Evaluation of relationship between left ventricular outflow tract diameter and body size in a multi-ethnic Southeast Asian population and the accuracy of size-adjusted left ventricular outflow tract diameter reference values in patients with severe aortic stenosis

2021 ◽  
Vol 345 ◽  
pp. 1-2
Author(s):  
L.K. Thien ◽  
Y.Y. Oon ◽  
B.K. Chung ◽  
I.X. Pang ◽  
L.S. Chen ◽  
...  
Keyword(s):  
Body Size ◽  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Severe Aortic Stenosis ◽  
Asian Population ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Southeast Asian Population ◽  
Left Ventricular Outflow

Left ventricular outflow tract obstruction masked by severe aortic stenosis

2015 ◽  
Vol 65 (3) ◽  
pp. 160-163 ◽  
Author(s):  
Shinya Fukui ◽  
Masataka Mitsuno ◽  
Mitsuhiro Yamamura ◽  
Hiroe Tanaka ◽  
Masaaki Ryomoto ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Severe Aortic Stenosis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

P910An Asian perspective on left ventricular outflow tract cut-offs and the resulting discrepancy in severity grading of aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Chew ◽  
N Ngiam ◽  
B Y Q Tan ◽  
H W Sim ◽  
W K F Kong ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Asian Population ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
P Value ◽  
Mean Pressure ◽  
Severity Grading ◽  
Left Ventricular Outflow

Abstract Objectives Inconsistencies in grading of aortic stenosis (AS) severity have been reported based on measurement of left ventricular outflow tract diameter (LVOTd), but this remains to be studied in an Asian population. We investigated consistency of grading AS severity at various LVOTd, and subsequently postulated alternative cut-offs for more consistent grading of AS severity. Methods 350 consecutive patients with index echocardiographic diagnosis of severe AS were divided them into three groups based on LVOTd: “small” (<20mm), “average” (20–22mm), “large” (>22mm). In each group, the consistency of flow-dependent (transaortic mean pressure gradient (MG)) and flow-independent parameters (AVA) were used for classification of AS severity. Results Of 350 patients, 51.7% had small LVOTd, while 30.8% and 17.5% had average and large LVOTd respectively. Consistent grading by LVOTd based on AVA and MG, was seen in 33.7% of patients with small, 47.6% with average, 57.7% with large LVOTd. When the hypothetical AVA cut-off of 0.9cm2 was used, consistent grading improved to 38.0% in small, 56.5% in average and 70% in large LVOTd. At an AVA cut-off of 0.8cm2, there was further incremental improvement in the small LVOTd group to 54.1% (p<0.05). Table 1. Consistent grading by LVOTd based on current guidelines Small LVOTd (<20mm, n=181) Average LVOTd (20–22mm, n=108) Large LVOTd (>22mm, n=61) Consistent grading AVA < cut-off MG >40 Consistency (%) Consistent grading AVA < cut-off MG >40 Consistency (%) Consistent grading AVA < cut-off MG >40 Consistency (%) n=61 33.7 n=51 47.6 n=35 57.7 n=69 38 n=61 56.5 n=43 70* n=98 54.1*+ n=70 65.1* n=43 70.8* *p-value <0.05 when compared with AVA cut-off 0.8cm2 for each LVOTd category; +p-value <0.05 when compared with AVA cut-off 0.9cm2 for each LVOTd category. Figure 1 Conclusion Current severe AS guidelines are most consistent with those in the large LVOTd group. However, the majority of the study's Asian population is in the small LVOTd group, which is the group most susceptible to discrepancy in AS grading. Improved consistency in echocardiographic grading may be attained with a lower AVA cut-off in this Asian cohort.

scholarly journals Outcomes in Patients With Obstructive Hypertrophic Cardiomyopathy and Concomitant Aortic Stenosis Undergoing Surgical Myectomy and Aortic Valve Replacement

2021 ◽  
Author(s):  
Milind Y. Desai ◽  
Alaa Alashi ◽  
Zoran B. Popovic ◽  
Per Wierup ◽  
Brian P. Griffin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Severe Aortic Stenosis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Outflow ◽  
Surgical Myectomy

Background Hypertrophic cardiomyopathy (HCM) and aortic stenosis can cause obstruction to the flow of blood out of the left ventricular outflow tract into the aorta, with obstructive HCM resulting in dynamic left ventricular outflow tract obstruction and moderate or severe aortic stenosis causing fixed obstruction caused by calcific degeneration. We sought to report the characteristics and longer‐term outcomes of patients with severe obstructive HCM who also had concomitant moderate or severe aortic stenosis requiring surgical myectomy and aortic valve replacement. Methods and Results We studied 191 consecutive patients (age 67±6 years, 52% men) who underwent myectomy and aortic valve (AV) replacement (90% bioprosthesis) at our center between June 2002 and June 2018. Clinical and echo data including left ventricular outflow tract gradient and indexed AV area were recorded. The primary outcome was death. Prevalence of hypertension (63%) and hyperlipidemia (75%) were high, with a Society of Thoracic Surgeons score of 5±4, and 70% of participants had no HCM‐related sudden death risk factors. Basal septal thickness and indexed AV area were 1.9±0.4 cm and 0.72±0.2 cm 2 /m 2 , respectively, while 100% of patients had dynamic left ventricular outflow tract gradient >50 mm Hg. At 6.5±4 years, 52 (27%) patients died (1.5% in‐hospital deaths). One‐, 2‐, and 5‐year survival in the current study sample was 94%, 91%, and 83%, respectively, similar to an age‐sex–matched general US population. On multivariate Cox survival analysis, age (hazard ratio [HR], 1.65; 95% CI, 1.24–2.18), chronic kidney disease (HR, 1.58; 95% CI, 1.21–2.32), and right ventricular systolic pressure on preoperative echocardiography (HR, 1.28; 95% CI, 1.05–1.57) were associated with longer‐term mortality, but traditional HCM risk factors did not. Conclusions In symptomatic patients with severely obstructive HCM and moderate or severe aortic stenosis undergoing a combined surgical myectomy and AV replacement at our center, the observed postoperative mortality was significantly lower than the expected mortality, and the longer‐term survival was similar to a normal age‐sex–matched US population.

scholarly journals Prevalence and prognostic impact of left ventricular outflow tract calcification in patients with severe aortic stenosis undergoing transfemoral TAVI using second-generation devices

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Waldschmidt ◽  
A Gossling ◽  
S Ludwig ◽  
M Linder ◽  
L Voigtlaender ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Second Generation ◽  
Left Ventricular Outflow Tract ◽  
Severe Aortic Stenosis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
All Cause Mortality ◽  
Left Ventricular Outflow ◽  
Transfemoral Tavi

Abstract Introduction Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after TAVI in patients receiving first-generation transcatheter heart valves (THV). Second-generation THV have been shown to improve outcomes of TAVI patients. Thus, aim of this study is to assess the prevalence of LVOT calcification as well as its impact on procedural and clinical outcomes in patients with severe aortic stenosis undergoing transfemoral TAVI with second-generation THV in a real-world patient cohort. Methods In this retrospective single-center analysis patients receiving transfemoral TAVI with second-generation THV for the treatment of aortic stenosis (AS) between 05/2012 and 06/2018 and with adequate CT data were included (n=836). Amount of LVOT calcification was measured quantitatively from contrast-enhanced multislice CT using a dedicated software. Baseline characteristics and outcomes were compared according to presence of significant LVOT calcification (none/≤10 mm3 vs. &gt;10 mm3). Procedural and clinical outcome were assessed in accordance with VARC-2 criteria. All-cause mortality was assessed by Kaplan-Meier method, median follow-up was 1.4 years. Results Significant LVOT calcification was present in 37.0% of patients. Patients with LVOT calcification were older (all results as follows without (w/o) vs. with (w) LVOT calcification: 81.4 (77.1, 84.8) vs. 82.3 (78.0, 86.3) years, p=0.006), but presented similar STS scores compared to those without LVOT calcification (5.4±4.7 vs. 5.4±3.5%, p=0.94). Moreover, patients with LVOT calcification had higher mean transvalvular gradients at baseline (30.0 (21.0, 41.0) vs. 37.0 (25.7, 47.0) mmHg, p&lt;0.001) and higher aortic valve calcium volume (380.7 (226.8, 632.1) vs. 663.6 (364.5, 1070.3) mm3, p&lt;0.001). There were no significant differences in rate of device success (97.0 vs. 94.2%, p=0.11), renal failure (2.6 vs. 2.3%, p=1.00), myocardial infarction (0.9 vs. 1.2%, p=1.00) or rate of permanent pacemaker implantation at 30 days after TAVI (16.6 vs. 17.2%, p=0.91). However, rate of TIA/stroke was significantly higher in patients with LVOT calcification (2.1 vs. 6.2%, p=0.0098). Furthermore, patients with LVOT calcification had a higher rate of more than mild paravalvular leakage at discharge (3.8 vs. 7.6%, p=0.033). Rate of 1 year all-cause mortality (17.8 vs. 21.2%, p=0.23) was not significantly different between both groups. Conclusions Significant LVOT calcification is present in a substantial proportion of patients receiving TAVI. In such patients, higher rates of cerebrovascular events and more than mild PVL occurred compared to those without significant LVOT calcification even with currently available second-generation THV. Although these findings did not translate into higher mortality rates in the present study, they underline the need for further optimization of THV technology in order to improve outcomes among all TAVI patients. Figure 1. 1-year mortality Funding Acknowledgement Type of funding source: None

Aortic stenosis and left ventricular outflow tract obstruction

ESC CardioMed ◽  
2018 ◽  
pp. 807-810
Author(s):  
David Anderson
Keyword(s):  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Long Term Follow Up ◽  
Balloon Valvotomy ◽  
Left Ventricular Outflow

Left ventricular outflow tract obstruction can occur at subvalvar, valvar, and supravalvar levels. Severity and progression can be evaluated by echocardiography. Aortic valve stenosis can usually be relieved by balloon valvotomy, but some patients require surgery, either with valvotomy, valve replacement, or the Ross procedure. Sub- and supravalvar aortic stenosis require surgical management. Long-term follow-up of all patients is required.

scholarly journals Subaortic stenosis and mitral dysplasia in three Black Russian Terrier puppies

2012 ◽  
Vol 50 (No. 7) ◽  
pp. 321-326
Author(s):  
J. Pikula ◽  
J. Pikulova ◽  
H. Bandouchova ◽  
P. Kohout ◽  
K. Najman ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Subaortic Stenosis ◽  
Maximum Pressure ◽  
Mitral Insufficiency ◽  
Left Ventricular Outflow

A combined congenital heart defect of aortic stenosis and mitral dysplasia was diagnosed in three Black Russian Terrier puppies two months old. The aortic stenosis component included both fixed and dynamic obstructions. The fixed obstruction was subvalvularly located at the entrance to the left ventricular outflow tract. The dynamic obstruction was caused by the septal leaflet of the mitral valve protruding into the left ventricular outflow tract. Mitral dysplasia resulted in mitral insufficiency leading to regurgitation through the mitral valve closer to the septal side. The maximum pressure gradient across the aortic valve amounting to 103 mmHg measured in one puppy was consistent with the most severe grade of stenosis. The diagnosis was confirmed by autopsy in all three puppies that were males and originated in one litter, so genetic influences are supposed.

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