Aortic Regurgitation as a Complication of Electrophysiologic Ablation Techniques: A narrative review

2021 ◽  
Vol 17 ◽  
Author(s):  
Esraa Shehata ◽  
Mohamed Samy Abdel-Samie ◽  
Ahmad Elkoumy ◽  
Ahmed Yehia ◽  
Osama Soliman ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Cardiac Arrhythmias ◽  
De Novo ◽  
Case Reports ◽  
Patient Characteristics ◽  
Aortic Insufficiency ◽  
Ablation Techniques ◽  
Direct Energy

Background: Radiofrequency catheter ablation is a well-established treatment for several cardiac arrhythmias. Arrhythmias originating from the left side of the heart including ventricular and supraventricular tachycardia and ectopy can be successfully ablated through either transseptal or retrograde aortic approach. Although these techniques have a generally low rate of complications, aortic valve injury is a potential complication of ablation at the left cardiac side that warrants more investigation. Objective: The purpose of this review is to evaluate the incidence of iatrogenic aortic valve regurgitation and explore the potential mechanisms and risk factors that might contribute to aortic valve injury during radiofrequency ablation. Additionally, the course and progression of aortic regurgitation in the reported cases will be described. Methods and results: Authors searched PubMed for articles using the keywords “ablation” AND "aortic insufficiency" OR "aortic valve injury" OR "aortic regurgitation". Case reports and series, as well as retrospective and prospective studies were included and relevant review articles and editorial comments were used as a supplementary source of data. A total of 19 references were used and a detailed description of patient characteristics, procedural techniques, and incidence, predictors, and fate of aortic regurgitation was reported by 11 clinical studies. Conclusion: There is a small risk of significant iatrogenic aortic regurgitation after radiofrequency ablation of left-sided cardiac arrhythmias especially techniques performed via a retrograde aortic approach. Although the risk is not confined to procedures applying direct energy to the aortic cusp region, a more aggressive ablation applied in the vicinity of the valvular complex seems to be associated with a higher risk. Routine post-procedural surveillance should be adopted to detect de novo aortic valve injury following radiofrequency ablation techniques.

scholarly journals P249 Iatrogenic aortic cusp laceration causing severe acute traumatic aortic regurgitation secondary to complex percutaneous coronary intervention using rotablator;3DTEE-anatomic correlates

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Vadgaonkar ◽  
H Tarief ◽  
S Shivappa ◽  
L Sulaibikh ◽  
S Saif ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
High Speed ◽  
Past History ◽  
Case Reports ◽  
Free Margin ◽  
Severe Aortic Regurgitation ◽  
Percutaneous Coronary ◽  
Coronary Cusp

Abstract Clinical case 59 years old male known case of long standing diabetes and dyslipidemia presented to our institute with Non-STEMI.His past history was significant for multiple admissions with acute coronary syndromes and percutaneous coronary interventions(PCI). Echocardiogram in this presentation showed preserved biventricular systolic function with no valvulopathies. He was taken up for coronary angiogram which showed significant calcified angulated lesion in LAD/LCX(Left anterior descending and circumflex) with diffuse disease in Ramus/RCA. Mode of revascularisation was discussed in detail with the patient for Rotablation-guided PCI to LAD/LCX vs CABG.He preferred and underwent complex PCI to LAD. During the procedure he developed acute heart failure which was managed conservatively. Immediate TTE showed new severe aortic regurgitation(AR) with probable left coronary cusp(LCC) perforation and preserved LVEF.After stabilization, he was scheduled for TEE which showed tear in the LCC with complex fragmented jet of holodiastolic AR filling the entire LVOT.There was new late diastolic to early systolic MR.3DTEE Enface view of the aortic valve was evident of ovoid shaped laceration in LCC extending till the free margin (Fig 1C). There were additional tears in Non-coronary cusp(NCC) extending till the free margin of right coronary cusp(RCC).3DTEE colour was notable for regurgitant jet origin from LCC/NCC (Fig 2B). Based on above findings,He was offered aortic valve intervention but was reluctant initially.He presented 2 months later with exertional dyspnoea, mild LV dilatation and drop in LVEF to 50%.He consented for surgery and underwent bioprosthetic Aortic valve replacement because of extensive cusp tear and deformation of the valve along with complete revascularisation of the remaining diseased coronaries.Post-operative course was complicated by vasoplegic arrest and acute renal failure which was successfully managed conservatively. Discussion We report this case for the rarity of this post-PCI iatrogenic complication and the incremental role of 3DTEE in identifying the exact pathology.It was proposed that during PCI multiple stalling of rotatbur in calcified LAD caused traction and eventually disengagement of guide causing rotabur to freely hang in ascending aorta close to the cusps.Possibly this rotablator with very high speed(180000rpm) would have momentarily come in contact with the aortic cusps causing cuspal perforation and heart failure in Cath lab.3DTEE correlated very well with the anatomo-pathology and matched with intraoperative finding as shown in figures 2A & 2C.These findings prior to aortic cross clamp could significantly reduce time of surgery as he had an additional CABG procedure to be performed.There are few isolated case reports of post PCI aortic valve perforation but probably ours is the first one secondary to the use of rotablator with near involvement of all the cusps and reasonably accurate 3DTEE-anatomic characterisation. Abstract P249 Figure.

scholarly journals SUBAORTIC MEMBRANE;

2017 ◽  
Vol 24 (12) ◽  
pp. 1801-1805
Author(s):  
Tariq Waqar ◽  
Yasir Khan ◽  
Muhammad Usman Riaz
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Aortic Insufficiency ◽  
P Value ◽  
Pressure Gradients ◽  
Severe Aortic Regurgitation ◽  
Associated Lesions ◽  
Dacron Patch ◽  
Pace Maker ◽  
The Right

Objectives: In this study, we presented our results regarding outcomes ofsurgical correction of sub-aortic membrane. Study Design: Retrospective observational study.Period: June 2012 to June 2017. Setting: CPEIC Multan, Pakistan. Methods: 51 patientsoperated for resection of sub aortic membrane. The resection of sub aortic membrane wasdone through the aorta. Evaluation of the aortic valve done in all patients. The aortic valve waseither replaced or repaired in cases of severe aortic regurgitation. Associated lesions such asventricular septal defects (VSD’s) were repaired with a dacron patch through the right atriumwhile ASD’s were repaired with a pericardial patch. Post-operative echocardiography was donebefore discharge and post-op LVOT gradients and aortic insufficiency were recorded for allthe patients. Results: There were 36 males and 15 females whose mean ages were 16.29years. On post-op echocardiography there was no residual significant LVOT gradient in anypatient. Three (3) patients developed mild to moderate aortic regurgitation post operativelybut none of them warrant any surgical intervention. There was only 1 death in the series whichwas due to VSD patch dehiscence. None of the patients developed conduction problems postoperatively needing any permanent pace maker. Mean pre-op LVOT gradient was 94.7 mmHgwhile it reduced to 20.7 post operatively (p-value <0.001). Conclusion: We concluded thatearly resection of sub aortic membrane can be safely accomplished with good results andsignificant drop in the mean LVOT pressure gradients post operatively.

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.

scholarly journals Resolution of post-anaesthesia aortic regurgitation by repair of a ruptured sinus of Valsalva aneurysm: 5 case reports

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Qian Xue ◽  
Chun Yang ◽  
Xiu Han
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Case Reports ◽  
Structural Defects ◽  
Sinus Of Valsalva ◽  
Aortic Sinus ◽  
Sinus Of Valsalva Aneurysm ◽  
Valve Insufficiency ◽  
Patch Closure

Abstract Background Ruptured sinus of Valsalva aneurysm (SVA) is a rare cardiovascular disease in which some patients exhibit aortic valve insufficiency. SVA repair and valve replacement are usually required for treatment. Here, we report 5 cases of ruptured SVA with severe post-anaesthesia aortic regurgitation (AR). To the best of our knowledge, this is the first report of ruptured SVA with severe post-anaesthesia AR. Case presentation: From 2018 to 2020, there were 5 cases of ruptured SVA with severe AR after anaesthesia in our hospital. The main symptoms were palpitation and shortness of breath. Transthoracic echocardiography (TTE) with colour-flow Doppler showed ruptured aortic sinus aneurysms without AR. Post-anaesthesia echocardiography showed severe AR. Direct patch closure of the ruptured aneurysm resolved the left-to-right shunt and AR, and the aortic valve was not replaced. Conclusions Post-anaesthesia AR without obvious structural defects may occur in patients with ruptured SVAs. Valve replacement may not be necessary.

scholarly journals Successful aortic valve repair for severe aortic insufficiency caused by radiofrequency ablation

2005 ◽  
Vol 130 (2) ◽  
pp. 564-565 ◽  
Author(s):  
Giovanni Melina ◽  
Riccardo Codecasa ◽  
Irene Capecchi ◽  
Maria Luisa Gianfaldoni ◽  
Sergio Bevilacqua ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Valve Repair

scholarly journals Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency

2016 ◽  
Vol 20 (2) ◽  
pp. 35 ◽  
Author(s):  
M. L. Gordeev ◽  
V. E. Uspenskiy ◽  
G. I. Kim ◽  
A. N. Ibragimov ◽  
T. S. Shcherbinin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Type A ◽  
Aortic Insufficiency ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

<p><strong>Aim:</strong> The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.<br /><strong>Methods:</strong> From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11), combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12), and Bentall procedure (group 3, n = 26). We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.<br /><strong>Results:</strong> The hospital mortality rate was 8.2% (4/49 patients). The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.<br /><strong>Conclusions:</strong> Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long-term follow-up is needed.</p><div class="well well-small"><strong>Funding</strong></div><p><strong></strong> The study has been performed within the framework of the 2015-2017 government task, “Cardiovascular diseases” platform, Theme No. 4 Research on genome/cellular mechanisms responsible for aorta/aortic valve pathology development and elaboration of new methods of its multimodality treatment including hybrid technologies.<br /><strong></strong></p><p><strong>Conflict of interest</strong></p><p><strong></strong>The authors declare no conflict of interest.</p><p><strong>Acknowledgement</strong></p><p>The authors express their deep gratitude for assistance in diagnostics and management of patients with aortic pathologies, as well as in preparation of this article to A.Yu. Bakanov, PhD, Head of Research Laboratory of Perfusiology and Cardiac Protection; V.V. Volkov, Fellow of Research Laboratory of Perfusiology and Cardiac Protection; A.V. Naymushin, PhD, Head of Anesthesiology &amp; Resuscitation/ICU-2 Department; I.V. Basek, Phd, Head of X-Ray Computer Tomography Department and the specialists of X-Ray Computer Tomography Department, as well as to the employees of Research Center for Non-Coronary Heart Diseases and to specialists of cardiovascular surgery departments.</p>

scholarly journals Trans-apical aortic valve implantation for quadricuspid aortic valve with aortic regurgitation using J-valve system: a case reports

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chaodi Luo ◽  
Yi Jiang ◽  
Qiang Chen ◽  
Yang Yan ◽  
Dan Han
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Case Reports ◽  
Left Ventricular ◽  
Quadricuspid Aortic Valve ◽  
Valve System ◽  
First Case ◽  
Valve Insufficiency ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Quadricuspid aortic valve (QAV) is a rare congenital heart defect usually accompanied with different hemodynamic abnormalities. Due to the rarity of QAV, treatment and prognosis of QAV patients with aortic regurgitation still remain challenging. We here present the first case of a patient with severe QAV regurgitation who underwent successful treatment and performed favorable prognosis with transapical aortic valve implantation (TAVI) using J-Valve system. Case presentation A 62-year-old man experienced intermittent palpitation, shortness of breath and chest pain. Echocardiography revealed congenital QAV with massive aortic regurgitation and mild aortic stenosis, left ventricular enlargement. Aortic valve replacement was successfully performed with TAVI using J-Valve system. The postoperation and follow-up was uneventful. Conclusion TAVI using J-Valve system has emerged as a new high success rate method for treatment of patients with simple non-calcified aortic valve insufficiency.

scholarly journals WCC 2017-C-109: Congenital Quadricuspid Aortic Valve Associated with Severe Aortic Regurgitation: A Rare Case Report

2017 ◽  
Vol 02 (S 01) ◽  
pp. S13-S15
Author(s):  
Pavaneel Bhandary ◽  
Palanki Satyagopal ◽  
Muppiri Kumar ◽  
Ravinuthala Kumar
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Male Patient ◽  
Rare Case ◽  
Aortic Insufficiency ◽  
Quadricuspid Aortic Valve ◽  
Severe Aortic Regurgitation ◽  
Rare Case Report

AbstractQuadricuspid aortic valve is a very rare congenital valvular anomaly. Most of these cases present with aortic insufficiency. We present a 38 year old male patient with aquadricuspid aortic valve with severe aortic regurgitation.

scholarly journals Management of aortic insufficiency in patients with left ventricular assist device ̶ a retrospective analysis

2018 ◽  
Author(s):  
Hartmuth B. Bittner
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Assist Device ◽  
De Novo ◽  
Aortic Insufficiency ◽  
Left Ventricular ◽  
Aortic Valve Insufficiency ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Valve Insufficiency

Background Aortic insufficiency is increasingly recognized as a complication of left ventricular assist device (LVAD) support and may lead to clinical decompensation requiring correction. This article describes experiences in managing patients presenting with concomitant aortic insufficiency and with de novo aortic insufficiency following left ventricular assist device implantations. Methods All patients undergoing LVAD implantation between 2012 and 2014 were included in this retrospective analysis if aortic valve insufficiency was present on implantation or newly developed (de novo) after implantation. Moderate to severe aortic valve insufficiency was corrected at implantation. Results The data of 39 patients were included. At the time of LVAD implantation, moderate to severe aortic valve insufficiency was present in 3 patients and was corrected by bioprosthetic valve replacement (2 patients) and by bioprosthetic valve replacement associated with ascending aorta with hemi arch replacement with a graft due to ascending aortic aneurysm (one patient). Four patients developed moderate to severe aortic insufficiency after LVAD surgery. Treatment with conservative medical management was successful in 3 patients. One patient underwent transcatheter aortic valve occlusion using an Amplatzer closure device after failure of medical management. Conclusions Concomitant aortic valve replacement with LVAD implantation is a safe and viable option in managing aortic valve insufficiency. De novo aortic insufficiency may lead to recurrent heart failure and presents a clinical treatment challenge following successful LVAD support; the most appropriate and effective treatment option awaits definition.

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