Pulmonary Hypertension Due to Valvular Heart Disease: Aortic and Mitral

2015 ◽  
Vol 14 (2) ◽  
pp. 95-101
Author(s):  
Ryan Karl Kaple ◽  
Evelyn M. Horn
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Aortic Valve ◽  
Valvular Heart Disease ◽  
Treatment Options ◽  
Venous Hypertension ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Surgical Interventions ◽  
Valve Lesions

Pulmonary hypertension (PH) can be due to a primary pulmonary vasculature abnormality, but is more often secondary to lung, cardiac, or environmental insults, and is frequently multifactorial. Most commonly, left heart disease is at fault, a subset of which is valvular heart disease (VHD). With sufficient time, most chronic left-sided valve lesions will result in some element of PH. Long-standing PH causes pulmonary vascular remodeling and progressive PH due to reduced vascular compliance. Careful monitoring of VHD progression is critical, both through screening imaging and patient education, in order to properly time intervention to prevent the development or worsening of PH. The primary diagnostic tool in PH due to VHD is echocardiography, while invasive hemodynamic evaluation can be helpful to determine PH etiology or severity when echocardiography is not adequate. The presence of PH in VHD is often an indication for intervention, but it also increases procedural risk. Severe PH, however, has not been proven to preclude safe intervention, but rather should prompt full preprocedural evaluation and close intra- and postprocedural monitoring. Valve replacement or repair can be viewed as a treatment for PH secondary to the valvular lesion. Percutaneous alternatives to surgical interventions are available for some mitral and aortic valve conditions. Though in relatively early stages of development, these less invasive procedures may improve the safety profile of valve interventions. Pulmonary hypertension that fails to improve after intervention should raise suspicion for procedural failure or underlying pulmonary vascular disease (either precapillary possibly in association with interstitial lung disease or scleroderma or secondary to combined pre-/postcapillary PH due to long-standing pulmonary venous hypertension). This review is focused on the pathophysiology, treatment options, and outcomes in patients with PH due to mitral and aortic valve lesions.

Endovascular treatment in patients with combined pathology

2015 ◽  
Vol 6 (3) ◽  
pp. 123-128 ◽  
Author(s):  
Evgeny Antonovich Shloydo ◽  
Igor Alexandrovich Pyaterichenko ◽  
Victoria Valentinovna Zvereva ◽  
Yuriy Romanovich Kovalev ◽  
Alexey Viktorovich Sizov
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Age Groups ◽  
Balloon Catheter ◽  
Severe Heart Failure ◽  
Uterine Fibroids ◽  
Surgical Interventions

Aortic valve stenosis is one of the most common diseases from the group of acquired heart disease, especially in elderly patients. Aortic valve replacement has become the “gold standard” and gives excellent results in all age groups of patients. For aortic valve replacement is sent to only one third of patients due to high risk due to age, severity of the defect, reduced contractility of the left ventricle, pulmonary hypertension and other comorbidities. One of the attempts to reduce the frequency of complications and mortality in this group of patients, and subsequently to make it possible to perform other surgical interventions, including aortic valve replacement, which is considered inoperable patients is holding a less traumatic surgery - aortic balloon catheter valvuloplasty. In the clinical observation deals with the case of heart disease - critical aortic stenosis, ischemic heart disease complicated by pulmonary hypertension and severe heart failure, in combination with gynecological diseases (uterine fibroids, endometrial hyperplasia in postmenopausal women), complicated by uterine bleeding and hemorrhagic anemia. Consider the risks of different surgical interventions. The possibility of modern endovascular care of patients in this situation simultaneously perform operations on uterine artery embolization, coronary angioplasty with stenting and aortic catheter balloon valvuloplasty. Also shown is the nearest and remote results of operative intervention.

scholarly journals Aortic valve stenosis awareness in Austria—results of a nationwide survey in 1001 subjects

2019 ◽  
Vol 170 (5-6) ◽  
pp. 141-149 ◽  
Author(s):  
Christian Hengstenberg ◽  
Martin Thoenes ◽  
Peter Bramlage ◽  
Jolanta Siller-Matula ◽  
Julia Mascherbauer
Keyword(s):  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Valvular Heart Disease ◽  
Treatment Options ◽  
Prognostic Significance ◽  
Improve Patient Care ◽  
Nationwide Survey ◽  
Awareness Campaigns ◽  
Information Awareness

Summary Despite the prognostic significance of severe aortic valve stenosis, knowledge is limited in the general population. To document the status quo for Austria, knowledge about valvular heart disease/aortic valve stenosis was documented in 1001 participants >60 years of age. 6.7% of respondents were knowledgeable of aortic valve stenosis, with 1.6% being concerned about the condition (24.1% cancer, 18.8% Alzheimer’s disease, 15.1% stroke). 29.5% were familiar with valvular heart disease (76.7% heart attack, 36.9% stroke). Only 1/3 reported auscultation by their general practitioner (GP) at least every third visit. Typical symptoms of aortic valve stenosis were likely to be reported by 50%. After exposure to further information on aortic valve stenosis, only 20% reported to be more concerned and ready to obtain more disease-related information. Awareness of surgical and catheter-based treatment options was claimed by 77% of respondents. Awareness campaigns on valvular heart disease are warranted to improve patient care in Austria.

Real-time Detection of Aortic Valve in Echocardiography using Convolutional Neural Networks

2020 ◽  
Vol 16 (5) ◽  
pp. 584-591 ◽  
Author(s):  
Muhammad Hanif Ahmad Nizar ◽  
Chow Khuen Chan ◽  
Azira Khalil ◽  
Ahmad Khairuddin Mohamed Yusof ◽  
Khin Wee Lai
Keyword(s):  
Neural Network ◽  
Neural Networks ◽  
Heart Disease ◽  
Aortic Valve ◽  
Real Time ◽  
Convolutional Neural Networks ◽  
Valvular Heart Disease ◽  
Detection System ◽  
Processing Unit ◽  
Real Time Detection

Background: Valvular heart disease is a serious disease leading to mortality and increasing medical care cost. The aortic valve is the most common valve affected by this disease. Doctors rely on echocardiogram for diagnosing and evaluating valvular heart disease. However, the images from echocardiogram are poor in comparison to Computerized Tomography and Magnetic Resonance Imaging scan. This study proposes the development of Convolutional Neural Networks (CNN) that can function optimally during a live echocardiographic examination for detection of the aortic valve. An automated detection system in an echocardiogram will improve the accuracy of medical diagnosis and can provide further medical analysis from the resulting detection. Methods: Two detection architectures, Single Shot Multibox Detector (SSD) and Faster Regional based Convolutional Neural Network (R-CNN) with various feature extractors were trained on echocardiography images from 33 patients. Thereafter, the models were tested on 10 echocardiography videos. Results: Faster R-CNN Inception v2 had shown the highest accuracy (98.6%) followed closely by SSD Mobilenet v2. In terms of speed, SSD Mobilenet v2 resulted in a loss of 46.81% in framesper- second (fps) during real-time detection but managed to perform better than the other neural network models. Additionally, SSD Mobilenet v2 used the least amount of Graphic Processing Unit (GPU) but the Central Processing Unit (CPU) usage was relatively similar throughout all models. Conclusion: Our findings provide a foundation for implementing a convolutional detection system to echocardiography for medical purposes.

scholarly journals Aortic valve replacement due to granulomatosis with polyangiitis: a case series

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Gilles Uijtterhaegen ◽  
Laura De Donder ◽  
Eline Ameloot ◽  
Kristof Lefebvre ◽  
Jo Van Dorpe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Granulomatosis With Polyangiitis ◽  
Surrounding Tissue ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Severe Aortic Regurgitation

Abstract Background Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a systemic inflammatory process predominantly affecting upper and lower respiratory tract and kidneys. Valvular heart disease is a rare manifestation of GPA. Case summary We report two cases of acute valvular heart disease mimicking acute endocarditis caused by GPA. Both patients were middle-aged females with acute aortic valve regurgitation suggestive of possible infective endocarditis. In their recent medical history, atypical otitis and sinusitis were noted. The first patient was admitted with heart failure and the second patient because of persisting fever. Echocardiogram revealed severe aortic regurgitation with an additional structure on two cusps, suggestive of infective endocarditis in both patients. Urgent surgical replacement was performed; however, intraoperative findings did not show infective endocarditis, but severe inflammatory changes of the valve and surrounding tissue. In both patients, the valve was replaced by a prosthetic valve. Microscopic examination of the valve/myocardial biopsy showed diffuse acute and chronic inflammation with necrosis and necrotizing granulomas, compatible with GPA after infectious causes were excluded. Disease remission was obtained in both patients, in one patient with Rituximab and in the other with Glucocorticoids and Cyclophosphamide. Both had an uneventful follow-up. Discussion Granulomatosis with polyangiitis can be a rare cause of acute aortic valve regurgitation mimicking infective endocarditis with the need for surgical valve replacement. Atypical ear, nose, and throat symptoms can be a first sign of GPA. Symptom recognition is important for early diagnosis and appropriate treatment to prevent further progression of the disease.

scholarly journals Valvular heart disease in autoimmune diseases in Mexico

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Aceituno Melgar ◽  
JF Fritche-Salazar ◽  
ME Soto-Lopez
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Autoimmune Diseases ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Valvular Heart Disease ◽  
Valve Disease ◽  
Calcium Deposit

Abstract Funding Acknowledgements Type of funding sources: None. Background  The autoimmune diseases (AD) have high morbidity and mortality due to their affection to the heart. Purpose Our objective was to describe the valvular heart disease (VHD) in patients with AD. Methods Patients with systemic lupus erythematous (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SS) diagnosis were included, from January 1st 2008 to December 31th 2018. Prevalence rates of valve involvement were calculated. Results A total of 163 patients (57.6% with SLE, 23.3% with RA, 19.0% with SS) were included. The global prevalence of VHD was 5.4% in SLS, 23.6% en RA, and 15.9% in SS. The more affected valve in SLS was the tricuspid valve in 24% (12% with severe tricuspid regurgitation (STR), p = 0.028), in RA was the aortic valve in 26% (13% with severe aortic stenosis (SAS), p = 0.02), and with SS was the tricuspid valve in 48% (29% with moderate tricuspid regurgitation (MTR)). The calcium deposit was present in 66% in RA (37% in aortic valve, p < 0.001). The valve thickening (>5 mm) was higher in RA (50%, p < 0.001), with predominance in mitral valve (26%). Conclusions We found significant higher rates of STR in SLE, SAS in RA, and MTR in SS compared with the literature. Moreover, calcification and valve thickening were found more often in RA. Early diagnosis of subclinical VHD is mandatory to improve the long-term prognosis of these patients. Valvular heart disease. Autoimmune Disease (n = 163) P value* SLE (n = 94) RA (n = 38) ES (n = 31) Demographic characteristics Age, years. Gender, Male / Female, n Body Mass Index (kg/m2) Arterial hypertension, n (%) Diabetes Mellitus, n (%) 38.8 (12.6) 9/85 26.2 (5.9) 21(22.3%) 6 (6.3%) 62.45 (12.3) 7/31 26.6 (7.1) 14(36.8%) 4 (10.5%) 53.8 (13.3) 2/29 25.4 (4.7) 12 (38.7) 5 (16.1%) <0.001 NS NS NS NS Echocardiographic findings. Valve thickening Aortic Mitral 8 (9%) 1 (1%) 7 (7%) 19 (50%) 9 (24%) 10 (26%) 1 (3%) 0 1 (3%) <0.001 Calcium Deposit Aortic Mitral 4 (4%) 2 (2%) 2 (2%) 25 (66%) 14 (37%) 11 (29%) 8 (26%) 4 (12.8%) 4 (12.9%) <0.001 Aortic valve disease 4 (4%) 10 (26%) 0 Aortic stenosis Moderate Severe 0 0 0 7 (18%) 2 (5%) 5 (13%) 0 0 0 0,02 Moderate Aortic Regurgitation 4 (4%) 3 (8%) 0 NS Mitral valve disease 8 (9%) 2 (5%) 2 (6%) Mitral stenosis Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Mitral Regurgitation Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Tricuspid Regurgitation Moderate Severe 22 (24%) 11 (12%) 11 (12%) 8 (21%) 7 (18%) 1 (3%) 15 (48%) 9 (29%) 6 (19%) 0,028 Pulmonic valve disease Moderate Pulmonic Stenosis Moderate Pulmonic Regurgitation 6 (6%) 1 (1%) 5 (5%) 1 (3%) 0 1 (3%) 0 0 0 NS * Not Significant.

4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kempny ◽  
K Dimopoulos ◽  
A E Fraisse ◽  
G P Diller ◽  
L C Price ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Cardiac Catheterization ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Significant Difference ◽  
The Difference ◽  
Clinically Significant ◽  
The Relationship

Abstract Background Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV). Objectives We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making. Methods We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method. Results We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2]. Adjustment of PVR required Conclusions We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.

scholarly journals P1692 The past returns after 20 years: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Habjan ◽  
D Cantisani ◽  
I S Scarfo` ◽  
M C Guarneri ◽  
G Semeraro ◽  
...  
Keyword(s):  
Heart Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Valvular Heart Disease ◽  
Radiation Treatment ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Radiation Induced ◽  
Valve Area

Abstract Introduction Radiation therapy is one of the cornerstones of treatment for many types of cancer. These patients can later in life develop cardiovascular complications associated with radiation treatment. Late cardiovascular effects of radiation treatment include coronary artery disease (CAD), valvular heart disease, congestive heart failure, pericardial disease and sudden death. The most common sign of radiation-induced valvular heart disease is the calcification of the intervalvular fibrosa between the aortic and mitral valve. Case presentation A 71-year-old male patient with a history of Non-Hodgkin lymphoma treated with radiotherapy and chemotherapy 20 years ago, CAD, arterial hypertension, diabetes type II, dyslipidemia, obesity and currently smoking presented in the emergency room in our medical facility with acute pulmonary edema. The patient had unstable angina pectoris in 2018, the coronary angiography showed two-vessel disease with a non-significant stenosis of the left main coronary artery (LMCA) and 70% stenosis of the left anterior descending artery (LAD), for which he refused the percutaneous coronary intervention. At the same time, a transthoracic echocardiography (TTE) showed severe aortic stenosis and moderately severe mitral stenosis, at that time the patient refused the operation. After the initial treatment for pulmonary edema, TTE and transesophageal echocardiography (TEE) were performed and showed a tricuspid aortic valve with calcification of the cusps and a very severe aortic stenosis (planimetric aortic valve area 0.74 cm², functional aortic valve area 0.55 cm², indexed functional aortic valve area 0.25 cm²/m², mean gradient 61 mmHg, peak gradient 100 mmHg, stroke volume (SV) 69 ml, stroke volume index (SVI) 31 ml/m², flow rate 221 ml/s, aortic annulus 20x26 mm). The left ventricle was severely dilated (end diastolic volume 268 ml) with diffuse hypokinesia and severe systolic dysfunction (ejection fraction 32%). We appreciated a calcification of the mitral-aortic intervalvular fibrosa and the mitral annulus, without mitral stenosis but with moderate mitral regurgitation. The calcification of the intervalvular fibrosa suggested our final diagnosis of radiation-induced valvular heart disease with a severe aortic stenosis in low-flow conditions. The patient was successfully treated with transcatheter aortic valve implantation (TAVI). Conclusion Radiation-induced heart disease is a common reality and is destinated to raise due to the increasing number of cancer survivors. Effects are seen also many years after the radiation treatment. The exact primary mechanism of radiation injury to the heart is still unknown. The treatment of radiation-induced valve disease is the same as the treatment of valve disease in the general population. Abstract P1692 Figure. Radiation-induced valvular heart disease

Abstract 12999: Correcting the Current: Modeling the Hemodynamic Impact of Transcatheter Aortic Valve Replacement in Multiple Valvular Heart Disease Precipitating Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael I Brener ◽  
Amisha Patel ◽  
Torsten Vahl ◽  
Nadira Hamid ◽  
Melana Yuzefpolskaya ◽  
...  
Keyword(s):  
Heart Disease ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Cardiogenic Shock ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Circulatory Support ◽  
Ventricular Performance ◽  
Transcatheter Aortic Valve

Introduction: Multiple valvular heart disease (mVHD) caused by mixed stenotic and regurgitant lesions involving at least two valves is a common condition which is poorly understood and challenging to manage. Herein, we simulate the hemodynamics of a patient with mVHD before and after transcatheter aortic valve replacement (TAVR) to better understand the physiology of this complex disease. Case: A 67-year-old man with celiac enteropathy presented to a local hospital with dyspnea, hypotension, and oliguria. Echocardiography revealed a dilated left ventricle (end-diastolic diameter [LVEDD] 6.7 cm) with an ejection fraction (EF) of 20% and multiple severe valvulopathies, including aortic stenosis (AS), aortic regurgitation (AR), and mitral regurgitation (MR). Right heart catheterization revealed a low cardiac index (1.76 L/min/m 2 ) and a high wedge pressure (36 mmHg) with V-waves exceeding 50 mmHg. The patient’s severe AR precluded mechanical circulatory support, so TAVR was emergently performed in the setting of worsening cardiogenic shock (CS) with a 29 mm self-expanding bioprosthesis via transfemoral access. Valve deployment was successfully guided by fluoroscopy and transthoracic echocardiography alone. CS resolved in the subsequent 48 hours, and at 3-month follow-up, his LV EF returned to 55% and LVEDD decreased to 4.4 cm. LV pressure-volume loops pre- and post-TAVR were generated using a cardiovascular physiology simulator (Fig. 1). TAVR’s correction of the patient’s severe AS and AR produced immediate energetic benefits, with pressure-volume area declining 13% and cardiac power output increasing 2.24-fold. Conclusions: This challenging case and the accompanying pressure-volume analysis affirms the feasibility of emergent TAVR in highly selected patients, the procedure’s ability to immediately improve ventricular performance, and the LV’s capacity to remodel when operating under more physiologic loading conditions.

scholarly journals Pulmonary hypertension: Proteins in the blood

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Martin Wilkins
Keyword(s):  
Pulmonary Hypertension ◽  
New Technology ◽  
Local Environment ◽  
Pulmonary Vasculature ◽  
Pulmonary Vascular Disease ◽  
Plasma Proteome ◽  
Bioinformatic Tools ◽  
Non Invasive ◽  
New Biomarkers ◽  
Small Aliquot

The plasma proteome is rich in information. It comprises proteins that are secreted or lost from cells as they respond to their local environment. Changes in the constitution of the plasma proteome offer a relatively non-invasive report on the health of tissues. This is particularly true of the lung in pulmonary hypertension, given the large surface area of the pulmonary vasculature in direct communication with blood. So far, this is relatively untapped; we have relied on proteins released from the heart, specifically brain natriuretic peptide and troponin, to inform clinical management. New technology allows the measurement of a larger number of proteins that cover a broad range of molecular pathways in a single small aliquot. The emerging data will yield more than just new biomarkers of pulmonary hypertension for clinical use. Integrated with genomics and with the help of new bioinformatic tools, the plasma proteome can provide insight into the causative drivers of pulmonary vascular disease and guide drug development.

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