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Lee SH, Yoon SJ, Sun BJ, Kim HM, Kim HY, Lee S, Shim CY, Kim EK, Cho DH, Park JB, Seo JS, Son JW, Kim IC, Lee SH, Heo R, Lee HJ, Park JH, Song JM, Lee SC, Kim H, Kang DH, Ha JW, Kim KH. 2023 Korean Society of Echocardiography position paper for diagnosis and management of valvular heart disease, part I: aortic valve disease. J Cardiovasc Imaging 2024; 32:11. [PMID: 39061115 PMCID: PMC11282617 DOI: 10.1186/s44348-024-00019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/24/2023] [Indexed: 07/28/2024] Open
Abstract
This manuscript represents the official position of the Korean Society of Echocardiography on valvular heart diseases. This position paper focuses on the clinical management of valvular heart diseases with reference to the guidelines recently published by the American College of Cardiology/American Heart Association and the European Society of Cardiology. The committee tried to reflect the recently published results on the topic of valvular heart diseases and Korean data by a systematic literature search based on validity and relevance. In part I of this article, we will review and discuss the current position of aortic valve disease in Korea.
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Affiliation(s)
- Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Se-Jung Yoon
- Division of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Byung Joo Sun
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - In-Cheol Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hyun Lee
- Division of Cardiology, Pusan National Yangsan Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National Yangsan Hospital, Busan, Republic of Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- Regional Cardiocerebrovascular Center, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyungseop Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
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Roselli EE, Thompson MA, Yazdchi F, Lowry A, Johnston DR, Desai M, Blackstone EH. Well-functioning bicuspid aortic valves should be preserved during aortic replacement for the ascending aortopathy phenotype. J Thorac Cardiovasc Surg 2024; 167:566-577.e9. [PMID: 35961879 DOI: 10.1016/j.jtcvs.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Consensus has not been reached on whether or not to replace or preserve a well-functioning bicuspid aortic valve (BAV) in patients undergoing aortic replacement for the ascending phenotype of BAV aortopathy. We characterize morphology, evaluate progression of aortic regurgitation or aortic stenosis, and investigate the need for aortic valve replacement in patients whose well-functioning BAV was preserved during ascending aortic replacement ≥10 years prior. METHODS From January 1991 to August 2011, 191 patients with a well-functioning BAV underwent supracoronary aortic replacement (113 valves were minimally repaired). Aortic morphology was evaluated, aortic regurgitation grade and transvalvular aortic gradient modeled parametrically, and survival assessed by the Kaplan-Meier method. Median follow-up was 10 years. RESULTS Mean aortic diameter was 2.9 ± 0.53 cm at the annulus and 4.2 ± 0.55 cm at the sinuses. Mean maximum ascending diameter was 5.1 ± 0.49 cm. All patients exhibited a cusp-fusion BAV phenotype. Fifteen-year progression to severe aortic regurgitation was 3.2%. Mean aortic valve gradient began to rise 5 years postoperatively to 27 mm Hg by 14 years. Freedom from aortic valve replacement at 1, 5, 10, and 15 years was 100%, 95%, 83%, and 63%, respectively. Minimal valve repair was not associated with late aortic valve replacement. Fifteen-year survival was 74%. CONCLUSIONS Preserving a well-functioning BAV should be considered in carefully selected patients undergoing aortic replacement for the ascending phenotype of BAV aortopathy. The valves remain durable in the long term, with slow progression of regurgitation or stenosis, and low probability of aortic valve replacement through 10 years.
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Affiliation(s)
- Eric E Roselli
- Aorta Center, Cleveland, Ohio; Bicuspid Aortic Valve Center, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland, Ohio.
| | - Matthew A Thompson
- Department of Thoracic and Cardiovascular Surgery, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Farhang Yazdchi
- Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Ashley Lowry
- Aorta Center, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Aorta Center, Cleveland, Ohio; Bicuspid Aortic Valve Center, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Cleveland, Ohio
| | - Milind Desai
- Aorta Center, Cleveland, Ohio; Bicuspid Aortic Valve Center, Cleveland, Ohio; Department of Cardiology, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland, Ohio; Department of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
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Hodges K, Rosinski BF, Roselli EE, Rajeswaran J, Griffin B, Vargo PR, Koprivanac M, Tong M, Blackstone EH, Svensson LG. Aortic valve cusp repair does not affect durability of modified aortic valve reimplantation for tricuspid aortic valves. JTCVS OPEN 2023; 16:105-122. [PMID: 38204640 PMCID: PMC10774985 DOI: 10.1016/j.xjon.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 01/12/2024]
Abstract
Objective During aortic valve reimplantation, cusp repair may be needed to produce a competent valve. We investigated whether the need for aortic valve cusp repair affects aortic valve reimplantation durability. Methods Patients with tricuspid aortic valves who underwent aortic valve reimplantation from January 2002 to January 2020 at a single center were retrospectively analyzed. Propensity matching was used to compare outcomes between patients who did and did not require aortic valve cusp repair. Results Cusp repair was performed in 181 of 756 patients (24%). Patients who required cusp repair were more often male, were older, had more aortic valve regurgitation, and less often had connective tissue disease. Patients who underwent cusp repair had longer aortic clamp time (124 ± 43 minutes vs 107 ± 36 minutes, P = .001). In-hospital outcomes were similar between groups and with no operative deaths. A total of 98.3% of patients with cusp repair and 99.3% of patients without cusp repair had mild or less aortic regurgitation at discharge. The median follow-up was 3.9 and 3.2 years for the cusp repair and no cusp repair groups, respectively. At 10 years, estimated prevalence of moderate or more aortic regurgitation was 12% for patients with cusp repair and 7.0% for patients without cusp repair (P = .30). Mean aortic valve gradients were 6.2 mm Hg and 8.0 mm Hg, respectively (P = .01). Ten-year freedom from reoperation was 99% versus 99% (P = .64) in the matched cohort and 97% versus 97%, respectively (P = .30), in the unmatched cohort. Survival at 10 years was 98% after cusp repair and 93% without cusp repair (P = .05). Conclusions Aortic valve reimplantation for patients with tricuspid aortic valves has excellent long-term results. Need for aortic valve cusp repair does not affect long-term outcomes and should not deter surgeons from performing valve-sparing surgery.
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Affiliation(s)
- Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Bradley F. Rosinski
- Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E. Roselli
- Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Science, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick R. Vargo
- Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marijan Koprivanac
- Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Tong
- Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Science, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Baman JR, Medhekar AN, Malaisrie SC, McCarthy P, Davidson CJ, Bonow RO. Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease. JAMA Cardiol 2022; 8:281-289. [PMID: 36542365 DOI: 10.1001/jamacardio.2022.4770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ImportanceThe management of aortic valve disease, including aortic stenosis and aortic regurgitation (AR), in younger adult patients (age <65 years) is complex, and the optimal strategy is often unclear, contingent on multiple anatomic and holistic factors.ObservationsTraditional surgical approaches carry significant considerations, including compulsory lifelong anticoagulation for patients who receive a mechanical aortic valve replacement (AVR) and the risk of structural valvular deterioration and need for subsequent valve intervention in those who receive a bioprosthetic AVR. These factors are magnified in young adults who are considering pregnancy, for whom issues of anticoagulation and valve longevity are heightened. The Ross procedure has emerged as a promising alternative; however, its adoption is limited to highly specialized centers. Valve repair is an option for selected patients with AR. These treatment options offer varying degrees of durability and are associated with different risks and complications, especially for younger adult patients. Patient-centered care from a multidisciplinary valve team allows for discussion of the optimal timing of intervention and the advantages and disadvantages of the various treatment options.Conclusions and RelevanceThe management of severe aortic valve disease in adults younger than 65 years is complex, and there are numerous considerations with each management decision. While mechanical AVR and bioprosthetic AVR have historically been the standards of care, other options are emerging for selected patients but are not yet generalizable beyond specialized surgical centers. A detailed discussion by members of the multidisciplinary heart team and the patient is an integral part of the shared decision-making process.
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Affiliation(s)
- Jayson R. Baman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit N. Medhekar
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - S. Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick McCarthy
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles J. Davidson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert O. Bonow
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Editor, JAMA Cardiology
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Tabrizi NS, Stout P, Richvalsky T, Cherukupalli D, Pedersen A, Samy S, Shapeton AD, Musuku SR. Aortic Valve Repair Using HAART 300 Geometric Annuloplasty Ring: A Review and Echocardiographic Case Series. J Cardiothorac Vasc Anesth 2022; 36:3990-3998. [PMID: 35545458 DOI: 10.1053/j.jvca.2022.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/24/2022] [Accepted: 03/13/2022] [Indexed: 11/11/2022]
Abstract
Aortic valve repair (AVr) aims to preserve the native aortic leaflets and restore normal valve function. In doing so, AVr is a more technically challenging approach than traditional aortic valve replacement. Some of the complexity of repair techniques can be attributed to the unique structure of the functional aortic annulus (FAA), which, unlike the well-defined mitral annulus, is comprised of virtual and functional components. Though stabilizing the ventriculo-aortic junction (VAJ), a component of the FAA, is considered beneficial for patients with chronic aortic insufficiency (AI), the ideal AVr technique remains a subject of much debate. The existing AVr techniques do not completely stabilize the VAJ which may increase susceptibility to recurrent AI due to VAJ dilation. An emerging new technique showing promise for the treatment of both isolated and complex AI is AVr using HAART 300TM geometric annuloplasty ring (GAR). The GAR is implanted below the valve leaflets in the left ventricular outflow tract (LVOT), providing stability and creating a neo-annulus. As with other AVr subtypes, this procedure has a learning curve. There are unique surgical and echocardiographic aspects of AVr with GAR, including the appearance of the LVOT, the aortic valve leaflets, and their motion which cardiac anesthesiologists and echocardiographers must be familiar with. In this work, using an eight-patient echocardiographic case series, we provide an overview of this novel AVr technique, including some unique aspects of device sizing, patient selection, expected post-repair echocardiographic features, and a review of outcomes data.
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Affiliation(s)
| | | | - Tanya Richvalsky
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Divya Cherukupalli
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | | | - Sanjay Samy
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Alexander D Shapeton
- Veterans Affairs Boston Healthcare System, Department of Anesthesia, Critical Care and Pain Medicine, and Tufts University School of Medicine, Boston, MA
| | - Sridhar R Musuku
- Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY.
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Nijs J, Vangelder B, Tanaka K, Gelsomino S, Van Loo I, La Meir M, Maessen J, Kietselaer BL. Geometric characteristics of bicuspid aortic valves. JTCVS Tech 2021; 10:200-215. [PMID: 34977726 PMCID: PMC8691778 DOI: 10.1016/j.xjtc.2021.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/19/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE We studied the coaptation angles α and β in bicuspid aortic valve geometry from computed tomography scan images. METHODS In 45 patients, we calculated the coaptation angle α (the angle between the nonfused commissures crossing the center of coaptation), angle β (between the nonfused commissures crossing the center of the reference circle), angles γ1 and γ2 and ε1 and ε2 (angle between the nonfused commissures and the coaptation point at the raphe or the perfect midpoint, respectively), the length of the raphe, the absolute and relative sinuses' surfaces (relative to the perfect circle and the percentage exceeding the ideal circle). Spearman correlation was employed to investigate the associations among all parameters. RESULTS The coaptation angles α and β were significantly different (P < .001). We found a significant correlation of α with the length of the raphe (P = .008), whereas β was dependent on the position of the commissures. Both γ1 and γ2 (P = .04), or ε1 and ε2 (P < .001) significantly differed from each other and ε2 was the most constant angle, although its size geometrically depends on β. The noncoronary was the largest sinus, and β was the primary determinant of its increased size in bicuspid aortic valves with righ/left fusion pattern. CONCLUSIONS The coaptation angle α is influenced by the length of the raphe, whereas angle β is dependent on the position of the commissures. The position of the raphe can vary and is not always situated in the middle of the free edge. The position of the right/non commissure is variable, whereas the right/left commissure is more fixed.
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Affiliation(s)
- Jan Nijs
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Department of Cardiac Surgery, Brussels Center for Aortic and Cardiovascular Connective Tissue Diseases, University Hospital Brussels, Brussels, Belgium
| | - Babs Vangelder
- Cardiology Division, Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Cardiac Surgery, Brussels Center for Aortic and Cardiovascular Connective Tissue Diseases, University Hospital Brussels, Brussels, Belgium
- Cardio-Radiology Division, Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Sandro Gelsomino
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ines Van Loo
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Division, Department of Cardiac Surgery, University Hospital Brussels, Brussels, Belgium
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos Maessen
- Cardiothoracic Surgery Division, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiothoracic Surgery Division, Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas L.J.H. Kietselaer
- Cardiology Division, Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Saef JM, Ghobrial J. Valvular heart disease in congenital heart disease: a narrative review. Cardiovasc Diagn Ther 2021; 11:818-839. [PMID: 34295708 DOI: 10.21037/cdt-19-693-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/29/2021] [Indexed: 12/29/2022]
Abstract
Patients with congenital heart disease (CHD) are one of the fastest growing populations in cardiology, and valvular pathology is at the center of many congenital lesions. Derangements in valvular embryology lead to several anomalies prone to dysfunction, each with hemodynamic effects that require appropriate surveillance and management. Surgical innovation has provided new treatments that have improved survival in this population, though has also contributed to esotericism in patients who already have unique anatomic and physiologic considerations. Conduit and prosthesis durability are often monitored collaboratively with general and specialized congenital-focused cardiologists. As such, general cardiologists must become familiar with valvular disease with CHD for appropriate care and referral practices. In this review, we summarize the embryology of the semilunar and atrioventricular (AV) valves as a foundation for understanding the origins of valvular CHD and describe the mechanisms that account for heterogeneity in disease. We then highlight the categories of pathology from the simple (e.g., bicuspid aortic valve, isolated pulmonic stenosis) to the more complex (e.g., Ebstein's anomaly, AV valvular disease in single ventricle circulations) with details on natural history, diagnosis, and contemporary therapeutic approaches. Care for CHD patients requires collaborative effort between providers, both CHD-specialized and not, to achieve optimal patient outcomes.
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Affiliation(s)
- Joshua M Saef
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Joanna Ghobrial
- Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 555] [Impact Index Per Article: 185.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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10
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 819] [Impact Index Per Article: 273.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). ACTA ACUST UNITED AC 2020; 67:446-480. [PMID: 32948329 DOI: 10.1016/j.redar.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
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Affiliation(s)
- P Carmona García
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Coordinadora del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SEDAR
| | - R García Fuster
- Servicio de Cirugía Cardiaca, Consorcio Hospital General Universitario de Valencia, España. Coordinador del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SECCE.
| | - E Mateo
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - S Badía Gamarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Trías y Pujol, Badalona, España
| | - M López Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España
| | - E Gutiérrez Carretero
- Servicio de Cirugía Cardiaca, Hospital, Universitario Virgen del Rocío, Sevilla, España
| | - M L Maestre
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - V Legname
- Servicio de Cirugía Cardiaca, Centro Médico Teknon, Barcelona, España
| | - G Fita
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación. Hospital Clínic, Barcelona, España
| | - M Vives
- EDAIC. PhD. Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Universitario Dr Josep Trueta de Girona, España. Representante de España en la EACTA. Co-director del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Representante del subcomité de Educación de EACTA. Co-director grupo EchoSim
| | - T Koller Bernhard
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - E Sánchez Pérez
- EDAIC. Sección de Cirugía Cardiaca, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR
| | - J Miralles Bagán
- Sección Cardiotorácica, Servicio Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - S Italiano
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - B Darias-Delbey
- Servicio Anestesiología y Reanimación, Proceso del Paciente, Cardioquirúrgico, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, España
| | - J M Barrio
- Sección Anestesia y Reanimación Cardiovascular, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Hortal
- Servicio de Anestesiología y Reanimación, Hospital General. Universitario Gregorio Marañón, Madrid, España
| | - J I Sáez de Ibarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - A Hernández
- Departamento de Anestesia y Cuidados Intensivos, Grupo Policlínica, Ibiza, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos, de la SEDAR Representante del subcomité de Educación de EACTA, EDAIC, Codirector grupo EchoSim
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12
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Jabagi H, Boodhwani M. Invited Commentary. Ann Thorac Surg 2019; 109:1007-1008. [PMID: 31846641 DOI: 10.1016/j.athoracsur.2019.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Habib Jabagi
- Division of Cardiac Surgery, University of Ottawa Heart Institute, H-34058A, 40 Ruskin St, Ottawa, Ontario K1Y 4W7, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, H-34058A, 40 Ruskin St, Ottawa, Ontario K1Y 4W7, Canada.
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14
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Doukky R, Golzar Y. Straining for New Prognostic Predictors in Asymptomatic Severe Aortic Regurgitation. JACC Cardiovasc Imaging 2019; 13:22-24. [PMID: 30772225 DOI: 10.1016/j.jcmg.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois; Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
| | - Yasmeen Golzar
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois
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15
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Ko H, Bavaria JE, Habertheuer A, Augoustides JG, Siki MA, Freas M, Komlo C, Milewski K, Desai ND, Szeto WY, Vallabhajosyula P. Functional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring. Ann Thorac Surg 2019; 107:68-75. [DOI: 10.1016/j.athoracsur.2018.06.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/11/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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16
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McConkey H, Zhao Z, Redwood S, Chen M, Prendergast BD. Timing and mode of intervention for patients with left sided valvular heart disease: an individualized approach. PRECISION CLINICAL MEDICINE 2018; 1:118-128. [PMID: 35692702 PMCID: PMC8985789 DOI: 10.1093/pcmedi/pby017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 02/05/2023] Open
Abstract
Left sided valvular heart disease poses major impact on life and lifestyle. Medical therapy merely palliates chronic severe valve disease and once symptoms or haemodynamic sequelae appear, life expectancy is markedly truncated. In this article, we review the mechanisms of valve pathology, latest evidence in the quest for pharmacological options, means by which to predict deterioration, and standard and novel treatment options.
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Affiliation(s)
- Hannah McConkey
- King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom, and the Department of Cardiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Zhengang Zhao
- Department of Cardiology, West China Hospital, Sichuan University
| | - S Redwood
- King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom, and the Department of Cardiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - M Chen
- Department of Cardiology, West China Hospital, Sichuan University
| | - B D Prendergast
- King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom, and the Department of Cardiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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17
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Durability of Aortic Valve Cusp Repair With and Without Annular Support. Ann Thorac Surg 2018; 105:739-748. [DOI: 10.1016/j.athoracsur.2017.09.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/11/2017] [Indexed: 11/23/2022]
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18
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Abstract
The management of aortic valve disease has been improved by accurate diagnosis and assessment of severity by echocardiography and advanced imaging techniques, efforts to elicit symptoms or objective markers of disease severity and progression, and consideration of optimum timing of aortic valve replacement, even in elderly patients. Prevalence of calcific aortic stenosis is growing in ageing populations. Conventional surgery remains the most appropriate option for most patients who require aortic valve replacement, but the transcatheter approach is established for high-risk patients or poor candidates for surgery. The rapid growth of transcatheter aortic valve replacement has been fuelled by improved technology, evidence-based clinical research, and setting up of multidisciplinary heart teams. Aortic regurgitation can be difficult to diagnose and quantify. Left ventricular dysfunction often precedes symptoms, needing active surveillance by echocardiography to determine the optimum time for aortic valve replacement. Development of transcatheter approaches for aortic regurgitation is challenging, owing to the absence of valvular calcification and distortion of aortic root anatomy in many patients.
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Affiliation(s)
- Robert O Bonow
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Martin B Leon
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Darshan Doshi
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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19
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Regeer MV, Versteegh MI, Marsan NA, Bax JJ, Delgado V. The role of multimodality imaging in the selection of patients for aortic valve repair. Expert Rev Cardiovasc Ther 2015; 14:75-86. [DOI: 10.1586/14779072.2016.1109448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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20
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Abstract
The key for successful valve repair is full understanding of the regurgitant mechanism and sufficient evaluation of the valve. Currently, multidetector computed tomography has been introduced for evaluation. The aortic valve can be analyzed in details preoperatively. The main causes of aortic regurgitation (AR) in the adult population are degenerative leaflet change and annulus dilatation. Restoration to normal structure can be accomplished mainly by plication. Central leaflet plication near the Arantius nodule is a simple technique for redundant tissue. For leaflet deficiency, pericardial patch plasty may be an option. No universal technique exists for plication of the aortic annulus. The valve-sparing aortic root replacement firmly stabilizes the ventriculo-aortic junction (VAJ) and assures repair durability even in patients with mild to moderate root dilatation. Subcommissural annuloplasty (Cabrol stitch) does not seem sufficient for the prevention of VAJ dilatation. Circumferential annuloplasties may have a greater potential. However, convenient device for annular plication is still in development. The bicuspid aortic valve is a congenital heart valve lesion. A basic technique is free margin plication of the fused leaflet. Aortic root dilatation may contribute to AR severity. Valve-sparing aortic root replacement may improve repair durability. Considering the great advances in valve repair, young patients with AR should be informed that valve repair is a promising option for surgical treatment.
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21
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Nijs J, Gelsomino S, Kietselaer BBLJH, Parise O, Lucà F, Maessen JG, Meir ML. 3D-echo in preoperative assessment of aortic cusps effective height. World J Cardiol 2014; 6:689-691. [PMID: 25068031 PMCID: PMC4110619 DOI: 10.4330/wjc.v6.i7.689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/12/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
Effective height, which represents the height difference between the central free margins and the aortic insertion lines can be easily determined by 2-D echocardiography and allows for identification of prolapse in the native cusps and assessment of prolapse correction after valve repair. Nonetheless, it allows to see only two of three aortic valve (AV) coaptation planes and this may lead to misunderstanding of the underlying pathophysiological mechanism for aortic regurgitation and hence in unsuccessful repair. In contrast, 3D transoesophageal echocardiography and multiple plane reconstruction lets visualize all the three coaptation planes between the AV cusps and it represents an invaluable tool in the assessment of aortic valve geometry. It is highly recommendable before AV repair to accurately study the complex three dimensional cusps anatomy and their geometric interrelation with aortic root.
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg 2014; 148:e1-e132. [DOI: 10.1016/j.jtcvs.2014.05.014] [Citation(s) in RCA: 631] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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23
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Gallego P, Chaparro M, Méndez I, Castro A, Martínez-Torres MÁ, Gómez-Domínguez R. Valoración ecocardiográfica de la anatomía funcional de la insuficiencia aórtica durante la cirugía de reparación valvular. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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24
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The role of transesophageal echocardiography in aortic valve preserving procedures. Indian Heart J 2014; 66:327-33. [PMID: 24973839 DOI: 10.1016/j.ihj.2014.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 05/07/2014] [Indexed: 11/21/2022] Open
Abstract
In selected cases of aortic regurgitation, aortic valve (AV) repair and AV sparing root reconstruction viable alternatives to aortic valve replacement. Repair and preservation of the native valve avoids the use of long-term anticoagulation, lowers the incidence of subsequent thromboembolic events and reduces the risk of endocarditis. Additionally repair has a low operative mortality with reasonable mid-term durability. The success and longer term durability of AVPP has improved with surgical experience. An understanding of the mechanism of the AR is integral to determining feasibility and success of an AVPP. Assessment of AV morphology, anatomy of the functional aortic annulus (FAA) and the aortic root with transesophageal echocardiography (TEE) improves the understanding of the mechanisms of AR. Pre- and intra-operative TEE plays a pivotal role in guiding case selection, surgical planning, and in evaluating procedural success. Post-operative transthoracic echocardiography is useful to determine long-term success and monitor for recurrence of AR.
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Kari FA, Kvitting JPE, Stephens EH, Liang DH, Merk DR, Fischbein MP, Mitchell RS, Miller DC. Tirone David procedure for bicuspid aortic valve disease: impact of root geometry and valve type on mid-term outcomes. Interact Cardiovasc Thorac Surg 2014; 19:375-81; discussion 381. [DOI: 10.1093/icvts/ivu123] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Svensson LG, Al Kindi AH, Vivacqua A, Pettersson GB, Gillinov AM, Mihaljevic T, Roselli EE, Sabik JF, Griffin B, Hammer DF, Rodriguez L, Williams SJ, Blackstone EH, Lytle BW. Long-Term Durability of Bicuspid Aortic Valve Repair. Ann Thorac Surg 2014; 97:1539-47; discussion 1548. [DOI: 10.1016/j.athoracsur.2013.11.036] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 11/13/2013] [Accepted: 11/19/2013] [Indexed: 02/03/2023]
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27
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Yamaguchi H, Nakao T, Kadowaki T, Nakamura H, Tokunaga N, Yoda M, Takagaki M. Successful bicuspid aortic valve repair using external aortic annuloplasty. Ann Thorac Surg 2014; 97:1443-5. [PMID: 24694428 DOI: 10.1016/j.athoracsur.2013.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 05/18/2013] [Accepted: 07/01/2013] [Indexed: 10/25/2022]
Abstract
A 33-year-old man presented with severe aortic insufficiency due to a prolapsed bicuspid aortic valve. The ventriculoaortic junction was dilated to 29 mm without root dilatation, and external ring annuloplasty was performed using a Gelweave (Terumo, Tokyo, Japan) graft to reduce the size to 22 mm. The leaflets were repaired by dividing and suturing a raphe between the right and left cusps. This combination provided adequate coaptation depth (8 mm) and showed excellent results, with trivial aortic insufficiency. This approach is suitable for repair of a bicuspid aortic valve with a dilated ventriculoaortic junction without root dilatation.
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Affiliation(s)
- Hiroki Yamaguchi
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan.
| | - Tatsuya Nakao
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Tasuku Kadowaki
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Hiromasa Nakamura
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Noriyuki Tokunaga
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Masataka Yoda
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Masami Takagaki
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:e521-643. [PMID: 24589853 DOI: 10.1161/cir.0000000000000031] [Citation(s) in RCA: 883] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Mori A, Takakura H, Hachiya T, Onoguchi K. Aortic valve repair with autologous pericardium for traumatic aortic valve regurgitation. Cardiovasc Diagn Ther 2013; 3:180-2. [PMID: 24282768 DOI: 10.3978/j.issn.2223-3652.2013.05.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 05/14/2013] [Indexed: 11/14/2022]
Abstract
We present a case of successful aortic valve repair for traumatic aortic valve regurgitation. A 26-year-old male who had a history of motor-cycle accident months prior to admission, was referred to our hospital for surgical treatment of severe aortic valve regurgitation. Intraoperative inspection revealed a tear in noncoronary cusp, with otherwise preserved valvular anatomy. Aortic valvuloplasty was successfully performed with closure using an autologous pericardium patch. Intraoperative transesophageal echocardiogram confirmed absence of residual regurgitation.
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Affiliation(s)
- Atsuo Mori
- Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
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ElZein C, Subramanian S, Polimenakos AC, Roberson D, Ilbawi MN. Systematic Approach to Aortic Valvuloplasty in Children and Young Adults. World J Pediatr Congenit Heart Surg 2013; 4:412-7. [DOI: 10.1177/2150135113504598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Valve repair in children and young adults is an attractive alternative to replacement or Ross procedure. In the past, the various valvuloplasty techniques have addressed isolated valve pathology. Recently, however, a holistic approach involving repair of all aortic root structures has evolved and promised to be an excellent alternative to valve replacement. It provides good long-term results and avoids all the drawback of prosthetic valve insertion in this age group. Development of ideal patch material needed for valve repair and better understanding of the anatomy and function of the aortic root may further improve the short- and long-term outcomes of aortic valvuloplasty.
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Affiliation(s)
- Chawki ElZein
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
| | - Sujata Subramanian
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
| | - Anastasios C. Polimenakos
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
| | - David Roberson
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
| | - Michel N. Ilbawi
- Division of Pediatric Cardiology and Cardiac Surgery, Hope Children’s Hospital, Oak Lawn, IL, USA
- Division of Cardiothoracic Surgery, University of Illinois, IL, USA
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Vohra HA, Whistance RN, de Kerchove L, Glineur D, Noirhomme P, El Khoury G. Influence of higher valve gradient on long-term outcome after aortic valve repair. Ann Cardiothorac Surg 2013; 2:30-9. [PMID: 23977556 DOI: 10.3978/j.issn.2225-319x.2012.12.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 12/15/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND To evaluate the effect of higher post-operative valve gradient on freedom from valve re-intervention and death in patients undergoing aortic valve repair (AVr). METHODS Patients who underwent AVr between March 1996 and June 2010 were divided into 2 groups: I: peak gradient (PG) <20 mmHg (n=358) and II: PG ≥20 mmHg (n=113). Age (53.6±16.0 vs. 50.6±16.4 years; P=0.08), impaired LV (n=44, 12.2% vs. n=12, 10.6%: P=0.73) as well as the body surface area (1.97 vs. 1.95 m(2); P=0.4) were similar. Pre-operative AI >2+ was greater in Group II compared to Group I (n=78, 69.0% vs. n=192, 53.6%; P=0.004). Patients in Group II had higher proportion of bicuspid valves (BV) (n=58, 51.3% vs. n=106, 29.6%; P=0.0001) and restrictive valves (n=34, 30.0% vs. n=52, 14.5%; P=0.0001) while Marfan patients were seen only in Group I (n=19; P=0.010). Mean follow-up for Group I and Group II was 123.1±89.7 and 147.1±108.0 months, respectively. RESULTS In-hospital mortality was n=2 (0.5%) for Group I and none for Group II (P=1.0). Valve-sparing was higher in Group I (P=0.0001) but sub-commissural annuloplasty was similar (P=0.15). Shaving and/or decalcification was performed more in Group II (n=68, 60.1% vs. n=117, 32.6%; P=0.0001). Logistic regression analysis identified calcified, restrictive and bicuspid valves as independent predictors of PG ≥20 mmHg (P=0.04 for each). Predictors of re-operation were increased end-diastolic diameter (P=0.03) and younger age (P=0.007), but not PG ≥20 mmHg (P=0.98) (based on logistic regression). Overall 10-year cardiac survival and freedom from AV re-intervention was 82.3±4.6% vs. 89.5±4.2% (P=0.53) and 89.1±3.0% vs. 76.8±8.4% (P=0.02), in Group I and II, respectively (based on Kaplan-Meier analysis). Sub-group analysis showed that Group II patients requiring re-intervention (n=10) were younger (41.8±13.1 vs. 51.0±16.0 years; P=0.08) with similar proportion of bicuspid valves (n=6; 60%; P=0.74). The main reason for AV re-operation was aortic insufficiency (n=7) and AI + stenosis (n=3). CONCLUSIONS Higher gradient after AVr is associated with a reduced freedom from AV re-intervention, especially in younger patients.
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Affiliation(s)
- Hunaid A Vohra
- Divisions of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Kari FA, Liang DH, Escobar Kvitting JP, Stephens EH, Mitchell RS, Fischbein MP, Miller DC. Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease. J Thorac Cardiovasc Surg 2013; 145:S35-40.e1-2. [DOI: 10.1016/j.jtcvs.2012.11.043] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 08/17/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
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34
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Chronic Mitral Regurgitation and Aortic Regurgitation. J Am Coll Cardiol 2013; 61:693-701. [DOI: 10.1016/j.jacc.2012.08.1025] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 08/13/2012] [Accepted: 08/21/2012] [Indexed: 11/22/2022]
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The David Procedure in Different Valve Pathologies: A Single-Center Experience in 236 Patients. Ann Thorac Surg 2013; 95:71-6. [DOI: 10.1016/j.athoracsur.2012.08.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/22/2022]
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Prodromo J, D'Ancona G, Amaducci A, Pilato M. Aortic Valve Repair for Aortic Insufficiency: A Review. J Cardiothorac Vasc Anesth 2012; 26:923-32. [DOI: 10.1053/j.jvca.2011.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Indexed: 11/11/2022]
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37
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Results of matching valve and root repair to aortic valve and root pathology. J Thorac Cardiovasc Surg 2011; 142:1491-8.e7. [DOI: 10.1016/j.jtcvs.2011.04.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/13/2011] [Accepted: 04/26/2011] [Indexed: 11/22/2022]
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Abstract
Bicuspid aortic valve (BAV) is the most common form of congenital heart disease, with frequent and premature occurrence of cardiac events, dominated by significant valvular dysfunction. BAV has a high prevalence of aortic wall abnormalities such as ascending aortic dilatation. Because more rapid aortic dilatation can occur, once the ascending aorta reaches 40 mm, annual imaging with echocardiography or other imaging techniques is indicated. The most feared complication is aortic dissection. However, the actual incidence of this complication is low (4%). Although limited data exist regarding prophylactic intervention, it is suggested that elective surgical repair of BAV-associated aortic dilatation should be more aggressively recommended. In patients with BAV, the decision to indicate surgical treatment in aortic diameters between 50 and 55 mm should be based on patient age, body size, comorbidities, type of surgery, and the presence of additional risk factors.
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Affiliation(s)
- Artur Evangelista
- Department of Cardiac Imaging, Hospital Vall d´Hebron, Pº Vall d´Hebron 119-129, Barcelona 08035, Spain.
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39
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Mingo S, Moñivas V, Cobo M, Ruiz L, Castedo E, Serrano S. Cirugía valvular aórtica. Indicaciones y resultados. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70086-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Van Dyck MJ, Watremez C, Boodhwani M, Vanoverschelde JL, El Khoury G. Transesophageal Echocardiographic Evaluation During Aortic Valve Repair Surgery. Anesth Analg 2010; 111:59-70. [DOI: 10.1213/ane.0b013e3181dd2579] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Ashikhmina E, Sundt TM, Dearani JA, Connolly HM, Li Z, Schaff HV. Repair of the bicuspid aortic valve: A viable alternative to replacement with a bioprosthesis. J Thorac Cardiovasc Surg 2010; 139:1395-401. [DOI: 10.1016/j.jtcvs.2010.02.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 12/15/2009] [Accepted: 02/13/2010] [Indexed: 10/19/2022]
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Kim TY, Alfirevic A, Wallace LK. Transesophageal echocardiography for tricuspid aortic valve repair. Anesth Analg 2010; 110:370-2. [PMID: 20032027 DOI: 10.1213/ane.0b013e3181c76d22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas Y Kim
- Department of Adult Cardiothoracic Anesthesia, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland Heights, Ohio, USA.
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Pettersson GB, Ramankutty RM. Repair of bicuspid aortic valve with severe regurgitation. Multimed Man Cardiothorac Surg 2010; 2010:mmcts.2009.004168. [PMID: 24413740 DOI: 10.1510/mmcts.2009.004168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To improve the success rate and reproducibility of bicuspid aortic valves, we apply a systematic segmental approach to their repair. A segmental analysis of the morphology is followed by corresponding pathology specific corrections of each morphological abnormality contributing to regurgitation.
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Affiliation(s)
- Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue/J4, Cleveland, OH, USA
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Borer JS, Girardi LN. Repair of the Congenitally Bicuspid Regurgitant Aortic Valve. J Am Coll Cardiol 2008; 52:50-1. [DOI: 10.1016/j.jacc.2008.02.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 02/04/2008] [Accepted: 02/18/2008] [Indexed: 11/29/2022]
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Dimitrova NA, Dimitrov GV, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. Effect of electrical stimulus parameters on the development and propagation of action potentials in short excitable fibres. J Am Coll Cardiol 1988; 63:e57-185. [PMID: 2460319 DOI: 10.1016/j.jacc.2014.02.536] [Citation(s) in RCA: 1843] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intracellular action potentials (IAPs) produced by short fibres in response to their electrical stimulation were analysed. IAPs were calculated on the basis of the Hodgkin-Huxley (1952) model by the method described by Joyner et al. (1978). Principal differences were found in processes of activation of short (semilength L less than 5 lambda) and long fibres under near-threshold stimulation. The shorter the fibre, the lower was the threshold value (Ithr). Dependence of the latency on the stimulus strength (Ist) was substantially non-linear and was affected by the fibre length. Both fibre length and stimulus strength influenced the IAP amplitude, the instantaneous propagation velocity (IPV) and the site of the first origin of the IAP (and, consequently, excitability of the short fibre membrane). With L less than or equal to 2 lambda and Ithr less than or equal to Ist less than or equal to 1.1Ithr, IPV could reach either very high values (so that all the fibre membrane fired practically simultaneously) or even negative values. The latter corresponded to the first origin of the propagated IAP, not at the site of stimulation but at the fibre termination or at a midpoint. The characters of all the above dependencies were unchanged irrespective of the manner of approaching threshold (variation of stimulus duration or its strength). Reasons for differences in processes of activation of short and long fibres are discussed in terms of electrical load and latency. Applications of the results to explain an increased jitter, velocity recovery function and velocity-diameter relationship are also discussed.
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Affiliation(s)
- N A Dimitrova
- CLBA, Centre of Biology, Bulgarian Academy of Sciences, Sofia
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