scholarly journals Causal Relationship of Transverse Left Ventricular Band and Bicuspid Aortic Valve

2021 ◽  
Author(s):  
Manoj Kumar Dubey ◽  
Avinash Mani ◽  
Vineeta Ojha
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Surrogate Marker ◽  
Left Ventricular ◽  
The Other ◽  
Average Thickness ◽  
Transverse Band ◽  
Study Population ◽  
Relationship Of

Objectives: Bicuspid aortic valve is the most common congenital lesion found in adults. It is can be seen in combination with a transverse left ventricular (LV) band. We aimed to find an essential relationship between the presence of transverse ventricular band and bicuspid aortic valve. Methods: 13 patients with transverse left ventricular band were investigated during a 6 month period from January 2019 to July 2019. LV band thickness and gradients at the site of the LV band were evaluated as part of its effect on LV hemodynamics. Morphology of aortic valve and LV outflow tract gradients were assessed. We aimed to establish the presence of robust LV band as a surrogate marker for bicuspid aortic valve and evaluate the effect of LV band on LV hemodynamics. Results: Mean age of study population was 41yrs. Majority had bicuspid aortic valve(n=11). Average thickness of transverse band was 6.2mm and average mean aortic gradient was4mmHg. Sequestration of blood was noted at the level of transverse band in all the patients with 2 separate jets at LVOT. Anterolateral jet was deflected from transverse band and showed higher velocity in comparison to the other jet, causing turbulence at the bicuspid aortic valve. No co-relation was found between the thickness of transverse band and aortic valve gradient. Conclusion: Presence of a robust transverse LV band can serve as a surrogate marker for bicuspid aortic valve. Keywords: Bicuspid aortic valve ; aortic stenosis

Left ventricular outflow tract obstruction (LVOTO)

2011 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Different Levels

Introduction 68Subvalvar aortic stenosis (AS) 70Bicuspid aortic valve 72Supravalvar AS 74LVOTO may occur at different levels: • Subvalvular.• Valvular—including bicuspid aortic valve.• Supravalvular.• Coarctation— see p.118.Effects of LVOTO, irrespective of site of lesion, are: • ↑ afterload on LV....

Abstract 18816: Relationship of Aortic Valve Surgery and Survival in Patients with Moderate or Severe Aortic Stenosis and Left Ventricular Dysfunction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Zainab Samad ◽  
Amit N Vora ◽  
Allison Dunning ◽  
Joseph A Sivak ◽  
Linda K Shaw ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Peak Velocity ◽  
Left Ventricular ◽  
Lower Mortality ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Relationship Of

Introduction: Aortic valve replacement (AVR) for aortic stenosis (AS) carries additional surgical risk in patients with left ventricular dysfunction (LVD) but has been associated with survival benefit. The current use of AVR and its relationship to mortality in patients with moderate or severe AS and LVD is ill defined. Hypothesis: We hypothesized that AVR was underutilized among patients with moderate/severe AS and LVD, and that it was associated with lower mortality. Methods: We queried the Duke Echocardiographic Database for patients with moderate (mean gradient >25 mmHg and/or peak velocity >3m/s) or severe AS (mean gradient >40 mmHg and or peak velocity >4m/s) and LVD (left ventricular ejection fraction [LVEF] <50%) from 1/1/1995-5/1/2014. We used multivariable Cox modeling to assess the relationship of AVR and all-cause mortality. Results: We identified a total of 1,634/132,804 patients with moderate (1,095, 67%) or severe (539, 33%) AS and LVD. Severe LVD (LVEF ≤35%) was present in 35% of the cohort. The median age of the cohort was 75 (IQR 67-83), and patients with moderate AS were more likely than those with severe AS to have a history of ischemic heart disease, diabetes, peripheral vascular disease, cerebrovascular disease, and renal disease (all p <0.01). Median logistic EuroSCORE was 9.8 (5.5, 16.8). Median follow-up time was 1.2 years (IQR 0.2- 3.9). There were 863 deaths in the cohort. Overall, 287 (26%) patients with moderate AS and 263 (48%) patients with severe AS underwent AVR within 5 years of the qualifying echo. After multivariable adjustment, AVR with (n=270) or without CABG (n=280), compared to medical therapy was associated with lower mortality (HR=0.47 [0.38, 0.59], p<0.0001) in the entire cohort. Compared to CABG alone, the combination of CABG + AVR (HR=0.19 [0.14, 0.27], p<0.0001) was associated with a significant survival advantage. Conclusions: Among patients with significant AS and LVD, AVR with or without CABG is associated with significant mortality benefit and may be underutilized in this population. Further research is required to understand factors contributing to current practice patterns and the possible utility of transcatheter approaches in this high-risk cohort.

Left Ventricular Function Assessment by Strain Analysis in Patients with Severe Aortic Stenosis with Preserved Ejection Fraction Undergoing Aortic Valve Replacement – A Prospective Longitudinal Study at a Tertiary Health Care Centre of South India

2021 ◽  
Vol 8 (27) ◽  
pp. 2405-2411
Author(s):  
Syed Waleem Pasha ◽  
Narasimha D. Pai ◽  
Padmanabha Kamath ◽  
Ramanatha L. Kamath ◽  
Francis N.P. Monteiro
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Strain Rate ◽  
Valve Replacement ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Study Population

BACKGROUND Aortic stenosis (AS) is the most common, single, native valvular heart disease in adult population. The purpose of this study was to detect abnormalities in global longitudinal strain (GLS) and strain rate using 2D - STI in patients with severe AS and preserved left ventricular ejection fraction (LVEF). The effect of aortic valve replacement (AVR) on changes in strain parameters 30 days after surgery was also analysed. METHODS A total number of 60 patients aged more than 18 years with aortic valve disease scheduled for surgical aortic valve replacement admitted in Department of Cardiology, KMC hospital Mangalore, were included over a period of 18 months from January 2017 to June 2018. RESULTS A total of 60 patients with severe AS, defined by an aortic valve area of < 1 cm², mean transaortic pressure gradient ( P) of > 40 mmHg and maximum aortic velocity (Vmax) of > 4 m/sec were studied. Mean age of the study population was 63.5 years. 60 % of the population were males and 40 % being females. Most common risk factor present in the study population was diabetes mellitus (DM). 83% of the patients in the study population had at least one symptom. Most common symptom with which the patients presented was exertional dyspnoea. All patients had normal left ventricle (LV) cavity dimensions and LVEF prior to surgery with diastolic dysfunction being present in all patients. The LV ejection fraction is not significantly altered. The aortic valve area calculated by continuity equation has significantly increased post AVR with a significant reduction in transaortic peak and means pressure gradients. Mean global longitudinal strain (GLS) improved from -15.1 % to - 16.9 % (P < 0.001) and longitudinal strain rate improved from -0.8 to -0.9/s (P < 0.001). CONCLUSIONS Global longitudinal strain and strain rate can be adequately measured by 2D speckle-tracking imaging and can be used to detect subtle changes of myocardial function in patients with severe AS with preserved LVEF. KEYWORDS Aortic Stenosis, Exertional Dyspnoea, Global Longitudinal Strain, Transaortic Pressure Gradient, Ventricular Hypertrophy

scholarly journals 621 Anemia and its impact on clinical, echocardiographic parameters and prognosis in patients with severe aortic stenosis and normal left ventricular ejection fraction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Beladan ◽  
A Calin ◽  
A D Mateescu ◽  
M Rosca ◽  
R Enache ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Nyha Class ◽  
Left Ventricular ◽  
Volume Index ◽  
All Cause Mortality ◽  
Echocardiographic Parameters ◽  
Study Population

Abstract Background Anemia is common in patients (pts) with severe aortic stenosis (AS). Untreated anemia and severe AS are individually associated with the development of heart failure, however data regarding the potential detrimental effect of anemia on left ventricular (LV) function and prognosis in pts with severe AS are controversial. Aim To investigate the impact of anemia on clinical status, echocardiographic parameters and prognosis in pts with severe AS and preserved LV ejection fraction (LVEF). Methods Consecutive patients with severe AS (aortic valve area [AVA] index ≤ 0.6 cm2/m2) and preserved LVEF (&gt;50%) referred to our echocardiography laboratory were prospectively screened. All patients underwent complete clinical examination and comprehensive echocardiography, including speckle tracking-derived measurements of LV and left atrial (LA) strain. Baseline clinical variables included NYHA class, cardiac risk factors, haemoglobin (Hb) level and glomerular filtration rates (GFR, by MDRD formula). The definition of anemia was based on gender-specific cut-off values, as recommended by the WHO (Hb &lt;13.0 g/dL for men, &lt;12.0 g/dL for women). Patients with more than mild aortic regurgitation or mitral valve disease, atrial fibrillation or cardiac pacemakers were excluded. Results The study population included 264 patients (pts) (66 ± 11 yrs, 147 men). Anemia was present in 64 pts (24%). Aortic valve replacement (AVR) was performed in 151 pts. Dividing the study population into 2 groups, according to the presence/absence of anemia, no significant differences were found between groups regarding: age (p = 0.09), body surface area (p = 0.6), LVEF (62 ± 7 vs 63 ± 6%, p = 0.2), LV Global Longitudinal Strain (-15.2 ± 4 vs -14.7 ± 3 %, p = 0.4), LV mass index (p = 0.9), mean aortic gradient (p = 0.2) and indexed AVA (0.40 ± 0.09 vs 0.39 ± 0.09 cm2/m2, p = 0.6), or presence of significant coronary artery disease (p = 0.9). Compared to pts with normal Hb level, in pts with anemia NYHA class (p = 0.03), brain natriuretic peptide values (p = 0.004), lateral E/e’(16.2 ± 6.9 vs 13.7 ± 6.3, p = 0.01) and average E/e" ratio (15.9 ± 5.9 vs 14.1 ± 5.3, p = 0.03), LA volume index (54.3 ± 16.9 vs 45.0 ± 12.1 ml/m2, p &lt; 0.001), and systolic pulmonary artery pressure (38 ± 13 vs 33 ± 8, p = 0.009) were all significantly higher. During a 3–years follow-up 47 pts died. Age, NYHA class, BNP serum level, baseline anemia, LA volume index and systolic pulmonary pressure were associated with all-cause mortality in the whole study group (p &lt; 0.03 for all). In the group of pts who underwent AVR, NYHA class was the only independent predictor of all-cause mortality. Conclusions In our study including pts with severe AS and preserved LVEF, patients with baseline anemia presented worse functional status and LV diastolic dysfunction and increased 3-year all-cause mortality compared to those with normal Hb levels. However, in pts who underwent surgical AVR, there was no impact of baseline anemia on 3-year survival.

Genetic and Developmental Contributors to Aortic Stenosis

2021 ◽  
Vol 128 (9) ◽  
pp. 1330-1343 ◽  
Author(s):  
Punashi Dutta ◽  
Jeanne F. James ◽  
Hail Kazik ◽  
Joy Lincoln
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Financial Burden ◽  
Left Ventricular ◽  
Valve Disease ◽  
Outflow Obstruction ◽  
Left Ventricular Outflow Obstruction ◽  
Ventricular Outflow Obstruction ◽  
Left Ventricular Outflow

Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular outflow obstruction and encompasses a series of stenotic lesions starting from the left ventricular outflow tract to the descending aorta. Obstructions may be subvalvar, valvar, or supravalvar and can be present at birth (congenital) or acquired later in life. Bicuspid aortic valve, whereby the aortic valve forms with two instead of three cusps, is the most common cause of AS in younger patients due to primary anatomic narrowing of the valve. In addition, the secondary onset of premature calcification, likely induced by altered hemodynamics, further obstructs left ventricular outflow in bicuspid aortic valve patients. In adults, degenerative AS involves progressive calcification of an anatomically normal, tricuspid aortic valve and is attributed to lifelong exposure to multifactoral risk factors and physiological wear-and-tear that negatively impacts valve structure-function relationships. AS continues to be the most frequent valvular disease that requires intervention, and aortic valve replacement is the standard treatment for patients with severe or symptomatic AS. While the positive impacts of surgical interventions are well documented, the financial burden, the potential need for repeated procedures, and operative risks are substantial. In addition, the clinical management of asymptomatic patients remains controversial. Therefore, there is a critical need to develop alternative approaches to prevent the progression of left ventricular outflow obstruction, especially in valvar lesions. This review summarizes our current understandings of AS cause; beginning with developmental origins of congenital valve disease, and leading into the multifactorial nature of AS in the adult population.

Left ventricular outflow tract obstruction

2016 ◽  
Author(s):  
Demosthenes G. Katritsis ◽  
Bernard J. Gersh ◽  
A. John Camm
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Valvular Aortic Stenosis

Conditions that result in left ventricular outflow tract obstruction, i.e. valvular aortic stenosis, due to a bicuspid aortic valve, and subvalvular and supravalvular aortic stenosis are discussed.

P2453Value of pre-operative left atrial minimum volume as a surrogate for post-operative symptoms in patients with aortic stenosis who underwent aortic valve replacement

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Hozumi ◽  
J Morimoto ◽  
K Takemoto ◽  
T Wada ◽  
N Maniwa ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Atrial ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Area Index ◽  
Study Population ◽  
Lv Volume

Abstract Background Previous reports have shown that symptoms after aortic valve replacement (AVR) are not uncommon depending on severity of myocardial fibrosis in patients with severe aortic stenosis (AS). Pre-operative minimum left atrial volume (LAVmin) at end-diastole determined by direct exposure of left ventricular end-diastolic pressure may be used as a surrogate for post-operative symptoms in patients with severe AS undergoing AVR. Purpose The purpose of this study was to examine the value of pre-operative echocardiographic LAVmin index (LAVImin) to predict post-operative symptomatic status after AVR in patients with severe AS. Methods The study population consisted of 219 patients with severe AS who underwent AVR and were followed up for 1000 days after AVR. Pre-operative maximum LAV index (LAVImax), LAVImin, LA emptying fraction (LAEF), LV volume indexes, LV ejection fraction (LVEF) by biplane Simpson's method, aortic valve area index (AVAI), mean aortic valve pressure gradient (mAV-PG), E/A, mean E/e' from LV inflow and mitral annular velocity, and pulmonary artery systolic pressure (PASP) were evaluated by Doppler echocardiography. Results After exclusion of 136 patients who met the exclusion criteria (atrial fibrillation, significant coronary artery disease, significant mitral valve diseases, pacemaker rhythm, and inadequate echocardiographic images), the final study population consisted of 75 patients (75±7 years old, 46 female). During a follow-up, 19 patients (25%) complained post-operative symptoms. There were no significant differences in pre-operative serum hemoglobin, creatinine, BNP, chronic obstructive pulmonary disease, hypertension, diabetes, LV volume indexes, LVEF, AVA, mAV-PG between patients with and without post-operative symptoms. There were significant differences in pre-operative LAVImax, LAVImin, and LAEF between patients with and without post-operative symptoms. (60±15 vs 47±15 ml/m2, 45±15 vs 28±1 ml/m2, and 29±12 vs 42±11 ml/m2, respectively). E/A, mean E/e', and PASP in patients with symptoms were significantly greater compared with patients without symptoms (1.0±0.3 vs 0.7±0.2, 25±3 vs 18±2, 44±17 vs 32±9 mmHg, respectively). In the multivariate analysis, pre-operative LAVImin was the independent predictor of the post-operative symptomatic status after AVR (odds ratio: 1.11, 95% confidence interval: 1.04 - 1.18). Receiver operating characteristic analysis revealed that area under the curve (AUC) of LAVImin (cutoff: 30ml/m2) for post-operative symptoms was the largest (0.84) among the other echocardiographic parameters, and significantly larger than that of mean E/e' (0.67, *p<0.01) and LVEF (0.53, **p<0.05) (figure). Figure 1. ROC analysis Conclusions The present results suggest that pre-operative echocardiographic LAVImin may be used as a surrogate for post-operative symptomatic status after AVR in patients with severe AS.

Sign in / Sign up

Export Citation Format

Share Document