scholarly journals Utility of dobutamine stress echocardiography in aortic valve regurgitation and reduced left ventricular function

2021 ◽  
Author(s):  
Chihiro Saito ◽  
Kotaro Arai ◽  
Kyomi Ashihara ◽  
Hiroshi Niinami ◽  
Nobuhisa Hagiwara
Keyword(s):  
Aortic Valve ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Aortic Valve Surgery ◽  
Ventricular Ejection Fraction

Objective: Predictors for post-operative reverse remodeling in patients with severe aortic regurgitation (AR) and reduced left ventricular ejection fraction (LVEF) are unknown. We performed low-dose dobutamine stress echocardiography (DSE) in patients with severe AR and reduced LVEF to evaluate the relationship between contractile reserve (CR) and reverse remodeling after surgery. Methods: In 31 patients with chronic severe AR and reduced LVEF (LVEF < 50%), we performed pre-operative DSE, assessed CR and examined whether changes in preoperative DSE were associated with improvement of post-operative LVEF after aortic valve surgery. Results: The pre-operative echocardiographic findings were as follows: left ventricular (LV) end-diastolic dimension: 67 ± 10 mm, LV end-systolic dimension: 52 ± 13 mm and LVEF: 42% ± 8%. All patients underwent aortic valve surgery. Patients with pre-operative LVEF of >45% exhibited a significant increase in LVEF; however, patients with pre-operative LVEF of <45% showed no significant change. When we examined the results of DSE performed in patients with pre-operative LVEF of <45%, ΔLVEF of ≥6% (with CR) during DSE was related to an improvement in post-operative LVEF; ΔLVEF of ≥6% during DSE predicted an improvement in post-operative LVEF, with a sensitivity and specificity of 80% and 85%, respectively. Conclusions: DSE may be a helpful tool for predicting post-operative reverse remodeling in patients with severe AR and moderately reduced LVEF.

scholarly journals Clinical Experience of Aortic Valve Surgery in Patients With Aortitis Disease

2019 ◽  
Vol 22 (5) ◽  
pp. E366-E371
Author(s):  
Yunxing Xue ◽  
Jun Pan ◽  
Qing Zhou ◽  
Qiang Wang ◽  
Hailong Cao ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Surgical Techniques ◽  
Group Versus ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Paravalvular Leak ◽  
Aortic Valve Surgery ◽  
Ventricular Ejection Fraction ◽  
Bentall Procedure

Objective: To investigate single center’s clinical experiences of aortic valve surgery for aortitis patients. Methods: From January 2010 to December 2018, 15 patients with aortitis disease were treated in our center. Among them, there were 7 males and 8 females with an average age of 48.5 ± 13.9 (29-76) years. Six patients were diagnosed as giant cell arteritis, 2 as Takayasu arteritis (Arteritis Group, N = 8) and 7 as Behcet's disease (BD Group, N = 7). Aortic valve surgery includes valvuloplasty, valve replacement, and root replacement (Bentall procedure). Results: There were 15 cases with 19 operations, 8 cases in the Arteritis Group received 8 operations while 7 cases in the BD Group received 11 operations, including 4 redo operations. Preoperative patients’ aortic valve regurgitation degree, diameter of ascending aorta and left ventricular ejection fraction were similar between the two groups. The type of aortic valve surgery also was no different. Cardiopulmonary bypass time of the BD Group seemed longer than the Arteritis Group but no different, the same as clamp time. Mechanical ventilation time is longer in the BD Group. The morbidity and mortality were similar, but the BD Group had significantly higher incidence of redo operations because of postoperative paravalvular leak or valve insufficiency (Arteritis Group versus BD Group, 0% versus 57.1%, P = .026). Conclusions: Clinical diagnosis and management of aortic valve patients with arteritis require comprehensive considerations. For aortitis patients with aortic valve surgery, special surgical techniques can be used to reduce the risk of prosthetic valve detachment.

Left ventricular reverse remodeling after aortic valve surgery for acute versus chronic aortic regurgitation

2016 ◽  
Vol 33 (10) ◽  
pp. 1458-1464 ◽  
Author(s):  
Madelien V. Regeer ◽  
Michel I. M. Versteegh ◽  
Nina Ajmone Marsan ◽  
Martin J. Schalij ◽  
Robert J. M. Klautz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Reverse Remodeling ◽  
Aortic Valve Surgery ◽  
Left Ventricular Reverse Remodeling ◽  
Chronic Aortic Regurgitation

scholarly journals Takotsubo cardiomyopathy induced during dobutamine stress echocardiography: an exhaustive review

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Kasongo ◽  
A Kone ◽  
D De Zuttere ◽  
P Meimoun ◽  
H Lardoux
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Rapid Recovery ◽  
Left Ventricular Ejection ◽  
Female Population ◽  
Coronary Syndrome ◽  
Central Registry

Abstract Funding Acknowledgements Type of funding sources: None. Introduction. Takotsubo cardiomyopathy (TTC) mimics an acute coronary syndrome and corresponds to an acute reversible stress-induced cardiomyopathy. Dobutamine Stress Echocardiography (DSE) has been widely used for more than 30 years and is considered as one of the gold standard non-invasive test to detect myocardial ischemia. DSE responsible for a TTC is a rare clinical entity. Purpose. Dobutamine induced takotsubo Cardiomyopathy (TTC-DSE) is an exceptional situation. We systematically search for TTC-DSE observations to analyse the specific characteristics of such a cohort. Methods and Results.  We conducted an extensive search in Medline, and the Cochrane Central Registry of Controlled Trials, using the key words "acute cardiomyopathy, takotsubo syndrome and DSE". File selection was based on the following criteria : (a) occurrence of TTC during DSE, (b) Mayo Clinic criteria (1) associating transient left ventricular systolic dysfunction, absence of significant coronary stenosis, ST-T abnormalities on EKG, moderate troponin elevation, and absence of pheochromocytoma or myocarditis. We identified 30 clinical observations of TTC-DSE published between 2006 and 2019, mostly from USA and Europe publications. Symptoms appear at high dobutamine dosages (30 or 40 gammas/kg/min: 24/30), rarely during recovery (4/30). These patients have the typical features of TTC : (1) strong predominance of a female population (26 women; 86.7%), aged over 50 years (24; 93.3%); (2) depression and/or anxiety (8 pts; 26.7%);  (3) ECG: ST elevation (21 pts; 70 %), ST depression (2 pts), no ST change (4 pts), and left conduction block (3 pts); (4) emergency coronary angiography without significant coronary lesion; (5) angiographic left ventricular ejection fraction (LVEF), calculated in 18/30pts : &lt; 40% for 14/18 pts; (6) segmental LV impairment (echo or angio): apical n = 17 (77.3%); mid-ventricular n = 3 (13.6%); reverse n = 2 (9%) and unspecified (8 pts); (7) low peak of Troponin: 2.65 ± 2.04 ng/ml; (8) one death from an acute heart failure (old lady 86 years age, with intra ventricular gradient), and rapid recovery of LVEF in other patients (29 pts). Despite the heterogeinity in TTC-DSE patients and large cohort of patients in the TTC publications, TTC-DSE and TTC patients have comparable caracteristics. Conclusion. TTC-DSE is an exceptional, but severe complication of DSE. It provides a unique opportunity to observe TTC in the acute phase. These observational studies show a similar profile between TTC-DSE and TTC patients. Mortality remains low in TTC-DSE cohort, probably because of prompt interruption of the test. Rapid recovery of LV function is consistent. High level of sympathetic stimulation secondary to dobutamine infusion, and frequent anxiety associated with DSE, are probably the major determinants of TTC-DSE. However, the rarity of the TTC-DSE, compared to the widespread daily practice of DSE in echo-laboratories, remains unexplained.

scholarly journals Adverse effects of left ventricular electrical dyssynchrony on cardiac reverse remodeling and prognosis after aortic valve surgery

2018 ◽  
Vol 72 (5) ◽  
pp. 385-392 ◽  
Author(s):  
Soo Youn Lee ◽  
Chi Young Shim ◽  
Geu-Ru Hong ◽  
In Jeong Cho ◽  
Seng Chan You ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Adverse Effects ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Reverse Remodeling ◽  
Aortic Valve Surgery
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