scholarly journals Does choice of mechanical prosthetic valve affect change in left ventricular functions after aortic valve replacement

2020 ◽  
Vol 08 (06) ◽  
Author(s):  
Dr Hakeem Zubair Ashraf (MCh.) ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Left Ventricular ◽  
Mechanical Prosthetic Valve ◽  
Ventricular Functions

Abstract 12934: Valve, Ventricle, Vessel or Virus: Who is the Shocking Culprit?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sudhi Tyagi ◽  
Harshal Patil ◽  
Robert Miles ◽  
Elizabeth Siegel ◽  
Salman Allana ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Cardiogenic Shock ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Clinical Condition ◽  
Prosthetic Valve ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Valve Function

Introduction: Determining the etiology of dyspnea in patients with structural heart disease can be challenging, especially in the current era with high prevalence of COVID-19. Our case highlights the importance of evaluating bioprosthetic valve function in the setting of a change in clinical status. Case: An 82 year old female with surgical coronary revascularization and bioprosthetic aortic valve replacement in 2003 presented with dyspnea. Her evaluation revealed hypoxemia, leukocytosis and a chest x-ray supportive of viral infection when the local prevalence of both COVID-19 and influenza were at their peak. She was admitted to the intensive care unit with impending respiratory failure most likely from an infectious etiology. Echocardiogram revealed an ejection fraction (EF) of 25% and severe prosthetic aortic regurgitation with a pressure half time of 117ms ( Figure ). Six months prior, she had normal EF and normal prosthetic valve function. Interestingly, she lacked a wide pulse pressure, murmur of aortic insufficiency, and other characteristic exam findings of valvular dysfunction. The patient rapidly deteriorated into cardiogenic shock. Following urgent evaluation for transcatheter aortic valve replacement, she had successful valve-in-valve deployment of a 23mm Edwards S3 Ultra valve. Her hemodynamic parameters improved immediately and she was weaned from inotropic support 1 day following valve replacement. Conclusions: Evaluation of prosthetic valve function is integral when a patient’s clinical condition changes. In our patient, depressed EF resulting in an elevated left ventricular end-diastolic pressure likely diminished the regurgitant fraction and the expected aortic insufficiency murmur. Periodic evaluation of prosthetic heart valve function is necessary, particularly when the patient’s clinical condition changes. Acute severe aortic regurgitation with cardiogenic shock is fatal without rapid evaluation and valve replacement.

Aortic Valve Replacement for Aortic Stenosis with a Small Mechanical Prosthetic Valve

2008 ◽  
Vol 17 (1) ◽  
pp. 70-74
Author(s):  
Toshiro Ogata ◽  
Tatsuo Kaneko ◽  
Tamiyuki Obayashi ◽  
Susumu Ishikawa ◽  
Yasushi Sato ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Mechanical Prosthetic Valve

scholarly journals Intermediate-term results after the aortic valve replacement using bileaflet mechanical prosthetic valve in children

2008 ◽  
Vol 34 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Munetaka Masuda ◽  
Hideaki Kado ◽  
Yusuke Ando ◽  
Akira Shiose ◽  
Toshihide Nakano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Mechanical Prosthetic Valve

Patient-prosthesis mismatch following aortic valve replacement

Heart ◽  
2019 ◽  
Vol 105 (Suppl 2) ◽  
pp. s28-s33 ◽  
Author(s):  
Rajdeep Bilkhu ◽  
Marjan Jahangiri ◽  
Catherine M Otto
Keyword(s):  
Renal Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Cardiac Symptoms ◽  
Patient Prosthesis Mismatch

Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.

scholarly journals More in, better out? Successful valve-in-valve procedure of an iatrogenic ventricular septal defect following transcatheter aortic valve replacement: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Klaus-Dieter Hönemann ◽  
Steffen Hofmann ◽  
Frank Ritter ◽  
Gerold Mönnig
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Septal Defect ◽  
Left Ventricular ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve

Abstract Background A rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD). Case summary We describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2–3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Discussion We suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.

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