Noninvasive assessment of pulmonary valve stenosis, aortic valve stenosis and coarctation of the aorta in critically ill neonates.
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Aortic Coarctation↗
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Results for “AORTIC VALVE STENOSIS”
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[Aortic valve stenosis].
Aortic valve stenosis is the most frequent reason for prosthetic valve replacement in adults. Its incidence increases with age. Development of the most frequent form, degenerative-calcific aortic stenosis, is related to atherosclerotic risk factors. The narrowing of the aortic valve orifice leads to creation of a systolic pressure drop, the gradient, between left ventricle and ascending aorta. The pressure overload from aortic stenosis causes concentric left ventricular hypertrophy and later heart failure. Typical symptoms of severe aortic stenosis include dyspnea, angina, and dizziness or syncope. On auscultation, a loud systolic murmur over the base of the heart is apparent, which is transmitted to the carotids. The ECG often shows left ventricular hypertrophy. The most important diagnostic technique is echocardiography, which allows to measure the gradient and to calculate the orifice area, which determine the degree of severity. The development of symptoms or impaired left ventricular function in severe aortic stenosis should prompt surgical treatment by valve replacement. Truly asymptomatic patients with preserved left ventricular function should be followed conservatively.
Aortic Valve↗
C-reactive protein in degenerative aortic valve stenosis.
Degenerative aortic valve stenosis includes a range of disorder severity from mild leaflet thickening without valve obstruction, "aortic sclerosis", to severe calcified aortic stenosis. It is a slowly progressive active process of valve modification similar to atherosclerosis for cardiovascular risk factors, lipoprotein deposition, chronic inflammation, and calcification. Systemic signs of inflammation, as wall and serum C-reactive protein, similar to those found in atherosclerosis, are present in patients with degenerative aortic valve stenosis and may be expression of a common disease, useful in monitoring of stenosis progression.
Aortic Valve Stenosis↗
Left ventricular remodeling early after aortic valve replacement: differential effects on diastolic function in aortic valve stenosis and aortic regurgitation.
OBJECTIVES: The aim of this study was to evaluate the effect of aortic valve replacement (AVR) on left ventricular (LV) function and LV remodeling, comparing patients with aortic valve stenosis to patients with aortic regurgitation. BACKGROUND: Aortic valve disease is associated with eccentric or concentric LV hypertrophy and changes in LV function. The relationship between LV geometry and LV function and the effect of LV remodeling after AVR on diastolic filling, in patients with aortic valve stenosis compared with aortic regurgitation, are largely unknown.Nineteen patients with aortic valve disease (12 aortic valve stenosis, 7 aortic regurgitation) were studied using magnetic resonance imaging to assess LV geometry and LV function before and 9 +/- 3 months after AVR. Ten age-matched healthy males served as control subjects. RESULTS: Before AVR, the ratio between left ventricular mass index (LVMI) and left ventricular end-diastolic volume index (LVEDVI) was only increased in patients with aortic valve stenosis (1.37 +/- 0.16 g/ml) compared with control subjects (0.93 +/- 0.08 g/ml, p < 0.05). After AVR, LVMI/LVEDVI decreased significantly in aortic valve stenosis (to 1.15 +/- 0.14 g/ml, p < 0.0001), but increased significantly in aortic regurgitation (1.02 +/- 0.20 g/ml to 1.44 +/- 0.27 g/ml, p < 0.0001). Before AVR, diastolic filling was impaired in both aortic valve stenosis and aortic regurgitation. Early after AVR, diastolic filling improved in patients with aortic valve stenosis, whereas patients with aortic regurgitation showed a deterioration in diastolic filling. CONCLUSIONS: Early after AVR, patients with aortic valve stenosis show a decrease in both LVMI and LVMI/LVEDVI and an improvement in diastolic filling, whereas in patients with aortic regurgitation, LVMI decreases less rapidly than LVEDVI, causing concentric remodeling of the LV, most likely explaining the observed deterioration of diastolic filling in these patients.
Adult↗
[Differences between degenerative (non-inflammatory) calcinosis- related stenosis of the aortic valve and the rheumatic calcinosis- induced aortic valve stenosis].
Calcified aortic valves were detected in 109 patients studied in hospital by an echocardiographic method (2D- and M-scanning). It was found that, unlike rheumatism, calcification starting in the aortic annulus and semilunar bases might result in formation of degenerative (non-inflammatory) calcific aortic stenosis. The latter differs from rheumatic aortic stenosis in commissural fusions. The authors defined clinical and echocardiographic differentially diagnostic criteria for degenerative (non-inflammatory) and rheumatic (inflammatory) calcific aortic stenosis. They also discussed pathogenetic aspects of aortic valve calcification and problems of terminology.
Aged↗
Histopathology of calcific aortic valve stenosis.
Calcific aortic valve stenosis is the most common and increasing heart valve disease in the western world. In the last 30 years, diagnosis and management were revolutionized by the development of cardiac catheterisation, echocardiography, cardiac surgery, and medication. Recently, new strategies were introduced for aortic valve replacement using more sophisticated bioprosthetic heart valves. Moreover, tissue-engineered heart valves are under development to improve management strategies. In this article we review the current morphological and histopathological findings in the progression of calcific aortic valve stenosis. This is, to our understanding, important to contribute to the knowledge of fundamental management strategies of this disease.
Aortic Valve Stenosis↗
[Diagnosis and assessment of severity of aortic valve stenosis].
Calcific aortic valve stenosis is the most common valvular heart disease in the elderly. Although the diagnosis can often be assumed at clinical presentation, determination of the disease severity is usually not accurately possible based on patient history and physical examination alone. In the past, invasive cardiac catheterization has been the most important strategy for assessing the hemodynamic severity of aortic stenosis. Nowadays, Doppler echocardiography has largely replaced invasive catheterization in many centers, since this modality allows for a comprehensive evaluation of the morphological and functional characteristics of the stenotic valve and for assessment of the prognosis of the disease. This article summarizes the current knowledge on the evaluation of aortic stenosis severity using Doppler echocardiography.
Aortic Valve↗
[Pathogenesis of calcific aortic valve stenosis].
Calcific aortic valve stenosis is the most common heart valve disorder in the elderly and the most common cause of heart valve replacement in industrialized countries. For decades, it was considered a passive age-dependent degeneration of the valve tissue. Newer studies have shown, however, that the pathologic changes in calcific aortic valve stenosis are based on an actively regulated process of matrix remodeling and biomineralization. This review summarizes the currently available data and gives an outlook on potential therapeutic approaches.
Age Factors↗
Prevalence of coronary artery disease in patients with isolated aortic valve stenosis.
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Aortic Valve Stenosis↗
[Vertigo attacks, syncopes or aortic valve stenosis].
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Aortic Valve Stenosis↗
[Colonic angiodysplasia with chronic digestive hemorrhage cured after valvular replacement for aortic valve stenosis].
Aortic stenosis is found in 15 to 25% of patients with gastrointestinal angiodysplasia. The usual treatment for haemorrhagic angiodysplasia associated with aortic stenosis is the same as for other types of gastrointestinal angiodysplasias: segmental intestinal resection, electrocoagulation and laser photocoagulation. The authors report the case of a 73 year old woman with a long history of gastro-intestinal bleeding and chronic anaemia requiring a number of hospital admissions for blood transfusions. The cause of this bleeding remained obscure for many years, as it was initially thought to be due to portal hypertension complicating cyrrhosis and a surgical porto-caval shunt was performed. Later, angiodysplasia of the colon was recognised and a segmental colonic resection was performed. These two surgical procedures had no effect on the chronic bleeding and finally the patient was referred for a gram negative endocarditis complicating aortic stenosis, previously considered to be non-surgical. After controlling the infection, the patient was sent for surgery of the aortic valve disease with mitral regurgitation in view of progressive degradation of left ventricular function. A double valve replacement with bioprostheses was undertaken with no complication. Finally, three years now after valve replacement, no further bleeding has occurred and control colonoscopy is normal. In the light of this case and a review of the literature of about 30 similar cases, the physiopathology and management of these patients is discussed with respect to the choice of valve prosthesis and the attitude to anticoagulant therapy. These observations suggest that in the presence of valvular heart disease at a surgical stage associated to an angiodysplasia, it is preferable to propose valve surgery to start with. Gastro-intestinal surgery is only indicated if haemorrhage persists after a period of observation.
Aged↗
Preoperative left ventricular wall stress, ejection fraction, and aortic valve gradient as prognostic indicators in aortic valve stenosis.
Patients with aortic valve stenosis (AS) and left ventricular (LV) dysfunction may dramatically improve after aortic valve replacement, but operative risk is high. In an earlier study, all patients with low preoperative wall stress and low ejection fraction, or with low aortic valve gradient, died or had persistent heart failure after operation. Because wall stress is difficult to calculate, we reassessed its effect and the effect of other preoperative characteristics on outcome in 66 consecutive catheterization patients with predominant aortic stenosis referred for valve replacement. Despite ejection fraction that was inordinately low compared with afterloading wall stress in nine patients, seven patients improved with surgery. All three patients with ejection fraction less than 20% improved after surgery. Two of three patients with mean aortic valve gradients of less than 30 mm Hg improved. Mortality was 33% in patients with mean gradient less than 30 mm Hg and 19% with mean gradient less than 50 mm Hg. In the 54 patients with calculated aortic valve areas of less than or equal to 0.8 cm2, 1 (2%) had continuing heart failure, while 6 of 12 (50%, P less than .01) patients with aortic valve areas of 0.9-1.2 cm2 had continued symptoms of or died of heart failure. Patients who died or failed to improve after operation were older (71 +/- 9 years) than those who improved (65 +/- 9 years, P = .02). We conclude that wall stress calculations do not predict which patients with aortic stenosis will benefit from aortic valve replacement and that poor left ventricular function and low mean aortic valve gradient do not absolutely preclude operation. On the other hand, low gradient, non-critical valve area, and advanced age are all relative contraindications to aortic valve replacement in aortic stenosis.
Aged↗
Using cardiac magnetic resonance tomography for assessment of aortic valve area in aortic valve stenosis.
Calcified aortic valve stenosis (AS) is the most common valvular disease in the elderly population and constitutes a significant health and socioeconomic problem. Doppler echocardiography is the recommended diagnostic tool for the initial evaluation of AS. Transvalvular pressure gradients and aortic valve area have been used as quantitative parameters for grading the severity of AS, but the latter one is less susceptible to changes in flow dynamics and therefore considered the more independent and reliable parameter. The aortic valve area can be assessed directly by transesophageal echocardiography (TEE), which reflects the anatomic or geometric orifice area, or it can be calculated noninvasively by transthoracic echocardiography (TTE) using the continuity equation, or, invasively, by cardiac catheterization (CC) using the Gorlin formula, both reflecting the effective orifice area. Assessment of aortic valve area by TTE can be limited in some patients due to inadequate acoustic window. Similarly, TEE as a semi-invasive technique is not well tolerated by some patients and the planimetry is limited in patients with heavily calcified aortic valve leaflets. CC is an invasive procedure associated with a substantial risk of cerebral embolism and the Gorlin formula has been shown to be susceptible to changes in flow dynamics. Cardiac magnetic resonance tomography (CMR) is a new imaging technique capable of imaging the aortic valve with high resolution and has recently been used for assessment of the aortic valve area in AS. This review focuses on the feasibility of CMR for the assessment of aortic valve area in AS compared to current standard techniques and discusses some of the typical pitfalls and the sources for the discrepant results observed between the different techniques for assessment of the aortic valve area.
Aortic Valve↗
Interleukin-1 beta promotes matrix metalloproteinase expression and cell proliferation in calcific aortic valve stenosis.
Calcific aortic valve stenosis (AS), the main heart valve disease in the elderly, is characterized by extensive remodeling of the extracellular matrix. Matrix metalloproteinases (MMPs) are upregulated in calcific AS and might modulate matrix remodeling. The regulatory mechanisms are unclear. As recent studies have suggested that calcific AS might result from an inflammatory process involving leukocyte invasion and activation, the present study aimed to elucidate the role of the pro-inflammatory cytokine interleukin (IL)-1 beta on MMP expression and cell proliferation in human aortic valves. Immunohistochemistry for leukocytes, IL-1 beta and MMP-1 was performed on aortic valves with (n=6) and without (n=6) calcification obtained at valve replacement or autopsy. Stenotic valves showed marked leukocyte infiltration and associated expression of IL-1 beta and MMP-1. In control valves only scattered leukocytes, low staining for MMP-1 and no staining for IL-1 beta were present. Double-label immunostaining localized IL-1 beta expression mainly to leukocytes and MMP-1 expression to myofibroblasts. Stimulation of cultured human aortic valve myofibroblasts with IL-1 beta lead to a time-dependently increased expression of MMP-1 and MMP-2 by Western blotting and zymography, whereas MMP-9 remained unchanged. Cell proliferation was increased by IL-1 beta as determined by bromodesoxyuridine incorporation. Thus, IL-1 beta may regulate remodeling of the extracellular matrix in calcific AS.
Aortic Valve Stenosis↗
Images in geriatric cardiology. Usefulness of live three-dimensional transthoracic echocardiography in aortic valve stenosis evaluation.
Aortic valve stenosis (AS) severity can be estimated by various modalities. Due to some of the limitations of the currently available methods, the usefulness of live three-dimensional transthoracic echocardiography (3D TTE) in the assessment of AS was explored. Live 3D TTE was able to visualize the aortic valve orifice in all 11 patients studied. Live 3D TTE correctly estimated the severity of AS in all 10 patients in whom AS severity could be evaluated at surgery. These included eight patients with severe AS and two with moderate AS. Two of these 10 patients with AS had associated hypertrophic cardiomyopathy and underwent myectomy at the time of aortic valve replacement. Aortic valve orifice area measurements by live 3D TTE correlated well with intraoperative three-dimensional transesophageal echocardiographic reconstruction measurements (r=0.85) but not as well with two-dimensional transesophageal echocardiography measurements (r=0.64). Live 3D TTE measurements of the aortic valve orifice area also did not correlate well with two-dimensional transthoracic echocardiography measurements (r=0.46) but the number of patients studied with two-dimensional transthoracic echocardiography was smaller (only seven) and four of these did not undergo two-dimensional transthoracic echocardiography at the authors' institution. Altogether, four patients with severe AS by live 3D TTE, and subsequently confirmed at surgery, were misdiagnosed as having moderate AS by two-dimensional transthoracic echocardiography. Because it is completely noninvasive and views the aortic valve in three dimensions, 3D TTE could be a useful complement to the existing modalities in the evaluation of AS severity.
Aged↗
[Transesophageal echocardiography in the assessment of the severity of aortic valve stenosis].
The aortic valve orifice area was measured in 95 patients with valvular aortic stenosis by means of transthoracic and transesophageal echocardiography. These results were compared to invasively determined measurements. The aortic-valve orifice area could be measured by transesophageal echocardiography in 87 patients (92%), and in 13 patients (14%) by the transthoracic approach. A comparison of the valve-orifice area determined by transthoracic and transesophageal echocardiography revealed a correlation coefficient of r = 0.91. There was also a good agreement when the aortic-valve orifice area determined by transesophageal echocardiography was compared to the invasive findings (r = 0.82; p less than 0.001). The morphology of the aortic valve could be better delineated with the transesophageal approach.
Adult↗
[Asymptomatic aortic valve stenosis and sudden death].
Dyspnea, angor and syncope are the most characteristic symptoms in stenosis aortic valve disease. Sudden death, as part of natural history of symptomatic stenosis aortic valve, is well know. On the other hand, sudden death in asymptomatic stenosis aortic valve is rarer. Different guidelines recommend a conservative management of these patients. We present here the case of a 58 year old woman, previously healthy, who arrived at Hospital because of sudden dyspnea at rest. The patient was diagnosed of pulmonary edema and died two hours later. Necropsy showed a stenosis aortica valve with a valve area of less than 0.8 cm2. We make a short review in medical literature about the incidence of sudden death in asymptomatic stenosis aortic valve, the risk groups and their management.
Aortic Valve Stenosis↗
Acquired and reversible von Willebrand disease with high shear stress aortic valve stenosis.
BACKGROUND: Severe aortic valve stenosis is relatively more prevalent in patients with repeated bleeding episodes. The goal of the present study was to determine the effect of aortic valve replacement on von Willebrand factor levels in patients with aortic stenosis. METHODS: von Willebrand factor levels were assessed by using immunoblotting electrophoresis techniques before and 1 month after surgery in 29 consecutive patients with severe aortic valve stenosis. RESULTS: Eight of 29 patients reported episodes of bleeding, including three episodes of major bleeding, in the 6 months before surgery. None of the patients were receiving anticoagulation therapy. Although there was no difference in platelet count before and after surgery, von Willebrand factor levels were significantly greater at 1 month after surgery (p = 0.05) when compared with preoperative values. Further, von Willebrand factor levels were significantly lower in patients with aortic valve prosthesis mismatch than in those patients without this phenomenon (p < 0.05). Electrophoresis experiments showed a deficit in large multimers of von Willebrand factor preoperatively but not postoperatively, except for in those patients with aortic valve prosthesis mismatch. CONCLUSIONS: In conclusion, valve replacement can result in increases in von Willebrand factor in patients with aortic valve stenosis.
Aortic Valve Stenosis↗