Aortic regurgitation

ESC CardioMed ◽  
2018 ◽  
pp. 1634-1641
Author(s):  
Pilar Tornos Mas ◽  
Emmanuel Lansac
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Aortic Surgery ◽  
Valve Surgery ◽  
Aortic Dilatation ◽  
Concomitant Surgery ◽  
Asymptomatic Patients ◽  
Aortic Pathology ◽  
Definition Of ◽  
And Function

Evaluation of aortic regurgitation requires consideration of valve morphology, mechanism and severity of regurgitation and assessment of aortic dilatation. In asymptomatic patients with severe aortic regurgitation, follow-up of symptomatic status and LV size and function is mandatory. The strongest indication for valve surgery is the presence of symptoms and/or the documentation of LVEF <50% and/or end-systolic diameter =50 mm. In patients with dilated aorta, definition of aortic pathology and accurate measurements of aortic diameters are crucial. Surgery is recommended whenever aortic dilation is = 55 mm or = 50 mm in patients with bicuspid aortic valves and Marfan syndrome or =45 mm when additional risk factors are present. For patients who have an indication for valve surgery, an aortic diameter of ≥45 mm is considered to indicate concomitant surgery of the aorta. Aortic valve repair and valve-sparing aortic surgery instead of aortic valve replacement should be considered in selected cases in experienced centres.

scholarly journals Prognostic value of diastolic function parameters in significant aortic regurgitation. The role of the left atrial strain

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Garcia Martin ◽  
M Abellas Sequeiros ◽  
L M Rincon Diaz ◽  
A Gonzalez Gomez ◽  
J M Monteagudo Ruiz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Diastolic Function ◽  
Aortic Regurgitation ◽  
Left Atrial ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Asymptomatic Patients ◽  
Lv Volumes

Abstract Background The management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. There are no strong indicators to recommend early surgery in patients with sAR, however delaying the time for the intervention could bring potential negative consequences, such as the risk of permanent left ventricular (LV) dysfunction. The prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. In particular, left atrial (LA) function has been shown to be an important determinant of morbimortality. Purpose The purpose of this study was to analyze the prognostic significance of diastolic function parameters, included LA strain, in asymptomatic patients with sAR and to evaluate whether these parameters could help to identify patients at high risk of adverse events that could benefit from early cardiac surgery. Methods From February 2013 to November 2019 consecutive asymptomatic patients with chronic sAR evaluated in the Heart Valve Clinic with a comprehensive transthoracic echocardiogram (TTE) were included. Combined clinical endpoint included hospital admission due to heart failure, cardiovascular mortality, or indication for aortic valve surgery. Results A total of 126 patients were included. During a mean follow up of 33±19 month, 25 (19.8%) patients reached the combined end-point. In a sub-group of 57 patients with TTE performed in the Philips stations, LA auto-strain analysis was obtained (figure 1). Univariate analysis showed that LV volumes, LVEF, E wave, E/e' ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events, whereas LA diameter, and LV diastolic diameters were not. Multivariate model 1 that tested all echocardiographic variables statistically significant in the univariate model showed that the LVEDV and E/e' ratio, were significant predictors of events. In the subgroup of patients with LA auto-strain analyzed, a second multivariable model was built, including the previous significant variables for the first model (LVEDV and E/e' ratio), as well as the LA volume and LASr. It showed that LVEDV and LASr were the most significant predictors of cardiovascular events (figure 2). Conclusions In this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LA reservoir strain played a strong independent predictor role. In addition, our results also showed that LV volumes had greater prognostic value that LV diameters in patients with asymptomatic sAR. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Association between Patterns of Aortic Dilatation and Aortic Pathology in Consecutive Aortic Surgery Cases in Relation to Aortic Valve Type

2016 ◽  
Vol 25 (8) ◽  
pp. e104
Author(s):  
Siew Simg Christine Goh ◽  
Sameer Thakur ◽  
Rajiv Sharma ◽  
Ashutosh Hardikar
Keyword(s):  
Aortic Valve ◽  
Aortic Surgery ◽  
Aortic Dilatation ◽  
Aortic Pathology

scholarly journals Bicuspid aortic valve: different clinical profiles for subjects with versus without repaired aortic coarctation

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001429
Author(s):  
Michelle S Lim ◽  
Paul G Bannon ◽  
David S Celermajer
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Aortic Coarctation ◽  
Aortic Surgery ◽  
Valve Surgery ◽  
Prior History ◽  
Phenotypic Differences ◽  
Group Type ◽  
History Of

ObjectivesA small proportion of patients undergoing bicuspid aortic valve (BAV) intervention have had prior repair of aortic coarctation (CoA). We aimed to describe phenotypic differences between BAV patients, comparing those with versus those without previous coarctation repair.Methods556 adults with BAV who had undergone aortic valve and/or ascending aortic surgery were identified, and relevant clinical and operative details were retrospectively analysed.ResultsOf the total cohort, 532 patients (95.7%) had isolated BAV (‘BAV-only’), and 24 (4.3%) had had a previous successful CoA repair (‘BAV-CoA’). The median age at surgery was significantly lower in BAV-CoA patients compared with BAV-only (median, IQR: 40 years, 26–57 vs 62 years, 51–69, p<0.001). Indications for surgery also differed, with BAV-CoA patients much more likely to undergo surgery for aortic regurgitation (BAV-CoA 38% vs BAV-only 13%, p<0.001); patients with isolated BAV were more likely to require surgery for aortic stenosis (BAV-only 75% vs BAV-CoA 50%, p<0.001). Two different BAV morphotypes were commoner in the BAV-CoA group; type 0 valves (24% vs 8%, p<0.05) and type 2 valves (12% vs 3%, p<0.05). The proportion of patients undergoing concomitant aortic surgery at the time of valve surgery were similar (BAV-only 38% vs BAV-CoA 42%, p=0.8).ConclusionIn adult patients undergoing aortic valve surgery for BAV disease, those with a prior history of repaired CoA underwent surgery at a very much younger age, and a higher proportion required intervention for aortic regurgitation.

scholarly journals 101 Quantifying aortic regurgitation with CMR can predict patients requiring aortic valve surgery

2008 ◽  
Vol 10 (S1) ◽  
Author(s):  
Saul G Myerson ◽  
Theodoros D Karamitsos ◽  
Jane M Francis ◽  
Adrian P Banning ◽  
Stefan Neubauer
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Valve Surgery ◽  
Aortic Valve Surgery

Aortic regurgitation

2015 ◽  
pp. 141-147
Author(s):  
Raphael Rosenhek
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Cardiac Computed Tomography ◽  
Transoesophageal Echocardiography ◽  
Left Ventricular ◽  
Disease Aetiology ◽  
Echocardiographic Parameters ◽  
And Function

The workup of patients with aortic regurgitation is routinely based on echocardiography and includes a detailed morphologic assessment of the aortic valve with the determination of disease aetiology. The quantification of aortic regurgitation is based on an integration of qualitative and quantitative parameters. Haemodynamic consequences of aortic valve disease on left ventricular size, hypertrophy, and function, as well as potentially coexisting valve lesions, are assessed. Predictors of outcome and indications for surgery are substantially defined by echocardiographic parameters. Cardiac magnetic resonance has become an important complementary technique, both for the quantification of regurgitant severity and for the assessment of ventricular function. While the proximal parts of the ascending aorta are routinely visualized by transthoracic echocardiography, transoesophageal echocardiography (TOE) and in particular cardiac magnetic resonance (CMR) and cardiac computed tomography (CT) allow a more comprehensive assessment of the thoracic aorta.

scholarly journals Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation

2019 ◽  
Vol 20 (10) ◽  
pp. 1105-1111
Author(s):  
E Mara Vollema ◽  
Gurpreet K Singh ◽  
Edgard A Prihadi ◽  
Madelien V Regeer ◽  
See Hooi Ewe ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Time Course ◽  
Pressure Overload ◽  
Volume Overload ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Lv Mass

Abstract Aims Pressure overload in aortic stenosis (AS) and both pressure and volume overload in aortic regurgitation (AR) induce concentric and eccentric hypertrophy, respectively. These structural changes influence left ventricular (LV) mechanics, but little is known about the time course of LV remodelling and mechanics after aortic valve surgery (AVR) and its differences in AS vs. AR. The present study aimed to characterize the time course of LV mass index (LVMI) and LV mechanics [by LV global longitudinal strain (LV GLS)] after AVR in AS vs. AR. Methods and results Two hundred and eleven (61 ± 14 years, 61% male) patients with severe AS (63%) or AR (37%) undergoing surgical AVR with routine echocardiographic follow-up at 1, 2, and/or 5 years were evaluated. Before AVR, LVMI was larger in AR patients compared with AS. Both groups showed moderately impaired LV GLS, but preserved LV ejection fraction. After surgery, both groups showed LV mass regression, although a more pronounced decline was seen in AR patients. Improvement in LV GLS was observed in both groups, but characterized by an initial decline in AR patients while LV GLS in AS patients remained initially stable. Conclusion In severe AS and AR patients undergoing AVR, LV mass regression and changes in LV GLS are similar despite different LV remodelling before AVR. In AR, relief of volume overload led to reduction in LVMI and an initial decline in LV GLS. In contrast, relief of pressure overload in AS was characterized by a stable LV GLS and more sustained LV mass regression.

Measurement of Valve Lesion Morphology and Aorta / Flow-Jet Patterns in Bicuspid Aortic Valve Patients

2009 ◽  
Author(s):  
Alex J. Barker ◽  
Craig Lanning ◽  
Robin Shandas
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Complex Disease ◽  
Aortic Dilatation ◽  
Hemodynamic Forces ◽  
Significant Incidence ◽  
Valve Opening ◽  
Valve Lesion ◽  
And Function ◽  
Lesion Morphology

Bicuspid aortic valve (BAV) patients are identified by a lesion of the tricuspid aortic leaflets in which only two ‘functional’ leaflets are visibly present. This lesion occurs in 0.5–2% of the population and is accompanied by a significant incidence of morbidity and mortality related to aortic valve dysfunction, aortic dilatation, aortic aneurysm, and aortic dissection. [1] The pathogenesis of the malformation has been postulated to be the result of a congenital or inflammatorily-mediated fusion of two of the three aortic leaflets. In addition, BAV is accompanied by a variety of heterogeneous complications and is considered a complex disease with many cofactors, the importance of which continue to be debated. Among these cofactors, the most commonly identified vascular manifestation is aortic dilatation. [1] There are two hypotheses for this manifestation: the first postulates the coexistence of BAV and genetically-based aortic fragility; the second proposes that BAV morphology and incomplete valve opening induces hemodynamic forces that influence structure and function at the aorta.

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