scholarly journals Aorto-cavitary fistula to the left ventricle with severe aortic regurgitation as a complication of prosthetic valve infective endocarditis: a novel report

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Alejandro Sanchez-Nadales ◽  
Valentina Celis-Barreto ◽  
Amir Khan ◽  
Andrea Anampa-Guzman ◽  
Olalekan Olanipekun
Keyword(s):  
Infective Endocarditis ◽  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
Fistulous Tract ◽  
Cardiac Complications ◽  
Unusual Complication ◽  
Intracardiac Shunt ◽  
Severe Aortic Regurgitation ◽  
Prosthetic Aortic Valve

ABSTRACT Infective endocarditis can present in different clinical forms and lead to a variety of complications depending on the affected valvular and perivalvular structures. We describe a case of a 74-year-old male who developed an aortic-cavitary fistulous tract as a complication of prosthetic aortic valve infective endocarditis. Transesophageal echocardiography (TEE) revealed an aorto-cavitary fistula (ACF) connecting the aortic root with the left ventricle, creating an intracardiac shunt, which resulted in severe aortic regurgitation physiology. The patient underwent surgery with successful exclusion of the ACF. ACF is an unusual complication of infective endocarditis that creates an abnormal communication between the aortic root and the heart chambers, establishing an intracardiac shunt. This case highlights that physicians should be aware of the possibility of rare cardiac complications in infective endocarditis. TEE is a valid diagnostic test for ACF.

Emergency aortic root replacement with the Bioconduit stentless aortic valve conduit

2020 ◽  
Vol 25 (6) ◽  
pp. 2055-2059
Author(s):  
ADRIAN TULIN ◽  
◽  
OVIDIU STIRU ◽  
MIRUNA LUANA MIULESCU ◽  
LAURA RADUCU ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
Aortic Root Replacement ◽  
Bentall Operation ◽  
Severe Aortic Regurgitation ◽  
Valve Conduit ◽  
Successful Case ◽  
Valved Conduit

This report concerns a 73-year-old woman who presented with asymptomatic aortic root an-eurysm with severe aortic regurgitation. The purpose of this article is to present our first successful case for emergency aortic root replacement (Bentall operation) that involves annular implantation of a pericardial valved conduit (Bioconduit TM, Biointegral Surgical, Inc., Ontario, Canada) and to discuss some essential technical clue issues related to this approach.

Dimensional analysis of the left ventricle: effects of acute aortic regurgitation

1975 ◽  
Vol 228 (2) ◽  
pp. 536-542 ◽  
Author(s):  
SJ Leshin ◽  
LD Horwitz ◽  
JH Mitchell
Keyword(s):  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Severe Aortic Regurgitation ◽  
End Diastolic Volume ◽  
Catheter Technique ◽  
End Systolic Volume

The effects of acute severe aortic regurgitation on the left ventricle were investigated in conscious, chronically instrumented dogs. Left ventricular dimensions and volumes were measured from biplane cineradiographs of beads positioned near the endocardium. Data were collected before and after the production of aortic regurgitation by a catheter technique. The aortic regurgitation resulted in increases in mean aortic pulse pressure from 44 to 73 mmHg (P smaller than 0.001), heart rate from 87 to 122 beats/min (P smaller than 0.02), and left ventricular end-diastolic pressure from 11 to 25 mmHg (P smaller than 0.05). Mean end-diastolic volume rose from 61 to 69 cc (P smaller than 0.001), while end-systolic volume remained unchanged at 37 cc. The end-diastolic dilatation following regurgitation was asymmetrical in that the increase in size was due principally to an increase in the septal-lateral axis. The acute volume load of aortic regurgitation was accomplished by an increase in end-diastolic volume, i.e., the Frank-Starling mechanism. The tachycardia probably reflects augmented cardiac sympathetic activity, but the constant end-systolic volume at a similar mean systolic pressure suggests that the net contractile state was unchanged.

scholarly journals P1578 The prognostic value of left ventricle longitudinal strain and cardiac biomarkers in asymptomatic patients with chronic severe aortic regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Verseckaite ◽  
D Vaiciuliene ◽  
J Laukaitiene ◽  
R Jonkaitiene ◽  
V Mizariene ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Primary Endpoint ◽  
Longitudinal Strain ◽  
Cardiac Biomarkers ◽  
Optimal Timing ◽  
Severe Aortic Regurgitation ◽  
Asymptomatic Patients

Abstract Background Because of adaptive remodelling of the left ventricle (LV), patients with chronic severe aortic regurgitation (AR) can remain asymptomatic for prolonged periods. The main clinical challenge is to avoid irreversible damage to the myocardium and LV dysfunction, but the time of surgery should be such that the benefits of surgery outweigh the risks at that particular time. We aimed to evaluate the predictive value of global LV longitudinal strain (GLS) and natriuretic peptide in severe AR. Methods Comprehensive and 2D speckle tracking echocardiography was performed in 84 patients with severe AR. Patients were divided into the asymptomatic group (n = 56; 41 men; mean age 46.1 ± 15.4 years) and the group with indications for AV surgery (n = 28; 27 men; mean age 49.0 ± 14.3 years). Asymptomatic patients were followed for about 4.4 ± 2.4 years. The primary endpoint was to detect the development of HF symptoms, deterioration in the LVEF(≤50%) and/or severe LV dilatation (EDD > 70mm or ESS > 50mm). Results Patients with the need of AV surgery showed a significantly larger impairment in GLS and higher increase in the values of NT-proBNP compared to asymptomatic patients (-17.2 ± 2.6 vs. -19.1 ± 2.4%, and 149.4 [86.6–500] vs. 112.5 [45.3–180.8]pg/mL, P < 0.05, resp.). Of the 56 patients who were initially asymptomatic, 49 patients were prospectively monitored. The primary endpoint was reached in 16 (33%) patients with AR. Despite the preserved LVEF at baseline, patients in need of AV surgery had lower GLS compared to those who remained stable while being monitored (-17.1 ± 2.3 vs. -20.1 ± 1.8%, P < 0.05). The baseline levels of NT-proBNP were higher among patients who progressed to needing AV surgery in comparison to that in no need of AV surgery at follow-up (194 [135-421.8] vs. 75.9 [34.1-136.7]pg/ml, P < 0.05). In multivariate analysis, GLS and NT-proBNP were independent predictors of AV surgery. ROC analysis showed that the probability of primary endpoint occurrence was greater in patients with GLS >-18.5% (AUC:0.85, P < 0.05) and NT-proBNP >130pg/ml (AUC:0.81, P < 0.05). Conclusion GLS and NT-proBNP may be used as independent prognostic predictors of optimal timing of operation in asymptomatic severe AR during follow-up. Multivariate analysis Variables OR (95% CI) P Age 0.97 (0.89-1.06) 0.54 LV ESD 1.02 (0.78-1.34) 0.87 LV EF 1.07 (0.74-1.56) 0.71 GLS 3.36 (1.09-10.36) 0.035 NT-proBNP 1.02 (1.0-1.04) 0.049

scholarly journals Anesthetic management of a patient with severe aortic regurgitation undergoing reoperation for ascending aorta false aneurysm using hypothermia: prevention of ventricular fibrillation by nifekalant

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Akiko Tomita ◽  
Tomoko Fujimoto ◽  
Shoko Takada ◽  
Yukio Hayashi
Keyword(s):  
Ventricular Fibrillation ◽  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Anesthetic Management ◽  
Myocardial Damage ◽  
Lung Ventilation ◽  
Left Ventricular ◽  
One Lung Ventilation ◽  
Severe Aortic Regurgitation ◽  
Vent Tube

Abstract Background To prevent cardiac collapse and to protect cerebral function, hypothermic cardiopulmonary bypass is established before resternotomy. However, ventricular fibrillation under hypothermia facilitates left ventricular distension, which causes irreversible myocardial damage when the patient has aortic regurgitation. We report a case of successful management in preventing ventricular fibrillation under hypothermia by using nifekalant. Case presentation A 56-year-old male, who had been performed a David operation, was scheduled for a Bentall operation for a pseudo aortic aneurysm with severe aortic regurgitation. After inducing anesthesia, we administered intravenous nifekalant and a vent tube was inserted into the left ventricle under one-lung ventilation. Extracorporeal circulation was established and resternotomy started after cooling to 27 °C. Although severe bradycardia and QT prolongation were observed, ventricular fibrillation did not occur until aortic cross-clamping. Conclusion Combining maintaining cerebral perfusion and avoiding left ventricle distension during hypothermia was successfully managed with nifekalant in our redo cardiac patient with aortic regurgitation.

scholarly journals Bicuspid Aortic Valve Associated with Severe Aortic Regurgitation and Large Aortic Root Aneurysm

Cureus ◽  
2020 ◽  
Author(s):  
Alejandro Sanchez-Nadales ◽  
Miguel Treminio Quezada ◽  
Valentina Celis ◽  
Jessica Navarro
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Severe Aortic Regurgitation ◽  
Aortic Root Aneurysm

An Unusual Complication of Infective Endocarditis Involving Bicuspid Aortic Valve

2021 ◽  
Vol 6 (3) ◽  
pp. 01-04
Author(s):  
Arnab Chaudhury
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Unusual Complication ◽  
Severe Mitral Regurgitation ◽  
Mitral Leaflet ◽  
Colour Doppler ◽  
Aneurysmal Dilatation ◽  
Severe Aortic Regurgitation

Bicuspid aortic valve is commonly associated with infective endocarditis with serious peri annular complications. We report a case of 37-year-old male patient presented with infective endocarditis involving bicuspid aortic valve with leaflet perforation and severe aortic regurgitation. Mitral valve was involved secondary to aortic valve endocarditis as a kissing lesion with severe mitral regurgitation. Anterior mitral leaflet (AML) had aneurysmal dilatation with mobile vegetations inside it. In colour Doppler, AML aneurysm was looking like a fireball inside the left atrium. Patient was treated with antibiotics and referred to surgery for aortic and mitral valve replacement.

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