scholarly journals Are Outcomes of Surgical Versus Transcatheter Balloon Valvotomy Equivalent in Neonatal Critical Aortic Stenosis?

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Brian W. McCrindle ◽  
Eugene H. Blackstone ◽  
William G. Williams ◽  
Rekwan Sittiwangkul ◽  
Thomas L. Spray ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Aortic Valve Stenosis ◽  
Balloon Dilation ◽  
Left Ventricular ◽  
Critical Aortic Stenosis ◽  
Significant Difference ◽  
Initial Procedure ◽  
Second Procedure

Background For neonates with critical aortic valve stenosis who are selected for biventricular repair, valvotomy can be achieved surgically (SAV) or by transcatheter balloon dilation (BAV). Methods and Results Data regarding 110 neonates with critical aortic valve stenosis were evaluated in a study by the Congenital Heart Surgeons Society from 1994 to 1999. Reduced left ventricular function was present in 46% of neonates. The initial procedure was SAV in 28 patients and BAV in 82 patients. Mean percent reduction in systolic gradient was significantly greater with BAV (65±17%) than SAV (41±32%; P <0.001). Higher residual median gradients were present in the SAV versus BAV group (36 mm Hg [range, 10 to 85 mm Hg] versus 20 mm Hg [0 to 85 mm Hg], P <0.001). Important aortic regurgitation was more often present after BAV (18%) than SAV (3%; P =0.07). Time-related survival after valvotomy was 82% at 1 month and 72% at 5 years, with no significant difference for SAV versus BAV, even after adjustment for differences in patient and disease characteristics. Independent risk factors for mortality were mechanical ventilation before valvotomy, smaller aortic valve annulus ( z score), smaller aortic diameter at the sinotubular junction ( z score), and a smaller subaortic region. A second procedure was performed in 46 survivors. Estimates for freedom from reintervention were 91% at 1 month and 48% at 5 years after the initial valvotomy and did not differ significantly between groups. Conclusions SAV and BAV for neonatal critical aortic stenosis have similar outcomes. There is a greater likelihood of important aortic regurgitation with BAV and of residual stenosis with SAV.

The carotid arterial approach for balloon dilation of critical aortic stenosis in neonates—immediate results and follow-up

1995 ◽  
Vol 5 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Sandra Giusti ◽  
Adele Borghi ◽  
Sofia Redaelli ◽  
Philipp Bonhoeffer ◽  
Isabella Spadoni ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Balloon Dilation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Critical Aortic Stenosis ◽  
The Right

SummaryBalloon dilation of the aortic valve was performed in 20 consecutive neonates with critical aortic stenosis using an approach achieved by cutting down on the right carotid artery. The age of the patients ranged from one to 25 days (mean seven days) and their weight from 2.1 to 4.0 kg (mean 3.16 kg). All patients were evaluated before cardiac catheterization with cross-sectional and Doppler echocardiography so as to keep the catheterization procedure as short as possible. Balloon dilation was accomplished in all patients. The only complication was an apical perforation by the guide wire in two cases. The ensuing pericardial effusion was immediately drained with pericardiocentesis and the subsequent course of the procedure was uneventful. Immediate results showed dramatic improvement in cardiovascular conditions. The transvalvar pressure gradient fell from 80±40 to 27±20 mm Hg (p<0.001). Left ventricular ejection fraction evaluated by echocardiography increased from 30±21% before dilation to 54±18% 24-48 hours after the procedure (p<0.001). In all patients, the procedure was free from vascular complications. Aortic regurgitation was documented after the procedure in 11 patients, being severe in one, moderate in five and trivial in five. Seven patients died, although in only one was the death related directly to the procedure itself. Six patients died because of associated lesions despite an immediate satisfactory result of the balloon valvoplasty. The 13 surviving patients are doing well, and are receiving no medications. During a mean follow-up of 25 months (range 2-54 months), four patients have developed restenosis. One underwent surgical valvotomy at one year of age. The second was successfully redilated through the same approach at two months of age. The other two have a significant gradient, as assessed by Doppler measurements (60 and 70 mm Hg), with normal systolic ventricular function. Two patients have moderate aortic regurgitation. Balloon dilation achieved through cutdown on the right carotid artery is a safe and effective alternative to surgery in neonates with isolated aortic stenosis. The unfavorable results are mainly due to associated anomalies.

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.

Impact of Associated Significant Aortic Regurgitation on Left Ventricular Remodeling and Hemodynamic Impairment in Severe Aortic Valve Stenosis

Cardiology ◽  
2013 ◽  
Vol 124 (3) ◽  
pp. 174-181 ◽  
Author(s):  
Andreea Catarina Popescu ◽  
Francesco Antonini-Canterin ◽  
Roxana Enache ◽  
Gian Luigi Nicolosi ◽  
Rita Piazza ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Aortic Valve Stenosis ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Hemodynamic Impairment

scholarly journals The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis

2016 ◽  
Vol 310 (11) ◽  
pp. H1801-H1807 ◽  
Author(s):  
Ikechukwu Okafor ◽  
Vrishank Raghav ◽  
Prem Midha ◽  
Gautam Kumar ◽  
Ajit Yoganathan
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Left Heart ◽  
Transmitral Flow ◽  
Transcatheter Aortic Valve ◽  
Diastolic Stiffness ◽  
Four Levels

Acute aortic regurgitation (AR) post-chronic aortic stenosis is a prevalent phenomenon occurring in patients who undergo transcatheter aortic valve replacement (TAVR) surgery. The objective of this work was to characterize the effects of left ventricular diastolic stiffness (LVDS) and AR severity on LV performance. Three LVDS models were inserted into a physiological left heart simulator. AR severity was parametrically varied through four levels (ranging from trace to moderate) and compared with a competent aortic valve. Hemodynamic metrics such as average diastolic pressures (DP) and reduction in transmitral flow were measured. AR index was calculated as a function of AR severity and LVDS, and the work required to make up for lost volume due to AR was estimated. In the presence of trace AR, higher LVDS had up to a threefold reduction in transmitral flow (13% compared with 3.5%) and a significant increase in DP (2-fold). The AR index ranged from ∼42 to 16 (no AR to moderate AR), with stiffer LVs having lower values. To compensate for lost volume due to AR, the low, medium, and high LVDS models were found to require 5.1, 5.5, and 6.6 times more work, respectively. This work shows that the LVDS has a significant effect on the LV performance in the presence of AR. Therefore, the LVDS of potential TAVR patients should be assessed to gain an initial indication of their ability to tolerate post-procedural AR.

scholarly journals Effect of persistence of left ventricular hypertrophy and left atrial dilatation after aortic valve replacement on early outcomes and survival: a prospective study

2019 ◽  
Vol 6 (10) ◽  
pp. 3786
Author(s):  
Hari Krishna Murthy P. ◽  
Abha Chandra
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Ventricular Hypertrophy ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Significant Difference ◽  
A Prospective Study

Background: The objective of the study was to evaluate the early outcomes and survival in patients with severe aortic stenosis associated with concentric left ventricular hypertrophy following aortic valve replacement.Methods: This is a prospective study done at SVIMS, Tirupati, from June 2014 to September 2015 evaluating out comes and survival in patients undergoing primary isolated aortic valve replacement (AVR) for severe aortic stenosis, severe aortic stenosis with mild aortic regurgitation and severe aortic stenosis with moderate aortic regurgitation.Results: A total of 40 cases 26 males and 14 females aged 18 to 60 years (mean age, 48.5±13.4 years) underwent elective AVR. Left ventricular end diastolic diameter (p=0.008) at 6 months, a statistically highly significant difference in left ventricular mass  preoperatively, at discharge, at 3rd and 6th month follow up. The difference in mean left ventricular mass index (LVMI) had declined from 244.425 to 141.100 at 6 months, showing a statistically highly significant difference in LVMI preop, at discharge, at 3rd month and at 6th month follow up.Conclusions: Patients with preoperative increase in LVMI, with large left atrial diameter carries a strong predictor of postoperative mortality for patients undergoing aortic valve surgery. We also conclude that there will be significant regression of LVMI following successful AVR. But, the decrease in LVMI is maximum during early three months and it is minimal though significant in the later course of follow up. 

scholarly journals Balloon Valvuloplasty for Congenital Aortic Stenosis: Experience at a Tertiary Center in a Developing Country

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Fatme A. Charafeddine ◽  
Haytham Bou Houssein ◽  
Nadine B. Kibbi ◽  
Issam M. El-Rassi ◽  
Anas M. Tabbakh ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Developing Country ◽  
Aortic Regurgitation ◽  
Developed Countries ◽  
Left Ventricular ◽  
Complication Rates ◽  
Congenital Aortic Stenosis ◽  
Tertiary Center

Background. Aortic valve stenosis accounts for 3–6% of congenital heart disease. Balloon aortic valvuloplasty (BAV) is the preferred therapeutic intervention in many centers. However, most of the reported data are from developed countries. Materials and Methods. We performed a retrospective single-center study involving consecutive eligible neonates and infants with congenital aortic stenosis admitted for percutaneous BAV between January 2005 and January 2016 to our tertiary center. We evaluated the short- and mid-term outcomes associated with the use of BAV as a treatment for congenital aortic stenosis (CAS) at a tertiary center in a developing country. Similarly, we compared these outcomes to those reported in developed countries. Results. During the study period, a total of thirty patients, newborns (n = 15) and infants/children (n = 15), underwent BAV. Left ventricular systolic dysfunction was present in 56% of the patients. Isolated AS was present in 19 patients (63%). Associated anomalies were present in 11 patients (37%): seven (21%) had coarctation of the aorta, two (6%) had restrictive ventricular septal defects, one had mild Ebstein anomaly, one had Shone’s syndrome, and one had cleft mitral valve. BAV was not associated with perioperative or immediate postoperative mortality. Immediately following the valvuloplasty, a more than mild aortic regurgitation was noted only in two patients (7%). A none-to-mild aortic regurgitation was noted in the remaining 93%. One patient died three months after the procedure. At a mean follow-up of 7 years, twenty patients (69%) had more than mild aortic regurgitation, and four patients (13%) required surgical intervention. Kaplan–Meier freedom from aortic valve reintervention was 97% at 1 year and 87% at 10 years of follow-up. Conclusion. Based on outcomes encountered at a tertiary center in a developing country, BAV is an effective and safe modality associated with low complication rates comparable to those reported in developed countries.

THE TELEMETERED EXERCISE ELECTROCARDIOGRAM IN CONGENITAL AORTIC STENOSIS

PEDIATRICS ◽  
1971 ◽  
Vol 47 (1) ◽  
pp. 31-39
Author(s):  
Katherine H. Halloran
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Stenosis ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Normal Children ◽  
Congenital Aortic Stenosis ◽  
Electrocardiographic Leads ◽  
Response To Exercise ◽  
Exercise Electrocardiogram

Since children with aortic valve stenosis, who are at risk of syncope or sudden death, cannot be identified by the resting electrocardiogram or vectorcardiogram, the exercise electrocardiogram was evaluated and compared with the hemodynamic data obtained during cardiac catheterization. Telemetered exercise electrocardiograms were obtained in 31 children, ages 8 to 18 years, with aortic valve stenosis and in 25 normal children of comparable age. Electrocardiographic leads V1, V5, and V6 were obtained prior to, during, and following exercise on a variable resistance bicycle ergometer. Subjects pedalled until a heart rate of 170 per minute or greater was attained and maintained for at least 2 minutes. An increase in T-wave amplitude was observed in both control children and in those with aortic stenosis. No S-T segment abnormalities were noted in the normal children. Of the 16 patients with peak systolic left ventricular to aortic pressure gradients of less than 50 mm Hg, only one showed a segmental S-T depression. Of the 15 children with aortic valve gradients of 50 to 100 mm Hg, however, all except one showed an S-T segment depression in lead V5 of 2 mm or greater. No correlation between the resting electrocardiogram or the vectorcardiogram and the aortic valve gradient or left ventricular peak systolic pressure could be made. In addition, the abnormal S-T segment response to exercise could not be predicted from or correlated with the resting electrocardiogram. Since an ischemic S-T segment response to exercise was found uniformly in those with the higher gradients, this test appears to have a high degree of specificity in the clinical evaluation of these patients.

Criteria for selection of balloon valvoplasty for treatment of aortic stenosis in neonates

1995 ◽  
Vol 5 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Andrea Donti ◽  
Marco Bonvicini ◽  
Gaetano Gargiulo ◽  
Guido Frascaroli ◽  
Fernando M. Picchio
Keyword(s):  
Aortic Stenosis ◽  
Aortic Root ◽  
Clinical Success ◽  
Balloon Dilation ◽  
Left Ventricular ◽  
Critical Aortic Stenosis ◽  
Anatomical Features ◽  
Echocardiographic Parameters ◽  
Predicting Outcome

SummaryIn 10 neonates with critical aortic stenosis who were treated with balloon dilation, we investigated retrospectively the predictive value for mortality of three echocardiographic parameters: early diastolic mitral valvar diameter, left ventricular end-diastolic diameter, and diameter of the aortic root. Valvoplasty was technically successful in each patient and the peak systolic ejection gradient decreased from 85±42 to 22±13 mm Hg, but clinical success was achieved in only six neonates, with four dying. The diameter of the aortic root was similar in survivors and non-survivors. The mitral valvar diameter and the left ventricular end-diastolic diameter, in contrast, were significantly smaller in non-survivors. The mitral valvar diameter and the left ventricular end-diastolic diameter, in contrast, were significantly smaller in non-survivors. The association of a mitral valvar diameter equal to, or less than, 9 mm with a left ventricular end-diastolic diameter equal to, or less than, 14 mm identified clearly all those who did not survive. In the future, we will recommend patients with these anatomical features for primary Norwood palliation. Neonates with a mitral valvar diameter equal to or greater than 12 mm and a left ventricular end-diastolic diameter equal to or greater than 17 mm, in contrast, are good candidates for balloon dilation. All our patients with these anatomical features survived and are doing well at follow-up (30±14.8 months). Simple echocardiographic measurements, therefore, can help in predicting outcome and choosing the best treatment in neonates with critical aortic stenosis.

scholarly journals The outcome and prognosis following the surgical intervention in patients with severe aortic stenosis with respecttothe presence and severity of associated aortic regurgitation

2004 ◽  
Vol 132 (7-8) ◽  
pp. 219-229
Author(s):  
Suad Catovic ◽  
Petar Otasevic ◽  
Milutin Miric ◽  
Aleksandar Neskovic ◽  
Zoran Popovic
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Functional Capacity ◽  
Surgical Intervention ◽  
Severe Aortic Stenosis ◽  
Nyha Class ◽  
Left Ventricular ◽  
Class Iii

INTRODUCTION It is not clear whether associated aortic regurgitation (AR) should be regarded as a risk factor in patients undergoing surgery for severe aortic stenosis (AS). Some authors have suggested that morbidity and mortality are increased in these patients as compared to patients operated for pure AS, whereas others have found no difference of the outcome and prognosis between these groups. OBJECTIVE This study made an attempt to compare the outcome and prognosis following the surgical intervention in patients with severe AS and associated AR and those operated for pure AS, as well as to determine predictive value of clinical, functional and echocardiographic data for the outcome of surgery. METHODS Study population consisted of 122 consecutive patients operated at Dedinje Cardiovascular Institute during 1999 due to severe AS, defined as mean gradient over aortic valve >30 mmHg. The patients were divided into AS group (63 patients with AS without AR or with mild AR) and AS+AR group (59 patients with AS and moderate, severe or very severe AR). The patients were subjected to control clinical, functional and echocardiographic examinations 12 and 18 months following the surgery. RESULTS AND DISCUSSION Preoperatively, the patients in AS group were older and had coronary artery disease more frequently, whereas patients in AS+AR group had higher left ventricular volumes and mass. Preoperative NYHA class, ejection fraction, mean gradient over aortic valve, type and size of the implanted mechanical prosthesis, and the incidence of associated coronary artery bypass surgery were similar between the groups. Similarly, the operative mortality was similar in AS and AS+AR groups (1.6% vs 8.5%, respectively, p=0.11). Twelve months postoperatively, there were no difference of average NYHA class and NYHA class III/ IV between the groups. The patients in AS+AR group were unable to walk >300 meters on 6 minute walk test more frequently than those in AS group (64% vs. 36%, respectively; p=0.043). Eighteen months postoperatively, NYHA class III/IV was found more frequently in AS+AR than in AS group (26% vs. 8%, respectively; p=0.0343). In patients with associated AR, there was no difference of NYHA class with respect to the severity of AR (p=0.815). Multivariate analysis found the association of more than mild AR as an independent predictor of poor functional capacity, irrespective of its severity. CONCLUSION Patients with severe AS and associated AR have poorer postoperative functional capacity as compared to patients operated for pure AS.

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