, concomitant ischemic heart disease, or diabetes. Statin-treated patients had a 20% lower vascular cellular adhesion molecule level than those without (484 +/- 143 ng/L vs 604 +/- 245 ng/L, P =.006). The reduction in cellular adhesion molecule levels was consistent in patients with aortic stenosis alone, aortic stenosis and ischemic heart disease, or ischemic heart disease alone. There were no differences in the levels of the other adhesion molecules between the three groups, or related to statin therapy. CONCLUSION: Statin therapy is associated with reduced serum levels of vascular cellular adhesion molecules in patients with aortic stenosis. Vascular cellular adhesion molecule levels are similar in patients who have aortic stenosis, ischemic heart disease, or both. A prospective study is required to confirm this finding and to determine whether this suppression of endothelial inflammation translates into a slowing of the progression of aortic stenosis.

Adult↗
PubMed1988

Corrected transposition presenting as aortic stenosis in an infant.

Associated intracardiac lesions have been well documented in congenitally corrected transposition. Most often these include ventricular septal defects, dysplasia of the morphologically tricuspid valve and subpulmonic stenosis. Aortic stenosis as the only isolated intracardiac defect in association with corrected transposition has not been described previously. We present such a patient and review the clinical features of corrected transposition.

Aortic Valve↗
PubMed1996

Apolipoproteins B, (a), and E accumulate in the morphologically early lesion of 'degenerative' valvular aortic stenosis.

Nonrheumatic aortic stenosis of trileaflet aortic valves has been considered to be a "degenerative" process, but the early lesion of aortic stenosis contains the chronic inflammatory cells, macrophages and T lymphocytes. Because lipoprotein deposition is prominent in atherosclerosis, another chronic inflammatory process, this study examined whether lipoproteins accumulate in aortic valve lesions. Immunohistochemical studies were performed to detect apolipoprotein (apo) B, apo(a), apoE, macrophages, and alpha-actin-expressing cells on 18 trileaflet aortic valves that ranged from normal to stenotic. All three apolipoproteins were detected in early through end-stage lesions of aortic stenosis but not in histologically normal regions. Comparison with oil red O staining suggested that most of the extracellular neutral lipid in these valves was associated with either plasma-derived or locally produced apolipoproteins. Thus, in early through end-stage aortic valve lesions, apolipoproteins accumulate and are associated with the majority of extracellular valve lipid. These results are consistent with the hypothesis that lipoprotein accumulation in the aortic valve contributes to pathogenesis of aortic stenosis.

Aortic Valve↗
PubMed2005

Changes in aortic root function after valve replacement in patients with aortic stenosis.

BACKGROUND: Aortic elastic properties are compromised in various states that induce functional and histological changes in the aortic wall. Aortic stenosis is frequent and often requires replacement of the stenotic valve. The purpose of this study was to examine the effect of aortic valve replacement on the aortic root function. METHODS: 31 patients, mean+/-SD age 67.2+/-9.1 years with severe aortic stenosis, who underwent aortic valve replacement with a bileaflet mechanical prosthesis, were studied. Aortic root function indices such as aortic cross-sectional compliance (CSC), aortic root distensibility (ARD), and aortic stiffness index (ASI) were calculated with the use of M-mode echocardiography in three sessions: one preoperatively (pre-op), one on day 7 postoperatively (early post-op), and one 6 months postoperatively (late post-op). RESULTS: Aortic root function deteriorated early post-op (p<0.001 for all) and returned towards pre-op levels late post-op (p=NS for all). CSC changed from 2.84+/-1.98 to 1.37+/-0.92, and 2.30+/-1.11 cm2/mmHg, ARD from 2.21+/-5.60 to 1.01+/-0.67, and 1.79+/-0.96 cm2/dyne, and ASI from 9.72+/-5.60 to 24.65+/-19.10, and 11.51+/-7.85, respectively. Correlations were found between early changes in some aortic root indices and the degree of aortic stenosis, denoting that aortic function deteriorated less in more severe cases of aortic stenosis. None of the late changes were related to aortic valve or left ventricular indices. CONCLUSIONS: Aortic valve replacement with a mechanical valve results in a significant but transient impairment of aortic distensibility.

Aged↗
PubMed1999

Regression of ventricular repolarisation inhomogeneity after aortic bileaflet valve replacement in patients with aortic stenosis.

BACKGROUND: Aortic valve replacement relieves mechanical outflow obstruction in patients with aortic stenosis. However, there is limited information on whether aortic valve replacement can provide regression of ventricular repolarisation inhomogeneity. OBJECTIVES: To determine whether aortic valve replacement can provide regression of ventricular repolarisation inhomogeneity in patients with aortic stenosis after bileaflet aortic valve replacement. METHODS: We studied the changes of electrocardiographic QT or QTc intervals and QT or QTc dispersions of 71 patients with severe aortic stenosis and angiographically insignificant coronary lesions (<50% in diameter) before and after valve replacement (6+/-3 days after operation). Seventy-one healthy control subjects, matched for age and sex, served as control subjects. Twelve-lead electrocardiograms and echocardiographic examinations were measured before and after surgery. The QT interval was corrected for heart rate using the standard Bazett formula. QT dispersion was defined as the difference between maximal and minimal QT interval measurements occurring among any of the 12 leads on a standard electrocardiogram. QTc dispersion was calculated in a manner similar to QT dispersion. No subject had fewer than nine measurable leads. RESULTS: Left ventricular systolic blood pressure, pressure gradient across aortic valve, left ventricular mass index, and systolic wall stress were significantly reduced after valve replacement compared with before valve replacement. The QT interval significantly decreased from 425+/-38 ms to 398+/-32 ms after replacement (P<0.0001). The QTc dispersion significantly decreased from 62+/-25 ms to 32+/-13 ms after replacement (P<0.0001). The value of QT or QTc dispersion after replacement was similar to that in controls. Univariate analysis revealed that QTc dispersion was significantly only correlated with left ventricular mass index (r=0.236, P=0.05). Multivariate analysis revealed that the best predictor of QTc dispersion was sex and left ventricular mass index (P=0.008 and 0.005, respectively). CONCLUSIONS: Our study demonstrated a favorable consequence of aortic valve replacement distinct from hemodynamic improvement. Patients with aortic stenosis before valve replacement have abnormal prolonged QT or QTc intervals and increased QT or QTc dispersions. After successful valve replacement left ventricular mass index regressed and QT or QTc intervals and QT or QTc dispersions were normalized. These findings warrant further investigation in a large trial and long-term follow-up for clinical implications.

Aortic Valve↗
PubMed2002

Aortic stenosis.

Valvular aortic stenosis in pediatric age group is mostly congenital in origin. The aortic valve may be unicuspid, bicuspid, tricuspid or rarely quadricuspid. Left ventricle undergoes concentric hypertrophy secondary to obstruction to its outflow tract. In neonatal aortic stenosis, left ventricle may be hypoplastic. The pathophysiology and clinical presentation vary with the age of onset and severity of obstruction. Echocardiography and Doppler are indispensible for the diagnosis of aortic stenosis and its severity. Cardiac catheterization is not necessary for the diagnosis, however it is performed as a part of balloon aortic valvuloplasty in severe cases. Balloon valvuloplasty is an effective alternative to surgery in pediatric age group. Some of these patients require surgical valve repair or replacement on follow-up. Neonates and young infants with critical aortic stenosis present with cardiogenic shock and need aggressive treatment with prostaglandin E1 infusion along with inotropic support. In experienced hands, balloon valvuloplasty is a safe procedure in neonates and infants with critical stenosis. Patients with mild and moderate aortic stenosis may be left on medical follow-up.

Adolescent↗
PubMed1975

Supravalvar aortic stenosis syndrome with stenosis of all aortic arch branches.

A 9-year-old girl with the supravalvar aortic stenosis syndrome is presented. In addition to the classical features of the syndrome, namely supravalvar aortic stenosis, peripheral pulmonary stenosis, typical facies, and mental retardation, she was also found to have stenosis at the origin of all aortic arch main branches, a hitherto undescribed feature.

Aortic Valve Stenosis↗
PubMed2004

Impact of left ventricular dysfunction on outcome in aortic stenosis patients after aortic valve replacement.

Surgical treatment for aortic stenosis includes aortic valve replacement, which alleviates symptoms and increases longevity. The purpose of this study was to evaluate the prevalence of left ventricular dysfunction after aortic valve replacement. Left ventricular function was assessed by a retrospective review of preoperative and postoperative ejection fractions (EF) using echocardiography. The prevalence of left ventricular dysfunction after aortic valve replacement was 17.39% with an odds ratio of 4.37 for low preoperative EF. Despite advances in myocardial protection and cardiothoracic surgical care, preoperative EF remains a strong predictor of outcome in patients undergoing aortic valve replacement.

Aortic Valve↗