Ciężkie zwężenie zastawki aortalnej u noworodka

2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Anna Prowotorow-Iwaniukowicz ◽  
Małgorzata Gołąbek-Dylewska ◽  
Krzysztof Godlewski ◽  
Bożena Werner
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Phosphodiesterase Inhibitor ◽  
External Iliac Artery ◽  
Balloon Valvuloplasty ◽  
Collateral Vessels

Aortic stenosis is a congenital heart disease which may present with different symptomatology and may lead to heart failure in newborn. A case of a 9-days old newborn with a severe aortic stenosis is presented. Due to impaired systolic function of the left ventricle and rapidly increasing symptoms of heart failure (tachypnea, dyspnoea, tachycardia) the neonate required pharmacological treatment (prostaglandin E1 infusion and phosphodiesterase inhibitor c-AMP) and balloon valvuloplasty as a matter of urgency. In chest X-ray the heart silhouette was enlarged, the electrocardiogram showed signs of overload of both ventricles. In echocardiography thickened aortic valves with a pin-hole opening, normal left ventricle size with signs of its hypertrophy and reduced contractility (ejection fraction 45%) and a moderate mitral regurgitation were found. Angiography and balloon valvuloplasty of the aortic valve was performed through puncture of the right femoral artery. After expansion of the balloon at the stenotic valve a very good result of the treatment was achieved – low invasive gradient (22 mm Hg) between the left ventricle and the aorta and a trivial aortic valve regurgitation. The good outcome of the procedure was confirmed and monitored in the next days. The general state of the child improved significantly, systolic function of the left ventricle returned to normal values. Because of a complication after the procedure – a thrombosis in the external iliac artery, a 3-month anti-clotting therapy was performed. No improvement in the patency of the vessel was observed; however, abundant collateral vessels provided the extremity with proper circulation.

scholarly journals Use and success evaluation of percutaneous aortic balloon valvuloplasty in different hemodynamic entities of severe aortic stenosis in the TAVR era

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Piayda ◽  
A Wimmer ◽  
H Sievert ◽  
K Hellhammer ◽  
S Afzal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Pressure Gradient ◽  
Severe Aortic Stenosis ◽  
Primary Treatment ◽  
Low Flow ◽  
Mean Pressure ◽  
The Mean

Abstract Background In the era of transcatheter aortic valve replacement (TAVR), there is renewed interest in percutaneous balloon aortic valvuloplasty (BAV), which may qualify as the primary treatment option of choice in special clinical situations. Success of BAV is commonly defined as a significant mean pressure gradient reduction after the procedure. Purpose To evaluate the correlation of the mean pressure gradient reduction and increase in the aortic valve area (AVA) in different flow and gradient patterns of severe aortic stenosis (AS). Methods Consecutive patients from 01/2010 to 03/2018 undergoing BAV were divided into normal-flow high-gradient (NFHG), low-flow low-gradient (LFLG) and paradoxical low-flow low-gradient (pLFLG) AS. Baseline characteristics, hemodynamic and clinical information were collected and compared. Additionally, the clinical pathway of patients (BAV as a stand-alone procedure or BAV as a bridge to aortic valve replacement) was followed-up. Results One-hundred-fifty-six patients were grouped into NFHG (n=68, 43.5%), LFLG (n=68, 43.5%) and pLFLG (n=20, 12.8%) AS. Underlying reasons for BAV and not TAVR/SAVR as the primary treatment option are displayed in Figure 1. Spearman correlation revealed that the mean pressure gradient reduction had a moderate correlation with the increase in the AVA in patients with NFHG AS (r: 0.529, p<0.001) but showed no association in patients with LFLG (r: 0.145, p=0.239) and pLFLG (r: 0.030, p=0.889) AS. Underlying reasons for patients to undergo BAV and not TAVR/SAVR varied between groups, however cardiogenic shock or refractory heart failure (overall 46.8%) were the most common ones. After the procedure, independent of the hemodynamic AS entity, patients showed a functional improvement, represented by substantially lower NYHA class levels (p<0.001), lower NT-pro BNP levels (p=0.003) and a numerical but non-significant improvement in other echocardiographic parameters like the left ventricular ejection fraction (p=0.163) and tricuspid annular plane systolic excursion (TAPSE, p=0.066). An unplanned cardiac re-admission due to heart failure was necessary in 23.7% patients. Less than half of the patients (44.2%) received BAV as a bridge to TAVR/SAVR (median time to bridge 64 days). Survival was significantly increased in patients having BAV as a staged procedure (log-rank p<0.001). Conclusion In daily clinical practice, the mean pressure gradient reduction might be an adequate surrogate of BAV success in patients with NFHG AS but is not suitable for patients with other hemodynamic entities of AS. In those patients, TTE should be directly performed in the catheter laboratory to correctly assess the increase of the AVA. BAV as a staged procedure in selected clinical scenarios increases survival and is a considerable option in all flow states of severe AS. (NCT04053192) Figure 1 Funding Acknowledgement Type of funding source: None

Treatment of Severe Aortic Stenosis: Development and Feasibility Testing of an Aortic Valve Bypass Apical Cannula

2011 ◽  
Author(s):  
Joel D. Graham ◽  
M. Keith Sharp ◽  
Steven C. Koenig ◽  
Guruprasad Giridharan ◽  
Michael A. Sobieski ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
The Elderly ◽  
Mortality Rates ◽  
Cardiovascular Medicine ◽  
Descending Aorta ◽  
Surgical Risk ◽  
Aortic Valve Bypass

Treatment of aortic stenosis through surgical replacement has been one of the most successful advances in cardiovascular medicine (1), though use in certain patient populations, specifically in the elderly, has been associated with increased mortality rates (2). A growing alternative surgery is Aortic Valve Bypass (AVB). This therapy offers decreased surgical risk because it does not require cardiopulmonary bypass, aortic crossclamping, aortotomy, or cardioplegic cardiac arrest (3). A one-way conduit between the apex of the left ventricle and the descending aorta increases flow by reducing afterload (Fig. 1, LEFT). Systolic blood from the left ventricle is ejected via both the native stenotic aortic valve and the AVB circuit. In this feasibility study, an apical cannula was developed and tested.

scholarly journals A ventricular-vascular coupling model in presence of aortic stenosis

2005 ◽  
Vol 288 (4) ◽  
pp. H1874-H1884 ◽  
Author(s):  
Damien Garcia ◽  
Paul J. C. Barenbrug ◽  
Philippe Pibarot ◽  
André L. A. J. Dekker ◽  
Frederik H. van der Veen ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Vascular System ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Arterial System ◽  
Coefficient Of Determination ◽  
Ventricular Afterload ◽  
Good Agreement

In patients with aortic stenosis, the left ventricular afterload is determined by the degree of valvular obstruction and the systemic arterial system. We developed an explicit mathematical model formulated with a limited number of independent parameters that describes the interaction among the left ventricle, an aortic stenosis, and the arterial system. This ventricular-valvular-vascular (V3) model consists of the combination of the time-varying elastance model for the left ventricle, the instantaneous transvalvular pressure-flow relationship for the aortic valve, and the three-element windkessel representation of the vascular system. The objective of this study was to validate the V3 model by using pressure-volume loop data obtained in six patients with severe aortic stenosis before and after aortic valve replacement. There was very good agreement between the estimated and the measured left ventricular and aortic pressure waveforms. The total relative error between estimated and measured pressures was on average (standard deviation) 7.5% (SD 2.3) and the equation of the corresponding regression line was y = 0.99 x − 2.36 with a coefficient of determination r2 = 0.98. There was also very good agreement between estimated and measured stroke volumes ( y = 1.03 x + 2.2, r2 = 0.96, SEE = 2.8 ml). Hence, this mathematical V3 model can be used to describe the hemodynamic interaction among the left ventricle, the aortic valve, and the systemic arterial system.

scholarly journals Decompensated Aortic Stenosis in a Young Patient with Multiple Comorbidities - A Case Report

2020 ◽  
Vol 25 (2) ◽  
pp. 39-41
Author(s):  
Alexandra Stoica ◽  
Marius Harpa ◽  
Hussam Al Hussein ◽  
Carmen Opriş ◽  
Cosmin Opriş ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Atrial Myxoma ◽  
Rapid Progression ◽  
Left Atrial Myxoma ◽  
Aortic Pathology

AbstractAortic valve replacement is a safe therapy that can reverse cardiac remodeling and increase cardiac contractility, improve symptoms and quality of life. We presented a case of a 35-year-old male patient admitted to the Emergency Institute for Cardiovascular Disease and Transplantation of Târgu Mureș, Romania, due to severe aortic stenosis with severely depressed ejection fraction, left atrial myxome and a history of deep vein thrombosis and pulmonary thromboembolism. He underwent excision of the aortic valve and replacement with a mechanical prosthesis, excision of left atrial myxoma and tricuspid annuloplasty. The postoperative evolution was favourable with a significant recovery of the left ventricular systolic function and regression of cardiac symptomatology. This case was particular due to the rapid progression of the aortic pathology with the reduction of cardiac (systolic) function in a relatively short time as well as the occurrence of the thromboembolic event unrelated to the left atrial myxoma and rather associated with the background of cardiac failure with low cardiac output.

Cardiovascular System

2010 ◽  
Author(s):  
Gautam Mehta ◽  
Bilal Iqbal
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Pulmonary Congestion ◽  
Atrial Contraction ◽  
Apex Beat

1. Always mention presence/absence of signs of endocarditis in any patient with physical signs of valvular heart disease. More than often, they are absent—but this is an important negative finding. 2. Both a low volume and a slow-rising pulse are signs of severe aortic stenosis. If the patient is in atrial fibrillation (AF), then the pulse usually has a variable volume, and some examiners believe that one cannot fully conclusively comment on pulse volume in AF. In patients with aortic stenosis and AF, the pulse exhbits a variable but diminished volume. It would be more appropriate in this setting to say, ‘the pulse is of variable but diminished volume’. 3. A narrow pulse pressure signifies a low cardiac output state, thus a sign of severe aortic stenosis. Other causes of a narrow pulse pressure include severe mitral stenosis or a hypovolaemic state. 4. If venous pressure is elevated, then look for signs of pulmonary hypertension (usually with giant systolic ‘v’ waves of tricuspid regurgitation, parasternal heave and thrill, and a loud pulmonary component to the second heart sound) or pulmonary congestion/cardiac failure (bibasal crepitations). The presence of pulmonary hypertension and pulmonary congestion are markers of severe aortic stenosis. 5. The left ventricle (LV) is hypertrophied, and is minimally displaced with a heaving character. A displaced apex beat indicates a dilated left ventricle, i.e. left ventricular failure. In the late stages of severe aortic stenosis, the left ventricle dilates and heart failure develops. However, the character of the apex beat remains the same. If the apex is displaced, in the absence of signs of severe aortic stenosis, then consider other causes of heart failure. 6. The presystolic impulse is transmission of atrial contraction just before closure of the mitral valve, as a result of forceful atrial contraction against a highly non-compliant and hypertrophied left ventricle. This is often accompanied by a fourth heart sound, and would be a marker of severe aortic stenosis. These signs would not be present in AF. A presystolic impulse is seen in other conditions with marked left ventricular hypertrophy, i.e. hypertensive heart disease or hypertrophic cardiomyopathy (giving a double apical impulse).

Abstract 11154: Predictors of Improvement of Left Ventricular Diastolic Function After Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis With Preserved Left Ventricular Systolic Function: A Serial Echocardiographic Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroto Utsunomiya ◽  
Hirotsugu Mihara ◽  
Yuji Itabashi ◽  
Javier Berdejo ◽  
Ken Matsuoka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Diastolic Function ◽  
Transcatheter Aortic Valve Replacement ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Valve Area

Background: Improvement of left ventricular (LV) diastolic function (DF) after transcatheter aortic valve replacement (TAVR) is not fully elucidated. The present serial transthoracic echocardiography study aimed to investigate the long-term clinical and hemodynamic impact of DF improvement after TAVR and to identify its predictors. Methods: We retrospectively reviewed echocardiographic and clinical data before and after TAVR in 98 patients with severe aortic stenosis (AS) and preserved LV systolic function. Mitral annular displacement was measured as the maximal distance of lateral annular motion during systole in apical 4-chamber view. DF was classified as grade 0 to 3 based on the recommendations of the American Society of Echocardiography. DF improvement was defined as ≥1 grade improvement at the 1-year follow-up. Results: Fifty-nine patients (60%) showed DF improvement. At baseline, patients with the improvement had a less severity of AS (valve area index, 0.37 ± 0.09 vs. 0.32 ± 0.08 cm2/m2) than those with no improvement. Despite similar baseline and changes in LV ejection fraction and mass index, the improvement group shows better recovery of functional status, stroke volume index, and E/e’ (Fig.1-3), as well as plasma brain natriuretic peptide level (median, 264 to 110 vs. 267 to 252 pg/ml, p = 0.017). When adjusting for age, demographic variables, valve area and change in mass index, absence of coronary artery disease (p = 0.03), mitral annular displacement (p < 0.001), and right ventricular end-diastolic diameter (p = 0.02) were independently associated with DF improvement. A mitral annular displacement >11.9 mm had a sensitivity of 83% and a specificity of 72% for prediction of DF improvement (Fig.4). Conclusion: DF improvement is often observed after TAVR and when present may be accompanied by more favorable clinical and hemodynamic changes. Mitral annular displacement, but not AS severity or degree of mass regression, predicts DF improvement after TAVR.

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