Abstract 5769: Correlation of Bicuspid Valve Morphology and Pattern of Aortic Root Dilatation: A Substudy of the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin (ASTRONOMER) Study

Bicuspid aortic valve is the leading cause of aortic stenosis in patients younger than the age of 50. A classification scheme of bicuspid aortic valves (BAV) was recently proposed based upon leaflet orientation: Type A (fusion of right and left coronary cusps) and Type B (fusion of right and non-coronary cusps). The correlation between BAV leaflet orientation and aortic root pathology however remains ill defined. To describe a potential relationship between BAV leaflet morphology and aortic root measurements in the ASTRONOMER study, a multicentre study to assess the effect of Rosuvastatin on the progression of AS. Transthoracic echocardiography was performed with 2D and Doppler imaging following a standardized protocol. BAV morphology was classified as Type A or Type B orientation following review of the parasternal short-axis view. Echo measurements including left ventricular and aortic root dimensions were obtained according to the ASE recommendations. We identified 89 patients (56±11 years; 44 males). There were 63 patients with Type A and 26 with Type B BAV. Baseline demographic, hemodynamics, aortic root and left heart dimensions are listed in Table 1 . Patients with Type A BAV had larger aortic and ascending root dimensions than those patients with Type B BAV (p<0.05). Aortic valvular calcification and mitral annular calcification were similar between the two groups. All values are expressed as mean±SD. In patients with mild to moderate asymptomatic BAV, the presence of Type A valve orientation was associated with significantly greater aortic root parameters compared to Type B valve orientation. Whether the morphology of BAV may predict a subset of patients who will respond to statin therapy in preventing the progression of AS remains to be determined upon completion of the ASTRONOMER trial.

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Abstract 2248: Prevalence and Long-term Clinical Significance of Aortic Root Dilatation in Competitive Athletes

Circulation ◽

10.1161/circ.118.suppl_18.s_693-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Fernando M Di Paolo ◽

Elvira De Blasiis ◽

Emanuele Guerra ◽

Cataldo Pisicchio ◽

Filippo M Quattrini ◽

...

Keyword(s):

Clinical Significance ◽

Aortic Root ◽

Large Population ◽

Multivariate Regression Analysis ◽

Left Ventricular ◽

Normal Limits ◽

Competitive Athletes ◽

Clinical Surveillance ◽

Aortic Root Dilatation

OBJECTIVES: Prevalence, clinical significance, and long-term consequences of aortic root (AoR) dilatation in competitive athletes are not yet investigated. Our aim was to assess the distribution and determinants of AoR size in a large population of competitive athletes. METHODS: AoR dimension were assessed by echocardiography in 2,361 athletes participating in 48 different sports. Of them, 43 were excluded because aortic structural abnormalities, such as bicuspid aortic valve, Marfan’s Syndrome, aortic prosthesis. The remaining 2,318, including 1,301 (56%) males and 1,017 (44%) females were the study population. Arbitrary cut-off of ≥ 40 mm, according to #36 th Bethesda Conference, was used as upper normal limits for AoR. RESULTS: AoR dimension was 32.2 ± 2.7 mm (23 to 44) in males, and 27.5 ± 2.6 mm (20 to 36) in females. AoR dimension exceeded accepted upper limits in only 18 male athletes (0.8%). Figure . Multivariate regression analysis showed left ventricular (LV) mass and body size explaining majority of AoR variability (R 2 = 0,59). Surprisingly, type of sport was not a determinant for AoR dimension. The 18 athletes with enlarged AoR were periodically followed for 7.0 ± 4.2 years. None developed cardiovascular events or symptoms. Two showed progression of AoR dilatation (from 40 to 48, and 43 to 46 mm, respectively), one had incident myocarditis and one developed moderate aortic regurgitation with enlarged LV cavity. CONCLUSIONS: Dilated aortic root is an uncommon finding in competitive athletes and do not represent expression of physiologic cardiac remodelling of the athlete’s heart. Therefore, athletes with dilated AoR deserves continued clinical surveillance.

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Association of aortic root dilatation with left ventricular function in patients with postoperative ventricular septal defect

Heart and Vessels ◽

10.1007/s00380-019-01372-7 ◽

2019 ◽

Vol 34 (9) ◽

pp. 1491-1498

Author(s):

Noritoshi Fukushima ◽

Keiko Fukushima ◽

Hiroki Sato ◽

Chihiro Saito ◽

Keiko Uchida ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Left Ventricular Function ◽

Ventricular Function ◽

Aortic Root ◽

Septal Defect ◽

Left Ventricular ◽

Aortic Root Dilatation

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INDIRECT ULTRASOUND EVALUATION OF LEFT VENTRICULAR OUTFLOW TRACT DIAMETER IMPLICATIONS FOR HEART FAILURE AND AORTIC STENOSIS SEVERITY ASSESSMENT.

10.22541/au.160615093.39506877/v1 ◽

2020 ◽

Author(s):

Gabriele Pestelli ◽

Andrea Fiorencis ◽

Valeria Pergola ◽

Giovanni Luisi ◽

Vittorio Smarrazzo ◽

...

Keyword(s):

Heart Failure ◽

Aortic Stenosis ◽

Aortic Root ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Regression Equation ◽

Ultrasound Evaluation ◽

Left Ventricular Outflow

Background. Whereas dependency of left ventricular outflow tract diameter (LVOTD) from body surface area (BSA) has been established and a BSA-based LVOTD formula has been derived, the relationship between LVOTD and aortic root and LV dimensions has never been explored. This may have implications for evaluation of LV output in heart failure (HF) and aortic stenosis (AS) severity. Methods. A cohort of 540 HF patients who underwent transthoracic echocardiography was divided in a derivation and validation subgroup. In the derivation subgroup (N=340) independent determinants of LVOTD were analyzed to derive a regression equation, which was used for predicting LVOTD in the validation subgroup (N=200) and compared with the BSA-derived formula. Results. LVOTD determinants in the derivation subgroup were sinuses of Valsalva diameter (SVD, beta=0.392, P<0.001), BSA (beta=0.229, P<0.001), LV end-diastolic diameter (LVEDD, beta=0.145, P=0.001), and height (beta=0.125, P=0.037). The regression equation for predicting LVOTD with the aforementioned variables (LVOTD=6.209+[0.201xSVD]+[1.802xBSA]+[0.03xLVEDD]+[0.025xHeight]) did not differ from (P=0.937) and was highly correlated with measured LVOTD (R=0.739, P<0.001) in the validation group. Repeated analysis with LV end-diastolic volume instead of LVEDD and/or accounting for gender showed similar results, whereas BSA-derived LVOTD values were different from measured LVOTD (P<0.001). Conclusion. Aortic root and LV dimensions affect LVOTD independently from anthropometric data and are included in a new comprehensive equation for predicting LVOTD. This should improve evaluation of LV output in HF and severity of AS, avoiding use of LVOT velocity-time integral alone, which can be misleading, especially when LV cavity and aortic root dimensions are abnormal.

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Zespół Marfana u 7-letniej dziewczynki – opis przypadku

Nowa Pediatria ◽

10.25121/np.2018.22.2.32 ◽

2018 ◽

Vol 22 (2) ◽

Author(s):

Małgorzata Ludzia ◽

Radosław Pietrzak ◽

Bożena Werner

Keyword(s):

Marfan Syndrome ◽

Aortic Root ◽

Body Height ◽

Premature Death ◽

Joint Hypermobility ◽

Left Ventricular ◽

Ventricular Enlargement ◽

Angiotensin Ii Receptor ◽

Aortic Root Dilatation ◽

Left Ventricular Enlargement

Marfan syndrome is a systemic, autosomal dominant connective tissue disorder with variable expressivity. An early diagnosis is challenging but important, because Marfan syndrome is associated with premature death in untreated patients. The authors present a case of a 7-year-old girl with Marfan syndrome. The child’s father was diagnosed with Marfan syndrome confirmed by genetic tests. The first symptoms of Marfan syndrome in the presented patient occurred at the age of 2 years, when she presented with mitral and tricuspid valve prolapse, scoliosis, joint hypermobility and body height above 97 percentile. In regular check-ups, aortic root dilatation and the enlargement of the left ventricle were first described one year later. It was decided to introduce beta blocker therapy. Due to the further progression of left ventricular enlargement the girl was given additionally angiotensin II receptor antagonist. In echocardiography follow up no increasing of the aortic root dilatation and the left ventricular enlargement is observed.

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

Cardiology in the Young ◽

10.1017/s1047951100011422 ◽

1995 ◽

Vol 5 (1) ◽

pp. 31-35 ◽

Cited By ~ 5

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.

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Transcatheter Closure of Perimembranous Ventricular Septal Defect with Aneurysm: Radiologic Characteristic and Interventional Strategy

Journal of Interventional Cardiology ◽

10.1155/2020/6646482 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Weibing Guo ◽

Yifan Li ◽

Jinjin Yu ◽

Junjie Li ◽

Ling Sun ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Type A ◽

Left Ventricular ◽

Type B ◽

Residual Shunt ◽

Perimembranous Ventricular Septal Defect ◽

Type C

Objectives. We aimed to explore the radiologic characteristics and interventional strategies for perimembranous ventricular septal defect (pmVSD) with aneurysm. Methods. 257 patients who underwent transcatheter closure of pmVSD with aneurysm were included in our study. We retrospectively reviewed the left ventricular opening of the aneurysm (a), diameter of the midsegment of the aneurysm (b), and diameter of the right ventricular opening of the aneurysm (c). If there were multiple defects within the aneurysm, the largest defect was denoted as c1 and so forth. We developed a novel VSD classification method in which pmVSD with aneurysm was classified into three types (A, B, and C). When a >b ≥ c, it was classified as type A, when b > a ≥ c, it was type B, and when c > a ≥ b, it was type C; c/c1 described the relationship among defects. Results. All of the 257 cases of pmVSD with aneurysm were defined using left ventriculography: type A, 60, type B, 58, and type C, 139. Transcatheter closure was attempted in 244 patients and succeeded in 227 cases (success rate was 93.0%; 227/244). Forty symmetric VSD occluders and 13 asymmetric VSD occluders were used for type A aneurysm occlusion; 31 symmetric VSD occluders, 19 asymmetric VSD occluders, and one Amplatzer duct occluder II (ADOII) were used for type B; 59 VSD symmetric occluders, 59 asymmetric VSD occluders, three eccentric VSD occluders, and two ADOII were used for type C. Within 24 hours after procedure, 2.2% patients had postprocedural residual shunt, and 2.2% experienced malignant arrhythmia (including type II second-degree AVB, cAVB, and CLBBB). Two hundred and twelve patients completed follow-up (93%, 212/227). No new severe complications were reported during follow-up, except in one patient who underwent surgery (removal of the device, VSD repair, and tricuspid valvuloplasty) due to severe postprocedural tricuspid regurgitation. Conclusions. It is safe and effective to apply this method for the classification of pmVSD with aneurysm and its interventional strategy.

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