scholarly journals Left Ventricular Chord Masquerading As An Aortic Valve Papillary Fibroelastoma

2021 ◽  
Author(s):  
Fatima M Ezzeddine ◽  
Melanie C Bois ◽  
Sorin V Pislaru ◽  
Hartzell V Schaff
Keyword(s):  
Aortic Valve ◽  
Multimodality Imaging ◽  
Surgical Excision ◽  
Left Ventricular ◽  
Papillary Fibroelastoma ◽  
Aortic Sinus ◽  
Acute Infarction ◽  
Coronary Cusp ◽  
Cardiac Masses

Abstract Background Characterization of cardiac masses and anomalies is challenging and usually requires multimodality imaging. Herein, we present the case of a left ventricular chord masquerading as an aortic valve papillary fibroelastoma. Case summary In this case, a 62-year-old woman presented with acute right foot weakness. Brain imaging showed multiple areas of acute infarction concerning for a cardioembolic stroke. Transesophageal echocardiography revealed a mass, which was thought to be a papillary fibroelastoma, attached to the non-coronary cusp of the aortic valve. The patient underwent surgical excision of the mass which turned out to be a left ventricular chord crossing the aortic valve and attaching to the left aortic sinus of Valsalva. Conclusion This case underlines the importance of close examination of the aortic subvalvular apparatus when assessing aortic valve masses.

scholarly journals Nonsurgical Management of a Papillary Fibroelastoma of the Aortic Valve

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Antonino M. Grande ◽  
Nicoletta Castiglione ◽  
Adelaide Iervolino ◽  
Francesco Nappi ◽  
Antonio Fiore
Keyword(s):  
Aortic Valve ◽  
Standard Of Care ◽  
Surgical Excision ◽  
Papillary Fibroelastoma ◽  
Surgical Removal ◽  
Nonsurgical Management ◽  
Asymptomatic Patients ◽  
Coronary Cusp ◽  
The Right ◽  
Right Coronary Cusp

We report the case of a 63-year-old woman who had an incidental echocardiographic diagnosis of papillary fibroelastoma (PFE) of the right coronary cusp of the aortic valve. The patient was informed about the embolic risk due to the pedunculated mass located on the aortic valve but she refused the proposed surgical removal. She was followed up yearly, and each follow-up included an echocardiographic evaluation of the mass. The lady is taking lysine acetylsalycilate 160 mg daily, and after more than 19 years later, she does not complain any symptoms or complications as a result of possible embolic episodes. If on one hand, our report is provocative for PFE nonsurgical management; on the other, we do believe that in symptomatic patients PFE located in the left heart chambers, the standard of care remains surgical excision after diagnosis. Anyway, our analysis shows that further data in this issue are needed in asymptomatic patients, and surgical indication should be proposed considering carefully the risk-benefit balance.

scholarly journals A new calcium score to predict paravalvular leak in transcatheter aortic valve implantation

2020 ◽  
Author(s):  
Markus Kofler ◽  
Alexander Meyer ◽  
Julian Schwartz ◽  
Simon Sündermann ◽  
Adam Penkalla ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Odds Ratio ◽  
Left Ventricular Outflow Tract ◽  
Calcium Score ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Outflow ◽  
Coronary Cusp

Abstract OBJECTIVES The present study sought to develop a reliable calcium score (Ca-score) to predict paravalvular leak (PVL) in patients undergoing transcatheter aortic valve (AV) implantation. METHODS A total of 965 patients were prospectively included from 2012 to 2019. Preprocedural contrast-media-enhanced computed tomography scans were analysed regarding the amount of AV cusp calcification and the presence of upper and lower left ventricular outflow tract calcification. The calcium volume threshold of each AV cusp [non-coronary cusp (NCC); left coronary cusp (LCC); right coronary cusp (RCC)] with optimal PVL prediction was defined using the Youden index value derived from receiver operating characteristic analysis. The final score was developed based on the multivariable regression analysis, while individual variables were weighted based on their corresponding odds ratio. RESULTS The AV calcium volume threshold with optimal PVL prediction was 733.6, 296.0 and 131.2 mm3 for the NCC, RCC and LCC respectively. Overall, calcification of the upper left ventricular outflow tract was present in 233 (23%), 111 (12%) and 304 (32%) of patients below the NCC, RCC and LCC respectively, while 260 (27%), 44 (5%) and 217 (23%) patients suffered from calcification under the NCC, RCC and LCC, respectively. A total Ca-score of ≥4 was present in 356 (37%) of patients and was independently associated with ≥ mild PVL [odds ratio 3.662; 95% confidence interval (2.740–4.911); P < 0.001]. The area under the curve of the Ca-score was 0.713 [95% confidence interval (0.678–0.748); P < 0.001]. CONCLUSION The provided Ca-score independently correlates with the development of PVL and improves risk stratification in patients undergoing transcatheter AV implantation.

scholarly journals P1333 The importance of multimodality imaging in the characterization of a congenital myocardial diverticulum

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Ramirez-Escudero Ugalde ◽  
A M R Arantza Manzanal Rey ◽  
N G I Nora Garcia Ibarrondo ◽  
M C P Mireia Codina Prat ◽  
L R G Lara Ruiz Gomez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Tissue Characterization ◽  
Multimodality Imaging ◽  
Interventricular Septum ◽  
Fibrous Tissue ◽  
Scar Tissue ◽  
Left Ventricular ◽  
Ventricular Diverticulum ◽  
Asymptomatic Patients

Abstract Congenital ventricular diverticulum is a rare cardiac malformation, usually detected on echocardiographic examinations in asymptomatic patients. However, they can also cause embolisms, arrhythmias and sudden death due to ventricular rupture. Multimodality imaging can help in the characterization of its morphology and in the differential diagnosis. We report a case of an 83-year-old woman, pacemaker carrier due to complete atrioventricular block, who consulted for paroxysmal episodes of palpitations, being diagnosed of atrial fibrillation. A transthoracic echocardiogram was performed, observing an appendix at basal septal level with contractility of its wall and with doppler-colour inside, suggestive of myocardial diverticulum. Echocardiographic contrast was injected for better delimitation and characterization of the cavity. MRI was after performed for better characterization of this structure, confirming the presence of an accessory chamber with muscular wall and normal contractility at the level of the basal interventricular septum, without pathological enhancements. We reviewed an angioCT performed for other reasons some years ago, confirming the presence of the same structure, which went unnoticed in that study. The patient followed controls and remained asymptomatic, without evolutionary echocardiographic changes, so that a conservative attitude was maintained. Congenital ventricular diverticulum is formed by an appendix of the entire left ventricular (LV) wall. It can be differentiated into two types: muscular (more frequent, not prone to rupture and associated with other congenital malformations) or fibrous (frequently localized at the base of the heart or in subvalvular areas). Differential diagnosis may include true LV aneurysms (abnormal LV contour with systolic dyskinesia and involving thinned fibrous tissue) and LV pseudoaneurysms (acute contained rupture of the ventricle wall, often after myocardial infarction, also akinetic or dyskinetic). Congenital cardiac diverticulum is characterized by a rapid contrast filling and a narrow neck. MRI provide tissue characterization and is an important tool that helps in the differential diagnosis. In cardiac diverticulums, a thinned but contractile wall is present, without pathological delayed enhancements. In true aneurysms, the wall shows delayed enhancement (scar tissue). Pseudoaneurysms are only composed by pericardium, and the border of the aneurysms show enhancement indicating peri-aneurysmal infarcted area. Left ventricular catheterization can also be useful assessing the morphology and dynamics of the left ventricular chamber. In small, muscular and asymptomatic diverticulums, conservative treatment with follow-up is often recommended. When symptoms appear, medical or surgical treatment should be proposed. Abstract P1333 Figure. Congenital myocardial diverticulum

scholarly journals Role of imaging for diagnosis and management of aortic valve papillary fibroelastoma and cardiac AL amyloidosis: A case report

2021 ◽  
Author(s):  
Ivan Dimov ◽  
Nathalie Meuleman ◽  
Didier de Cannière ◽  
Philippe Unger
Keyword(s):  
Aortic Valve ◽  
Cardiac Function ◽  
Cardiac Amyloidosis ◽  
Global Longitudinal Strain ◽  
Surgical Excision ◽  
Papillary Fibroelastoma ◽  
Uneventful Recovery ◽  
Optimal Timing ◽  
Surgical Removal ◽  
Al Amyloidosis

Abstract Background We report the case of a patient who presented with concomitant aortic valve papillary fibroelastoma and cardiac amyloidosis. Although histologically benign, papillary fibroelastoma confers an increased thromboembolic risk, and surgical excision is often indicated. However, outcomes of cardiac surgery are poor in patients with cardiac amyloidosis. Case summary A 61-year old man with complaints of dyspnoea and weight loss of 10 kg developing over the past five months was evaluated in the cardiology clinic. Echocardiography revealed sessile aortic valve papillary fibroelastoma and was also highly suggestive of cardiac amyloidosis. The diagnosis of amyloid light chain amyloidosis secondary to indolent multiple myeloma was eventually confirmed. Therapy with daratumumab, bortezomib, cyclophosphamide and dexamethasone allowed full remission over a six month period and resulted in marked improvement in symptoms and cardiac function as evaluated by global longitudinal strain. Further workup with cerebral magnetic resonance revealed multiple vascular sequelae. Surgical removal of the aortic fibroelastoma with bioprosthetic aortic valve replacement was performed successfully and the patient had an uneventful recovery. Discussion Papillary fibroelastoma and cardiac amyloidosis are rare and most likely unrelated entities. Concomitant presentation of both conditions in the same patient presents a unique therapeutic challenge. By allowing cardiac function to be monitored during chemotherapy, speckle tracking echocardiography can prove instrumental in determining the optimal timing of surgical intervention.

scholarly journals Successful interdisciplinary treatment as a rare cause of acute myocardial ischemia by intermittent tumor-associated obstruction of the left main coronary artery– A case report

2021 ◽  
Author(s):  
Katharina Huenges ◽  
Franz Hartmann ◽  
Bernd Panholzer ◽  
Thomas Puehler
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Myocardial Ischemia ◽  
Left Main Coronary Artery ◽  
Left Ventricular ◽  
Papillary Fibroelastoma ◽  
Interdisciplinary Treatment ◽  
Bridge To Surgery ◽  
Left Main

Abstract Background A papillary fibroelastoma of the aortic valve has been reported as a rare cause of myocardial ischemia. An advanced combined interventional and surgical approach leading to sufficient therapy for the patient is presented in this case report. Case summary A 56-year old female patient presented in an emergency room of a hospital with an acute coronary syndrome. Over 1.5 years, recurrent stable angina had been known in the patient and significant coronary artery disease has already been ruled out in a previous coronary angiogram. The patient was immediately transferred to the catheter laboratory due to cardiogenic shock where a drug-eluting stent was implanted to, firstly, recanalize the left main coronary artery and, secondly, to protect the left main ostium from obstruction by an echocardiographic-proven mass. During subsequent deterioration of hemodynamics caused by decreasing left ventricular function and acute severe mitral insufficiency, firstly an intra-aortic balloon pump and secondly a VA-ECMO was established through the femoral vessels. The patient was transferred to our cardiac surgery unit and was successfully operated utilizing a valve-sparing technique by extracting the tumor mass from the left coronary cusp and extracting the stent carefully from the left main coronary artery. Histology revealed a papillary fibroelastoma (Figure 4). Conclusion A papillary fibroelastoma of the aortic valve with intermittent obstruction of the coronary arteries requires surgical therapy. Interventional recanalization and extracorporeal support might be useful strategies to ensure the patient’s safety as a bridge to surgery.

Design and Validation of a Novel Bioreactor to Expose Aortic Valve Leaflets to Side-Specific Shear Stress

2011 ◽  
Author(s):  
Ling Sun ◽  
Nalini M. Rajamannan ◽  
Philippe Sucosky
Keyword(s):  
Shear Stress ◽  
Aortic Valve ◽  
Fluid Shear Stress ◽  
Left Ventricular ◽  
Calcific Aortic Valve Disease ◽  
Aortic Valve Leaflets ◽  
Left Ventricular Outflow ◽  
Pulsatile Shear Stress ◽  
Plate Geometry

Calcific aortic valve disease (CAVD), the most common aortic valve disorder, is characterized by an accumulation of calcium on the valve leaflets that contributes to the obstruction of the left ventricular outflow and progressive heart failure. CAVD follows an active process presumably triggered by atherogenic risk factors and hemodynamic cues1,2. Resulting from the relative motion between the deforming leaflets and the surrounding blood flow, fluid shear stress is an important component of the valve hemodynamic environment. The ventricular surface of the leaflets is exposed to a unidirectional pulsatile shear stress, while the aortic surface experiences a bidirectional oscillatory shear stress3. The characterization of the effects of shear stress on valvular pathogenesis, which requires the replication of the native valvular shear stress in the laboratory setting, has been hampered by this hemodynamic complexity. In an effort to address this challenge, the goal of this study was to design and validate a novel apparatus capable of exposing simultaneously but independently both surfaces of aortic valve leaflets to native side-specific shear stress. The device based on a cone-and-plate geometry was validated with respect to its ability to expose each surface of aortic valve leaflets to its native, time-varying shear stress waveform, while maintaining the tissue under sterile conditions for 96 hours.

scholarly journals Multimodality imaging derived energy loss index and outcome after transcatheter aortic valve replacement

2020 ◽  
Vol 21 (10) ◽  
pp. 1092-1102 ◽  
Author(s):  
Erik W Holy ◽  
Thi Dan Linh Nguyen-Kim ◽  
Lisa Hoffelner ◽  
Daniel Stocker ◽  
Thomas Stadler ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Energy Loss ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Multimodality Imaging ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Transcatheter Aortic Valve ◽  
Loss Index

Abstract Aims  To assess whether the combination of transthoracic echocardiography (TTE) and multidetector computed tomography (MDCT) data affects the grading of aortic stenosis (AS) severity under consideration of the energy loss index (ELI) in patients undergoing transcatheter aortic valve replacement (TAVR). Methods and results  Multimodality imaging was performed in 197 patients with symptomatic severe AS undergoing TAVR at the University Hospital Zurich, Switzerland. Fusion aortic valve area index (fusion AVAi) assessed by integrating MDCT derived planimetric left ventricular outflow tract area into the continuity equation was significantly larger as compared to conventional AVAi (0.41 ± 0.1 vs. 0.51 ± 0.1 cm2/m2; P < 0.01). A total of 62 patients (31.4%) were reclassified from severe to moderate AS with fusion AVAi being >0.6 cm2/m2. ELI was obtained for conventional AVAi and fusion AVAi based on sinotubular junction area determined by TTE (ELILTL 0.47 ± 0.1 cm2/m2; fusion ELILTL 0.60 ± 0.1 cm2/m2) and MDCT (ELIMDCT 0.48 ± 0.1 cm2/m2; fusion ELIMDCT 0.61 ± 0.05 cm2/m2). When ELI was calculated with fusion AVAi the effective orifice area was >0.6 cm2/m2 in 85 patients (43.1%). Survival rate 3 years after TAVR was higher in patients reclassified to moderate AS according to multimodality imaging derived ELI (78.8% vs. 67%; P = 0.01). Conclusion  Multimodality imaging derived ELI reclassifies AS severity in 43% undergoing TAVR and predicts mid-term outcome.

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