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JACC. Cardiovascular Imaging Sep 2019The first-line evaluation of aortic stenosis severity is Doppler echocardiography. However, in up to 40% of patients, resting echocardiographic assessment of aortic... (Review)
Review
The first-line evaluation of aortic stenosis severity is Doppler echocardiography. However, in up to 40% of patients, resting echocardiographic assessment of aortic stenosis severity is discordant, leading to clinical uncertainty. Interest has therefore grown in aortic valve calcium scoring by multidetector computed tomography (CT-AVC) as an alternative load independent assessment of aortic stenosis severity. This paper will briefly review the pathophysiology of aortic stenosis and the crucial role that calcification plays in driving progressive obstruction of the valve. Subsequently, it will describe published reports that have investigated CT-AVC, validating this parameter against histology, and establishing its diagnostic accuracy versus echocardiography as well as its powerful independent prognostic capability. Finally, this review seeks to provide a practical guide about how best to acquire and interpret CT-AVC with a close focus on potential pitfalls and how these might be best avoided as this technique becomes more widely adopted in to clinical practice.
Topics: Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Hemodynamics; Humans; Male; Multidetector Computed Tomography; Predictive Value of Tests; Prognosis; Reproducibility of Results; Severity of Illness Index
PubMed: 31488252
DOI: 10.1016/j.jcmg.2019.01.045 -
Anaesthesiology Intensive Therapy 2019
Topics: Aortic Valve; Aortic Valve Insufficiency; Echocardiography, Transesophageal; Humans
PubMed: 31995954
DOI: 10.5114/ait.2019.90986 -
Cardiology 2022Unicuspid aortic valve (UAV) is a rare congenital aortic valve anomaly. It has 2 subtypes and often is associated with aortic valve dysfunction and corresponding... (Review)
Review
Unicuspid aortic valve (UAV) is a rare congenital aortic valve anomaly. It has 2 subtypes and often is associated with aortic valve dysfunction and corresponding clinical presentations. Echocardiography is the first choice of diagnostic method for UAV. Three-dimensional echocardiography has played an increasingly important role in diagnosis, intraprocedural guidance, and post-procedural assessment in recent years. There remain challenges in distinguishing UAV from bicuspid aortic valve or tricuspid aortic valve. Misdiagnosis is most resulted from raphes or leaflet calcifications. Multi-modality imaging has obvious advantages over single-modality imaging and is crucial for UAV diagnosis. Accurate identification of aortic valve morphology is important to choose the best treatment. Aortic balloon valvoplasty, surgical valvotomy, commissurotomy, Ross procedure, surgical valve repair, and surgical replacement are most common treatment modalities of UAV. In this review, we aim to discuss UAV including epidemiology, definition, classification, diagnostic importance and necessity, valvular function, clinical presentation, associated disorders, noninvasive diagnostic modalities, and therapeutic approaches.
Topics: Aortic Valve; Aortic Valve Stenosis; Echocardiography; Heart Defects, Congenital; Heart Valve Diseases; Humans
PubMed: 34965530
DOI: 10.1159/000521623 -
Expert Review of Medical Devices Nov 2017Replacement with a prosthetic device remains a major treatment option for the patients suffering from heart valve disease, with prevalence growing resulting from an... (Review)
Review
Replacement with a prosthetic device remains a major treatment option for the patients suffering from heart valve disease, with prevalence growing resulting from an ageing population. While the most popular replacement heart valve continues to be the bioprosthetic heart valve (BHV), its durability remains limited. There is thus a continued need to develop a general understanding of the underlying mechanisms limiting BHV durability to facilitate development of a more durable prosthesis. In this regard, computational models can play a pivotal role as they can evaluate our understanding of the underlying mechanisms and be used to optimize designs that may not always be intuitive. Areas covered: This review covers recent progress in computational models for the simulation of BHV, with a focus on aortic valve (AV) replacement. Recent contributions in valve geometry, leaflet material models, novel methods for numerical simulation, and applications to BHV optimization are discussed. This information should serve not only to infer reliable and dependable BHV function, but also to establish guidelines and insight for the design of future prosthetic valves by analyzing the influence of design, hemodynamics and tissue mechanics. Expert commentary: The paradigm of predictive modeling of heart valve prosthesis are becoming a reality which can simultaneously improve clinical outcomes and reduce costs. It can also lead to patient-specific valve design.
Topics: Anisotropy; Aortic Valve; Biocompatible Materials; Bioprosthesis; Cardiovascular Physiological Phenomena; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Materials Testing; Models, Cardiovascular; Prosthesis Design
PubMed: 28980492
DOI: 10.1080/17434440.2017.1389274 -
High Blood Pressure & Cardiovascular... May 2022Aortic stenosis (AS) is the most common degenerative valvular disease in western word. In patients with severe AS, small changes in aortic valve area can lead to large... (Review)
Review
Aortic stenosis (AS) is the most common degenerative valvular disease in western word. In patients with severe AS, small changes in aortic valve area can lead to large changes in hemodynamics. The correct understanding of cardiac hemodynamics and its interaction with vascular function is of paramount importance for correct identification of severe AS and to plan effective strategies for its treatment. In the current review with highlight the importance of pressure recovery phenomenon and valvular arterial impedance as novel tools in the evaluation of patients with aortic stenosis.
Topics: Aortic Valve; Aortic Valve Stenosis; Cardiovascular System; Hemodynamics; Humans
PubMed: 35438477
DOI: 10.1007/s40292-022-00520-x -
Cardiology 2018
Topics: Aortic Valve; Aortic Valve Stenosis; Humans; Tomography, X-Ray Computed; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 29996138
DOI: 10.1159/000490094 -
JACC. Cardiovascular Interventions Jan 2020
Topics: Aortic Valve; Aortic Valve Stenosis; Bicuspid Aortic Valve Disease; Computer Simulation; Heart Valve Diseases; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 31629748
DOI: 10.1016/j.jcin.2019.08.040 -
Current Cardiology Reports Jul 2021Preservation or repair of the aortic valve has evolved dynamically in the past 20 years. It leads to a high freedom from valve-related complications if an adequate valve... (Review)
Review
PURPOSE OF REVIEW
Preservation or repair of the aortic valve has evolved dynamically in the past 20 years. It leads to a high freedom from valve-related complications if an adequate valve durability can be achieved; it may possibly also improve survival. To date, little structured information is available about which valves can be repaired and which should better be replaced.
RECENT FINDINGS
For surgical decision-making, the size of the aortic root is important and the anatomy of the aortic valve must be considered. In the presence of root aneurysm, most tricuspid and bicuspid aortic valves can be preserved. In aortic regurgitation and normal aortic dimensions, the majority of tricuspid and bicuspid aortic valves can be repaired with good long-term durability. In bicuspid aortic valves, the morphologic characteristics must be taken into consideration. Unicuspid and quadricuspid aortic valves can be repaired in selected cases. Generally, cusp calcification is a sign of a poor substrate for repair; the same is true for cusp retraction and cusp destruction due to active endocarditis. They are associated with limited valve durability. Using current concepts, many non-calcified aortic valves can be repaired. Modern imaging, in particular three-dimensional transesophageal echocardiography (TEE), should be able to define repairable aortic valves with a high probability.
Topics: Aorta; Aortic Valve; Aortic Valve Insufficiency; Bicuspid Aortic Valve Disease; Humans; Reoperation
PubMed: 34213661
DOI: 10.1007/s11886-021-01525-z -
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 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Dec 2017
Topics: Aged; Aorta; Aortic Valve; Bicuspid Aortic Valve Disease; Echocardiography; Heart Valve Diseases; Humans; Middle Aged; Phenotype
PubMed: 29226888
DOI: 10.5543/tkda.2017.01801