Abstract 17189: Radiation-induced Accelerated Multi-valve Disease In A Patient With Subaortic Membrane

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Mariana Garcia-Arango ◽  
Shravya Vinnakota ◽  
Hector R Villarraga
Keyword(s):  
Mitral Valve ◽  
Wall Thickness ◽  
Nyha Class ◽  
Valve Disease ◽  
Subaortic Stenosis ◽  
Early Screening ◽  
Severe Aortic Regurgitation ◽  
Septal Myectomy ◽  
Radiation Induced ◽  
Subaortic Membrane

A 69-year-old woman with history of right breast cancer status post lumpectomy and radiation (4.2 cGy) 18 months prior, presented with progressive NYHA class III dyspnea. TTE obtained prior to her cancer diagnosis was notable for normal LV size and wall thickness, a subaortic membrane with systolic mean Doppler gradient of 21 mmHg and a mildly thickened mitral valve without significant stenosis or regurgitation. On presentation, TTE was notable for severely increased concentric LV wall thickness (LV mass index 140 g/m 2 ), preserved ejection fraction, increased RV wall thickness, subaortic stenosis with systolic mean Doppler gradient 35 mmHg, moderate-severe aortic regurgitation, thickened mitral valve with posterior leaflet tethering and anterior leaflet override causing severe mitral regurgitation and moderate mitral stenosis (valve area 1.7 cm 2 by pressure half-time). She underwent a surgical intervention with septal myectomy, subaortic membrane resection, aortic root reconstruction, aortic and mitral valve replacement with bioprostheses. She did well post-operatively and had complete resolution of symptoms following cardiac rehabilitation. Radiation-induced valvular heart disease is linked to the total dose of radiation, use of sequential chemotherapy and time since irradiation, with a typical latency of 10-20 years. However, there is paucity of data regarding the influence of these variables in patients with pre-existing valve disease. This case illustrates dramatic acceleration of underlying aortic and mitral valve pathology in a patient with a subaortic membrane, 18 months after radiation. We also noted development of significant concentric LV hypertrophy that was disproportionate to the degree of obstruction across the sub-aortic membrane. Potential candidates for radiation therapy must be carefully screened for pre-existing valve disease, which should warrant increased vigilance and early screening for progressive valve disease.

scholarly journals P1321 A case of multiple levels of ventricular obstruction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Oikonomidis ◽  
A Klitirinos ◽  
M Koutouzis ◽  
A Kalangos ◽  
E Lazaris ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Imaging Modalities ◽  
Subaortic Stenosis ◽  
Shortness Of Breath ◽  
Septal Myectomy ◽  
Subaortic Membrane

Abstract Subaortic stenosis (SAS) is a rare entity in adults with unclear etiology and variable presentation. SAS may be presented with symptoms mimicking Hypertrophic Cardiomyopathy (HCM). Often a combination of imaging modalities is needed to distinguish SAS from HCM with obstruction. A 53 years old man, smoker, was referred to our medical center suffering from shortness of breath on exertion. He first presented at another facility with a 2 month history of shortness of breath and chest discomfort during brisk physical activity and the possible diagnosis of HCM was made. On physical examination, a 3/6 systolic murmur was audible along the left sternal border, that became louder with standing and the Valsalva maneuver. The patient had non distended jugular veins, clear lung fields and no ankle edema. The results of laboratory exams did not reveal any pathological sign. The transthoracic echocardiogram revealed significant left ventricular hypertrophy (Interventricular septum 21 mm, Posterior wall 16 mm) with normal left ventricular systolic performance (ejection fraction >70%). The aortic valve was tricuspid and calcified whereas mitral valve was morphologically normal, with systolic anterior motion and mild posterolaterally directed regurgitation. Two systolic gradients, one dynamic, late peaking of 85mmHg and another fixed of 70mmHg were detected in left ventricular outflow track (LVOT). Transesophageal echocardiography was performed for the better evaluation of aortic valve and showed a three level obstruction caused by the systolic motion of the mitral valve towards the hypertrophic septum at LVOT, the presence of a membranous subaortic membrane and the calcified aortic valve respectively. The aortic valve was calcified with a moderate stenosis (0.8cm2 / m2) from 3D planimetry. A Cardiac Magnetic Resonance exam was ordered and confirmed the significance of hypertrophy and the presence of circumferential subaortic membrane. No late enhancement after the administration of Gadolinium was observed. Coronary angiography was performed and demonstrated normal coronary arteries. We hypothesized that the presence of subaortic membrane led to marked myocardial wall thickness and to the destruction of the aortic valve due to turbulent flow in the LVOT. The patient was referred for surgical management Extended septal myectomy combined with complete resection of orbital subaortic membrane were performed. he calcified aortic valve was replaced by bioprosthetic valve No 23mm. The patient tolerated the procedure well with significant symptomatic improvement. TTE performed 1 month postoperatively showed no remarkable LVOT gradient. The results of histopathology and genes investigations are pending. Subaortic membrane is a rare cause of symptoms that can mimic hypertrophic cardiomyopathy. A combination of imaging modalities is needed to distinguish subaortic stenosis from aortic valve stenosis and hypertrophic obstructive cardiomyopathy. Abstract P1321 Figure. Three levels obstruction

P1244Survival after septal myectomy in male and female patients with hypertrophic obstructive cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Huurman ◽  
A Schinkel ◽  
M Van Slegtenhorst ◽  
P De Jong ◽  
A Hirsch ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Left Atrial ◽  
Nyha Class ◽  
Composite Endpoint ◽  
P Value ◽  
Time To Treatment ◽  
Left Atrial Diameter ◽  
Septal Myectomy ◽  
Maximal Wall Thickness ◽  
The Impact

Abstract In recent years, studies have debated the impact of gender on the presentation and clinical course of HCM, with research showing that at time of myectomy, women are older, have worse diastolic function and more advanced cardiac remodeling. The clinical impact of these differences is unknown. We included 221 HCM patients (57% men) who underwent septal myectomy and are followed in our center. Time to treatment was calculated in relation to symptom onset. Pre- and post-operative clinical and echocardiographic data were collected. Gender differences were assessed at baseline and in survival analyses for the composite endpoint of all-cause mortality, cardiac transplantation, re-intervention and aborted sudden cardiac death. Women were older at time of myectomy, but time until treatment was similar (table). Pre-operative echocardiographic indices were comparable among groups, but were significantly higher in women when correcting for body surface area. At three months, no differences were found in clinical and echocardiographic results. After 6.1 [2.9–10.1] years, 24% of women and 23% of men had reached the composite endpoint (p=0.30, figure). Gender comparison pre- and post-myectomy Men (n=125) Women (n=96) p value Age 49±14 54±17 0.02 Maximal wall thickness, mm 19.9±4.7 19.8±5.8 0.97 Indexed maximal wall thickness, mm/m2 9.8±2.5 11.5±4.5 0.001 Left atrial diameter, mm 48.1±7.3 45.9±7.3 0.06 Indexed left atrial diameter, mm/m2 23.5±3.5 26.5±7.5 0.002 LV end-diastolic diameter, mm 45.4±7.6 42.8±5.6 0.04 Indexed LV end-diastolic diameter, mm/m2 22.1±3.7 23.6±3.0 0.02 Gradient reduction, %* 75.1±25.0 72.9±28.6 0.63 Improvement in symptoms*† 97 (95%) 64 (89%) 0.34 MWT = maximal wall thickness; LV = left ventricle. *At three months follow-up; †Defined as a reduction of ≥1 NYHA class, measured in 102 men and 72 women. Survival after myectomy Although women present later in life and seem to have more advanced disease at time of myectomy, time to treatment is similar and survival after myectomy is excellent for both men and women.

scholarly journals Mitraclip for high risk patients with barlow mitral valve disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Gavazzoni ◽  
M Taramasso ◽  
D Voci ◽  
A Pozzoli ◽  
M Miura ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Valve Disease ◽  
Nyha Class ◽  
Valve Disease ◽  
Volume Index ◽  
Barlow’S Disease ◽  
The Mean ◽  
Procedural Success

Abstract Background No data have been published to now about the outcomes of MitraClip in inoperable patients with Barlow's Mitral Valve Disease. Despite the technical advantages of the new generation of MitraClips, the length and the thickness of the mitral leaflets and presence of flails with complete eversion and pseudo-cleft are challenging MitraClip procedure. Purpose To analyse the results of MitraClip in inoperable patients with Barlow's disease of Mitral valve. Methods We retrospectively collected the cases of MR in Barlow's disease treated with MitraClip in our institution from 2012 to 2018. The case were included in the analysis in presence of the following characteristics: bileaflet billowing or prolapse [or both], excessive leaflet tissue, and annular dilatation with or without calcification. Results We included in this analysis 59 patients (mean age 78±8 years, STS mortality score 4±2.9%). Echo data at baseline showed normal left ventricle ejection fraction and diastolic volume and increased left atrial volume index. Half of the included patients had a chordal rupture (n=27, 47%) and in 14 patients (23%) calcification of annulus and/or leaflet was diagnosed. The mean procedural time was 92±41min with a technical success (M-VARC) of 100% and more than 80% of patients requiring more than 1 clip. At 30 days follow-up the device success and the procedural success were respectively 59% and 56%. The mean diastolic mitral valve gradient was 3.1±1.5mmHg. At 30 days follow-up, 91% of the patients were NYHA class II stable patients; no death and no hospitalization occurred. During a median follow-up time of 412 days (IQR: 209–992 days) death for any cause occurred in 23% of the patients (n=14) and 16% of the patients (n=10) died because of a cardiovascular cause; 10 patients were re-hospitalized for heart failure and 5% of the patients (n=3) underwent an open-heart surgery at follow-up time. At univariate cox regression analysis the 1-Y composite end-point (death for any cause, HF re-hospitalization, MV surgery) was predicted by LV dimensions and 30 days procedural success. Conclusions To our knowledge, this is the first analysis of outcomes of Barlow's disease treated with MitraClip. Despite a high incidence of MR recurrence, we observed a good clinical response in term of NYHA class and mortality rate. Left ventricle size and 30-day procedural success predict outcomes. Funding Acknowledgement Type of funding source: None

scholarly journals Prevalence and Prognosis of Anemia in Dogs with Degenerative Mitral Valve Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Ivarosa Bing-Ye Yu ◽  
Hui-Pi Huang
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Nyha Class ◽  
Prognostic Significance ◽  
Heart Association ◽  
Valve Disease ◽  
New York Heart Association ◽  
Prevalence Of Anemia ◽  
Class Iv

In humans, heart failure (HF) and renal insufficiency (RI) have negative reciprocal effects, and anemia can exacerbate their progression. In this retrospective study, the prevalence and prognostic significance of anemia in 114 dogs with degenerative mitral valve disease (DMVD) was investigated. Pretreatment clinical parameters, prevalence of anemia and azotemia, and survival time were analyzed in relation to HF severity. The prevalence of anemia was highest in dogs with the modified New York Heart Association (NYHA) class IV HF (33.3%), followed by classes III (15.2%) and II (0%; p < 0.001). The presence of anemia was associated with HF severity and blood creatinine > 1.6 mg/dL (both p < 0.001). Anemic dogs had a shorter median survival [13 months; 95% confidence interval (CI): 0.7–19.1] than nonanemic dogs (28 months; 95% CI: 15.3–40.7; p < .001). NYHA class IV (hazard ratio (HR): 3.1, 95% CI: 2.2–4.3; p < 0.001), left atrium/aorta ratio > 1.7 (HR: 2.7, 95% CI: 1.7–4.2; p = 0.001), and presence of anemia (HR: 1.43, 95% CI: 1.1–1.9; p = 0.004) emerged as predictors of mortality. A cardiorenal-anemia syndrome-like triangle was observed and anemia was a prognostic factor for survival in dogs with DMVD.

scholarly journals Rheumatic Mitral and Aortic Valve Disease- A Case Report from USA

2018 ◽  
Vol 11 (1) ◽  
pp. 81-85
Author(s):  
Debasish Roychoudhury ◽  
Navin C Nanda ◽  
John J Hon ◽  
Farzan Filsoufi ◽  
Ahmed Y Salma ◽  
...  
Keyword(s):  
United States ◽  
Mitral Valve ◽  
Pacific Islands ◽  
Systolic Function ◽  
The United States ◽  
Left Ventricular ◽  
Valve Disease ◽  
Mitral Valve Stenosis ◽  
Mortality And Morbidity ◽  
Severe Aortic Regurgitation

Although virtually eradicated in the United States, rheumatic heart disease still carries a sinister outcome causing significant mortality and morbidity in developing countries in Asia, Africa and the Pacific Islands where it still remains in endemic form. Our case involves a 35-year-old female patient born and raised in India who recently migrated to the United States. Her echocardiogram revealed severe combined aortic and mitral valve stenosis and severe aortic regurgitation. We hereby analyze echocardiographic findings in concomitant rheumatic aortic and mitral valve disease with preserved left ventricular (LV) systolic function. We also discuss treatment implications with combined surgical replacements of both valves with mechanical prostheses.Cardiovasc. j. 2018; 11(1): 81-85

scholarly journals Reconstructive surgery of idiopathic hypertrophic cardiomyopathy, systolic anterior motion and severe mitral regurgitation

2004 ◽  
Vol 132 (7-8) ◽  
pp. 254-257
Author(s):  
Ivan Stojanovic ◽  
Milan Vukovic ◽  
Vojislava Neskovic ◽  
Milan Babic ◽  
Miroljub Zlatanovic ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Annulus ◽  
Subaortic Stenosis ◽  
Mitral Insufficiency ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Septal Myectomy ◽  
Long Time ◽  
Subaortic Obstruction ◽  
Idiopathic Disease

Hypertrophie obstructive cardiomyopathy (HOCM) is an idiopathic disease frequently associated with systolic anterior motion (SAM). The anterior leaflet of mitral valve is sucked by Ventury effect into the left ventricle outflow tract making subaortic stenosis more severe and producing mitral insufficiency at the same time. Septal myectomy along with mitral valve replacement has been the treatment of choice for a long time. An understanding of pathoanatomy and hemodynamics of the disease has opened possibility for total reconstructive treatment of both subaortic stenosis and mitral insufficiency in such patients. This is a case report of 50-year-old male with severe subaortic stenosis (136/70 mmHg) due to HOCM and SAM along with grade IV mitral insufficiency. Septal myectomy was performed. Mitral insufficiency was managed by reducing the height of posterior cusp along with remodeling of mitral annulus by Carpentier-Classic ring. In that way, subaortic obstruction was reduced to 30.9/10 mmHg while mitral insufficiency was lowered to negligible level. The patient was discharged from hospital with sinus rhythm eight days after the surgery.

Sign in / Sign up

Export Citation Format

Share Document