scholarly journals LV reverse remodeling imparted by aortic valve replacement for severe aortic stenosis; is it durable? A cardiovascular MRI study sponsored by the American Heart Association

2011 ◽  
Vol 6 (1) ◽  
Author(s):  
Robert WW Biederman ◽  
James A Magovern ◽  
Saundra B Grant ◽  
Ronald B Williams ◽  
June A Yamrozik ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
American Heart Association ◽  
American Heart ◽  
Severe Aortic Stenosis ◽  
Heart Association ◽  
Reverse Remodeling ◽  
Cardiovascular Mri ◽  
Mri Study

Abstract 2468: Is the LV Reverse Remodeling Imparted by Aortic Valve Replacement for Severe Aortic Stenosis Durable? A Cardiovascular MRI Study sponsored by the American Heart Association

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Robert W Biederman ◽  
James A Magovern ◽  
Saundra Grant ◽  
Ronald Williams ◽  
June Yamrozik ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Structure And Function ◽  
Reverse Remodeling ◽  
Beneficial Effects ◽  
And Function ◽  
Surgically Induced

Background In patients with severe aortic stenosis (AS), long-term data tracking surgically induced beneficial effects of afterload reduction on reverse LV remodeling are not available. Echocardiographic data is available short term, but in limited fashion beyond one year. Cardiac MRI (CMR) offers the ability to track changes in LV metrics with small numbers due to its inherent high spatial resolution and low variability. Hypothesis We hypothesize that progressive changes following aortic valve replacement (AVR) are detectable by CMR and changes in LV structure and function, triggered by AVR, continue for an extended period following AVR. Methods Ten patients (67±12 yrs, 6 female) with severe, but compensated AS, underwent CMR pre-AVR and post AVR at 6±2mo, 1yr±2mo, 4yrs±5mo. LV mass index (LVMI), LV geometry, volumetrics and EF were measured (GE, EXCITE 1.5T, Milwaukee, WI). A Kruskall-Wallis one-way ANOVA was performed. Results All 10 pts survived AVR and underwent CMR at the 4-year time point (40 total time points). LVMI markedly decreased at 6 months (157±42 to 134±32g/m 2 , p<0.005) and continued to trend down at 4 yrs (127±32g/m 2 ). Similarly, EF increased pre to post AVR (55±22 to 65±11%, (p<0.05)) and continued trending upward, remaining stable at years 1–4 (66±11 vs. 65±9%). LVEDV index, initially high pre AVR, normalized post AVR (83±30 to 68±11ml/m 2 , p<0.05) trending even lower by yr 4 (66±10 ml/m 2 ). LV stroke volume increased rapidly from pre to post AVR (40±11 to 44±7ml) continuing to increase at 4 yrs (49±14ml, p=0.3). Most importantly, LVMI/volume, a 3D measure of LV geometry, remained unchanged initially but over 4 yrs markedly improved (1.07±0.2 to 0.94±0.24, p<0.05) all paralleling improvements in NYHA (3.2±1.0 to 1.5±1.1, p<0.05). Conclusion After the initial beneficial effects imparted by AVR in severe AS patients, there are, as expected, marked improvements in LV reverse remodeling. We have shown, via CMR, that surgically induced benefits to LV structure and function, including favorable alterations in LV geometry, are durable and, unexpectedly, show continued improvement past 4 years concordant with sustained improved clinical status. This supports down regulation of both mRNA and MMP activity acutely and robust suppression long term.

Emergency TAVI in cardiogenic shock and cardiorenal syndrome secondary to severe bicuspid aortic stenosis

2021 ◽  
Vol 14 (4) ◽  
pp. e239003
Author(s):  
Luke Byrne ◽  
Peter Wheen ◽  
Stephen O'Connor
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Cardiogenic Shock ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Heart Association ◽  
Transoesophageal Echocardiography ◽  
Cardiorenal Syndrome ◽  
Surgical Aortic Valve Replacement

A 78-year man with severe aortic stenosis awaiting elective surgical aortic valve replacement presented with worsening New York Heart Association IV shortness of breath. Despite appropriate heart failure treatment, he deteriorated and developed cardiogenic shock and cardiorenal syndrome which progressed despite inotropic support. A non-contrast-gated CT coronary angiogram was arranged in light of acute renal failure which revealed a bicuspid aortic valve. Three-dimensional transoesophageal echocardiography guidance was used to assist annulus sizing. An emergency transcatheter aortic valve replacement (eTAVI) was carried out 5 days into admission with a 34 mm Core Valve Evolut Pro valve with a no contrast technique. The patient’s blood pressure and urine output improved and no procedural complications were encountered. He was discharged after 21 days and has remained well subsequently. This case highlights the utility of eTAVI and demonstrates the feasibility of a no contrast approach.

scholarly journals Physiologic Compensation Is Supranormal in Compensated Aortic Stenosis: Does it Return to Normal After Aortic Valve Replacement or Is it Blunted by Coexistent Coronary Artery Disease?

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Robert W.W. Biederman ◽  
Mark Doyle ◽  
June Yamrozik ◽  
Ronald B. Williams ◽  
Vikas K. Rathi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Systolic Function ◽  
Reverse Remodeling ◽  
Cardiovascular Mri ◽  
Artery Disease

Background— In compensated aortic stenosis (AS), cardiac performance measured at the ventricular chamber is typically supranormal, whereas measurements at the myocardium are often impaired. We investigated intramyocardial mechanics after aortic valve replacement (AVR) and the effects relative to the presence or absence of coronary artery disease (CAD+ or CAD−), respectively. Methods and Results— Twenty-nine patients (46 to 91years, 10 female) with late but not decompensated AS underwent cardiovascular MRI before AVR (PRE), with follow-up at 6±1 (EARLY) and 13±2 months (LATE) to determine radiofrequency tissue-tagged left ventricle (LV) transmural circumferential strain, torsion, structure, and function. At the myocardial level, concentric LV hypertrophy regressed 18% LATE (93±22 versus 77±17g/m 2 ; P <0.0001), whereas at the LV chamber level, ejection fraction was supranormal PRE, 67±6% (ranging as high as 83%) decreasing to 59±6% LATE ( P <0.05), representing not dysfunction but a return to more normal LV physiology. Between the CAD+ and CAD− groups, intramyocardial strain was similar PRE (19±10 versus 20±10) but different LATE, with dichotomization specifically related to the CAD state. In the CAD− patients, strain increased to 23±10% (+20%), whereas in CAD+ patients it fell to 16±11% (−26%), representing a nearly 50% decline after AVR ( P <0.05). This was particularly evident at the apex, where CAD− strain LATE improved 17%, whereas for CAD+ it decreased 2.5-fold. Transmural strain and myocardial torsion followed a similar pattern, critically dependent on CAD. AVR impacted LV geometry and mitral apparatus, resulting in decreased mitral regurgitation, negating the double valve consideration. Conclusions— In AS patients after AVR, reverse remodeling of the supranormal systolic function parallels improvement in cardiovascular MRI-derived regression of LV hypertrophy and LV intramyocardial strain. However, discordant effects are evident after AVR, driven by CAD status, suggesting that the typical AVR benefits are experienced disproportionately by those without CAD and not by those obliged to undergo concomitant coronary artery bypass grafting/AVR.

The Ross-Konno Procedure as Reoperative Treatment in a Young Adult with Congenital Aortic Stenosis

2012 ◽  
Vol 15 (4) ◽  
pp. 182
Author(s):  
Fotios A. Mitropoulos ◽  
Meletios A. Kanakis ◽  
Sotiria C. Apostolopoulou ◽  
Spyridon Rammos ◽  
Constantine E. Anagnostopoulos
Keyword(s):  
Young Adult ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Young Patients ◽  
Uneventful Recovery ◽  
Ross Procedure ◽  
Congenital Aortic Stenosis ◽  
Biological Prostheses

<p>Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients.</p><p>We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was performed, and within 8 months the patient developed recurrent symptoms of severe aortic stenosis. He underwent redo sternotomy and a Ross-Konno procedure with an uneventful recovery.</p>

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