Abstract 5863: Rate and Correlates of Aortic Regurgitation Progression in a Cohort of 4128 Patients with Mild or Mild to Moderate Aortic Regurgitation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Reena Patel ◽  
Ashvin Kamath ◽  
Padmini Varadarajan ◽  
Srikanth Krishnan ◽  
Ramdas G Pai
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Clinical Decision Making ◽  
Aortic Surgery ◽  
Clinical Decision ◽  
The Elderly ◽  
List Type ◽  
Average Increase

Background : Though the natural history of aortic stenosis is well studied, rate of progression of aortic regurgitation (AR) is not clear. This information is valuable for clinical decision making in patients with milder degrees of AR undergoing non aortic valve cardiac surgery. Methods : Our echocardiographic database between the years 1993 and 2007 was screened for patients with 1 or 2+ AR who had follow up echocardiograms at least 3 months later. AR severity was graded 1–4 based on standard criteria. A change in AR grade was annualized. Results : Of the 4128 patients, 3266 had 1+ and 862 had 2+ AR on the initial echocardiogram: age was 67±15 years, duration of follow up 4.2±2.7 years. Of those with 1+ AR on the initial echocardiogram, 95% had no change over a mean interval of 4.2 years and 2% increased the grade by ≥1+ per year. The average increase in AR grade was 0.04 per year. Of those with 2+ AR on initial echo, 90% had no change over this period and 2% increased the grade by ≥1+ per year. The average increase in grade was 0.07 per year. In the whole cohort, the AR progression correlated positively with age (p=0.03), ventricular septal thickness (p<0.0001), stroke distance (p=0.0003), increased transaortic velocity (p=0.01) and gradient (0.01) and initial AR severity (p<0.0001). Conclusions : The rate of AR progression is extremely slow and prophylactic aortic valve replacement during non aortic surgery may not be indicated in those with 1 or 2+ AR. AR progression seems to be higher in the elderly and those with aortic stenosis, higher cardiac output and greater AR severity. On the average, it would take 25 years to progress from grade 1+ to 2+ AR and 14 years to progress from grade 2+ to 3+ assuming linear progression.

scholarly journals The Immediate And Intermediate Results Of Percutaneous Balloon Aortic Valvuloplasty In Patients With Congenital Valvular Aortic Stenosis

2019 ◽  
Vol 13 (2) ◽  
pp. 51-55
Author(s):  
Hussein A. Alwahab
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Pressure Gradient ◽  
Aortic Regurgitation ◽  
Balloon Aortic Valvuloplasty ◽  
Maximum Peak ◽  
Percutaneous Balloon ◽  
Aortic Valvuloplasty ◽  
Valvular Aortic Stenosis

Background: Aortic valve stenosis results from minor to severe degrees of aortic valve maldevelopment. This stenosis causes mild to severe obstruction of the left ventricular outflow . Objectives : to study the immediate and intermediate results of percutaneous balloon aortic valvuloplasty in patients with congenital valvular aortic stenosis . Type of the study: A prospective study. Methods: The study was done on thirty five patients with congenital valvular aortic stenosis who had percutaneous balloon aortic valvuloplasty  in Ibn Al- Bitar Center for Cardiac Surgery from May 2009 to February 2011. Results: Twenty seven patients were male (77.2%) and 8 patients were female (22.8%), male to female ratio 3.5/ 1, . The aortic valve was bicuspid in 18 patients (51.4%) while 17 patients ( 48.6%) had tricuspid aortic valve. Balloon aortic valvuloplasty was successful in 30 patients (85.7%),. Maximum peak instantaneous Doppler pressure gradient across the aortic valve 24 hours postprocedural echocardiography showed reduction which is statistically significant. New aortic regurgitation had occurred in 15 patients ( 42.8%), it was mild in 9 patients ( 25.6%), moderate in 5 patients ( 14.3%) and severe in 1 patient( 2.9%) which is statistically significant. The follow up of 12.57 ± 3.88 ( 3- 22) months after intervention was done for all patients using echocardiography Doppler study, reveal the maximum peak instantaneous Doppler pressure gradient  across the aortic valve was raised  which is statistically significant. The aortic regurgitation was present in 18 patients (51.4%) , it was mild in 9 patients (25.7%) , moderate in 6 patients (17.1%) and severe in 3 patients  ( 8.6%). No mortality had been reported during the procedure or on follow up.                                                                                  Conclusion: Aortic balloon valvuloplasty is safe and effective procedure in the treatment of congenital valvular aortic stenosis but mild aortic regurgitation is the most common immediate complication of aortic balloon dilatation and progressive aortic regurgitation is a major problem during the intermediate 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.

Bicuspid aortic valve disease and competitive sports: key considerations and challenges

2019 ◽  
pp. 233-238
Author(s):  
Benjamin S. Wessler ◽  
Natesa G. Pandian
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Bicuspid Aortic Valve ◽  
Aortic Dilation ◽  
Valvular Stenosis ◽  
Valvular Function ◽  
A Minor ◽  
Valve Lesion

Bicuspid aortic valve (BAV) is a common congenital disorder. It could simply be a minor anatomic abnormality or be associated with progressive aortic stenosis, aortic regurgitation, and aortic dilation. If an athlete is recognized to have a BAV, questions arise with regard to whether they can pursue their selected sports, particularly elite athletic activity, and what type of follow-up examinations are necessary and how often should be done. Valvular disorders such as the degree of aortic stenosis and aortic regurgitation, aortic size, and coexisting disorders are also influencing factors. The absence of robust controlled studies, which are difficult to perform, make decision-making difficult, although recommendations by expert panels provide some guidance. The general consensus is that athletes with BAV with normal valvular function and no aortic dilation can participate in all athletic activities. Those with mild aortic dilation should undergo annual screening, some more frequently than others. Those with moderate or severe valvular stenosis or regurgitation should be managed based on the haemodynamic impact of the valve lesion. Athletes with coexisting lesions or syndromes should be evaluated comprehensively. The overall recommendation to an individual athlete should incorporate many factors and employ a multidisciplinary approach.

scholarly journals Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

2021 ◽  
Vol 10 (16) ◽  
pp. 3745
Author(s):  
Gloria Santangelo ◽  
Andrea Rossi ◽  
Filippo Toriello ◽  
Luigi Paolo Badano ◽  
David Messika Zeitoun ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Decision Making ◽  
Left Ventricular Systolic Dysfunction ◽  
Imaging Techniques ◽  
Systolic Dysfunction ◽  
Clinical Decision ◽  
Left Ventricular ◽  
Heart Valve Disease ◽  
Optimal Timing

Aortic stenosis is the most common heart valve disease necessitating surgical or percutaneous intervention. Imaging has a central role for the initial diagnostic work-up, the follow-up and the selection of the optimal timing and type of intervention. Referral for aortic valve replacement is currently driven by the severity and by the presence of aortic stenosis-related symptoms or signs of left ventricular systolic dysfunction. This review aims to provide an update of the imaging techniques and seeks to highlight a practical approach to help clinical decision making.

scholarly journals Long-term outcomes in patients undergoing transcatheter aortic valve implantation: insights on clinical outcomes and prognostic markers from a large cohort of patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Munoz-Garcia ◽  
E Munoz-Garcia ◽  
A J Munoz Garcia ◽  
A J Dominguez-Franco ◽  
J H Alonso-Briales ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Outcomes ◽  
Aortic Regurgitation ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Transcatheter Aortic Valve

Abstract   Transcatheter Aortic valve Replacement (TAVR) has emerged as paradigm shift in the treatment of patients with severe symptomatic aortic stenosis. Clinical and performance data on long-term TAVR are still limited. The aim of this study was to determine the survival and the factors predicting mortality after TAVR with the first and second generation of prostheses. Methods From April 2008 to December 2019, the auto-expandible prostheses were implanted in 765 patients with symptomatic severe aortic stenosis with deemed high risk. The first generation prostheses included CoreValve and Accutrak System and the second prostheses included Evolut R and Pro. Results The mean age was 79.4±6.6 years. The logistic EuroSCORE and STS score were 17.1±11% and 5.7±3.9%, respectively. The implantation success rate was 98.87%. In-hospital mortality was 3.7%, and the combined endpoint of death, vascular complications, myocardial infarction or stroke had a rate of 15.1%. The clinical outcomes in according to prosthesis generation were, for pacemaker requirement (CoreValve vs. Accutrak system vs. Evolut R vs. and Evolut pro) 35.3% vs. 26.1% vs. 14.3% vs. 14%, p=0.001; and the paravalvular aortic regurgitation, were: none 28% vs. 44.8% vs. 43.3% vs. 58; mild 40% vs. 32.3% vs. 30.8% vs. 35.2%; moderate 32% vs. 20.3 vs. 23.9% vs. 5.7%; severe 0% vs. 2.6% vs. 0% vs. 1.1, p 0.001 The late mortality (beyond 30 days) was 35.9%. Survival at 1, 3, 5, 7 and 9 years were 88.9%, 76.1%, 61.1%, 44% and 32.6% respectively, after a mean follow-up of 42.3±27 months. The NYHA functional class improved from 3.1±0.6 to 1.77±0.7 in the follow-up. At 5 years, 5 patients had severe prosthetic valve dysfunction (severe stenosis and moderate transvalvular regurgitation The predictors of cumulative mortality were: Charlson index [HR 1.25 (95% CI 1.077–1.461), p=0.004], Readmision Heart Failure [HR 3.02 (95% CI 1.554–5.879), p=0.001], stroke post-TAVR [HR 3.472 (95% CI 1.115–10.53), p=0.032], residual aortic regurgitation [HR 1.45 (95% CI 1.093–1.934), p=0,010], and severe pulmonary hypertension [HR −0.983 (95% CI 0.645–0.423) p=0.032]. Conclusions TAVR is associated with significant survival benefit throughout 3.09 years of follow-up. Survival during follow-up depends particularly among patients with associated comorbidities and cardiac markers such as aortic regurgitation or pulmonary hypertension FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Multimodality Imaging for Discordant Low-Gradient Aortic Stenosis: Assessing the Valve and the Myocardium

2020 ◽  
Vol 7 ◽  
Author(s):  
Ezequiel Guzzetti ◽  
Mohamed-Salah Annabi ◽  
Philippe Pibarot ◽  
Marie-Annick Clavel
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Decision Making ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Significant Proportion ◽  
Clinical Decision ◽  
Myocardial Remodeling ◽  
Positron Emission ◽  
Detailed Assessment

Aortic stenosis (AS) is a disease of the valve and the myocardium. A correct assessment of the valve disease severity is key to define the need for aortic valve replacement (AVR), but a better understanding of the myocardial consequences of the increased afterload is paramount to optimize the timing of the intervention. Transthoracic echocardiography remains the cornerstone of AS assessment, as it is universally available, and it allows a comprehensive structural and hemodynamic evaluation of both the aortic valve and the rest of the heart. However, it may not be sufficient as a significant proportion of patients with severe AS presents with discordant grading (i.e., an AVA ≤ 1 cm2 and a mean gradient &lt;40 mmHg) which raises uncertainty about the true severity of AS and the need for AVR. Several imaging modalities (transesophageal or stress echocardiography, computed tomography, cardiovascular magnetic resonance, positron emission tomography) exist that allow a detailed assessment of the stenotic aortic valve and the myocardial remodeling response. This review aims to provide an updated overview of these multimodality imaging techniques and seeks to highlight a practical approach to help clinical decision making in the challenging group of patients with discordant low-gradient AS.

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