scholarly journals P1692 The past returns after 20 years: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Habjan ◽  
D Cantisani ◽  
I S Scarfo` ◽  
M C Guarneri ◽  
G Semeraro ◽  
...  
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Valvular Heart Disease ◽  
Radiation Treatment ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Radiation Induced ◽  
Valve Area

Abstract Introduction Radiation therapy is one of the cornerstones of treatment for many types of cancer. These patients can later in life develop cardiovascular complications associated with radiation treatment. Late cardiovascular effects of radiation treatment include coronary artery disease (CAD), valvular heart disease, congestive heart failure, pericardial disease and sudden death. The most common sign of radiation-induced valvular heart disease is the calcification of the intervalvular fibrosa between the aortic and mitral valve. Case presentation A 71-year-old male patient with a history of Non-Hodgkin lymphoma treated with radiotherapy and chemotherapy 20 years ago, CAD, arterial hypertension, diabetes type II, dyslipidemia, obesity and currently smoking presented in the emergency room in our medical facility with acute pulmonary edema. The patient had unstable angina pectoris in 2018, the coronary angiography showed two-vessel disease with a non-significant stenosis of the left main coronary artery (LMCA) and 70% stenosis of the left anterior descending artery (LAD), for which he refused the percutaneous coronary intervention. At the same time, a transthoracic echocardiography (TTE) showed severe aortic stenosis and moderately severe mitral stenosis, at that time the patient refused the operation. After the initial treatment for pulmonary edema, TTE and transesophageal echocardiography (TEE) were performed and showed a tricuspid aortic valve with calcification of the cusps and a very severe aortic stenosis (planimetric aortic valve area 0.74 cm², functional aortic valve area 0.55 cm², indexed functional aortic valve area 0.25 cm²/m², mean gradient 61 mmHg, peak gradient 100 mmHg, stroke volume (SV) 69 ml, stroke volume index (SVI) 31 ml/m², flow rate 221 ml/s, aortic annulus 20x26 mm). The left ventricle was severely dilated (end diastolic volume 268 ml) with diffuse hypokinesia and severe systolic dysfunction (ejection fraction 32%). We appreciated a calcification of the mitral-aortic intervalvular fibrosa and the mitral annulus, without mitral stenosis but with moderate mitral regurgitation. The calcification of the intervalvular fibrosa suggested our final diagnosis of radiation-induced valvular heart disease with a severe aortic stenosis in low-flow conditions. The patient was successfully treated with transcatheter aortic valve implantation (TAVI). Conclusion Radiation-induced heart disease is a common reality and is destinated to raise due to the increasing number of cancer survivors. Effects are seen also many years after the radiation treatment. The exact primary mechanism of radiation injury to the heart is still unknown. The treatment of radiation-induced valve disease is the same as the treatment of valve disease in the general population. Abstract P1692 Figure. Radiation-induced valvular heart disease

scholarly journals Percutaneous Balloon Aortic Valvuloplasty (Pbav) in a Child With Congenital Severe Aortic Stenosis –A Case Report

1970 ◽  
Vol 1 (2) ◽  
pp. 234-236
Author(s):  
AQM Reza ◽  
MSR Patwary ◽  
A Baqui
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Aortic Valve Area ◽  
Balloon Aortic Valvuloplasty ◽  
Percutaneous Balloon ◽  
Aortic Valvuloplasty ◽  
Valve Area

A 8 years old boy presented with shortness of breath, cough and palpitation and subsequently diagnosed as a case of severe aortic stenosis with bicuspid aortic valve. Percutaneous balloon aortic valvuloplasty (PBAV) was done and he became asymptomatic. Post procedure his aortic valve area and aortic systolic pressure increased, transaortic pressure gradient decreased. So good result, lower cost, elimination of drawbacks of thoracotomy and cardiopulmonary bypass suggest in children percutaneous balloon aortic valvuloplasty should be the treatment of choice for patients with severe aortic stenosis. Key Words: Percutaneous balloon aortic valvuloplasty, Severe aortic stenosis, Bicuspid aortic valve DOI: http://dx.doi.org/10.3329/cardio.v1i2.8241 Cardiovasc. j. 2009; 1(2): 234-236

Abstract 18065: Combining Echo Doppler and CT Derived LVOT Measurements Improve Accuracy of Continuity Equation Based Aortic Valve Area Determination

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sami Alnasser ◽  
Asim Cheema ◽  
Vamshi Kotha ◽  
Djeven Deva ◽  
Jeremy Edwards ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Correlation Coefficient ◽  
Continuity Equation ◽  
Severe Aortic Stenosis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Left Ventricular Outflow ◽  
Valve Area

Background: Left ventricular outflow tract (LVOT) measurement by Echo falsely assumes circular LVOT with implications for aortic valve area (AVA) determined using continuity equation. In this study, we investigated the utility of combining Echo Doppler and computed tomography (CT) based LVOT area for precise AVA assessment. Methods: AVA-echo was calculated using continuity equation and standard echocardiography techniques. CT-LVOT area was measured by 3 independent readers. Blinded measurements were obtained in candidates for percutaneous aortic valve replacement. AVA-CT was calculated using CT-LVOT area and echo Doppler measurements. The inter-observer variability for CT-LVOT area and correlation between AVA-echo and AVA-CT was analyzed using intra-class (ICC) and Spearman correlation coefficient. Results: Complete data for 66 patients was analyzed. The ICC for CT derived LVOT measurement by three observers was 0.96 demonstrating excellent reliability. The LVOT area by echo was significantly smaller than that obtained by CT (3.43±0.8 vs. 4.45±1.2 cm2, p<0.0001) and showing moderate correlation (r=0.66, p=0.006). Similarly, the AVA-echo was significantly lower compared to AVA-CT (0.76±0.46 vs. 0.97±0.53 cm2, p<0.0001). The correlation coefficient for AVA-echo and AVA-CT was 0.7 (p < 0.0001), 0.4 (p=0.06) and 0.9 (p<0.0001) for AVA-echo of 0.8 cm2 respectively. The regression analysis showed that AVA-CT could be predicted by applying a correction factor to the AVA-echo as AVA-CT = AVA-echo x 1.1+0.14. Conclusion: CT provides accurate and reliable LVOT assessment. Combining CT-LVOT and echo Doppler measurements result in a larger AVA compared to AVA-echo representing a true anatomic measurement. These findings have important implications for grading of aortic stenosis and management of patients with moderate to severe aortic stenosis.

Abstract 4692: Impact of Pressure Recovery on Diagnosis of Severe Aortic Stenosis in Asymptomatic Patients. (A SEAS Substudy)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Edda Bahlmann ◽  
Dana Cramariuc ◽  
Eva Gerdts ◽  
Christa Gohlke-Baerwolf ◽  
Chritoph Nienaber ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Energy Loss ◽  
Severe Aortic Stenosis ◽  
Pressure Recovery ◽  
Doppler Velocity ◽  
Aortic Valve Area ◽  
Total Study Population ◽  
Asymptomatic Patients ◽  
Valve Area

Background: Downstream pressure recovery (PR) in the aorta affects transvalvular pressure gradient measurement and calculation of aortic valve area by continuity equation in patients with aortic stenosis (AS). Methods: To assess the clinical importance of PR on evaluation of severity of AS, echocardiographic data in 1562 patients with asymptomatic aortic stenosis (mean age 67 ± 10, 39% women, 51% hypertensive) recruited in the Simvastatin Ezitimibe in Aortic Stenosis (SEAS) study was used. The inner diameter of the ascending aorta was measured at annulus and at sinutubular junction. The aortic valve area (AVAI) was calculated from annular diameter and velocity time integrals from sub- and transaortic flow by Doppler. PR and PR corrected AVAI assessed as energy loss index (ELI) were calculated by previously published equations. Severe aortic stenosis was defined as AVAI <0.60cm 2 /m 2 and ELI <0.55cm 2 /m 2 , respectively. Patients were grouped into tertiles of peak transaortic Doppler velocity (<2.79, 2.79 –3.32, ≥3.33 m/sec, respectively). Results: In the total study population, PR ranged from 1.22–16.75 mmHg (mean 5.9±2.3), AVAI from 0.20 –1.85 cm 2 /m 2 (mean 0.67±0.22) and ELI from 0.22–5.94 cm 2 /m 2 (mean 0.89±0.45). PR increased significantly with severity of AS (Table 1 ). Both AVAI and ELI decreased with increasing peak transaortic velocity, and the overestimation of AS severity by using unadjusted AVA was largest in the lowest tertile (Table 1 ). Conclusion: Severity of AS is often overestimated in milder degrees of asymptomatic AS if correction for pressure recovery is not performed. Adjustment of AVA for the effect of energy loss should be performed routinely, and this may be especially important for accuracy of severity assessment in patients with relatively low transvalvular velocities. Table 1

scholarly journals Evaluation of low gradient severe aortic stenosis: should we change our outlook in the analysis of clinical data?

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001746
Author(s):  
Ivan Corazza ◽  
Margherita Zecchi ◽  
Romano Zannoli
Keyword(s):  
Clinical Practice ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Doppler Echocardiography ◽  
Technological Progress ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Physiological Models ◽  
Pathological Conditions ◽  
Valve Area

Nowadays, technological progress has equipped clinicians with new useful devices for the collection, analysis and presentation of data. As a consequence, many diseases and pathological conditions have been studied in a more detailed way, sometimes with remarkable results. In fact, they are not always validated by the old physiological models. In this respect, we present the case of low gradient severe aortic stenosis, a condition characterised by a small aortic valve area and a low-pressure gradient. According to the mathematical and physical assumptions these readings are contradictory whereas the Doppler-echocardiography shows clearly the existence of such a situation. In this work, we have described the physiological base of this phenomenon and discussed the limitations of the technology used. In this work, we are going to analyse some conditions commonly observed in daily clinical practice in order to prompt a critical outlook in both clinicians and technicians about the instrumentations used and the methods applied.

Abstract 4290: Risk Factors and Prognostic Implications of Mitral Regurgitation in Severe Aortic Stenosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Padmini Varadarajan ◽  
Ramdas G Pai
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Independent Predictor ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
List Type ◽  
Prognostic Implications ◽  
Valve Area

Introduction: Mitral regurgitation (MR) is present in nearly half of the patients with severe aortic stenosis (AS). Risk factors for its development and its prognostic implications are not clear. Methods: Search of our echocardiographic database between 1993 to 2003 yielded 740 patients with severe AS defined as aortic valve area (AVA) ≤ 0.8cm2. Thorough chart reviews were conducted to collect clinical and pharmacological data. Mortality data was obtained from National death index. Results: Patient characteristics: age 74±13 years; females 60%, EF 54±20%, aortic valve area 0.67±0.17 cm2. MR grade ≥2+ were present in 339 (46%) patients: 2+ in 166 (22%), 3+ in 115 (16%) and 4+ in 58 (8%). There was a progressive decrease in survival with each grade of MR in the whole cohort as well as the surgically and medically treated subsets (p<0.0001, figure ). Presence of 3 and 4+ MR was associated with a larger LV (p<0.0001), lower EF (p<0.0001), greater age (p=0.0001), a smaller aortic valve area (p=0.001) and female gender (p=0.003). It remained an independent predictor of lower survival after adjusting for group differences using the Cox regression model. There was a lower AVR rate in those with 3 or 4+ MR compared to the rest (32 vs. 41%, p=0.03) despite a distinct independent survival advantage with AVR (RR 0.40, p<0.0001). Conclusion: Significant MR is present in nearly half of the patients with severe AS. The risk factors for its development include age, greater AS severity and LV dysfunction. It is an independent predictor of reduced survival.

Clinical features and prognosis of patients with isolated severe aortic stenosis and valve area less than 1.0 cm2

Heart ◽  
2017 ◽  
Vol 104 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Praveen Mehrotra ◽  
Katrijn Jansen ◽  
Timothy C Tan ◽  
Aidan Flynn ◽  
Judy W Hung
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Features ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Aortic Valve Area ◽  
High Gradients ◽  
Current Guidelines ◽  
Valve Area

ObjectiveCurrent guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA)≤1.0 cm2, but some authors have suggested that the AVA cut-off be decreased to 0.8 cm2. The aim of this study was, therefore, to better describe the clinical features and prognosis of patients with an AVA of 0.8–0.99 cm2.MethodsPatients with isolated, severe AS and ejection fraction ≥55% with an AVA of 0.8–0.99 cm2 (n=105) were compared with those with an AVA<0.8 cm2 (n=155) and 1.0–1.3 cm2 (n=81). The endpoint of this study was a combination of death from any cause or aortic valve replacement at or before 3 years.ResultsPatients with an AVA of 0.8–0.99 cm2 group comprised predominantly normal-flow, low-gradient (NFLG) AS, while high gradients and low flow were more often observed with an AVA<0.8 cm2. The frequency of symptoms was not significantly different between an AVA of 0.8–0.99 cm2 and 1.0–1.3 cm2. The combined endpoint was achieved in 71%, 52% and 21% of patients with an AVA of 0.8 cm2, 0.8–0.99 cm2and 1.0–1.3 cm2, respectively (p<0.001). Among patients with an AVA of 0.8–0.99 cm2, NFLG AS was associated with a lower hazard (HR=0.40, 95% CI 0.23 to 0.68, p=0.001) of achieving the combined endpoint with outcomes similar to moderate AS in the first 1.5 years of follow-up. Patients with high-gradient or low-flow AS with an AVA of 0.8–0.99 cm2 had outcomes similar to those with an AVA<0.8 cm2. The sensitivity for the combined endpoint was 61% for an AVA cut-off of 0.8 cm2 and 91% for a cut-off of 1.0 cm2.ConclusionsThe outcomes of patients with AS with an AVA of 0.8–0.99 cm2 are variable and are more precisely defined by flow-gradient status. Our findings support the current AVA cut-off of 1.0 cm2.

scholarly journals Prognostic Impact of Aortic Valve Area in Conservatively Managed Patients With Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction

2019 ◽  
Vol 8 (3) ◽  
Author(s):  
Norio Kanamori ◽  
Tomohiko Taniguchi ◽  
Takeshi Morimoto ◽  
Hirotoshi Watanabe ◽  
Hiroki Shiomi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Prognostic Impact ◽  
Aortic Valve Area ◽  
Preserved Ejection Fraction ◽  
Link Type ◽  
Valve Area

See Editorial by Tribouilloy et al

Sign in / Sign up

Export Citation Format

Share Document