scholarly journals 619 Left ventricle remodelling in severe aortic stenosis: analysis of a large cohort of patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ramos Jimenez ◽  
S Hernandez ◽  
M Plaza Martin ◽  
J L Zamorano Gomez
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Systolic Arterial Pressure ◽  
Large Cohort ◽  
P Value ◽  
Aortic Valve Area ◽  
Lv Mass

Abstract Introduction Aortic stenosis (AS) is the most prevalent valve disease. It involves increased left ventricle (LV) postcharge leading to LV hypertrophy. The aim of the study was to assess the burden of LV hypertrophy and its different patterns among a large cohort of patients with severe AS. Methods Observational, multicentre and prospective study of consecutive cases. Patients with severe AS defined as aortic valve area (AVA) <1.0 cm2, and preserved LV ejection fraction (LVEF≥50%) were included. LV hypertrophy was diagnosed in case of LV indexed mass >95 g/m2 in females or >115 g/m2 in males. LV geometry was assessed by relative wall thickness ratio, considering a cut-off value of 0.42. A p value <0.05 was considered statistically significant. Results A total of 805 patients with severe AS were included, 49.7% (n = 400) of them females and 50.3% (n = 405) males. LV indexed mass was available in 665 subjects, most of them (74.9%, n = 498) presenting LV hypertrophy. Females showed higher prevalence of LV hypertrophy than males (82.7% vs. 60.5%; p < 0.01). Concentric hypertrophy was the most frequently encountered phenotype (63.9%; n = 420), being significantly more prevalent among women (74.3% vs 53.4%; p < 0.01). Despite that increased hypertrophy, females showed less severe AS when comparing mean transaortic gradient (39 mmHg vs 42 mmHg; p = 0.04) and indexed AVA (0.42 cm/m2 vs 0.40 cm/m2; p = 0.02). LV hypertrophy was associated with enlarged atria and higher pulmonary systolic pressure. Conclusions LV hypertrophy affects most of patients with severe AS. LV remodelling is different between gender, with women developing higher grade of hypertrophy despite lesser AS severity. LV hypertrophy is associated with poor prognosis echocardiographic signs (increased PSAP and indexed LAV). Differences related to LV mass Normal LV mass LV hypertrophy P value Indexed AVA (cm/m2) 0.42 ± 0.01 0.41 ± 0.01 0.52 Mean gradient (mmHg) 42 ± 0.7 36 ± 1.1 <0.01 Indexed stroke volumen (mL/m2) 41 ± 1 37 ± 1 <0.01 Indexed LAV (mL/m2) 46 ± 1 38 ± 1 <0.01 PSAP (mmHg) 30 ± 2 41 ± 1 0.01 LAV left atrial volume PSAP: pulmonary systolic arterial pressure Abstract 619 Figure. Sex related LV geometry patterns

Correlation between Left Atrial Volume Index and Pulmonary Hypertension in Patient with Moderate to Severe Aortic Stenosis

2020 ◽  
Vol 103 (8) ◽  
pp. 824-828
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Left Atrium ◽  
Left Atrial ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Left Atrium Volume

Background: Left atrial dilatation is a response to pressure overload in aortic stenosis (AS). Objective: To study the correlation between left atrium volume index (LAVI) and the pulmonary hypertension in patients with moderate to severe AS. Materials and Methods: The authors retrospectively studied patients with moderate to severe AS (either one or all echocardiographic criteria of aortic valve area [AVA]) smaller than 1.5 cm², AV Vmax of more than 3 m/s, AV mean PG of more than 30 mmHg who underwent transthoracic echocardiography at Pranangklao Hospital between January 2015 and December 2019. Results: One hundred thirty-four patients (age 72.31±12.32 years, 46.3% male) were enrolled. In pulmonary hypertension group, proportion of atrial fibrillation (75%) were significantly higher Sinus Rhythm (26.3%). Right ventricular systolic pressure (RVSP) tended to increase when LAVI increased (r=0.695, p<0.001). The mean RVSP in four groups of LAVI (less than 35 ml/m², 35 to 41 ml/m², 42 to 48 ml/m², and more than 48 ml/m²) were 35.11±8.97, 38.22±11.71, 39.0±8.57, and 60.05±31 mmHg, respectively. RVSP in patients with LAVI of more than 48 ml/m² was significantly higher than those of the other group (p<0.001). LAVI in patients with RVSP of less than 50 and more than 50 mmHg were 35.13±6.86 and 65.22±11.55 ml/m², respectively (p<0.001). Conclusion: Moderate to severe AS, RVSP increase when LAVI increases. Keywords: Echocardiography, Left atrium volume index, Aortic stenosis, Pulmonary hypertension

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

scholarly journals P200 The impact of left venticule ejection fraction on long-term outcome in patients with high- and low-gradient severe aortic stenosis - data from ASRegistry

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Strozyk ◽  
J Marlega ◽  
M Nowak ◽  
R Galaska ◽  
M Fijalkowski
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Pressure Gradient ◽  
Severe Aortic Stenosis ◽  
Common Finding ◽  
Ageing Population ◽  
Aortic Valve Area ◽  
The Impact ◽  
Left Ventricle Dysfunction

Abstract Background Aortic stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention with a growing prevalence due to the ageing population. Severe aortic stenosis with reduced transaortic flow and gradient although it is a common finding still remains diagnostic challenge. Purpose The aim of study was to analyse the outcomes of patients with high- and low-gradient aortic stenosis depending on the ejection fraction. Methods 621 patients hospitalized in the First Department of Cardiology, with severe aortic stenosis defined as aortic valve area &lt;1cm2 were enrolled to the Aortic Stenosis Registry (ASRegistry). The high-gradient aortic stenosis (HG-AS) [mean transvalvular pressure gradient (PGmean) ≥40mmHg and peak transvalvular velocity (Vmax) ≥ 4 m/s] and low-gradient aortic stenosis (LG-AS) [mean transvalvular pressure gradient (PGmean) &lt;40mmHg and peak transvalvular velocity (Vmax) &lt;4 m/s] were observed in 54%(n = 340) and 45% (n = 281) patients, respectively. In the subgroup of HG-AS were 80% (n = 275) and in the subgroup of LG-AS were 61%(n = 174) of patients with preserved left ventricle ejection fraction (LVEF &gt; 50%). The patients were observed for a period of 6 years (2012-2018). The primary end-point, all-cause mortality, was obtained from Nation Health Registry. Results Patients with LG-AS had a significantly higher risk of mortality compared to patients with HG-AS: 35% (n = 101) vs 26% (n = 87), p &lt; 0,05. Mortality in both group with HG-AS and LG-AS was significantly higher in the subgroup with diminished left ventricle dysfunction than in the subgroup with preserved ejection fraction: HG-AS: 44%(n = 29) vs 21%(n = 58), p &lt; 0,05 and LG-AS: 53%(n = 57) vs 25%(n = 44), p &lt; 0,05. The highest mortality rates was observed in the LG-AS group with left ventricule dysfunction, p &lt; 0,001. Conclusions The study shows the negative impact of left ventricle dysfunction in both groups of patients: high- and low-gradient severe aortic stenosis. The worst prognosis is in patients with LG-AS and low LVEF.

scholarly journals Prognostic value of contractile reserve evaluated by global longitudinal strain in patients with asymptomatic severe aortic stenosis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
RA Rosina Arbucci ◽  
MGR Maria Graciela Rousse ◽  
DML Diego Maximiliano Lowenstein ◽  
AKS Ariel Karim Saad ◽  
CC Cristian Caniggia ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Aortic Valve Area

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Investigaciones Médicas. Cardiodiagnóstico. Buenos Aires Introduction. Left ventricle Global Longitudinal Strain(GLS) at rest has shown prognostic value in patients(pts) with severe aortic stenosis(SAS). Contractile reserve(CR) during exercise stress echo(ESE) estimated by GLS(CR-GLS) could better stratify the asymptomatic patients who could benefit from early intervention.  Objective. To establish the long-term prognostic value of CR-GLS in pts with asymptomatic SAS during ESE. Secondly, to compare if the CR evaluated by ejection fraction(CR-EF) presented similar results to those of CR-GLS.  Methodology. In a single center, prospective study carried out between May 2013 to Oct 2019, we enrolled 101 pts(69 ± 12 years,54 men) with asymptomatic SAS(aortic valve area &lt; 0,6cm2/m2) and preserved EF(&gt;55%). GLS value was considered as the average of the 16 segments, obtained from the apical views of 3, 4 and 2 chambers at rest and peak ESE. CR was considered present with stress-rest increase of &gt;5points with EF and &gt;2 absolute points by GLS. The pts were divided into 2 groups(G): G1:Pts with presence of CR-GLS and G2:Pts with absence of CR-GLS. Major cardiovascular event was considered to be: need for valve replacement due to the presence of symptoms, death, acute myocardial infarction and stroke. All patients were followed-up.  Results. Of the 101 pts analyzed, 56pts(55.4%) were included in G1(CR-GLS) and 45pts(44.6%) in G2(no CR-GLS). The G2 patients were older(G2 72.2 ± 8.5 vs G1 66.5 ± 14.1) with lower METS(G1 5.6 ± 2 vs G2 4.2 ± 1.1,p 0.004), a higher percentage of flat blood pressure response(G1 19.6% vs. G2 37.8%,p 0.036), lower peak EF(G1 71.5%±5.8 vs G2 66.8 ± 7.9,p0.001),peak GLS(G1 -22.2%±2.8 vs G2 -18.45%±2.4 p 0.001) and lower ΔGLSstress-rest(G1 GLS 3.07 ± 0.85 vs G2 0.08 ± 1.9 p 0.003). The same behaviour with the EF response(G1 7.32 ± 2.9 vs G2 4.7 ± 5.3,p 0.024). The average follow-up was 46.6 ± 3.4 months, and events occurred in 45 patients: 12 all-cause deaths(9 cardiac), 31 valve replacement, 1 myocardial infarctions, 1 strokes. G2 pts had more events compared to G1 pts (G2 = 26 events 57.8% vs G1 = 19 events 42.2%,p &lt; 0.01)(figure 1). The CR-EF did not separate patients with and without events. At Cox analysis, CR-GLS was the only predictor variable of major events(HR:1.97, 95% CI 1.09-3.58)p &lt; 0.025). Conclusions In patients with asymptomatic SAS, the absence of CR-GLS during ESE identifies a group of patients with a worse prognosis and the need for aotic valve intervention. CR-GLS proved to be superior tan CR-EF. Baselin characteristic between groups Abstract Figure. Left ventricle RC-GLS and survival

scholarly journals P1366 Low-flow, low-gradient severe aortic stenosis: might mitral regurgitation be a culprit?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ferreira ◽  
M Beringuilho ◽  
D Faria ◽  
D Roque ◽  
H Ferreira ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Preserved Ejection Fraction

Abstract Introduction According to current guidelines, given a patient with low-gradient (aortic valve maximum velocity &lt; 4m/s and/or aortic valve mean gradient &lt;40mmHg), aortic valve area (AVA) &lt; 1cm2 and low-flow (stroke volume (SV) &lt; 35mL/min/m2), with preserved left ventricle function (ejection fraction (EF) ≥50%), an integrated approach for assessment of aortic stenosis severity is proposed. We aimed to investigate whether mitral regurgitation can play a role in those cases, possibly being responsible for low antegrade systolic flow. Methods We retrospectively analysed 121 consecutive transthoracic echocardiograms (TTEs) of patients with severe aortic stenosis, with AVA &lt; 1.0cm2 as assessed by continuity equation. Patients with low ejection fraction (&lt; 50%) were excluded. We therefore included 84 patients (females 53,6%, mean age 79,1+-10 years). Stroke volume was assessed by Doppler at the left ventricle outflow tract (LVOT). We then compared the prevalence of more than mild mitral regurgitation among patients with low-gradient and low-flow and the other patients. Results 15 patients had both low-gradient, low-flow and preserved ejection fraction. There was a significant association regarding the presence of more than mild mitral regurgitation among these patients (p = 0.028, OR = 4.7, CI 95% 1.1-20.1). In these patients, it was also observed a higher prevalence of atrial fibrillation (p = 0.03, OR = 6.9, CI 95% 1.74-27.1), lower longitudinal systolic function of right ventricle as measured by TAPSE (16.6 vs 21.5mm, p = 0.028), and a tendency towards higher left atrial volume (113 vs 87mL, p = 0.06). Conclusions Given the findings that the prevalence of more than mild mitral regurgitation is higher in patients with severe aortic stenosis as assessed by AVA with both low-gradient, low-flow and preserved ejection fraction, we suggest that the presence of more than mild mitral regurgitation should be considered on the approach of aortic stenosis classification of these patients.

scholarly journals 227 Myocardial work evaluation in severe aortic stenosis undergoing transcatheter aortic valve implantation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Simona Sperlongano ◽  
Francesca Renon ◽  
Carmen Del Giudice ◽  
Angela Iannuzzi ◽  
Marco Bocchetti ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Atrial Volume ◽  
Transcatheter Aortic Valve ◽  
Before And After ◽  
Global Work ◽  
Valve Implantation

Abstract Aims Myocardial work (MW) is a novel echocardiographic technique which assesses left ventricular (LV) performance through LV pressure-strain loops. MW corrects speckle tracking echocardiography (STE)-derived parameters for afterload using non-invasive systolic blood pressure (SBP) as a surrogate for LV systolic pressure. In patients with severe aortic stenosis (AS), the corrected MW (cMW) has been proposed, consisting in adding the mean aortic gradient in SBP. This method revealed to be feasible and reliable, demonstrating good correlation with invasively measured LV systolic pressure. To evaluate myocardial performance of patients with severe AS, before and after transcatheter aortic valve implantation (TAVI), by MW indices. Methods patients with severe AS undergoing TAVI were included. Transthoracic, standard echocardiography and STE were performed the day before the procedure and within 2 days after. MW was calculated by combining STE-derived indices with non-invasively estimated LV systolic pressure. Results 30 patients (79±5 years old, 56% females) with severe AS (mean gradient 47±14 mmHg, aortic valve area 0.6±0.1 cm2), and eligible for TAVI were enrolled. Baseline global longitudinal strain was impaired (GLS −15±4%), in presence of normal LV ejection fraction (LVEF 57±10%). Corrected global work index and global constructive work were preserved at baseline and markedly decreased after TAVI (cGWI 2322±791 vs. 1710±505 mmHg%, P=0.001; cGCW 2774±803 vs. 2083±536 mmHg%, P=0.0007). Corrected global wasted work and global work efficiency were respectively higher and lower than reference values existing in literature, and no significant changes were observed after TAVI (cGWW 276±174 vs. 277±165 mmHg%, P=0.974; cGWE 89±5 vs. 87±5%, P=0.177). A significant inverse correlation was found between baseline cGWI and left atrial volume index (r = −0.5, P=0.03). Conclusions Patients with severe aortic stenosis and preserved LVEF show a good LV performance before and after TAVI, with a significant decrease in MW indices after TAVI, because of the reduced afterload due to AS treatment. The negative correlation between left atrial volume and cGWI may reflect the extent of myocardial damage in AS. However, further studies with larger sample size and appropriate follow-up are needed to evaluate the role of MW in prognosis and risk stratification of this subset of patients.

scholarly journals 616 Aortic stenosis: changing with age?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ramos Jimenez ◽  
S Hernandez ◽  
M Plaza Martin ◽  
J L Zamorano Gomez
Keyword(s):  
Aortic Stenosis ◽  
Age Groups ◽  
Low Flow ◽  
P Value ◽  
Aortic Valve Area ◽  
Concentric Hypertrophy ◽  
End Diastolic Volume ◽  
Age Related ◽  
Lv Mass ◽  
Eccentric Hypertrophy

Abstract Introduction and aim Aortic stenosis (AS) represents the main valve disease, thus, addressing its epidemiology and natural history becomes crucial. The aim of the present study is to shed light in the differences appearing with age in severe AS. Methods Observational, multicentre and prospective study of consecutive cases. Patients with severe AS, defined as aortic valve area (AVA) &lt;1.0 cm2, and preserved left ventricle ejection fraction (LVEF≥50%) were included. Subjects under and above 85 years were compared. Low gradient (LG) was defined by mean transaortic gradient (MG) &lt;40 mmHg and low flow (LF) by indexed stroke volume (iSV) &lt;35 mL/m2. LV geometry was defined according to current chamber quantification guidelines. A p-value &lt;0.05 was considered significant. Results A total of 636 patients were included, with slight predominance of females (53.9%; n = 343). No differences were found in AVA, LVEF, end-diastolic indexed values, LV mass or LV geometry between both age groups. MG and SVi were significantly lower in people over 85, who also presented more frequently with atrial fibrillation (AF) and significant mitral (MR) and tricuspid regurgitation (TR). Flow and gradient pattern vary significantly as shown in the graphic. Conclusions In our cohort, flow and gradient pattern in severe AS varies with age, despite no differences in LV geometry. This contrasts with previously assumed, relating LF and LG to more severe concentric hypertrophy. LF and LG can be explained by AF, significant MR and TR affecting more frequently those over 85. Age-related differences in severe AS Less than 85 y.o. ≥85 y.o. p-value AVA (cm2) 0.73 (± 0.16) 0.72 (±0.18) 0.46 LVEF (%) 65 (±7.9) 64 (±7.8) 0.21 MG (mmHg) 41 (±14.2) 37 (±13) 0.04 iSV (mL/m2) 40 (±11) 36 (±11) 0.01 iLVEDV (mL/m2) 47 (±16) 45 (±16) 0.07 iLVMass (g/m2) 126 (±36) 127 (±36) 0.66 Normal geometry (%) 3.9 2.5 0.64 Concentric remodelling (%) 24.3 24.4 Concentric hypertrophy (%) 64.2 66.4 Eccentric hypertrophy (%) 7.6 6.7 AF (%) 12.3 19.3 0.04 Significant MR (%) 11.3 18.7 0.02 Significant TR (%) 50.4 65.7 &lt;0.01 iLVEDV indexed LV end-diastolic volume iLVMass: indexed LV mass Abstract 616 Figure. Age-related flow and gradient pattern

scholarly journals Haemodynamic Patterns of Severe Aortic Stenosis

2020 ◽  
Vol 16 (5) ◽  
pp. 822-830
Author(s):  
A. E. Komlev ◽  
M. A. Saidova ◽  
T. E. Imaev ◽  
V. N. Shitov ◽  
R. S. Akchurin
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Pressure Gradient ◽  
Clinical Decision Making ◽  
Systolic Pressure ◽  
Low Flow ◽  
Aortic Valve Area

The authors present up-to-date review of clinical pathophysiology of aortic stenosis (AS) based on differentiation of its haemodynamic patterns, and some actual issues of instrumental diagnostics and classification of AS. The variety of clinical presentations of AS is based on diverse combination of pathological changes of haemodynamics. In Russian cardiology, there is no clear pathophysiological classification of AS despite of its relevance under the progress of surgical and transcatheter treatment of AS. The authors suggest the pilot haemodynamic classification of AS which includes 6 types (0-5) based on different combination of the following variables: left ventricle ejection fraction, stroke volume, mean aortic systolic pressure gradient. Severe AS with low transaortic pressure gradient in patients with depressed systolic function of the left ventricle (so called «low flow-low» gradient phenomenon) is referred to as the most frequent, classical haemodynamic pattern of low-gradient AS. The prevalence of this variant is about 10% among European population of patients with severe AS. The inconsistence between aortic valve area and mean pressure gradient is as common as in 35-40% of patients with AS, however, in 30-50% of these cases, AS is not severe. Severe AS is a surgical disease that should be treated in a surgical way in all patients but those in whom predicted risk overbalances potential benefits of the procedure. The use of integrated clinical and instrumental approach for identification of a true sever AS is the matter of great concern, as both overestimation and underestimation can misguide the clinical decision-making process. Verification of severe AS in patients with classical and paradoxical low flow-low gradient AS with specific indications for surgical treatment regarded is further emphasized in the paper. Since transcatheter aortic valve implantation has become a commonly recognized alternative to surgical aortic valve replacement, its role in the treatment of severe AS with different haemodynamic patterns is also discussed. The authors stress on the necessity of using tailored approach for treatment of AS regarding different clinical and pathophysiological scenarios: high gradient AS with preserved ejection fraction, classical and paradoxical low flow-low gradient AS.

scholarly journals Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis

2021 ◽  
Author(s):  
Tohru Takaseya ◽  
Atsunobu Oryoji ◽  
Kazuyoshi Takagi ◽  
Tomofumi Fukuda ◽  
Koichi Arinaga ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Stroke Volume Index ◽  
Low Flow ◽  
Volume Index ◽  
Effective Orifice Area ◽  
Aortic Valve Area ◽  
Hemodynamic Performance ◽  
Mid Term Results

AbstractAortic stenosis (AS) is the most common valve disorder in advanced age. Previous reports have shown that low-flow status of the left ventricle is an independent predictor of cardiovascular mortality after surgery. The Trifecta bioprosthesis has recently shown favorable hemodynamic performance. This study aimed to evaluate the effect of the Trifecta bioprosthesis, which has a large effective orifice area, in patients with low-flow severe AS who have a poor prognosis. We retrospectively evaluated 94 consecutive patients with severe AS who underwent aortic valve replacement (AVR). Patients were divided into two groups according to the stroke volume index (SVI): low-flow (LF) group (SVI < 35 ml/m2, n = 22) and normal-flow (NF) group (SVI ≥ 35 ml/m2, n = 72). Patients’ characteristics and early and mid-term results were compared between the two groups. There were no differences in patients’ characteristics, except for systolic blood pressure (LF:NF = 120:138 mmHg, p < 0.01) and the rate of atrial fibrillation between the groups. A preoperative echocardiogram showed that the pressure gradient was higher in the NF group than in the LF group, but aortic valve area was similar. The Trifecta bioprosthesis size was similar in both groups. The operative outcomes were not different between the groups. Severe patient–prosthesis mismatch (PPM) (< 0.65 cm2/m2) was not observed in either of the groups. There were no significant differences in mid-term results between the two groups. The favorable hemodynamic performance of the Trifecta bioprosthesis appears to have the similar outcomes in the LF and NF groups. AVR with the Trifecta bioprosthesis should be considered for avoidance of PPM, particularly in AS patients with LV dysfunction.

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

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