Abstract 6143: Regression of Aortic Valve Stenosis by ApoA-I Mimetic Peptide Infusions in Rabbits

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
David Busseuil ◽  
Yanfen Shi ◽  
Mélanie Mecteau ◽  
Geneviéve Brand ◽  
Teodora Avram ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Stenosis ◽  
White Male ◽  
Treated Group ◽  
Saline Control ◽  
Control Group ◽  
Clinical Approach ◽  
Aortic Valve Area ◽  
Mimetic Peptide

Purpose : Aortic valve stenosis is the most common valvular heart disease, and standard curative therapy remains open-heart surgical valve replacement. The aim of our experimental study was to determine if ApoA-I mimetic peptide infusions could induce regression of aortic valve stenosis. Methods : Twenty-seven New-Zealand White male rabbits received a cholesterol-enriched diet and vitamin D 2 until significant aortic valve stenosis was detected by echocardiography. The enriched diet was then stopped to mimic cholesterol-lowering therapy and animals were randomized to receive saline (control group, n =14) or an ApoA-I mimetic peptide (treated group, n =13), 3 times per week for 2 weeks. Serial echocardiograms and post mortem valve histology were performed. Results : Aortic valve area improved significantly in the treated group compared to controls after 7 days (20.9±0.9 mm 2 vs. 18.2±0.6 mm 2 , P <0.0001) (corresponding to increases of 15.9% and 1.9%), 10 days (21.5±1.0 mm 2 vs. 19.5±0.6 mm 2 , P =0.0032) (increases of 19.2% vs. 9.1%), and 14 days of treatment (22.4±0.9 mm 2 vs. 20.4±0.6 mm 2 , P =0.0028) (increases of 24.4% vs. 14.2%). Likewise, aortic valve thickness decreased by 19% after 14 days of treatment in the treated group (0.951±0.070 mm at baseline vs. 0.768±0.074 mm at follow-up) whereas it was unchanged in controls ( P <0.0001). Histological analysis revealed that lesion extent at the base of valve leaflets and sinuses of Valsalva was smaller in the treated compared to control group (52.8±12.5% vs. 66.7±9.9%, P =0.032). The ApoA-I mimetic peptide treatment also leads to a reduction in aortic valve calcifications as revealed by the loss of the positive relationship observed in the control group ( r =0.87, P =0.004) between calcifications area and aortic valve thickness. Conclusions : Infusions of an ApoA-I mimetic peptide lead to regression of experimental aortic valve stenosis. These positive results justify the further testing of HDL-based therapies in patients with valvular aortic stenosis. Regression of aortic stenosis, if achieved safely, could transform our clinical approach of this disease.

scholarly journals Significance of transesophageal echocardiography in the evaluation of aortic valve stenosis

2010 ◽  
Vol 67 (1) ◽  
pp. 7-12
Author(s):  
Biljana Prcovic
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Aortic Valve Stenosis ◽  
Clinical Information ◽  
Aortic Valve Area ◽  
Prosthetic Valves ◽  
Dimensional Echocardiography ◽  
Seriously Ill Patients ◽  
Aortic Orifice

Background/Aim. Transesophageal echocardiography (TEE) is a relatively new diagnostic method offering better resolution of cardiac anatomy than the conventional transthoracal two-dimensional echocardiography (TTE). Clinical indications for TEE have been expanding, thus the technique as a diagnostic procedure is used in numerous cardiac diseases such as endocarditis, congenital heart defect, aortic dissection, prosthetic valves dysfunction, as well as in calculation of aortic valve surface in aortic stenosis. The aim of the study was to prove TEE as a more precise method in determination of the level of seriousness of aortic valve stenosis. Methods. All the patients went through TTE and TEE. Evaluating of the aortic valve surface was performed by the use of Gorlin's formula in TTE while it was planimetric in TEE examination. Results. Comparative analysis of all parameters obtained by TTE and TEE showed a difference between them. All the parameters values except that for surface area of the aortic valve orifice confluence were higher in TEE than in TTE examination, but no difference was statistically significant (p > 0.05; t-test for a dependant specimens). By the use of the TTE method, the size of aortic orifice stenosis was 1.22 ? 0.54 cm2, and by the TEE method it was 1.08 ? 0.54 cm2. Conclusion. Multiplain TEE is reliable in quantification of an aortic valve area in patients with aortic stenosis. It offers useful clinical information, particularly in patients with non-adequate evaluation with TTE, as well as in seriously ill patients or those with a confirmed valvular defect.

P3369Impact of global left ventricular afterload, aortic stenosis severity and left ventricular hypertrophy on global myocardial work

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Ilardi ◽  
S Marchetta ◽  
R E Dulgheru ◽  
S Cimino ◽  
G D'Amico ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Stroke Volume ◽  
Speckle Tracking ◽  
Left Ventricular ◽  
Low Flow ◽  
Control Group ◽  
Aortic Valve Area ◽  
Global Work ◽  
Valve Area

Abstract Background Myocardial work (MW) is an innovative tool, that derives from myocardial strain with the advantage to incorporate measurement of deformation and load. Therefore, it could be useful in conditions of increased afterload, such as aortic stenosis (AS). To date, little is known about the changes in MW related to AS severity, left ventricle (LV) geometry and arterial compliance. Purpose We investigated the effect of valvulo-arterial impedance (Zva), stroke volume and LV hypertrophy in patients with AS and preserved LV ejection fraction (EF). Methods We retrospectively analyzed 283 patients (60% males, mean age 71±12 years old) with AS (aortic valve area ≤1.5 cm2) and LVEF≥50%. Exclusion criteria were more than mild associated cardiac valve lesion, left bundle branch block, and suboptimal quality of speckle-tracking image analysis. The control group included 50 patients matched for age and sex. Clinical, demographic and resting echocardiographic data were recorded, including quantification of 2D global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). Results Patients with AS had higher systolic (p=0.017) and diastolic arterial pressure (p=0.007), increased LV wall thickness, mass index (p<0.001) and volumes (p=0.045) compared to controls. Greater indexed left atrial volume, E/e' and trans-tricuspid gradient were also observed in the AS group (p<0.001). As expected, speckle tracking analysis revealed significant lower GLS in AS than in control group (18.7±3.2 vs 20.7±2.1%, p<0.001). Conversely, increased values of GCW and GWI (respectively 2965±647 vs 2360±353 mmHg%, and 2535±559 vs 2005±302 mmHg%, p<0.001) were observed in patients with AS. Besides, GWW was significantly increased in AS vs controls (147±108 vs 90±49 mmHg%, p=0.001), with no changes in terms of GWE (95±4 vs 96±2%, p=0.110). When patients were stratified according to the AS severity, the analysis of variance revealed that GCW, GWI and GWW significantly increased with higher transaortic mean gradient and lower aortic valve area (p<0.001). Also Zva demonstrated to impact on CGW (p=0.040) and GWW (p<0.001), with increased values in presence of increased global LV afterload (Zva>4.5 mmHg/ml/m2). Conversely, patients with low-flow AS (stroke volume index <35 ml/m2) showed lowers values of GCW (p=0.014) and GWI (p=0.001) compared to normal flow AS, but increased GWW (p=0.041) and reduced GWE (93±7 vs 95±4%, p=0.010). Finally, LV geometry didn't influence significantly GCW and GWE, only an increase of GWW was observed in patients with eccentric hypertrophy (p=0.031). Conclusion In patients with AS and preserved LVEF, GLS reduction is accompanied by an increase of GCW, GWI and GWW, without affecting the GWE. These modifications seem to be correlated to the severity of AS, low-flow state and increased global LV afterload but not on the grade of LV hypertrophy.

scholarly journals Diabetes concomitant to aortic stenosis is associated with increased expression of NF-κB and more pronounced valve calcification

Diabetologia ◽  
2021 ◽  
Author(s):  
Magdalena Kopytek ◽  
Piotr Mazur ◽  
Michał Ząbczyk ◽  
Anetta Undas ◽  
Joanna Natorska
Keyword(s):  
Type 2 Diabetes ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bone Morphogenetic Protein 2 ◽  
Control Group ◽  
Aortic Valve Area ◽  
Coagulation Activation ◽  
Valve Calcification

Abstract Aims/hypothesis Type 2 diabetes has been demonstrated to predispose to aortic valve calcification. We investigated whether type 2 diabetes concomitant to aortic stenosis (AS) enhances valvular inflammation and coagulation activation via upregulated expression of NF-κB, with subsequent increased expression of bone morphogenetic protein 2 (BMP-2). Methods In this case–control study, 50 individuals with severe isolated AS and concomitant type 2 diabetes were compared with a control group of 100 individuals without diabetes. The median (IQR) duration of diabetes since diagnosis was 11 (7–18) years, and 36 (72%) individuals had HbA1c ≥48 mmol/mol (≥6.5%). Stenotic aortic valves obtained during valve replacement surgery served for in loco NF-κB, BMP-2, prothrombin (FII) and active factor X (FXa) immunostaining. In vitro cultures of valve interstitial cells (VICs), isolated from obtained valves were used for mechanistic experiments and PCR investigations. Results Diabetic compared with non-diabetic individuals displayed enhanced valvular expression of NF-κB, BMP-2, FII and FXa (all p ≤ 0.001). Moreover, the expression of NF-κB and BMP-2 positively correlated with amounts of valvular FII and FXa. Only in diabetic participants, valvular NF-κB expression was strongly associated with serum levels of HbA1c, and moderately with fructosamine. Of importance, in diabetic participants, valvular expression of NF-κB correlated with aortic valve area (AVA) and maximal transvalvular pressure gradient. In vitro experiments conducted using VIC cultures revealed that glucose (11 mmol/l) upregulated expression of both NF-κB and BMP-2 (p < 0.001). In VIC cultures treated with glucose in combination with reactive oxygen species (ROS) inhibitor (N-acetyl-l-cysteine), the expression of NF-κB and BMP-2 was significantly suppressed. A comparable effect was observed for VICs cultured with glucose in combination with NF-κB inhibitor (BAY 11–7082), suggesting that high doses of glucose activate oxidative stress leading to proinflammatory actions in VICs. Analysis of mRNA expression in VICs confirmed these findings; glucose caused a 6.9-fold increase in expression of RELA (NF-κB p65 subunit), with the ROS and NF-κB inhibitor reducing the raised expression of RELA by 1.8- and 3.2-fold, respectively. Conclusions/interpretation Type 2 diabetes enhances in loco inflammation and coagulation activation within stenotic valve leaflets. Increased valvular expression of NF-κB in diabetic individuals is associated not only with serum HbA1c and fructosamine levels but also with AVA and transvalvular gradient, indicating that strict long-term glycaemic control is needed in AS patients with concomitant type 2 diabetes. This study suggests that maintaining these variables within the normal range may slow the rate of AS progression. Graphical abstract

scholarly journals Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis

2021 ◽  
Author(s):  
Tohru Takaseya ◽  
Atsunobu Oryoji ◽  
Kazuyoshi Takagi ◽  
Tomofumi Fukuda ◽  
Koichi Arinaga ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Stroke Volume Index ◽  
Low Flow ◽  
Volume Index ◽  
Effective Orifice Area ◽  
Aortic Valve Area ◽  
Hemodynamic Performance ◽  
Mid Term Results

AbstractAortic stenosis (AS) is the most common valve disorder in advanced age. Previous reports have shown that low-flow status of the left ventricle is an independent predictor of cardiovascular mortality after surgery. The Trifecta bioprosthesis has recently shown favorable hemodynamic performance. This study aimed to evaluate the effect of the Trifecta bioprosthesis, which has a large effective orifice area, in patients with low-flow severe AS who have a poor prognosis. We retrospectively evaluated 94 consecutive patients with severe AS who underwent aortic valve replacement (AVR). Patients were divided into two groups according to the stroke volume index (SVI): low-flow (LF) group (SVI < 35 ml/m2, n = 22) and normal-flow (NF) group (SVI ≥ 35 ml/m2, n = 72). Patients’ characteristics and early and mid-term results were compared between the two groups. There were no differences in patients’ characteristics, except for systolic blood pressure (LF:NF = 120:138 mmHg, p < 0.01) and the rate of atrial fibrillation between the groups. A preoperative echocardiogram showed that the pressure gradient was higher in the NF group than in the LF group, but aortic valve area was similar. The Trifecta bioprosthesis size was similar in both groups. The operative outcomes were not different between the groups. Severe patient–prosthesis mismatch (PPM) (< 0.65 cm2/m2) was not observed in either of the groups. There were no significant differences in mid-term results between the two groups. The favorable hemodynamic performance of the Trifecta bioprosthesis appears to have the similar outcomes in the LF and NF groups. AVR with the Trifecta bioprosthesis should be considered for avoidance of PPM, particularly in AS patients with LV dysfunction.

True-severe stenosis in paradoxical low-flow low-gradient aortic stenosis: outcomes after transcatheter aortic valve replacement

2021 ◽  
Author(s):  
Taishi Okuno ◽  
Noé Corpataux ◽  
Giancarlo Spano ◽  
Christoph Gräni ◽  
Dik Heg ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Functional Status ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Low Flow ◽  
Aortic Valve Area ◽  
High Gradient ◽  
Transcatheter Aortic Valve

Abstract Aims The ESC/EACTS guidelines propose criteria that determine the likelihood of true-severe aortic stenosis (AS). We aimed to investigate the impact of the guideline-based criteria of the likelihood of true-severe AS in patients with low-flow low-gradient (LFLG) AS with preserved ejection fraction (pEF) on outcomes following transcatheter aortic valve replacement (TAVR). Methods and results In a prospective TAVR registry, LFLG-AS patients with pEF were retrospectively categorized into high (criteria ≥6) and intermediate (criteria &lt;6) likelihood of true-severe AS. Haemodynamic, functional, and clinical outcomes were compared with high-gradient AS patients with pEF. Among 632 eligible patients, 202 fulfilled diagnostic criteria for LFLG-AS. Significant haemodynamic improvement after TAVR was observed in LFLG-AS patients, irrespective of the likelihood. Although &gt;70% of LFLG-AS patients had functional improvement, impaired functional status [New York Heart Association (NYHA III/IV)] persisted more frequently at 1 year in LFLG-AS than in high-gradient AS patients (7.8%), irrespective of the likelihood (high: 17.4%, P = 0.006; intermediate: 21.1%, P &lt; 0.001). All-cause death at 1 year occurred in 6.6% of high-gradient AS patients, 10.9% of LFLG-AS patients with high likelihood [hazard ratio (HR)adj 1.43, 95% confidence interval (CI) 0.68–3.02], and in 7.2% of those with intermediate likelihood (HRadj 0.92, 95% CI 0.39–2.18). Among the criteria, only the absence of aortic valve area ≤0.8 cm2 emerged as an independent predictor of treatment futility, a combined endpoint of all-cause death or NYHA III/IV at 1 year (OR 2.70, 95% CI 1.14–6.25). Conclusion Patients with LFLG-AS with pEF had comparable survival but worse functional status at 1 year than high-gradient AS with pEF, irrespective of the likelihood of true-severe AS. Clinical Trial Registration https://www.clinicaltrials.gov. NCT01368250.

scholarly journals Toll-like-receptor-3 function is critical for aortic valve stenosis development in mice

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.T Niepmann ◽  
A.S Boucher ◽  
M Bulic ◽  
P.R Goody ◽  
F Jansen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Histological Analysis ◽  
Peak Velocity ◽  
Macrophage Infiltration ◽  
Funding Source ◽  
Aortic Valve Area ◽  
Mrna Levels ◽  
Toll Like Receptor ◽  
Age Related

Abstract Background Aortic valve stenosis (AS) is the most common valve diseases in the western world. After having been considered a passive degenerative process, which develops as an inevitable consequence of age-related valvular degeneration, basic research of the last two decades has led to a paradigm shift. It is now believed that AS pathophysiology is driven by distinct molecular and cellular mechanisms which include inflammatory pathways. In recent years, Toll-like-receptor-3 (TLR3) has emerged as a major regulator of vascular inflammation. TLR3 is a lysosomal pattern recognition receptor that recognizes single and double stranded RNA. Its activation leads to expression of pro-inflammatory cytokines via NFkb activation. The role of TLR3 in the development of AS has never been investigated. Methods Severe AS was induced in Wildtype-, ApoE- and TLR3/ApoE−/− mice. For this, a coronary springwire was used to induce an endothelial injury under echocardiographic guidance. Stenosis development was confirmed via ultrasound examinations. To inhibit TLR-3 activation, TLR3/RNA- Complex inhibitor C4a was injected every 48h after wire injury in WT mice. Valves were explanted and stained with hematoxylin/eosin (valve thickening) or anti-68 (macrophage infiltration). Valves from patients who received aortic valve replacement due to AS or aortic regurgitation (AR) were collected and mRNA levels of TLR3 and MyD88 were measured with use of quantitative-PCR. Results To evaluate weather TLR3 effects AS development in mice, we subjected TLR3/ApoE double- and ApoE knockout mice to our model of wire-induced AS. Surprisingly, TLR3 deficient mice failed to develop AS after wire injury. Peak velocity measurements showed no increase and histological analysis showed lower aortic valve area and macrophage infiltration compared to control mice. In order to pharmacological inhibit TLR3, WT mice were treated with C4a after wire injury. Compared to PBS control, C4a mice also did not develop AS upon wire injury. Trans-aortic valve peak velocity levels were significantly lower in C4a mice. Histological analysis underlined these results and showed thinner aortic valves and decreased macrophage infiltration in C4a mice comparted to control animals. To confirm our hypothesis, the expression of TLR3 and its downstream effector MyD88 were measured in human aortic valve specimens. qPCR analysis revealed decreased TLR3 and MyD88 expression in patients with AS compared to patients with AR. Conclusion In the presented study, we present first data that theTLR3 has a crucial role in the development of AS in mice. The exact downstream effects after TLR3 activation in AS need to be further investigated. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)

Loss of smooth muscle SDF-1/CXCL12 leads to cardiac hypertrophy and aortic valve stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.K Ghadge ◽  
M Messner ◽  
H Seiringer ◽  
T Zeller ◽  
D Boernigen ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Cardiac Hypertrophy ◽  
Smooth Muscle Cells ◽  
Aortic Valve Stenosis ◽  
Cardiac Fibrosis ◽  
Muscle Cells ◽  
Funding Source ◽  
Lineage Tracking

Abstract Background Stromal cell-derived factor-1 (SDF-1 or CXCL12) and its receptors CXCR4/CXCR7 have prominent role in cardiovascular development and myocardial repair following ischemic injury. Nevertheless, detailed mechanisms of the cell specific role of SDF-1 are poorly understood. Since SDF-1-EGFP lineage tracking revealed high expression of SDF-1 in smooth muscle cells, we aimed to investigate the cell specific role by generating a smooth muscle cell specific SDF-1 (SM-SDF-1−/−) knockout mouse model. Methods SDF-1 expression was analyzed utilizing SDF-1-EGFP reporter mice. Conditional SM-SDF-1 KO mice were generated using Tagln-Cre; SDF-1fl/fl mice. Hearts were analysed with histology and high-resolution episcopic microscopy. Cardiac function was assessed utilizing echocardiography. RNAseq, qRT-PCR, flow cytometry and western blotting were performed. Cardiac fibrosis, apoptotic index, cell proliferation, aortic valve calcification were analyzed. SM-SDF-1−/− mice were treated with the CXCR7 agonist TC14012 (10mg/kg/I.P). Results SDF-1-EGFP lineage tracking and immunofluorescence revealed high expression of SDF-1 particularly in smooth muscle cells and less frequently in perivascular and endothelial cells. Conditional SM-SDF-1−/− mice showed a high pre- and perinatal mortality (50%). Immunohistochemistry of SM-SDF-1−/− mice revealed severe cardiac hypertrophy, associated with increased cardiac fibrosis, apoptotic cell death, thinned and dilated arteries and significantly decreased M2 like CD11b+/CD206+ cells. Echocardiography confirmed concentric hypertrophy, with decreased stroke volume. As a possible reason for cardiac hypertrophy, SDF-1 mutants exhibited aortic stenosis due to aortic valve thickening associated with downregulation of the SDF-1 co-receptor CXCR7. We further noticed increased plasma levels of SDF-1 in aortic stenosis patients suggesting a cardioprotective role. Transcriptome analyses from KO hearts showed an abnormal extracellular matrix (ECM) remodelling with a specific upregulation of the important valve related proteoglycans Versican, Glycan. Western blot analysis revealed activation of AKT and ERK, whereas CXCR7 expression was significantly downregulated in KO mice. To rescue the phenotype we treated KO mice with the CXCR7 agonist (TC14012) which partially attenuated aortic valve remodelling through activation of the ERK signalling pathway. Conclusion Our data suggest that SDF-1 is critically involved in maintaining the homeostasis of the aortic valve by regulating CXCR7 signalling. Pharmacological activation of CXCR7 might be a promising therapeutic target to limit the progression of aortic valve stenosis. Ghadge_SM-SDF-1−/− Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Austrian Science Fund, Austrian research promotion agency

scholarly journals P1692 The past returns after 20 years: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Habjan ◽  
D Cantisani ◽  
I S Scarfo` ◽  
M C Guarneri ◽  
G Semeraro ◽  
...  
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Valvular Heart Disease ◽  
Radiation Treatment ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Radiation Induced ◽  
Valve Area

Abstract Introduction Radiation therapy is one of the cornerstones of treatment for many types of cancer. These patients can later in life develop cardiovascular complications associated with radiation treatment. Late cardiovascular effects of radiation treatment include coronary artery disease (CAD), valvular heart disease, congestive heart failure, pericardial disease and sudden death. The most common sign of radiation-induced valvular heart disease is the calcification of the intervalvular fibrosa between the aortic and mitral valve. Case presentation A 71-year-old male patient with a history of Non-Hodgkin lymphoma treated with radiotherapy and chemotherapy 20 years ago, CAD, arterial hypertension, diabetes type II, dyslipidemia, obesity and currently smoking presented in the emergency room in our medical facility with acute pulmonary edema. The patient had unstable angina pectoris in 2018, the coronary angiography showed two-vessel disease with a non-significant stenosis of the left main coronary artery (LMCA) and 70% stenosis of the left anterior descending artery (LAD), for which he refused the percutaneous coronary intervention. At the same time, a transthoracic echocardiography (TTE) showed severe aortic stenosis and moderately severe mitral stenosis, at that time the patient refused the operation. After the initial treatment for pulmonary edema, TTE and transesophageal echocardiography (TEE) were performed and showed a tricuspid aortic valve with calcification of the cusps and a very severe aortic stenosis (planimetric aortic valve area 0.74 cm², functional aortic valve area 0.55 cm², indexed functional aortic valve area 0.25 cm²/m², mean gradient 61 mmHg, peak gradient 100 mmHg, stroke volume (SV) 69 ml, stroke volume index (SVI) 31 ml/m², flow rate 221 ml/s, aortic annulus 20x26 mm). The left ventricle was severely dilated (end diastolic volume 268 ml) with diffuse hypokinesia and severe systolic dysfunction (ejection fraction 32%). We appreciated a calcification of the mitral-aortic intervalvular fibrosa and the mitral annulus, without mitral stenosis but with moderate mitral regurgitation. The calcification of the intervalvular fibrosa suggested our final diagnosis of radiation-induced valvular heart disease with a severe aortic stenosis in low-flow conditions. The patient was successfully treated with transcatheter aortic valve implantation (TAVI). Conclusion Radiation-induced heart disease is a common reality and is destinated to raise due to the increasing number of cancer survivors. Effects are seen also many years after the radiation treatment. The exact primary mechanism of radiation injury to the heart is still unknown. The treatment of radiation-induced valve disease is the same as the treatment of valve disease in the general population. Abstract P1692 Figure. Radiation-induced valvular heart disease

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