scholarly journals Metabolic Modulation and Potential Biomarkers of the Prognosis Identification for Severe Aortic Stenosis after TAVR by a Metabolomics Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Yanbiao Liao ◽  
Chang Liu ◽  
Tianyuan Xiong ◽  
Mingyue Zhao ◽  
Wen Zheng ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Coronary Sinus ◽  
Metabolic Profile ◽  
Ascending Aorta ◽  
Peripheral Vein ◽  
Metabolism Pathway ◽  
Before And After ◽  
Potential Biomarkers

Objectives. To investigate the metabolic profile in patients with aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR) and explore the potential biomarkers to predict prognosis after TAVR based on metabolomics. Methods and Results. Fifty-nine consecutive AS patients were prospectively recruited. Blood samples from the ascending aorta, coronary sinus, and peripheral vein at before and after TAVR were collected, respectively. Liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry were performed to analyze the metabolic profile before and after TAVR. Influential metabolites were identified by integrating the univariate test, multivariate analysis, and weighted gene coexpression network analysis (WGCNA) algorithm. PLS-DA analysis revealed a significant extremely early (within 30 minutes after TAVR) alterations of metabolites in the ascending aorta, coronary sinus, and peripheral vein. The early (within 7 days after TAVR) changed metabolites in the peripheral vein were involved in purine metabolism, primary bile acid biosynthesis, glycerolipid metabolism, amino sugar and nucleotide sugar metabolism, one carbon pool by folate and alanine, and the aspartate and glutamate metabolism pathway. We used volcano plots to find that the cardiac-specific changed metabolites were enriched to the sphingolipid metabolism pathway after TAVR. Besides, WGCNA algorithm was performed to reveal that arginine and proline metabolites could reflect left ventricle regression to some extent. Conclusion. This is the first study to reveal systemic and cardiac metabolites changed significantly in patients with AS after TAVR. Some altered metabolites involved in the arginine and proline metabolism pathway in the peripheral vein could predict left ventricle regression, which merited further study.

scholarly journals In vitro estimation of the energy loss through turbulence in a porcine aortic valve stenosis model and silicone ascending aorta phantom using backlight particle tracking velocimetry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Chiarelli ◽  
S F De Marchi ◽  
D Obrist ◽  
E Buffle
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Energy Loss ◽  
Particle Tracking Velocimetry ◽  
Ascending Aorta ◽  
Low Flow ◽  
Mean Flow ◽  
Flow Rates ◽  
Stenosis Severity

Abstract Introduction Patients suffering from low-flow, low-gradient aortic stenosis present a decreased stroke volume due to decreased contraction or relaxation function of the left ventricle. As a low stroke volume tends to cause a low transvalvular flow, transvalvular pressure gradient (TVPG) and effective orifice area, the clinician cannot rely on those parameters with confidence for the evaluation of aortic stenosis severity. Hence new diagnostic parameters have to be developed. Energy loss through turbulence associated with aortic stenosis represented the wasted left ventricle work. Currently, echocardiographic measurement of the turbulence intensity is not validated for clinical evaluations of aortic stenosis. Methods Two porcine aortic valves were harvested and inserted in a flow loop that replicates the pulsatile flow of the heart. A stiffening of the valves was achieved by treating them with formaldehyde. The stiffening was externally confirmed by a custom-made force-displacement device quantifying the rigidity of the leaflet yielding two stiffness grades per valve. Each valve was tested under three different mean flow rates (1, 2.5, and 4 l/min) at each of the two stiffness grades. Moreover the pressure in the left ventricle chamber and in the aortic chamber was recorded to calculate the TVPG. Particle tracking velocimetry measurements into the transparent silicone ascending aorta phantom allowed the computation of the turbulent kinetic energy (TKE), to evaluate the energy loss due to turbulence. Results We could confirm the enhanced rigidity of the valve leaflets with our custom device (data not shown) and measure a consistent increase in TVPG across all mean flow rates between the two stiffness grades. Moreover, an explicit increase of the TKE in the aortic phantom could be measured after the stiffening process (73.1% under 1 l/min, and 43% under both 2.5 and 4 l/min). In addition, a good correlation (R = 0.86) between the mean TVPG and the TKE was found. Conclusions This project demonstrated the possibility of quantifying the energy loss attributed to turbulence for porcine valves in vitro for native and added stiffness grade. This project lays the foundation for the development of a new diagnostic tool for the assessment of stenosis severity in patients with low-flow, low-gradient aortic stenosis in cardiac imaging tool such as echocardiography. FUNDunding Acknowledgement Type of funding sources: None. TVPG and its correlation with TKE Intensity graphs of the TKE

scholarly journals P1489 Late cardiovascular manifestations of Gregg syndrome: Importance of multimodal imaging approach to optimize diagnosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S A Higuera Leal ◽  
O M Perez-Fernandez ◽  
A Bernal ◽  
S Gallo-Bernal ◽  
J F Forero ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Pulmonary Artery ◽  
Peak Velocity ◽  
Multimodality Imaging ◽  
Ascending Aorta ◽  
Pulmonary Artery Stenosis ◽  
Aortic Pseudoaneurysm ◽  
Valvular Aortic Stenosis ◽  
The Right

Abstract Background Congenital rubella syndrome, also known as Gregg syndrome (after Dr. Norman Gregg’s first description in 1941) is a variable constellation of multisystemic manifestations caused by rubella intrauterine infection. In this case, a patient known to have Gregg syndrome underwent trans-thoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) for optimizing the characterization and determining the status of her disease. Case report A 31-year-old female attends routine cardiology outpatient clinic prior initiation of pregnancy due to prior history of Gregg syndrome. Extent of disease includes congenital cataracts, neurosensorial bilateral hearing loss, supra-valvular aortic stenosis (treated percutaneously at age 4 with a subsequent aortic root reconstruction with homograft at age 6) and pulmonary artery stenosis (status-post surgical correction followed by angioplasty at age 9). The patient was asymptomatic with functional class NYHA I and was taking no medication. A TTE was requested which showed a left ventricle with low-normal systolic function. At the pulmonary valve, she had a residual peak velocity and mean gradient of 2.6 m/sec and 15 mmHg, respectively, with moderate regurgitation; the right ventricle was dilated with mild systolic dysfunction. Doppler evaluation of the ascending aorta revealed a peak velocity of 3,5 m/sec and a mean gradient of 30 mmHg (Figure 1a). Anatomical evaluation was limited because of the acoustic window but due to the cited hemo-dynamics, a CMR was requested for further characterization of her disease prior to pregnancy. CMR showed a normal sized left ventricle with an ejection fraction of 62%, without late gadolinium enhancement. The right pulmonary artery lumen was diminished, probably corresponding to an artifact due to previous stent angioplasty. In the ascending aorta there was residual supra-valvular aortic stenosis 9 mm from the sino-tubular junction with an adjacent, non-mobile, 33 x 39 x 20 mm mass, anterior to the aorta and immediately posterior to the sternum, consistent with aortic pseudoaneurysm (Figure 1b). Due to this finding pregnancy was discouraged, and she was referred to the Cardiovascular Surgery for aortic pseudoaneurysm correction. Conclusion Although infrequent because of successful worldwide vaccination policies, sporadic cases of Gregg syndrome can still be seen, especially in neglected populations with poor access to health services or in unvaccinated patients. Long-term follow-up of all patients undergoing repair procedures is warranted for evaluation of late occurring complications. This case underscores the importance of multimodality imaging for a complete anatomical and functional diagnosis of complex cardiovascular conditions. Abstract P1489 Figure 1

scholarly journals Supravalvulaire Aortic Stenosis: Case Report

2020 ◽  
pp. 07-11
Author(s):  
Redha Lakehal ◽  
Soumaya Bendjaballah ◽  
Khaled Khacha ◽  
Baya Aziza ◽  
Abdelmallek Brahami
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Coronary Sinus ◽  
Congenital Heart ◽  
Surgical Techniques ◽  
Dacron Patch ◽  
Aortic Root Enlargement ◽  
One Year

Introduction: Exceptional congenital heart disease (1 for 26000 birth) characterized by rétrécissement of aortic light. It can be isolated or part of William syndrome. The diagnosis is based on echocardiography. The intervention consists of an aortic root enlargement with Dacron patch. Surgery was indicated if gradient aortic left ventricle Superior of 50 mm hg. This clinical case is for us an opportunity to recall of this type of congenital aortic retrécissement. Methods: We reported the observation of patient 17-year-old without history presented since one-year dyspnea on exersion, palpitation and syncopes. Physical examination: murmur systolic in aortic home without other abnormalities. Chest X ray: CTI: 0.48., ECG: RSR with HVL. Echocardiography: supravalvulaire aortic stenosis; mean gradient AO-LV: 46 mm hg, LV -aortic; LV 48/26 mm + HLV, RV: 20 mm. Exploration per-opératoire: hipoplasie of the left coronary sinus, anomaly of implantation of antero -external pillar of mitral valve, aortic bicuspidie type 1, absence of coronary anomalies. It has benefit under cardio-pulmonary bypass an enlargement of the left coronary sinus according to DOTY technique with Dacron patch and conservation of aortic valve. Results: The immediate post-operative suites were favoured with gradient aortic –left ventricle drop to 20 mm hg. Conclusion: This is very rare congenital heart disease; echocardiography remains the key of diagnosis. It must be operated early. The prognostic is enhanced by the advances in surgical techniques. The treatment consists of surgery. Keywords: Supravalvulaire aortic stenosis; Surgery; Cardiopulmonary bypass

scholarly journals Comparison of the geometry of the left ventricle outflow tract, the aortic root and the ascending aorta in patients with severe tricuspid aortic stenosis versus healthy controls

2019 ◽  
Vol 36 (2) ◽  
pp. 357-366
Author(s):  
Małgorzata Nieznańska ◽  
Karina Zatorska ◽  
Patrycjusz Stokłosa ◽  
Małgorzata Ryś ◽  
Piotr Duchnowski ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Aortic Root ◽  
Ascending Aorta ◽  
Outflow Tract ◽  
Aortic Annulus ◽  
Healthy Controls ◽  
Sinus Of Valsalva ◽  
Root Volume ◽  
Imaging Geometry

Abstract The purpose of this study was to assess by multislice computed tomography (MSCT) imaging geometry of the ascending aorta, the aortic root, the aortic annulus and the left ventricle outflow tract (LVOT) in aortic stenosis (AS) patients, to compare aortic root morphology in patients with AS with healthy controls and to evaluate sex differences. Fifty patients with severe AS and 50 age- and gender-matched controls who underwent MSCT were included in the study. The dimensions of the LVOT, the aortic annulus, the aortic root, the ascending aorta, and the volume of the aortic root were retrospectively assessed and a comparison was made between patients with severe tricuspid AS and controls. Patients with tricuspid AS in comparison with controls had smaller dimensions of the sinus of Valsalva resulting in reduction of the aortic root volume, whereas the dimensions of the other structures were comparable. MSCT revealed larger annular, LVOT and the sinus of Valsalva dimensions and the aortic root volume in men than women. Men with AS differed from healthy men only in regard to the dimensions of the sinus of Valsalva, while women showed significant differences also in the LVOT, and the aortic annulus. MSCT showed accurately aortic root remodeling in tricuspid AS patients and indentified sex-dependent differences. Women with tricuspid AS differ from healthy women more than men did. A high degree of the variability in the aortic root dimensions requires further careful research.

Origin of great cardiac vein and coronary sinus drainage within the left ventricle

1976 ◽  
Vol 230 (2) ◽  
pp. 486-492 ◽  
Author(s):  
DL Roberts ◽  
HK Nakazawa ◽  
FJ Klocke
Keyword(s):  
Steady State ◽  
Left Ventricle ◽  
Coronary Sinus ◽  
Marginal Vein ◽  
Great Cardiac Vein ◽  
Before And After ◽  
Arterial Inflow ◽  
Sinus Drainage ◽  
Relationship Of ◽  
The Relationship

The relative contributions of left anterior descending (LAD) and left circumflex (LC) arterial inflow to blood sampled at various points within the great cardiac vein (GCV) and coronary sinus (CS) have been investigated in open-chest dogs. Dissolved helium (He) and hydrogen (H2) were infused into external circuits perfusing the LAD and LC, respectively, and their steady-state concentrations were measured chromatographically at various points within the GCV and CS. Under basal conditions GCV H2 averaged only 5% of mid-CS H2 and did not change greatly during alterations of preload and afterload or during selective LAD or LC obstruction and vasodilation. The relationship of mid-CS He to GCV. He was more variable under basal conditions and changed noticeably during selective changes in LAD or LC inflow. Appreciable amounts of He were present consistently in left marginal vein drainage. We conclude that: 1) GCV blood is remarkably free of LC inflow in both normal and abnormal physiological states; 2) the origin of mid-CS blood is more variable, both from animal to animal and in individual animals before and after interventions; 3) a portion of LAD drainage normally reaches the CS through circumflex venous branches rather than the GCV.

Prosthetic creation of a double outlet left ventricle: Clinical experience of five cases

1980 ◽  
Vol 3 (3) ◽  
pp. 181-188
Author(s):  
M. Cotrufo ◽  
G.A. Nappi ◽  
A. d'Angelo ◽  
M. Scar-done ◽  
F. de Vivo
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Thoracic Aorta ◽  
Clinical Experience ◽  
Abdominal Aorta ◽  
Ascending Aorta ◽  
Late Mortality ◽  
Cerebral Bleeding ◽  
Extracardiac Conduit ◽  
Subaortic Membrane

Five clinical cases were treated with the implantation of an apical-aortic conduit. Two adult patients were affected by obstructive myocardiopathy associated to subaortic membrane in one case, and three children by different forms of aortic stenosis (subaortic tunnel in one case; subaortic tunnel associated to severe coartation of the thoracic aorta in one case; aortic annulus hypoplasia in one case). A double outlet left ventricle has been created in all cases by implanting a composite prosthesis between the apex of the left ventricle and the aorta. The extracardiac conduit consisted of an apical curved connector and a valved dacron tubular prosthesis. The site of implantation was the supraceliac abdominal aorta in three cases and the ascending aorta in two cases. All patients survived the operation and one late mortality was observed for cerebral bleeding. The surviving patients have been restudied with satisfactory data.

A Novel Approach: Trans-ascending Aorta Balloon Aortic Valvuloplasty via Sternotomy for Treating Severe Valvular Aortic Stenosis in a Low-Weight Infant

2014 ◽  
Vol 17 (1) ◽  
pp. 25 ◽  
Author(s):  
Lei Gao ◽  
Qin Wu ◽  
Xinhua Xu ◽  
Tianli Zhao ◽  
Wancun Jin ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Severe Aortic Stenosis ◽  
Ascending Aorta ◽  
Balloon Aortic Valvuloplasty ◽  
Congenital Aortic Stenosis ◽  
Novel Approach ◽  
Low Weight ◽  
Aortic Valvuloplasty ◽  
Peak Gradient

<p><b>Background:</b> Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty.</p><p><b>Methods:</b> The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe aortic stenosis (peak gradient was 103 mmHg) was successfully treated with a novel approach, that is trans-ascending aorta balloon aortic valvuloplasty guided by transesophageal echocardiography.</p><p><b>Results:</b> The patient tolerated the procedure well, and no major complications developed. After the intervention, transesophageal echocardiography indicated a significant reduction of the aortic valvular peak gradient from 103 mmHg to 22 mmHg, no aortic regurgitation was found. Eighteen months after the intervention, echocardiography revealed that the aortic valvular peak gradient had increased to 38 mmHg and that still no aortic regurgitation had occurred.</p><p><b>Conclusions:</b> In our limited experience, trans-ascending aorta balloon aortic valvuloplasty for severe aortic stenosis under transesophageal echocardiography guidance effectively reduces the aortic peak gradient. As this is a new procedure, long-term follow up and management will need to be established. It may be an alternative technique to treat congenital aortic stenosis in low-weight patients.</p>

scholarly journals Congenital fistula between left ventricle and coronary sinus.

Heart ◽  
1981 ◽  
Vol 45 (1) ◽  
pp. 101-104 ◽  
Author(s):  
K M McGarry ◽  
J Stark ◽  
F J Macartney
Keyword(s):  
Left Ventricle ◽  
Coronary Sinus ◽  
Congenital Fistula
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