Abstract 18662: Aortic Valve Orientation Angle is Associated With Aortic Morphology and Dissection Risk

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ashutosh A Hardikar ◽  
Andrea Iannaccone ◽  
Thomas H Marwick
Keyword(s):  
Aortic Root ◽  
Orientation Angle ◽  
Aortic Disease ◽  
Asymmetry Index ◽  
Aortic Annulus ◽  
Shear Stresses ◽  
Aortic Dilatation ◽  
Left Wall ◽  
Root Angle ◽  
Aortic Root Enlargement

Introduction: Asymmetric aortic root enlargement may lead to unequal thinning of the aortic wall, differential shear stresses and dissection. We sought the association of aortic root morphology with aortoventricular angle (AVAng), LVOT-root angle (RootAng), root-aorta angle (AortAng) [Fig 1] and outcomes. Methods: Demographic, morphometric and epidemiological parameters were gathered in 100 patients with aortic disease over last 6 years and 50 age and sex matched controls undergoing aortic CT. Two observers measured AVAng, RootAng, AortAng between the proximal aorta, aortic annulus and LV outflow tract [Figure 1] and orthogonal diameters along the thoracic aorta, noting the type of arch and other pathologies. The root axis was taken by joining the midpoints of aortic annulus and sinotubular junction, and asymmetry index (AI) [Fig 1] was calculated as the ratio of the maximal distance between axis and right wall, and axis to left wall in coronal view. There were 22 aortic dissections in the study group, and follow up was 32.3 months. Results: AortAng was different between TAV and BAV, but AI and AVAng were similar. AortAng [P= 0.008], AI [P= 0.004] and AVAng [p=0.013] had the strongest correlation with aortic dilatation [>40 mm], and were different in the dissection group (Table). The AI correlated well with root dilatation while AortAng and AVAng correlated with ascending aortic dilatation. TAV had a diffuse pattern of aortic dilatation as compared to BAV. Conclusions: AVAng and RootAng correlate with aortic dilatation patterns, and also aortic dissection. The AVAng and AortAng may explain the differential shear stresses seen along the 2 curvatures in aortic pathologies.

scholarly journals Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. A retrospective Comparative cohort study

2020 ◽  
Author(s):  
Yasser Shaban Mubarak ◽  
Ahmed Abdel Rahman Abdeljawad
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Pressure ◽  
Aortic Annulus ◽  
Paravalvular Leak ◽  
Double Valve Replacement ◽  
Small Aortic Annulus ◽  
Aortic Root Enlargement

Abstract Objectives Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of inappropriate-sized prostheses especially during Double Valve Replacement (DVR). Despite that small aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures fearing from morbidity and mortality. We evaluate clinical and echocardiographic outcomes in patients with small AA undergoing DVR. Methods The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between June 2016 and November 2020. Only (50) patients had ARE with DVR. ARE was performed using an autologous or bovine pericardium or Dacron patch by Nick′s or Manouguian procedures. The estimated post-operative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least post-operative follow-up period was 6 months. Results The study included 30 male and 70 female patients with mean age of 45 ± 10 years, body surface area (BSA) of 1.6 ± 0.50 m2, aortic annulus diameter was 20 ± 0.4 mm, EOAi was 0.80 ± 0.50 cm2/m2, and aortic mean gradient (PG) 80 ± 40 mm Hg. During follow-up period, there was a mild paravalvular leak (1%) with, (1%) heart block, and residual mean PG on prosthetic aortic valve with all cases of DVR alone. Conclusion Enlargement of aortic root by Nick′s or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.

scholarly journals Aortic Valve Replacement in Patients with Small Aortic Annulus: New Pericardial Stented Valves vs Aortic Root Enlargement Procedures.

2021 ◽  
Author(s):  
Ahmed Fouad ◽  
ehab elshihy ◽  
Mohammed Hassan ◽  
Mohammed Maged ◽  
Ashraf Mostafa Abd Raboh
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Mechanical Valve ◽  
Aortic Annulus ◽  
University Hospitals ◽  
Small Aortic Annulus ◽  
Postoperative Drainage ◽  
Aortic Root Enlargement

Objectives: Newer generations of stented pericardial valves may offer hemodynamic benefit in patients with small aortic annulus. The aim of this study was to determine the effectiveness of isolated aortic valve replacement with one such valve, the Trifecta valve, when compared to Aortic root enlargement surgery in reducing postoperative gradients and the severity of PPM in patients with small aortic annulus. Patients and methods: A prospective observational study of 100 patients with SAA who underwent AVR from March 2020 to October 2021 in Cairo university hospitals and other centers. The cohort was divided into two groups based on surgical technique: Isolated AVR using Trifecta valve or ARE and mechanical valve placement. Preoperative characteristics, intraoperative times and postoperative outcomes were recorded and compared in all patients, including a pre-discharge echocardiography. Results: Increased operative times, increased ICU stay and need for blood products were observed in the ARE group and operative time was determined as an independent risk factor. Higher rate of complications such as need for permanent pacemaker as well increased postoperative drainage was also recorded in ARE group, with no difference between groups in in-hospital mortality. Higher incidence of PPM was recorded in the Trifecta group (24%) compared to the ARE group (8%). but, the severity of PPM within the Trifecta group was reduced compared to the ARE group, and no degree of PPM was observed in Trifecta valves sized 21. Conclusion The Trifecta valve offers excellent postoperative hemodynamics and significant reduction in severity of PPM in patients with SAA undergoing AVR, with gradients and iEOA almost comparable to larger sized valves implanted after ARE, making the increased surgical burden of ARE unnecessary in most patients.

scholarly journals Aortic Root Enlargement in Patients With Small Aortic Annulus Undergoing Double Valve Replacement: A Retrospective Comparative Cohort Study

2021 ◽  
Vol 24 (2) ◽  
pp. E239-E242
Author(s):  
Yasser Mubarak ◽  
Ahmed Abdel Rahman Abdel jawad
Keyword(s):  
Aortic Valve ◽  
Pressure Gradient ◽  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Annulus ◽  
Paravalvular Leak ◽  
Double Valve Replacement ◽  
Small Aortic Annulus ◽  
Aortic Root Enlargement

Background: Small aortic annulus (AA) is a big issue during aortic valve replacement (AVR), necessitating replacement of an undersized prosthetic valve especially with double valve replacement (DVR). Despite the fact that small aortic valve prostheses can lead to prosthesis-patient mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures, fearing morbidity and mortality. Objective: To evaluate clinical and echocardiographic outcomes in patients with small aortic annulus (<18 mm) undergoing double valve replacement. Methods: The study included 100 consecutive patients who underwent DVR for combined rheumatic aortic and mitral valve diseases, between January 2016 and September 2020. Only 50 patients had ARE with DVR. ARE was performed using an autologous or bovine pericardium or Dacron patch by Nick's or Manouguian procedures. The estimated postoperative endpoints were mortality, effective orifice areas (EOA), mean aortic pressure gradient (PG), and valve-related complications. The shortest postoperative follow-up period was 6 months. Results: The study included 30 male and 70 female patients with mean age of 35±20 years, body surface area (BSA) of 1.7 ± 0.3 m2, aortic annulus diameter was 1.4 ± 0.4 mm, aortic orifice area was 0.8 ± 0.1 cm2, and mean pressure gradient 85 ± 2.5 mmHg. During the follow-up period, there was a mild to moderate paravalvular leak (1%) with 1% heart block and residual gradient on prosthetic aortic valve; this was all in DVR alone. Conclusion: Enlargement of the aortic root by Nick's or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.

scholarly journals Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. A retrospective Comparative cohort study.

2020 ◽  
Author(s):  
Yasser Mubarak ◽  
Ahmed Abdeljawad
Keyword(s):  
Aortic Valve ◽  
Pressure Gradient ◽  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Annulus ◽  
Paravalvular Leak ◽  
Double Valve Replacement ◽  
Small Aortic Annulus ◽  
Aortic Root Enlargement

Background: Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of an undersized prosthetic valve especially with Double Valve Replacement (DVR). Despite that small aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures fearing from morbidity and mortality. Objective: To evaluate clinical and echocardiographic outcomes in patients with small aortic annulus undergoing double valve replacement. Methods: The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between Jan. 2016 and Sept. 2020. Only (50) patients had ARE with DVR. ARE was performed using an autologous or bovine pericardium or Dacron patch by Nicks or Manouguian procedures. The estimated postoperative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least postoperative follow-up period was 6 months. Results: The study included 30 male and 70 female patients with mean age of 35±20 years, body surface area (BSA) of 1.7 ±0.3 m2, aortic annulus diameter was 20±1.4 mm, aortic orifice area was 0.8±0.1 cm2, and mean pressure gradient 85±2.5 mmHg. During follow-up period, there was a mild to moderate paravalvular leak (1%) with, (1%) heart block, and residual gradient on prosthetic aortic valve; that was all in DVR alone. Conclusion: Enlargement of aortic root by Nicks or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.

scholarly journals A New Surgical Approach for Aortic Root Aneurysm and Small Aortic Annulus

2020 ◽  
Vol 23 (2) ◽  
pp. E171-E173
Author(s):  
Mehmet Kaplan ◽  
Anil Karaagac ◽  
Mehmet Inanc Yesilkaya ◽  
Yusuf Kagan Pocan ◽  
Hakki Aydogan
Keyword(s):  
Surgical Approach ◽  
Aortic Root ◽  
Mechanical Valve ◽  
Composite Graft ◽  
Aortic Annulus ◽  
Aortic Root Aneurysm ◽  
Small Aortic Annulus ◽  
Novel Method ◽  
Valved Conduit ◽  
Aortic Root Enlargement

Reconstruction of the aortic root in patients with aortic root aneurysm and small aortic annulus is an intricate surgical procedure. Here, we describe our technique performed in 2 patients, that involved aortic root enlargement with grafting in conjunction with annular implantation of the composite graft with a prosthetic mechanical valve, which allowed us to avoid incompatibility. This novel method offers an alternative combined surgical approach for patients with small aortic annulus and aortic root aneurysm that preserves the structure of the valved conduit at the level of the aortic annulus.

scholarly journals Management of Small Aortic Root during Aortic Valve Replacement

2020 ◽  
Vol 2 (1) ◽  
pp. 1-7
Author(s):  
Ahmed Nabil Malek ◽  
Mohamed A.K. Salama Ayyad ◽  
Hussein Elkhayat ◽  
Ahmed El-Minshawy
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Aortic Annulus ◽  
Early Results ◽  
Significant Difference ◽  
Small Aortic Root ◽  
Group A ◽  
Aortic Root Enlargement

Background: Concomitant aortic root enlargement (ARE) increases the risk of aortic valve replacement (AVR). The objectives of this study were to identify the patients who needed aortic root enlargement and compare the outcomes and the risk of adding ARE to AVR. Methods: We retrospectively reviewed 62 patients who underwent isolated mechanical aortic valve replacement between 2017 and 2019. We divided the patients into two groups: group A included patients with small aortic root who had AVR with one of the different surgical strategies for small aortic annulus (n= 32) and group B, which included patients with a normal aortic annulus and underwent conventional AVR (n= 30). Group A was further sub-divided based on the surgical strategy into 4 categories; patients who had supra-annular implantation of size 19 mm St. Jude prosthetic valve (n= 11; 34.4%), Nicks procedure (n= 13 40.6%), Manougian procedure (n= 4; 12.5%), Konno procedure (n= 4; 12.5%).  Results: Group A patients were significantly younger (26.16 ± 11.49 vs. 34.63 ± 8.9 years; p< 0.001) and had lower body weight (55.09 ± 21.41 vs. 69.80 ± 19.20; p= 0.01). Group A had significantly smaller valves (p = 0.03), and total cardiopulmonary bypass (148.65 ± 44.09 vs. 97.46 ± 20.90 minutes; p<0.001) and aortic cross-clamp times (118.13 ± 36.70 vs. 78.06 ± 16.01 minutes; p < 0.001) were significantly longer in group A. There was no significant difference in operative complications between groups. Among patients with small aortic root; Konno procedure had the longest bypass time (236.3 ± 19.70 minutes; p<0.001); cross-clamp time (192.5 ± 22.2 minutes; p <0.001); mechanical ventilation (4.75 ± 0.50 hours; p<0.001) and intensive care unit stay (6.50 ± 0.57 days; p <0.001). Patients with supra-annular implantation of the St. Jude valve had a significantly higher postoperative pressure gradient (14.64 ± 6.84 mmHg; p= 0.02). No difference in procedure complications was observed among aortic root enlargement procedures. Conclusion: Patients who had aortic root enlargement procedure were younger, with lower weight and body surface area. Surgical procedures used to manage small aortic root had comparable early results, and no technique was superior to the others.

Functional Results in Aortic Root Enlargement

2004 ◽  
Vol 7 (2) ◽  
pp. E160-E163 ◽  
Author(s):  
Serap Aykut Aka ◽  
Gökçen Orhan ◽  
Şennur Ünal ◽  
Seden Çelik ◽  
Şahin Şenay ◽  
...  
Keyword(s):  
Aortic Root ◽  
Functional Results ◽  
Aortic Root Enlargement

Ciliary Flow of Casson Nanofluid with the Influence of MHD having Carbon Nanotubes

2020 ◽  
Vol 16 ◽  
Author(s):  
Adel Alblawi ◽  
Saba Keyani ◽  
S. Nadeem ◽  
Alibek Issakhov ◽  
Ibrahim M. Alarifi
Keyword(s):  
Carbon Nanotubes ◽  
Velocity Profile ◽  
Pressure Gradient ◽  
Volume Fraction ◽  
Solid Volume Fraction ◽  
Pressure Rise ◽  
Shear Stresses ◽  
Left Wall ◽  
Coupled Equations ◽  
The Right

Objective: In this paper, we consider a model that describes the ciliary beating in the form of metachronal waves along with the effects of Magnetohydrodynamic fluid over a curved channel with slip effects. This work aims at evaluating the effect of Magnetohydrodynamic (MHD) on the steady two dimensional (2-D) mixed convection flow induced in carbon nanotubes. The work is done for both the single wall nanotube and multiple wall nanotube. The right wall and the left wall possess a metachronal wave that is travelling along the outer boundary of the channel. Methods: The wavelength is considered as very large for cilia induced MHD flow. The governing linear coupled equations are simplified by considering the approximations of long wavelength and small Reynolds number. Exact solutions are obtained for temperature and velocity profile. The analytical expressions for the pressure gradient and wall shear stresses are obtained. Term for pressure rise is obtained by applying Numerical integration method. Results: Numerical results of velocity profile are mentioned in a table form, for various values of solid volume fraction, curvature, Hartmann number [M] and Casson fluid parameter [ζ]. Final section of this paper is devoted to discussing the graphical results of temperature, pressure gradient, pressure rise, shear stresses and stream functions. Conclusion: Velocity profile near the right wall of the channel decreases when we add nanoparticles into our base fluid, whereas an opposite behaviour is depicted near the left wall due to ciliated tips whereas the temperature is an increasing function of B and ߛ and decreasing function of ߶.

Racial and ethnic differences in response to treatment for Marfan syndrome

2021 ◽  
pp. 1-8
Author(s):  
Rachel Ayers ◽  
Michael Kelleman ◽  
Glen Iannucci ◽  
Courtney McCracken ◽  
Matthew E. Oster
Keyword(s):  
Marfan Syndrome ◽  
Ethnic Differences ◽  
Aortic Root ◽  
Randomised Trial ◽  
Z Score ◽  
Treatment Groups ◽  
Black Patients ◽  
Aortic Root Enlargement ◽  
Racial Ethnic ◽  
Hispanic White

Abstract Objective: To determine whether racial/ethnic differences exist for the treatment of Marfan syndrome aortopathy. The 2014 Pediatric Heart Network randomised trial of losartan versus atenolol in Marfan syndrome paediatric and young adult patients showed no treatment differences in the rate of aortic root growth over 3 years; however, they did not examine racial/ethnic differences, and recent data suggest that angiotensin receptor blockers may have different pharmacologic effects in different racial/ethnic populations. Methods: We performed a secondary analysis of public-use data from the Pediatric Heart Network randomised trial comparing the differences by race/ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic patients) amongst the treatment groups for the primary outcome of rate of aortic root enlargement by z score and secondary outcome of rate of change of absolute diameter of aortic root, z score and absolute diameter of ascending aorta, and blood pressure changes. Results: For aortic root enlargement by z score amongst on-Hispanic White patients, patients on losartan exhibited an annual z score change of –0.090 ± 0.016, compared to –0.146 ± 0.015 for those on atenolol (p = 0.01), favouring atenolol. For Hispanic and non-Hispanic Black patients, there was no difference in primary or secondary outcomes between treatment groups. Conclusion: Non-Hispanic White patients had a small, but statistically significantly greater decrease in aortic root z score favouring atenolol over losartan. There were no significant differences amongst Hispanic or non-Hispanic Black patients, which may be due to relatively small size numbers. These findings may have important implications for medication selection by race/ethnicity in Marfan syndrome patients, which has not previously been evaluated in studies.

scholarly journals Radial self-navigated native magnetic resonance angiography in comparison to navigator-gated contrast-enhanced MRA of the entire thoracic aorta in an aortic patient collective

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Martina Correa Londono ◽  
Nino Trussardi ◽  
Verena C. Obmann ◽  
Davide Piccini ◽  
Michael Ith ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Image Quality ◽  
Magnetic Resonance Angiography ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Scan Time ◽  
Contrast Enhanced

Abstract Background The native balanced steady state with free precession (bSSFP) magnetic resonance angiography (MRA) technique has been shown to provide high diagnostic image quality for thoracic aortic disease. This study compares a 3D radial respiratory self-navigated native MRA (native-SN-MRA) based on a bSSFP sequence with conventional Cartesian, 3D, contrast-enhanced MRA (CE-MRA) with navigator-gated respiration control for image quality of the entire thoracic aorta. Methods Thirty-one aortic native-SN-MRA were compared retrospectively (63.9 ± 10.3 years) to 61 CE-MRA (63.1 ± 11.7 years) serving as a reference standard. Image quality was evaluated at the aortic root/ascending aorta, aortic arch and descending aorta. Scan time was recorded. In 10 patients with both MRA sequences, aortic pathologies were evaluated and normal and pathologic aortic diameters were measured. The influence of artifacts on image quality was analyzed. Results Compared to the overall image quality of CE-MRA, the overall image quality of native-SN-MRA was superior for all segments analyzed (aortic root/ascending, p < 0.001; arch, p < 0.001, and descending, p = 0.005). Regarding artifacts, the image quality of native-SN-MRA remained superior at the aortic root/ascending aorta and aortic arch before and after correction for confounders of surgical material (i.e., susceptibility-related artifacts) (p = 0.008 both) suggesting a benefit in terms of motion artifacts. Native-SN-MRA showed a trend towards superior intraindividual image quality, but without statistical significance. Intraindividually, the sensitivity and specificity for the detection of aortic disease were 100% for native-SN-MRA. Aortic diameters did not show a significant difference (p = 0.899). The scan time of the native-SN-MRA was significantly reduced, with a mean of 05:56 ± 01:32 min vs. 08:51 ± 02:57 min in the CE-MRA (p < 0.001). Conclusions Superior image quality of the entire thoracic aorta, also regarding artifacts, can be achieved with native-SN-MRA, especially in motion prone segments, in addition to a shorter acquisition time.

Sign in / Sign up

Export Citation Format

Share Document