Transverse aortic wall tears in infants after balloon angioplasty for aortic valve stenosis: Relation of aortic wall damage to diameter of inflated angioplasty balloon and aortic lumen in seven necropsy cases

Background: Histological studies have demonstrated a potential role of inflammation and neoangiogenesis in aortic valve stenosis (AVS). Inflammatory activation may generate heat. We investigated in vivo in patients with AVS whether there is: thermal heterogeneity within the valve leaflets, temperature difference between the leaflets and the ascending aortic wall and a possible correlation between heat production, inflammation and neoangiogenesis. Methods: We examined 96 leaflets from 32 patients scheduled for aortic valve replacement. Seventy-five leaflets were from 25 patients with AVS and 21 from 7 patients with aortic valve insufficiency (AVI) (control group). Temperature measurements were performed right before the hypothermic cardioplegia. Temperature difference (ΔT) was assigned as the mean temperature of each aortic leaflet minus the temperature of the aortic wall. Results: Histological, immunohistological analysis for inflammatory cells and vascular endothelial growth factor (VEGF) immunoreactivity was performed. Significant thermal heterogeneity was recorded within the leaflets of AVS, compared AVI (1.52±1.35°C vs 0.13±0.11°C, p<0.01). In AVS ΔT was 1.09±1.16°C for the non-coronary (NC), 1.24±1.03°C for the right and 1.53±1.23°C, for the left leaflet. ΔT was lower in AVI (0.10±0.10°C for the NC, 0.02±0.19°C for the right and 0.05±0.19°C, for the left leaflet, p<0.01 for all comparisons). Leaflets of AVS had increased inflammatory cell infiltration, calcium deposit, and anti-VEGF expression compared to AVI (p<0.01). Conclusions: Thermal heterogeneity is increased in AVS and correlates with inflammatory mononuclear cell infiltration, expression of pro-inflammatory cytokines and neoangiogenic factors. Future studies need to be performed to investigate possible prognostic and therapeutic implications.

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Balloon Angioplasty for Congenital Aortic Valve Stenosis

The American Journal of Cardiology ◽

10.1016/j.amjcard.2012.02.036 ◽

2012 ◽

Vol 109 (10) ◽

pp. 1536-1537

Author(s):

George G.S. Sandor ◽

Derek G. Human ◽

James E. Potts

Keyword(s):

Aortic Valve ◽

Aortic Valve Stenosis ◽

Balloon Angioplasty ◽

Congenital Aortic Valve Stenosis

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Natural history of the aortic wall changes in adults with the degenerative tricuspid aortic valve stenosis: The morphometric proofs and implications for echocardiography

Vojnosanitetski pregled ◽

10.2298/vsp170317082b ◽

2019 ◽

Vol 76 (3) ◽

pp. 241-258

Author(s):

Sasa Borovic ◽

Milica Labudovic-Borovic ◽

Vera Todorovic ◽

Jelena Rakocevic ◽

Jelena Marinkovic-Eric ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Stenosis ◽

Aortic Wall ◽

Ascending Aorta ◽

Morphological Data ◽

Histopathological Changes ◽

Tricuspid Aortic Valve ◽

Hemodynamic Stress ◽

Sinus Valsalvae ◽

Echocardiographic Parameters

Background/Aim. So far, no study has been focused exclusively on the tricuspid aortic valve stenosis (TAV) in the aorta without severe dilatation and none has aimed at correlating the high mycroscopy findings with the echocardiographic parameters. This research was conducted on the postulate that detecting the histopathological changes of different severity in the aortic wall could tailor decision about an aortic surgery. The aim of this study was to grade the histopathological changes in the wall of the nonseverely dilated ascending aorta in patients with the severe, calcific TAV stenosis and to correlate them with the echocardiographic parameters in order to analyze when the ascending aorta should be replaced simultaneously with the aortic valve replacement (AVR). Methods. The samples from 37 patients subjected to the AVR and the samples from the control group were analyzed morphologically. The echocardiographic parameters obtained in the TAV stenosis patients were preoperatively correlated with the morphological data, age and gender, diameters of the ventriculo-aortic junction (AA), the sinus Valsalvae (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA), the sinus Valsalvae index (SVI) and AscA/AA index. Results. We confirmed morphometrically the exact region of the hemodynamic stress influence with the mathematical distinction in comparison to the controls. In this region, the gradual elastic lamellae disruption was proved by a statistically significant difference through the 3 grades. The elastic skeleton alterations were potentiated with aging and in females. The morphometric parameters of the ascending aorta wall statistically significantly correlated with the echocardiographic parameters: AA, SV, AscA and SVI. The echocardiographic parameters tended to be higher in the most severe grade 3, in the patients younger than 65 years of age. The AscAof more than 4.5 cm was associated with the irreversible morphological defects in these patients. Conclusion. The hemodynamic stress induced by the TAV stenosis leads to the ascending aorta elastic lamellae disruption that could be histopathologically graded and correlated with the echocardiographic parameters of the ascending aorta providing a potential tool for decision-making process in cases when the ascending aorta replacement is considered simultaneously with the AVR.

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