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Journal of the American College of... Apr 2013
Topics: Aortic Valve Insufficiency; Aortic Valve Stenosis; Female; Heart Valve Prosthesis Implantation; Humans; Male
PubMed: 23500258
DOI: 10.1016/j.jacc.2013.01.029 -
Interactive Cardiovascular and Thoracic... Jul 2015The emerging new treatment options for aortic valve disease call for more sophisticated diagnostics. We aimed to describe the echocardiographic pathophysiology and...
OBJECTIVES
The emerging new treatment options for aortic valve disease call for more sophisticated diagnostics. We aimed to describe the echocardiographic pathophysiology and characteristics of the purely regurgitant aortic valve in detail.
METHODS
Twenty-nine men, with chronic aortic regurgitation without concomitant heart disease referred for aortic valve intervention, underwent 2D transoesophageal echocardiographic (TEE) examination prior to surgery according to a previously published matrix. Measurements of the aortic valve apparatus in long and short axis view were made in systole and diastole and analysed off-line. The aortic valves were grouped as tricuspid (TAV) or bicuspid (BAV), and classified by regurgitation mechanism.
RESULTS
Twenty-four examinations were eligible for analysis of which 13 presented TAV and 11 BAV. The regurgitation mechanism was classified as dilatation of the aorta in 6 cases, as prolapse in 11 cases and as poor cusp tissue quality or quantity in 7 cases. The ventriculo-aortic junction (VAJ) and valve opening were closely related (TAV r = 0.5, BAV r = 0.73) but no correlation was found between the VAJ and the maximal sinus diameter (maxSiD) or the sinotubular junction (STJ). However, the STJ and maxSiD were significantly related (TAV vs BAV: systole r = 0.9, r = 0.8; diastole r = 0.9, r = 0.7), forming an entity. The conjoined BAV cusps were shorter than the anterior cusps when closed (P = 0.002); the inter-commissural distances of the cusps in the BAV group were significantly different (P = 0.001 resp. 0.03) in both systole and diastole.
CONCLUSIONS
The VAJ was independent of other aortic dimensions and should thereby be considered as a separate entity with influence on valve opening. The detailed 2D TEE measurements of this study add further important information to our knowledge about the function and echocardiographic anatomy of the pathological aortic valve and root either as a stand-alone examination or as a benchmark and complement to 3D echocardiography. This may have an impact on decisions regarding repairability of the native aortic valve.
Topics: Adult; Aged; Aortic Valve; Aortic Valve Insufficiency; Bicuspid Aortic Valve Disease; Echocardiography, Transesophageal; Heart Valve Diseases; Hemodynamics; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis
PubMed: 25840434
DOI: 10.1093/icvts/ivv072 -
Interactive Cardiovascular and Thoracic... Oct 2022Calcified or fibrotic cusps in patients with bicuspid aortic valves and aortic regurgitation complicate successful aortic valve (AV)-repair. Aortic valve...
OBJECTIVES
Calcified or fibrotic cusps in patients with bicuspid aortic valves and aortic regurgitation complicate successful aortic valve (AV)-repair. Aortic valve neocuspidization (AVNeo) with autologous pericardium offers an alternative treatment to prosthetic valve replacement. We compared patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo.
METHODS
We retrospectively analysed patients with regurgitant bicuspid valves undergoing AV-repair or AVNeo. We focused on residual regurgitation, pressure gradients and effective orifice area, determined preoperatively and at discharge.
RESULTS
AV-repair was performed in 61 patients (mean age: 43.2 ± 11.3 years) and AVNeo in 22 (45.7 ± 14.1). Prior to the operation patients of the AV-repair group showed severe regurgitation in 38 cases (62.3%) and moderate in 23 (37.6%); in the AVNeo group, all patients exhibited severe regurgitation. Postoperatively, 57 patients (93.4%) patients had no or mild regurgitation after AV-repair and 21 (95.4%) after AVNeo. In AVNeo-patients, peak (10.6 ± 3.1 mmHg vs 22.7 ± 11 mmHg, P< 0.001) and mean pressure gradients (5.9 ± 2 mmHg vs 13.8 ± 7.3 mmHg, P < 0.001) were significantly lower and the orifice area significantly larger (2.9 ± 0.8 cm2 vs 1.9 ± 0.7 cm2, P < 0.001) compared to repair.
CONCLUSIONS
Compared to AV-repair, patients AVNeo showed lower mean pressure gradients and larger orifice areas at discharge. The functional result was not different.
Topics: Humans; Adult; Middle Aged; Aortic Valve; Bicuspid Aortic Valve Disease; Retrospective Studies; Aortic Valve Insufficiency; Hemodynamics; Treatment Outcome
PubMed: 36018270
DOI: 10.1093/icvts/ivac226 -
Canadian Medical Association Journal Aug 1966One hundred consecutive aortograms, performed with careful attention to recommended technical details, were reviewed to identify cases of "factitious" aortic valve...
One hundred consecutive aortograms, performed with careful attention to recommended technical details, were reviewed to identify cases of "factitious" aortic valve insufficiency, viz. aortic regurgitation seen during aortography for which there is no clinical evidence. Five patients with this condition were identified. Two of these subsequently underwent mitral valve replacement under cardiopulmonary by-pass. Aortic insufficiency was not detected during this procedure and the aortic valve appeared to be anatomically normal at postmortem examination. That factitious aortic insufficiency may exist should be remembered when aortography is used to differentiate aortic from pulmonary valve insufficiency.
Topics: Aortic Valve Insufficiency; Aortography; Female; Heart Valve Diseases; Humans; Middle Aged; Mitral Valve Stenosis
PubMed: 5943197
DOI: No ID Found -
JACC. Cardiovascular Interventions Apr 2022
Topics: Aortic Valve; Aortic Valve Insufficiency; Heart-Assist Devices; Humans; Treatment Outcome
PubMed: 35367172
DOI: 10.1016/j.jcin.2022.01.286 -
Texas Heart Institute Journal Sep 2022
Topics: Aortic Valve; Aortic Valve Insufficiency; Humans; Quadricuspid Aortic Valve
PubMed: 36223205
DOI: 10.14503/THIJ-19-7177 -
Texas Heart Institute Journal 2013
Review
Topics: Aortic Valve; Aortic Valve Insufficiency; Cardiac Valve Annuloplasty; Echocardiography, Transesophageal; Humans; Suture Techniques
PubMed: 24391316
DOI: No ID Found -
The Journal of Thoracic and... Feb 2009Valve repair for aortic insufficiency requires a tailored surgical approach determined by the leaflet and aortic disease. Over the past decade, we have developed a...
OBJECTIVE
Valve repair for aortic insufficiency requires a tailored surgical approach determined by the leaflet and aortic disease. Over the past decade, we have developed a functional classification of AI, which guides repair strategy and can predict outcome. In this study, we analyze our experience with a systematic approach to aortic valve repair.
METHODS
From 1996 to 2007, 264 patients underwent elective aortic valve repair for aortic insufficiency (mean age - 54 +/- 16 years; 79% male). AV was tricuspid in 171 patients bicuspid in 90 and quadricuspid in 3. One hundred fifty three patients had type I dysfunction (aortic dilatation), 134 had type II (cusp prolapse), and 40 had type III (restrictive). Thirty six percent (96/264) of the patients had more than one identified mechanism.
RESULTS
In-hospital mortality was 1.1% (3/264). Six patients experienced early repair failure; 3 underwent re-repair. Functional classification predicted the necessary repair techniques in 82-100% of patients, with adjunctive techniques being employed in up to 35% of patients. Mid-term follow up (median [interquartile range]: 47 [29-73] months) revealed a late mortality rate of 4.2% (11/261, 10 cardiac). Five year overall survival was 95 +/- 3%. Ten patients underwent aortic valve reoperation (1 re-repair). Freedoms from recurrent Al (>2+) and from AV reoperation at 5 years was 88 +/- 3% and 92 +/- 4% respectively and patients with type I (82 +/- 9%; 93 +/- 5%) or II (95 +/- 5%; 94 +/- 6%) had better outcomes compared to type III (76 +/- 17%; 84 +/- 13%).
CONCLUSION
Aortic valve repair is an acceptable therapeutic option for patients with aortic insufficiency. This functional classification allows a systematic approach to the repair of Al and can help to predict the surgical techniques required as well as the durability of repair. Restrictive cusp motion (type III), due to fibrosis or calcification, is an important predictor for recurrent Al following AV repair.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aortic Valve Insufficiency; Cardiac Surgical Procedures; Child; Female; Hospital Mortality; Humans; Male; Middle Aged; Recurrence; Reoperation; Suture Techniques; Treatment Outcome; Young Adult
PubMed: 19185138
DOI: 10.1016/j.jtcvs.2008.08.054 -
Heart (British Cardiac Society) Jul 2006
Review
Topics: Aortic Valve Insufficiency; Echocardiography, Doppler, Color; Humans; Magnetic Resonance Angiography
PubMed: 16775114
DOI: 10.1136/hrt.2004.042614 -
Journal of Cardiology Feb 2022Aortopathy is a well-known feature of conotruncal anomalies, but it remains unknown whether valve-sparing aortic root replacement, such as the David procedure, is...
BACKGROUND
Aortopathy is a well-known feature of conotruncal anomalies, but it remains unknown whether valve-sparing aortic root replacement, such as the David procedure, is feasible in young patients with severe aortic regurgitation. We assessed the aortic valve complex and aortic root morphology in patients with conotruncal anomalies using echocardiography. Furthermore, we evaluated the relevant factors associated with aortopathy in this population.
METHODS
A total of 172 adult patients with conotruncal anomalies were enrolled in this study. Dimensions of the aortic valve complex were measured at the level of the sinus of Valsalva (SV) and sinotubular junction (STJ). The geometric height (GH), effective height (EH), and coaptation length (CL) were also assessed to analyze the aortic valve complex in detail.
RESULTS
Sixteen of 172 patients were excluded due to poor imaging; 105 patients with tetralogy of Fallot, 24 with double outlet right ventricle, and 27 with transposition of the great arteries totaling 156 patients (32+/-11 years old) were included in the analysis. The patients were divided into four groups: Group 1 (98 patients) had no dilatation of SV or STJ; Group 2 (32 patients) had dilated SV and STJ; Group 3 (14 patients) had dilated SV; and Group 4 (12 patients) had dilated STJ. GH and EH in Group 2 were also highest among the four, whereas CL was not significantly shortened. Multivariate analysis revealed that male sex, age, and conduit repair were risk factors for aortopathy in this population.
CONCLUSIONS
Patients with dilated SV and STJ (Group 2) were the most common among the patients with aortopathy (Groups 2, 3, and 4). The aortic valve leaflets themselves were enlarged, and the poor coaptation of the valve tips was compensated in spite of aortic root dilatation, which plays an important role in preventing severe aortic regurgitation in this population. Overall, valve-sparing aortic valve replacement is more feasible in the young populations than we expected.
Topics: Adult; Aorta; Aortic Valve; Aortic Valve Insufficiency; Heart Defects, Congenital; Humans; Male; Transposition of Great Vessels; Young Adult
PubMed: 34600781
DOI: 10.1016/j.jjcc.2021.09.007