-
JAMA Mar 2022
Topics: Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Transcatheter Aortic Valve Replacement
PubMed: 35258531
DOI: 10.1001/jama.2022.0332 -
Circulation Research Apr 2021Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular... (Review)
Review
Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular outflow obstruction and encompasses a series of stenotic lesions starting from the left ventricular outflow tract to the descending aorta. Obstructions may be subvalvar, valvar, or supravalvar and can be present at birth (congenital) or acquired later in life. Bicuspid aortic valve, whereby the aortic valve forms with two instead of three cusps, is the most common cause of AS in younger patients due to primary anatomic narrowing of the valve. In addition, the secondary onset of premature calcification, likely induced by altered hemodynamics, further obstructs left ventricular outflow in bicuspid aortic valve patients. In adults, degenerative AS involves progressive calcification of an anatomically normal, tricuspid aortic valve and is attributed to lifelong exposure to multifactoral risk factors and physiological wear-and-tear that negatively impacts valve structure-function relationships. AS continues to be the most frequent valvular disease that requires intervention, and aortic valve replacement is the standard treatment for patients with severe or symptomatic AS. While the positive impacts of surgical interventions are well documented, the financial burden, the potential need for repeated procedures, and operative risks are substantial. In addition, the clinical management of asymptomatic patients remains controversial. Therefore, there is a critical need to develop alternative approaches to prevent the progression of left ventricular outflow obstruction, especially in valvar lesions. This review summarizes our current understandings of AS cause; beginning with developmental origins of congenital valve disease, and leading into the multifactorial nature of AS in the adult population.
Topics: Age Factors; Animals; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Disease Progression; Humans; Medical Illustration; Mice; Risk Factors; Ventricular Outflow Obstruction
PubMed: 33914609
DOI: 10.1161/CIRCRESAHA.120.317978 -
Herz Oct 2021Aortic valve stenosis in old age has become a topic of interest for cardiology and cardiac surgery after the development of transvascular and transluminal minimally...
Aortic valve stenosis in old age has become a topic of interest for cardiology and cardiac surgery after the development of transvascular and transluminal minimally invasive techniques for aortic valve implantation. The observation of amyloid deposits in surgically excised valvular material led to the diagnostics of amyloidosis of the myocardium, which was discovered in up to 20% of the patients who underwent valve implantation. Clinical signs of cardiac amyloidosis, such as carpal tunnel syndrome and ruptured distal biceps tendon should be taken into account. In addition to the electrocardiogram (ECG), echocardiogram and magnetic resonance imaging, technetium bone scintigraphy plays a key diagnostic role. The simultaneous occurrence of severe aortic valve stenosis and amyloidosis explains the special hemodynamic situation of a low gradient with low blood flow in high-grade valve stenosis. The interventional or surgical valve implantation improves the prognosis for these patients, similarly to aortic valve stenosis alone, followed by a specific pharmaceutical treatment depending on the type of amyloidosis.
Topics: Amyloidosis; Aortic Valve; Aortic Valve Stenosis; Echocardiography; Heart Valve Prosthesis Implantation; Humans; Magnetic Resonance Imaging
PubMed: 34487196
DOI: 10.1007/s00059-021-05054-x -
Journal of the American College of... Dec 2020
Topics: Aortic Valve Stenosis; Crime; Diastole; Humans; Registries; Transcatheter Aortic Valve Replacement
PubMed: 33334423
DOI: 10.1016/j.jacc.2020.10.034 -
International Journal of Cardiology Sep 2021
Topics: Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 34293365
DOI: 10.1016/j.ijcard.2021.07.032 -
Heart, Lung & Circulation Sep 2019Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries.... (Review)
Review
Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries. Transthoracic echocardiography remains the quintessential imaging modality for the non-invasive characterisation of AS due to its widespread availability, superior assessment of flow haemodynamics, and a wealth of prognostic data accumulated over decades of clinical utility and research applications. With expanding technologies and increasing availability of treatment options such as transcatheter aortic valve replacements, in addition to conventional surgical approaches, accurate and precise assessment of AS severity is critical to guide decisions for and timing of interventions. Despite clear guideline echocardiographic parameters demarcating severe AS, discrepancies between transvalvular velocities, gradients, and calculated valve areas are commonly encountered in clinical practice. This often results in diagnostically challenging cases with significant implications. Greater emphasis must be placed on the quality of performance of basic two dimensional (2D) and Doppler measurements (attention to detail ensuring accuracy and precision), incorporating ancillary haemodynamic surrogates, understanding study- or patient-specific confounders, and recognising the role and limitations of stress echocardiography in the subgroups of low-flow low-gradient AS. A multiparametric approach, along with the incorporation of multimodality imaging (cardiac computed tomography or magnetic resonance imaging) in certain scenarios, is now mandatory to avoid incorrect misclassification of severe AS. This is essential to ensure appropriate selection of patients who would most benefit from interventions on the aortic valve to relieve the afterload mismatch resulting from truly severe valvular stenosis.
Topics: Aortic Valve; Aortic Valve Stenosis; Calcinosis; Echocardiography; Echocardiography, Stress; Hemodynamics; Humans; Multimodal Imaging; Transcatheter Aortic Valve Replacement
PubMed: 31266725
DOI: 10.1016/j.hlc.2019.05.177 -
European Heart Journal. Cardiovascular... Apr 2022
Topics: Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 35175351
DOI: 10.1093/ehjci/jeac040 -
European Heart Journal. Cardiovascular... Jan 2022
Topics: Aortic Valve; Aortic Valve Stenosis; Calcinosis; Humans
PubMed: 34618019
DOI: 10.1093/ehjci/jeab204 -
The Canadian Journal of Cardiology Aug 2022
Topics: Acute Coronary Syndrome; Aortic Valve Stenosis; Coronary Stenosis; Drug-Eluting Stents; Humans; Percutaneous Coronary Intervention
PubMed: 35568267
DOI: 10.1016/j.cjca.2022.05.006 -
Heart (British Cardiac Society) Dec 2020
Topics: Aortic Valve; Aortic Valve Stenosis; Calcinosis; Dipeptidyl-Peptidases and Tripeptidyl-Peptidases; Humans
PubMed: 32917733
DOI: 10.1136/heartjnl-2020-317421