Conundrum of aortic stenosis in a case of multivalvular rheumatic heart disease: perspicuity is in the details

2020 ◽  
Vol 13 (8) ◽  
pp. e236141
Author(s):  
Ahamed Shaheer Ahmed ◽  
Rahul Kumar ◽  
Aseem Basha
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Mitral Stenosis ◽  
Severe Aortic Stenosis ◽  
Valve Surgery ◽  
Treatment Needs ◽  
Dimensionless Velocity ◽  
Detailed Assessment ◽  
Rheumatic Heart

A 36-year-old woman presented with dyspnoea on exertion for 5 years. She was evaluated elsewhere and diagnosed to have severe mitral stenosis. She was referred for mitral valve replacement to our centre. Echocardiography revealed a thickened aortic valve with mild aortic regurgitation, with transaortic gradient suggestive of mild aortic stenosis, in addition to severe rheumatic mitral stenosis. Detailed echocardiographic analysis and cardiac catheterisation revealed features suggestive of moderate to severe aortic stenosis. Detailed assessment of aortic valve needs to be done in patients with coexistent mitral stenosis. Each modality for assessment of aortic stenosis has its own limitations and a decision regarding treatment needs to be taken based on combined analysis of all the parameters. Dimensionless velocity index is a relatively less time-consuming, flow independent measure of aortic stenosis. Prompt recognition of this concealed aortic stenosis helps to avoid repeat valve surgery. Subsequently, patient was sent for dual valve replacement.

scholarly journals Concomitant Transapical Transcatheter Aortic Valve Replacement and Transapical Balloon Mitral Valvuloplasty to Treat Severe Aortic Stenosis with Severe Mitral Stenosis

2021 ◽  
Vol 24 (4) ◽  
pp. E624-E627
Author(s):  
Peijian ◽  
Jian Liu ◽  
Huiming Guo
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Mitral Stenosis ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Heart Team ◽  
Mitral Valvuloplasty ◽  
Transcatheter Aortic Valve

This paper reports concomitant transapical transcatheter aortic valve replacement (TA-TAVR) and transapical balloon mitral valvuloplasty (TA-BMV) for the first time. A 72-year-old man with a diagnosis of rheumatic severe aortic stenosis with mild insufficiency and rheumatic severe mitral stenosis with mild insufficiency was referred to the Department of Cardiac Surgery of Guangdong Provincial People’s Hospital. After the interdisciplinary discussion in the heart team (cardiac surgeon, cardiologist, anesthesiologist and image specialist), we decided to perform concomitant TAVR and BMV through one transapical approach considering the patient’s preference, NYHA class IV heart failure, and the calculated perioperative risk (Euroscore II 3.74%, STS score for the combined mitral and aortic procedure is not available). No intraoperative or postoperative complications were observed.

scholarly journals Concomitant aortic valve replacement and retrosternal goitre resection via mini-sternotomy: a novel case

2020 ◽  
Vol 2020 (5) ◽  
Author(s):  
Rickesh B Karsan ◽  
Prakash Nanjaiah ◽  
John Hogan ◽  
Dheeraj Mehta ◽  
Michael Stetchman
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Aortic Arch ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Median Sternotomy ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Combined Procedure

Abstract Median sternotomy has been used to aide thyroidectomies demonstrating good outcomes; however no cases have been documented to show the use of mini-sternotomy to perform simultaneous thyroidectomy and valve surgery. We present a novel case of an 83-year-old woman with severe aortic stenosis and retrosternal goitre extending to the aortic arch deemed unsuitable for TAVI. Due to co-morbid status and anatomical position preventing routine thyroidectomy, we elected to perform a combined procedure to excise the goitre and perform an aortic valve replacement through a mini-J sternotomy, utilizing 3D-reconstructed imaging to plan our approach. This case shows that mini-sternotomy is a safe and effective method to perform concomitant thyroidectomy and aortic valve surgery.

scholarly journals Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Charbel Abi Khalil ◽  
Barbara Ignatiuk ◽  
Guliz Erdem ◽  
Hiam Chemaitelly ◽  
Fabio Barilli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Randomized Clinical Trials ◽  
Severe Aortic Stenosis ◽  
Paravalvular Leak ◽  
Effective Orifice Area ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Heart Valve

AbstractTranscatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

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