scholarly journals Characteristics and long-term outcomes of aortico-left ventricular tunnel

2020 ◽  
Author(s):  
Jing Sun ◽  
Hongxia Qi ◽  
Hongyuan Lin ◽  
Wenying Kang ◽  
Shoujun Li ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Surgical Repair ◽  
Mechanical Valve ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Orifice ◽  
The Right

Abstract OBJECTIVES Aortico-left ventricular tunnel (ALVT) is an extremely rare, abnormal paravalvular communication between the aorta and the left ventricle. Few studies have identified the characteristics and long-term prognosis associated with ALVT. METHODS The data of 31 patients with ALVT from July 2002 to December 2019 were reviewed. Echocardiography was performed in all patients during the follow-up period. RESULTS The median age of the patients was 11.5 years. Bicuspid aortic valve and dilatation of the ascending aorta were found in 13 patients, respectively. The aortic orifice in 20 patients showed a close relation to the right sinus and the right–left commissure. Of the 31 patients, 26 were operated on. Mechanical valve replacement was performed in 4 patients and aortic valve repair, in 6 patients. Ascending aortoplasty was performed in 5 patients and aortic replacement was done in 2 patients. One patient died of ventricular fibrillation before the operation. Follow-up of the remaining 30 patients ranged from 1 to 210 months (median 64 months). There were 4 deaths during the follow-up period: 1 had mechanical valve replacement and 3 did not undergo surgical repair. In the 26 patients without aortic valve replacement, 6 had severe regurgitation and 2 had moderate regurgitation. In the 28 patients without replacement of the ascending aorta, 11 had continued dilatation of the ascending aorta, including those who had aortoplasty. CONCLUSIONS The aortic orifice of ALVT showed an association with the right sinus and the right–left commissure. For patients who did not have surgery, the long-term survival rate remained terrible. Surgical closure should be done as soon as possible after ALVT is diagnosed. The main long-term complications after surgical repair included aortic regurgitation and ascending aortic dilatation.

scholarly journals Perceval Sutureless Bioprosthesis for Degenerative Aortic Valve Stenosis: Initial Experience With 67 Patients

2021 ◽  
Vol 24 (6) ◽  
pp. E1065-E1069
Author(s):  
Dejan Lazovic ◽  
Mladen Kocica ◽  
Filip Vucicevic ◽  
Milica Kocica ◽  
Milos Grujic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Approaches ◽  
Biological Prosthesis ◽  
Group I ◽  
Postoperative Time ◽  
The Right

Objective: The objective of this prospective study was to evaluate the characteristics (positive and negative) of Perceval S valve in patients undergoing aortic valve replacement with a biological prosthesis. The study included 67 patients operated on at our institution and a mean follow-up period of 18 months. Methods: From June 2016 to November 2019, 209 patients underwent aortic valve replacement with a biological prosthesis. Of these, 67 patients were included in the study based on the exclusion and inclusion criteria set before the study began. Their data were recorded during their hospital stay (preoperative, intraoperative, and early and late postoperative time). Results: Fifty-four patients underwent isolated aortic valve replacement (group I) with a Perceval S prosthesis, and 13 patients had combined aortic valve replacement procedures and CABG procedures (group II). Patients were implanted with the following prosthesis sizes: S (N = 12), M (N = 18), L (N = 28), or XL (N = 9). The Perceval S valve successfully was implanted in 67 (91.8%) patients (in 6 patients, the preoperative transthoracic echocardiographic data did not coincide with intraoperative TEE and surgical measurement of the size of the annulus in the suture). Surgical approaches in patients were medial sternotomy (N = 48), mini sternotomy (N = 15), and thoracotomy through the second intercostal space to the right (N = 4). The mean clamping time of the aorta and CPB length for isolated cases was 54 and 82 minutes, respectively, and 96 and 120 minutes for combined procedures. Four (5.9%) patients died within 30 days. Conclusion: Early postoperative results showed that the Perceval S valve was safe. Further follow up is required to evaluate the long-term duration of patients with this bioprosthesis.

scholarly journals Changes in dynamic left ventricular function, assessed by the strain-volume loop, relate to reverse remodeling after aortic valve replacement

2019 ◽  
Vol 127 (2) ◽  
pp. 415-422
Author(s):  
Hugo G. Hulshof ◽  
Frederieke van Oorschot ◽  
Arie P. van Dijk ◽  
Maria T. E. Hopman ◽  
Keith P. George ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Lv Mass ◽  
Insight Into

Aortic valve replacement (AVR) leads to remodeling of the left ventricle (LV). Adopting a novel technique to examine dynamic LV function, our study explored whether post-AVR changes in dynamic LV function and/or changes in aortic valve characteristics are associated with LV mass regression during follow-up. We retrospectively analyzed 30 participants with severe aortic stenosis who underwent standard transthoracic echocardiographic assessment before AVR [88 (IQR or interquartile range: 22–143) days], post-AVR [13 (6–22) days], and during follow-up [455 (226–907) days]. We assessed standard measures of LV structure, function, and aortic valve characteristics. Novel insight into dynamic LV function was provided through a four-chamber image by examination of the temporal relation between LV longitudinal strain (ε) and volume (ε-volume loops), representing the contribution of LV mechanics to volume change. AVR resulted in immediate changes in structural valve characteristics, alongside a reduced LV longitudinal peak ε and improved coherence between the diastolic and systolic part of the ε-volume loop (all P < 0.05). Follow-up revealed a decrease in LV mass ( P < 0.05) and improvements in LV ejection fraction and LV longitudinal peak ε ( P < 0.05). A significant relationship was present between decline in LV mass during follow-up and post-AVR improvement in coherence of the ε-volume loops ( r = 0.439, P = 0.03), but not with post-AVR changes in aortic valve characteristics or LV function (all P > 0.05). We found that post-AVR improvements in dynamic LV function are related to long-term remodeling of the LV. This highlights the potential importance of assessing dynamic LV function for cardiac adaptations in vivo. NEW & NOTEWORTHY Combining temporal measures of left ventricular longitudinal strain and volume (strain-volume loop) provides novel insights in dynamic cardiac function. In patients with aortic stenosis who underwent aortic valve replacement, postsurgical changes in the strain-volume loop are associated with regression of left ventricular mass during follow-up. This provides novel insight into the relation between postsurgery changes in cardiac hemodynamics and long-term structural remodeling, but also supports the potential utility of the assessment of dynamic cardiac function.

scholarly journals A national study of the outcome after treatment of critical aortic stenosis in the neonate

2020 ◽  
Vol 30 (9) ◽  
pp. 1321-1327
Author(s):  
Cecilia Kjellberg Olofsson ◽  
Katarina Hanseus ◽  
Jens Johansson Ramgren ◽  
Mats Johansson Synnergren ◽  
Jan Sunnegårdh
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
National Study ◽  
Term Survival ◽  
Critical Aortic Stenosis

AbstractObjective:This study describes short-term and long-term outcome after treatment of critical valvular aortic stenosis in neonates in a national cohort, with surgical valvotomy as first choice intervention.Methods:All neonates in Sweden treated for critical aortic stenosis between 1994 and 2016 were included. Patient files were analysed and cross-checked against the Swedish National Population Registry as of December 2017, giving complete survival data. Diagnosis was confirmed by reviewing echo studies. Critical aortic stenosis was defined as valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function. Primary outcome was all-cause mortality and secondary outcomes were reintervention and aortic valve replacement.Results:Sixty-one patients were identified (50 boys, 11 girls). Primary treatment was surgical valvotomy in 52 neonates and balloon valvotomy in 6. Median age at initial treatment was 5 days (0–26), and median follow-up time was 10.8 years (0.14–22.6). There was no 30-day mortality but four late deaths. Freedom from reintervention was 66%, 61%, 54%, 49%, and 46% at 1, 5, 10, 15, and 20 years, respectively. Median time to reintervention was 3.4 months (4 days to 17.3 years). Valve replacement was performed in 23 patients (38%).Conclusions:Surgical valvotomy is a safe and reliable treatment in these critically ill neonates, with no 30-day mortality and long-term survival of 93% in this national study. At 10 years of age, reintervention was performed in 54% and at end of follow-up 38% had had an aortic valve replacement.

Abstract 2865: Enhanced Left Ventricular Mass Regression Following Aortic Valve Replacement is Associated with Improved Long-Term Survival: A 15-year Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Ayyaz Ali ◽  
Amit Patel ◽  
Yasir Abu-Omar ◽  
Anila Mehta ◽  
Ziad Ali ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Rank Test ◽  
Actuarial Survival ◽  
Term Survival ◽  
Long Term Survival

Background Aortic valve replacement (AVR) is followed by regression of LVH. More complete resolution of LVH is suggested to be associated with superior clinical outcomes, however its impact on long-term survival following AVR has not been investigated. Methods Demographic and clinical data were obtained retrospectively through casenote review. Transthoracic echocardiography was used to measure LVM pre-operatively and at annual follow-up visits. Patients were grouped according to their reduction in LVM at late follow-up: Group A < 25 grams, Group B 25–150 grams and Group C > 150 grams. Results 211 patients underwent AVR between 1 st January 1991 and 1 st January 2001. Pre-operative LVM was 295 ± 118 g in A (n=63), 346 ± 97 g in B (n=75) and 539 ± 175 g in C (n=73), P <0.001. Mean time to last echocardiogram was 6.4 ± 3.3 years. LVM at late follow-up was 351 ± 160 g in A, 265 ± 95 g in B and 270 ± 90 g in C, P <0.001. Transvalvular gradients at follow-up were not significantly differerent between groups (A: 21 ± 21 mm Hg, B: 20 ± 15 mm Hg, C: 14 ± 11 mm Hg), P = 0.10. There was no difference in the prevalence of other factors influencing LVM regression such as IHD or hypertension. Ten year actuarial survival was significantly greater in patients with enhanced LVM regression when compared with the log-rank test (A: 49% ± 7, B: 67%± 6, C: 75% ± 6), P =0.03 (Figure 1 ). LVM reduction > 150 grams was an independent predictor of long-term survival on multivariate analysis (P = 0.03). Conclusion Enhanced LVM regression at late follow-up in patients undergoing AVR is associated with improved long-term survival. Strategies to optimize post-operative LVM regression should be considered in view of potential prognostic benefit.

scholarly journals 624 Is TAVI a useful procedure in paradoxical low flow-low gradient aortic stenosis? A long-term mortality study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Fusini ◽  
M Muratori ◽  
N Corrieri ◽  
I Capodaglio ◽  
G Tamborini ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Survival Curve ◽  
Left Ventricular ◽  
Low Flow ◽  
Aortic Valve Area

Abstract Background Clinical outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG) undergoing valve replacement are controversial. PLF-LG is a combination of a small aortic valve area (AVA &lt; 1cm²), a preserved left ventricular (LV) ejection fraction (LVEF≥50%), and a ‘paradoxical’ low mean gradient due to the presence of low LV stroke volume (≤35 mL/m²). The low flow state is explained by the presence of a high afterload and pronounced LV concentric remodeling, with impaired LV filling. Surgical aortic valve replacement has been associated with very positive outcomes in normal-flow high-gradient (NF-HG) AS, whereas poorer outcomes has been reported in patients with PLF-LG AS. Purpose The aim of this study is to determine the clinical outcomes in patients with PLF-LG AS undergoing transcatheter aortic valve implantation (TAVI) compare to NF-HG patients. Methods A total of 624 patients (age 81 ± 7 years) with symptomatic severe AS and preserved LVEF who underwent TAVI, was enrolled and divided in 2 groups: group NF-HG included 554 patients (89%) and group PLF-LG including 70 patients (11%). At 1-year follow-up, death and clinical events were reported. Results TAVI was feasible in all patients. A significant reduction in mean aortic pressure gradient was observed after TAVI both in PLF-LG (baseline, 30 ± 6 mmHg; 1-year, 12 ± 4 mmHg; p &lt; 0.001) and in NF-HG (baseline, 55 ± 12 mmHg; 1-year, 11 ± 4 mmHg; p &lt; 0.001) together with an increase in AVA (PLF-LG: baseline, 0.73 ± 0.16 cm², 1-year: 1.82 ± 0.43 cm², p &lt; 0.001; NF-HG: baseline, 0.66 ± 0.18 cm², 1-year: 1.84 ± 0.38cm², p &lt; 0.001). Perioperative mortality at 30-days was similar in group NF-HG (17/554, 3%) and in group PLF-LG (2/70, 3%). Figure shows the survival curves up to 5 years follow-up according to the two groups. PLF-LG and HG-AS had similar survival rate throughout the long-term follow-up. Similarly, rehospitalization rate was not different in the two groups (PLF-LG: 12% vs NF-HG: 7%, p = 0.127). Conclusions Differently from surgical series, TAVI in PLF-LG AS is a useful procedure showing similar mortality and rehospitalization rates compared to NF-HG AS patients. Abstract 624 Figure. Survival curve

Aorto-left ventricular tunnel: case series of a rare disease

2020 ◽  
pp. 1-5
Author(s):  
Obayda M. Diraneyya ◽  
Fahad Alhabshan ◽  
Abdullah Alghamdi ◽  
Hussein Moafa ◽  
Mohammed Alnasef ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Rare Disease ◽  
Aortic Root ◽  
Surgical Repair ◽  
Case Series ◽  
Left Ventricular ◽  
Patch Closure

Abstract Introduction: Aorto-left ventricular tunnel is a rare disease that can cause significant morbidity early in life due to volume overload and left ventricular failure. Surgical intervention is usually curative with minimal early complications. However, long-term effects and outcome are not fully determined. Objective: We are reporting a case series of this rare CHD with its long-term outcome. Methods: We conducted a retrospective analysis of all children from birth to 14 years of age who were admitted between 2001 and 2020 with the diagnosis of aorto-left ventricular tunnel. Demographic, echocardiographic, and perioperative data were collected and reviewed. The pre-operative data were compared with data reviewed on the last outpatient follow-up. Results: Total of five patients fulfilled our inclusion criteria. Three patients were diagnosed after auscultating an incidental murmur, one had symptoms of congestive heart failure, and one had an abnormal fetal echocardiogram. Echocardiography demonstrated stenotic and regurgitant aortic valve with severely depressed left ventricle function in two patients, one of them with also single left coronary artery. The other three patients had normal aortic valve structure and normal ventricular function. All five patients had surgical repair, two by patch closure at aortic end of aorto-left ventricular tunnel, two by patch closure at both aortic and left ventricular ends, and one by aortic root replacement using a homograft. During follow-up, there was no residual aorto-left ventricular tunnel in any of our five cases, two had moderate aortic regurgitation and one had moderate residual aortic stenosis. Conclusions: Spectrum of presentation for aorto-left ventricular tunnel varies from an occult lesion to frank left heart failure due to volume or less commonly, pressure overload. Early surgical repair is recommended and is usually associated with complete resolution. Long-term follow-up is recommended for aortic root dilatation and aortic valve competency, as valve function need to be addressed in a timely manner to avoid further complications.

scholarly journals 681 Ventricular fibrosis affects diastolic function and atrial remodelling long-term after aortic valve replacement for aortic valve stenosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Enrico Tadiello ◽  
Laura Trento ◽  
Martina Setti ◽  
Giorgia De Conti ◽  
Francesco Onorati ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Myocardial Fibrosis ◽  
Left Ventricular ◽  
Atrial Function ◽  
Study Cohort ◽  
Ventricular Performance

Abstract Aims Aortic stenosis (AS) is characterized both by progressive valve narrowing and left ventricular remodelling response. Myocardial fibrosis has significant functional consequences and is the key pathological process driving left ventricular decompensation. Furthermore, studies suggest that myocardial fibrosis is irreversible, despite surgical aortic valve replacement (SAVR). The study aims to define the association between myocardial fibrosis and long-term diastolic and atrial function after SAVR, which are both markers of poor clinical outcomes. Methods We evaluated patients with isolated AS and no-coronary artery disease referred for SAVR in 2015. All of them received a biological valve and a left ventricular biopsy was performed at the time of surgery. Clinical and echocardiographic evaluation was performed before surgery and after about 6 years, including fully automated 2D speckle tracking analysis software (TomTec). Atrial function was evaluated with PALS, PACS, and LAVi/septal a’ TDI. Results Nineteen patients completed the follow-up and formed the study cohort, age 72 ± 6 years, 42% female, ejection fraction 63 ± 6.4%, mean fibrosis 26.4 ± 12.7%. Significant myocardial fibrosis (&gt; 33%) was found in 13/19 patients (68%). Although similar at baseline, after 5.6±0.5 years, PACS was significantly higher in patients with low myocardial fibrosis (13.7±4.2 vs. 8.0±3.8, P=0.01), the same trends were observed for PALS (24.1±7.9 vs. 17.0±6.6, P=0.07) and LAVi/septal a’TDI (5.4±1.3 vs. 7.4±2.8, P=0.06). The diastolic profile at long term follow-up was also significantly worsened in patients with LV fibrosis: E/A 0.9±0.3 vs. 1.3±0.4 P= 0.03 and E/e’ 10.6±3.3 vs. 16.6±4.5 P=0.01). Conclusions Myocardial fibrosis at the time of SAVR strongly influences long-term diastolic Doppler profile and atrial function with potentially harmful consequences on clinical status and ventricular performance.

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