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The Journal of Thoracic and... Jul 2021
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Tricuspid Valve Insufficiency
PubMed: 32245666
DOI: 10.1016/j.jtcvs.2020.02.097 -
Engineering the aortic valve extracellular matrix through stages of development, aging, and disease.Journal of Molecular and Cellular... Dec 2021For such a thin tissue, the aortic valve possesses an exquisitely complex, multi-layered extracellular matrix (ECM), and disruptions to this structure constitute one of... (Review)
Review
For such a thin tissue, the aortic valve possesses an exquisitely complex, multi-layered extracellular matrix (ECM), and disruptions to this structure constitute one of the earliest hallmarks of fibrocalcific aortic valve disease (CAVD). The native valve structure provides a challenging target for engineers to mimic, but the development of advanced, ECM-based scaffolds may enable mechanistic and therapeutic discoveries that are not feasible in other culture or in vivo platforms. This review first discusses the ECM changes that occur during heart valve development, normal aging, onset of early-stage disease, and progression to late-stage disease. We then provide an overview of the bottom-up tissue engineering strategies that have been used to mimic the valvular ECM, and opportunities for advancement in these areas.
Topics: Aging; Animals; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Extracellular Matrix; Humans; Tissue Engineering; Tissue Scaffolds
PubMed: 34339757
DOI: 10.1016/j.yjmcc.2021.07.009 -
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 -
JACC. Cardiovascular Interventions Nov 2022
Topics: Humans; Aortic Valve; Depression; Treatment Outcome; Heart Valve Prosthesis; Anxiety
PubMed: 36423977
DOI: 10.1016/j.jcin.2022.09.029 -
Annals of Thoracic and Cardiovascular... 2015Bicuspid aortic valve (BAV) has been identified as the most common heart valve anomaly and is considered to be a heritable disorder that affects various cardiovascular... (Review)
Review
Bicuspid aortic valve (BAV) has been identified as the most common heart valve anomaly and is considered to be a heritable disorder that affects various cardiovascular disorders, including aortopathy. Current topics regarding the clinical management of BAV including surgical strategies with or without concomitant aortic repair or replacement are attracting interest, in addition to the pathological and morphological aspects of BAV as well as aortopathy. However, surgical indications are still being debated and are dependent on current clinical guidelines and surgeons' preferences. Although clinical guidelines have already been established for the management of BAV with or without aortopathy, many studies on clinical management and surgical techniques involving various kinds of subjects have previously been published. Although a large number of studies concerning the clinical aspects of BAV have been reviewed in detail, controversy still surrounds the clinical and surgical management of BAV. Therefore, surgeons should carefully consider valve pathology when deciding whether to replace the ascending aorta. In this review, we summarized current topics on BAV and the surgical management of diseased BAV with or without aortopathy based on previous findings, including catheter-based interventional management.
Topics: Aortic Aneurysm, Thoracic; Aortic Valve; Aortic Valve Stenosis; Bicuspid Aortic Valve Disease; Evidence-Based Medicine; Heart Valve Diseases; Humans; Japan; Practice Guidelines as Topic; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 26095042
DOI: 10.5761/atcs.ra.15-00130 -
The Journal of Thoracic and... Feb 2020
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Surgeons; Surgical Instruments; Transcatheter Aortic Valve Replacement
PubMed: 31630838
DOI: 10.1016/j.jtcvs.2019.06.129 -
JACC. Cardiovascular Imaging Jan 2019
Topics: Aortic Valve; Heart Valve Prosthesis; Transcatheter Aortic Valve Replacement
PubMed: 29778870
DOI: 10.1016/j.jcmg.2018.04.007 -
International Journal of Cardiology Jul 2021Porcine aortic valve (PAV) and bovine aortic valve (BAV) are commonly used in aortic valve replacement (AVR) surgeries. A detailed comparison for their hemodynamic and...
BACKGROUND
Porcine aortic valve (PAV) and bovine aortic valve (BAV) are commonly used in aortic valve replacement (AVR) surgeries. A detailed comparison for their hemodynamic and structural stress/strain performances would help to better understand valve cardiac function and select valve type and size for AVR outcome optimizations.
METHODS
Eight fluid-structure interaction models were constructed to compare hemodynamic and stress/strain behaviors of PAV and BAV with 4 sizes (19, 21, 23, and 25 mm). Blood flow velocity, systolic cross-valve pressure gradient (SCVPG), geometric orifice area (GOA), flow shear stresses (FSS), and stress/strain were obtained for comparison.
RESULTS
Compared with PAV, BAV has better hemodynamic performance, with lower maximum flow velocity (7.17%) and pressure (9.82%), smaller pressure gradient (mean and peak SCVPG: 8.92% and 9.28%), larger GOA (9.56%) and lower FSS (6.61%). The averages of the mean and peak net pressure gradient values from 4 BAV models were 8.10% and 8.35% lower than that from PAV models. Larger valve sizes for both PAV and BAV had improved hemodynamic performance. Maximum flow velocity, pressure, mean SCVPG and maximum FSS from 25 mm BAV were 36.80%, 15.81%, 39.05% and 38.83% lower than those from 19 mm BAV. The GOA of PAV and BAV 25 mm Valve were 43.75% and 33.07% larger than 19 mm valves, respectively. BAV has lower stress on the leaflets than PAV.
CONCLUSIONS
BAV had better hemodynamic performance and lower leaflets stress than PAV. More patient studies are needed to validate our findings.
Topics: Animals; Aortic Valve; Aortic Valve Stenosis; Bicuspid Aortic Valve Disease; Cattle; Heart Valve Diseases; Heart Valve Prosthesis; Hemodynamics; Humans; Swine
PubMed: 33932427
DOI: 10.1016/j.ijcard.2021.04.051 -
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 -
International Journal of Cardiology Jul 2022Although a familial component of calcific aortic valve stenosis (CAVS) has been described, its heritability remains unknown. Hence, we aim to assess the heritability of...
BACKGROUND
Although a familial component of calcific aortic valve stenosis (CAVS) has been described, its heritability remains unknown. Hence, we aim to assess the heritability of CAVS and the prevalence of bicuspid aortic valve among CAVS families.
METHODS
Probands were recruited following aortic valve replacement (AVR) for severe CAVS on either tricuspid (TAV) or bicuspid aortic valve (BAV). After screening, relatives underwent a Doppler-echocardiography to assess the aortic valve morphology as well as the presence and severity of CAVS. Families were classified in two types according to proband's aortic valve phenotype: TAV or BAV families. Control families were recruited and screened for the presence of BAV.
RESULTS
Among the 2371 relatives from 138 CAVS families (pedigree cohort), heritability of CAVS was significant (h = 0.47, p < 0.0001), in TAV (h = 0.49, p < 0.0001) and BAV families (h = 0.50, p < 0.0001). The prevalence of BAV in 790 relatives (phenotype cohort) was significantly increased in both TAV and BAV families compared to control families with a prevalence ratio of 2.6 ([95%CI:1.4-5.9]; p = 0.005) and 4.6 ([95%CI:2.4-13.4]; p < 0.0001), respectively. At least one relative had a BAV in 22.2% of tricuspid CAVS families.
CONCLUSIONS
Our study confirms the heritability of CAVS in both TAV and BAV families, suggesting a genetic background of this frequent valvular disease. In addition, BAV enrichment in TAV families suggests an interplay between tricuspid CAVS and BAV. Overall results support the need to improve phenotyping (i.e. BAV, TAV, risk factors) in CAVS families in order to enhance the identification of rare and causal genetic variants of CAVS.
CLINICAL TRIALS IDENTIFIER
NCT02890407.
Topics: Aortic Valve; Aortic Valve Stenosis; Bicuspid Aortic Valve Disease; Calcinosis; Heart Valve Diseases; Humans
PubMed: 35427703
DOI: 10.1016/j.ijcard.2022.04.022