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Almaghrabi S, Michelena H, Jelenc M, Abeln KB, Ehrlich T, Schäfers HJ. Contemporary Valvular Mechanisms of Aortic Regurgitation in Tricuspid Aortic Valves: Importance in Repair Versus Replacement Strategy. J Am Heart Assoc 2024; 13:e032532. [PMID: 38686861 PMCID: PMC11179890 DOI: 10.1161/jaha.123.032532] [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: 09/24/2023] [Accepted: 02/19/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND This study was performed to determine cusp causes of aortic regurgitation in patients with tricuspid aortic valves without significant aortic dilatation and define cusp pathologies amenable to surgical repair (aortic valve repair [AVr]) versus aortic valve replacement. METHODS AND RESULTS We retrospectively reviewed surgical reports of consecutive adults with tricuspid aortic valves undergoing surgery for clinically significant aortic regurgitation within a prospective registry from January 2005 to September 2019. Valvular mechanisms were determined by systematic in vivo intraoperative quantification methods. Of 516 patients, 287 (56%) underwent repair (AVr; mean±SD age, 59.9±12.4 years; 81% men) and 229 (44%) underwent replacement (aortic valve replacement; mean±SD age, 62.8±13.8 years [P=0.01 compared to AVr]; 67% men). A single valvular mechanism was present in 454 patients (88%), with cusp prolapse (46%), retraction (24%), and perforation (18%) being the most common. Prolapse involved the right cusp in 86% of cases and was more frequent in men (P<0.001). Two-dimensional transesophageal echocardiography accuracy for predicting mechanisms was 73% to 82% for the right cusp, 55% to 61% for the noncoronary cusp, and 0% for the left-coronary cusp. Cusp prolapse, younger age, and larger patient size were associated with successful AVr (all P<0.03), whereas retraction, perforation, older age, and concomitant mitral repair were associated with aortic valve replacement (all P<0.03). CONCLUSIONS Right cusp prolapse is the most frequent single valvular mechanism in patients with tricuspid aortic valve aortic regurgitation, followed by cusp retraction and perforation. The accuracy of 2-dimensional transesophageal echocardiography is limited for left and noncoronary cusp mechanistic assessment. Prolapse is associated with successful AVr, whereas retraction and perforation are associated with aortic valve replacement. With systematic intraoperative quantification methods and current surgical techniques, more than half of tricuspid aortic valve aortic regurgitation cases may be successfully repaired.
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Affiliation(s)
- Saifalislam Almaghrabi
- Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg/Saar Germany
| | | | - Matija Jelenc
- Department of Cardiovascular Surgery University Medical Center Ljubljana Ljubljana Slovenia
| | - Karen B Abeln
- Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg/Saar Germany
| | - Tristan Ehrlich
- Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg/Saar Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg/Saar Germany
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2
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Juzga-Corrales C, Ayerza-Casas A, Figueras-Coll M, Escribà-Bori S, Plata-Izquierdo B, Collell R, González-Marín MA, Siurana JM, Sorlí M, Albert de la Torre L, Teodoro-Marín S, Rodríguez M, Domínguez-García O, Rellán S, Manso B, López-Abel B, Álvarez-Pérez R, Portillo-Márquez M, Rezola E, Centeno-Malfaz F, Solana-Gracia R, Rojo-Sombrero H, Cantero-Tejedor MT, Riaño B, Tejero-Hernández MÁ, Jiménez-Casso M, Pérez-Pardo AM, Moriano-Gutiérrez A, Marrero-Calvo M, Fernández MT, Salido-Peracaula C, Bravo MJ, Gutiérrez-Larraya F, Sabaté-Rotés A. Characteristics and outcomes of the Spanish registry for pediatric patients with bicuspid aortic valve (REVAB). REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:961-969. [PMID: 36924830 DOI: 10.1016/j.rec.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/16/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION AND OBJECTIVES Bicuspid aortic valve (BAV) disorder is the most common congenital heart disease. The aim of this study was to describe the characteristics of 0- to 18-year olds with BAV in a population-based registry. METHODS Data from all pediatric patients were obtained from the Spanish registry for pediatric patients with bicuspid aortic valve (REVAB) (< 18 years). For data analysis, patients with BAV were divided into 2 groups by their features: isolated BAV and BAV with associated congenital heart disease. RESULTS We included 1681 patients from 33 hospitals. Males accounted for 69.6% (n = 1158). Valve morphology was horizontal in 63.4% (n = 1012) and pure (Sievers type 0) in 28.4% (n=469). Isolated BAV was present in 63.7% (n=1060), and concomitant left-sided obstructive lesions in 23.4% (n=390). Interventions were required in 8.6% (n=145). CONCLUSION These data represent the first large, population-based description of the clinical presentations and outcomes of patients enrolled in the Spanish registry for pediatric patients with bicuspid aortic valve.
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Affiliation(s)
- Carolina Juzga-Corrales
- Departamento de Pediatría, Obstetricia, Ginecología, Medicina Preventiva y Salud Pública, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Ariadna Ayerza-Casas
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marc Figueras-Coll
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Silvia Escribà-Bori
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitari Son Espases, Mallorca, Spain
| | - Beatriz Plata-Izquierdo
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Complejo Asistencia Universitario de Salamanca, Salamanca, Spain
| | - Rosa Collell
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitari Sant Joan de Reus, Reus, Tarragona, Spain
| | - María Arántzazu González-Marín
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - José Manuel Siurana
- Servicio de Cardiología Pediátrica, Servicio de Cardiología, Hospital HM Nens, Barcelona, Spain
| | - Moisés Sorlí
- Sección de Cardiología Pediátrica, Servicio de Pediatría, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | | | - Silvia Teodoro-Marín
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Mónica Rodríguez
- Unidad de Cardiopatías Congénitas y Cirugía Cardiaca, Hospital HM Montepríncipe, Madrid, Spain
| | - Olga Domínguez-García
- Unidad de Cardiología Pediátrica, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Sara Rellán
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Sección de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Begoña Manso
- Sección de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Bernardo López-Abel
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Complejo Hospitalario Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Roser Álvarez-Pérez
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Erika Rezola
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario de Donostia, Donostia, Spain
| | - Fernando Centeno-Malfaz
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Ruth Solana-Gracia
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Henar Rojo-Sombrero
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - María Teresa Cantero-Tejedor
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - Bibiana Riaño
- Unidad de Cardiología Pediátrica, Servicio de Cardiología, Hospital San Pedro, Logroño, Spain
| | | | - Marisol Jiménez-Casso
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital General de Segovia, Segovia, Spain
| | - Ana María Pérez-Pardo
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Ana Moriano-Gutiérrez
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Lluis Alcanyis de Játiva, Valencia, Spain
| | - Manuel Marrero-Calvo
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Nuestra Señora de Sonsoles, Ávila, Spain
| | - María Teresa Fernández
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario Infanta Elena, Madrid, Spain
| | - Carlos Salido-Peracaula
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
| | - María José Bravo
- Unidad de Cardiología Pediátrica, Servicio de Pediatría, Hospital Costa del Sol, Marbella, Málaga, Spain
| | | | - Anna Sabaté-Rotés
- Departamento de Pediatría, Obstetricia, Ginecología, Medicina Preventiva y Salud Pública, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
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Alwaheidi DF, Abdalghafoor TMM, Serhan H, Kindawi A. A successful double valve repair on an interesting background: Case report. J Card Surg 2022; 37:2426-2428. [PMID: 35526129 DOI: 10.1111/jocs.16582] [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: 03/14/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/28/2022]
Abstract
Aortic regurgitation in a bicuspid aortic valve is a complex entity that involves not only the semilunar valve but also the structure of the aortic root which is functionally and pathologically in a very close relationship to it. Considering repairing a bicuspid valve mandates a mindful involvement of all related structures concurrently. Here, we report an interesting case of both bicuspid aortic valve and mitral valve regurgitation in a patient with a history of infective endocarditis, that was successfully managed by double valve repair.
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Affiliation(s)
- Dina Fa Alwaheidi
- Department of Cardiothoracic Surgery, Heart Hospital, HMC, Doha, Qatar
| | | | - Hatem Serhan
- Department of Cardiothoracic Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Ali Kindawi
- Department of Cardiothoracic Surgery, Heart Hospital, HMC, Doha, Qatar
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Basnet K, Bhattarai SR, Shah S, Joshi A, Sah SK, Gami R, Khanal R. Rheumatic Heart Disease among Patients with Valvular Heart Disease Admitted to the In-patient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:419-424. [PMID: 35633232 PMCID: PMC9252223 DOI: 10.31729/jnma.7457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/03/2022] [Indexed: 11/02/2022] Open
Abstract
Introduction Valvular heart disease continues to cause significant morbidity and mortality around the world, with rheumatic heart disease accounting for the bulk of cases in developing nations. The aim of this study is to find out the prevalence of rheumatic heart disease among patients with valvular heart disease admitted to the in-patient department of a tertiary care centre. Methods A descriptive cross-sectional study was conducted from December, 2018 to December, 2020 at a tertiary care centre after receiving ethical approval from the Institutional Review [Reference number: 395 (6-11) e2 077/078]. Patients of age ≥18 years presenting with valvular manifestations of any disease diagnosed by transthoracic echocardiography were included and patients other than Nepalese nationals were excluded. Convenience sampling was done and a sample size of 327 was taken. Data were collected, entered and analyzed using the Statistical Package for the Social Sciences version 22.0. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results Among 327 patients, the prevalence of rheumatic heart disease was found to be 237 (72.47%) (67.63-77.31 at 95% Confidence Interval). Conclusions The prevalence of rheumatic heart disease was similar to the other similar studies conducted in similar settings. Keywords epidemiology; prevalence; rheumatic heart disease.
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Affiliation(s)
- Kriti Basnet
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Shreeyash Raj Bhattarai
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Sangam Shah
- Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Amir Joshi
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Sanjit Kumar Sah
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Roshan Gami
- Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Rajaram Khanal
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Maharajgunj, Kathmandu, Nepal
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Buja LM, Zhao B, Segura A, Lelenwa L, McDonald M, Michaud K. Cardiovascular pathology: guide to practice and training. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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6
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Galea N, Pambianchi G, Cundari G, Sturla F, Marchitelli L, Putotto C, Versacci P, De Paulis R, Francone M, Catalano C. Impaction of regurgitation jet on anterior mitral leaflet is associated with diastolic dysfunction in patients with bicuspid aortic valve and mild insufficiency: a cardiovascular magnetic resonance study. Int J Cardiovasc Imaging 2021; 38:211-221. [PMID: 34448067 PMCID: PMC8818636 DOI: 10.1007/s10554-021-02384-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
To assess the impact of regurgitant jet direction on left ventricular function and intraventricular hemodynamics in asymptomatic patients with bicuspid aortic valve (BAV) and mild aortic valve regurgitation (AR), using cardiac magnetic resonance (CMR) feature tracking and 4D flow imaging. Fifty BAV individuals were retrospectively selected: 15 with mild AR and posterior regurgitation jet (Group-PJ), 15 with regurgitant jet in other directions (Group-nPJ) and 20 with no regurgitation (Controls). CMR protocol included cine steady state free precession (SSFP) sequences and 4D Flow imaging covering the entire left ventricle (LV) cavity and the aortic root. Cine-SSFP images were analyzed to assess LV volumes, longitudinal and circumferential myocardial strain. Circumferential and longitudinal peak diastolic strain rate (PDSR) and peak diastolic velocity (PDV) were reduced in group PJ if compared to group nPJ and control group (PDSR = 1.10 ± 0.2 1/s vs. 1.34 ± 0.5 1/s vs. 1.53 ± 0.3 1/s, p:0.001 and 0.68 ± 0.2 1/s vs. 1.17 ± 0.2 1/s vs. 1.05 ± 0.4 1/s ; p < 0.001, PDV = − 101.6 ± 28.1 deg/s vs. − 201.4 ± 85.9 deg/s vs. − 221.6 ± 67.1 deg/s; p < 0.001 and − 28.1 ± 8 mm/s vs. − 38.9 ± 11.1 mm/s vs. − 43.6 ± 14.3 mm/s, p < 0.001, respectively), whereas no differences have been found in systolic strain values. 4D Flow images (available only in 9 patients) showed deformation of diastolic transmitral streamlines direction in group PJ compared to other groups. In BAV patients with mild AR, the posterior direction of the regurgitant jet may hamper the complete mitral valve opening, disturbing transmitral flow and slowing the LV diastolic filling.
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Affiliation(s)
- Nicola Galea
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy. .,Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - Giacomo Pambianchi
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Cundari
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Sturla
- Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Livia Marchitelli
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Paolo Versacci
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital, Rome, Italy.,Unicamillus International Medical University in Rome, Rome, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
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Petersen J, Lenz A, Adam G, Reichenspurner H, Bannas P, Girdauskas E. Changes in transvalvular flow patterns after aortic valve repair: comparison of symmetric versus asymmetric aortic valve geometry. Eur J Cardiothorac Surg 2021; 59:1087-1094. [PMID: 33284970 DOI: 10.1093/ejcts/ezaa445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the effect of asymmetric versus symmetric bicuspid aortic valve (BAV) repair on transvalvular flow patterns and aortic wall shear stress (WSS). METHODS Four-dimensional flow magnetic resonance imaging was prospectively and consecutively performed in patients with congenital aortic valve (AV) disease before and after AV repair. The following MRI-based parameters were assessed: (i) flow eccentricity index, (ii) backward flow across the AV, (iii) grading of vortical and helical flow, and (iv) WSS (N/m2) in the proximal aorta. MRI-derived flow parameters were compared between patients who underwent 'asymmetric BAV repair' (n = 13) and 'symmetric BAV repair' (n = 7). RESULTS A total of 20 patients (39 ± 12 years, 80% male), who underwent BAV repair, were included. In the asymmetric BAV repair group, circumferential WSS reduction was found at the level of the aortic arch (P = 0.015). In the symmetric BAV repair group, postoperative circumferential WSS was significantly reduced compared to baseline at all levels of the proximal aorta (all P < 0.05). Postoperative circumferential WSS was significantly higher in the asymmetric versus symmetric BAV repair group at the level of the sinotubular junction (0.45 ± 0.15 vs 0.30 ± 0.09 N/m2; P = 0.028), ascending aorta (0.59 ± 0.19 vs 0.44 ± 0.08 N/m2; P = 0.021) and aortic arch (0.59 ± 0.25 vs 0.40 ± 0.08 N/m2; P = 0.017). Segmental WSS analysis showed significantly higher postoperative WSS after asymmetric versus symmetric BAV repair, especially in the anterior aortic segment (P = 0.004). CONCLUSIONS Symmetric BAV repair results in more physiological flow patterns and significantly reduces WSS, as compared to asymmetric BAV repair. From a haemodynamic point of view, symmetric AV geometry should be attempted in every congenital AV repair.
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Affiliation(s)
- Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, UKE, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, UKE, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, UKE, Hamburg, Germany
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8
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Ring L, Shah BN, Bhattacharyya S, Harkness A, Belham M, Oxborough D, Pearce K, Rana BS, Augustine DX, Robinson S, Tribouilloy C. Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography. Echo Res Pract 2021; 8:G19-G59. [PMID: 33709955 PMCID: PMC8115410 DOI: 10.1530/erp-20-0035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/15/2022] Open
Abstract
The guideline provides a practical step-by-step guide in order to facilitate high-quality echocardiographic studies of patients with aortic stenosis. In addition, it addresses commonly encountered yet challenging clinical scenarios and covers the use of advanced echocardiographic techniques, including TOE and Dobutamine stress echocardiography in the assessment of aortic stenosis.
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Affiliation(s)
- Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
| | - Benoy N Shah
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Mark Belham
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - David Oxborough
- Liverpool John Moores University, Research Institute for Sports and Exercise Physiology, Liverpool, UK
| | | | - Bushra S Rana
- Imperial College Healthcare NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College, London
| | - Daniel X Augustine
- Royal United Hospital NHS Foundation Trust, Bath, UK
- Department for Health, University of Bath, Bath, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Trust, Peterborough, UK
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9
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Bicuspid reconstruction surgery in a patient suffering from aortic valve infective endocarditis with annular abscess using Ozaki's procedure: A case report. Int J Surg Case Rep 2020; 76:266-269. [PMID: 33053487 PMCID: PMC7566199 DOI: 10.1016/j.ijscr.2020.09.197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Aortic valve infective endocarditis with annular abscess is associated with high mortality rate and surgery is usually the choice of treatment. Plasty or reconstruction of aortic valve is being performed more widely. PRESENTATION OF CASE We report a case study of a 56-year-old male who was diagnosed with congenital bicuspid aortic valve, severe aortic stenosis and regurgitation, and annular abscess. This patient underwent operation in december 2019 and Ozaki's procedure was used to measure the distance between two commissures to reconstruct new leaflets and close the abscess using autologous pericardium. A bicuspid valve was reconstructed based on the anatomical feature of the patient. 6 months after surgery, aortic valve function was good with no residual insufficiency, maximum gradient was 8 mmHg. DISCUSSION Reconstruction of aortic valve by Ozaki's procedure has been reported with many advantages for the patient. In case of infectious endocarditis, this technique helps avoid the use of artificial materials. Bicuspid aortic valve reconstruction surgery following the novel methods of reconstructing three leaflets or maintaining the bicuspid morphology could both be performed with good results. CONCLUSION Reconstruction of aortic valve by Ozaki's procedure in infectious endocarditis has good results. In case of true bicuspid aortic valve, reconstruction bi-leaflets can be performed.
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10
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Nakano Y, Waseda K, Ando H, Tanabe S, Niwa T, Amano T. Tumor-like appearance in ruptured sinus of Valsalva with quadricuspid aortic valve. J Cardiol Cases 2019; 20:115-117. [PMID: 31969937 DOI: 10.1016/j.jccase.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
Sinus of Valsalva rarely ruptures due to congenital causes. When it comes to ruptured sinus of Valsalva combined with quadricuspid aortic valve, no cases have so far been reported in Japan. Here, we describe the case of 32-year-old female who developed ruptured sinus of Valsalva with tumor-like appearance. Some of the cases of ruptured sinus of Valsalva show aorta to right atrial tunnel with a windsock aneurysm looking like a tumor by echocardiography. <Learning objective: Sinus of Valsalva rarely ruptures due to congenital causes such as aortic valve anomalies such as quadricuspid aortic valve. Ruptured sinus of Valsalva sometimes shows tumor-like appearance by echocardiography. In such a case, we need to keep in mind that the sinus of Valsalva with aortic valve anomalies rarely ruptured showing a fistulous pouch-like "windsock" in the edge of aneurysm by echocardiography.>.
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Affiliation(s)
- Yusuke Nakano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Katsuhisa Waseda
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Subaru Tanabe
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Toru Niwa
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
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Yang LT, Michelena HI, Maleszewski JJ, Schaff HV, Pellikka PA. Contemporary Etiologies, Mechanisms, and Surgical Approaches in Pure Native Aortic Regurgitation. Mayo Clin Proc 2019; 94:1158-1170. [PMID: 31272566 DOI: 10.1016/j.mayocp.2018.11.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To study contemporary etiologies, mechanisms, and corresponding surgical approaches in isolated aortic regurgitation (AR). PATIENTS AND METHODS Consecutive patients undergoing surgery for moderately severe and severe AR were retrospectively identified from January 1, 2006, through October 20, 2017. Intraoperative echocardiograms, surgical reports, and pathology reports were reviewed. RESULTS Of 382 patients (54±16 years, 82% men), there were 207 (54%) tricuspid (TAV), 167 (44%) bicuspid (BAV), 5 quadricuspid, and 3 unicuspid aortic valves. Isolated AR mechanisms (n=116, 30%) included cusp prolapse (n=44, 11%), restriction/retraction (n=33, 9%), aortic root dilatation (n=33, 9%), perforation (n=5, 1%), and fenestration (<1%); mixed mechanisms were present in 266 (70%). The most common mixed mechanism was root dilatation and prolapse (27% BAV vs 16% TAV, P=.01). Valve repair (AVr) was performed in 31% BAV and 23% TAV (P=.06). Aortic surgery was more common in BAV (37% vs 27%, P<.001). Overall, root dilatation was associated with AVr. In TAV, cusp prolapse and restriction/retraction were associated with replacement; in BAV, prolapse was associated with AVr. AR etiology was idiopathic in 43% TAV patients, 47% of whom had root dilatation. CONCLUSIONS BAV accounted for 44% of surgical referrals for AR and, compared with TAV, was more often associated with prolapse, root dilatation, and mixed mechanisms of AR. Because mechanisms affected the choice of AVr differently in BAV and TAV, comprehensive mechanistic description of surgical AR is critical.
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Affiliation(s)
- Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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13
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Kayatta MO, Leshnower BG, McPherson L, Binongo JN, Lasanajak Y, Chen EP. Valve-Sparing Root Replacement Provides Excellent Midterm Outcomes for Bicuspid Valve Aortopathy. Ann Thorac Surg 2019; 107:499-504. [DOI: 10.1016/j.athoracsur.2018.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/06/2018] [Accepted: 08/13/2018] [Indexed: 12/01/2022]
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Roberts WC, McCullough SP, Vasudevan A. Characteristics of Adults Having Aortic Valve Replacement for Pure Aortic Regurgitation Involving a Congenitally Bicuspid Aortic Valve Unaffected by Infective Endocarditis or Aortic Dissection. Am J Cardiol 2018; 122:2104-2111. [PMID: 30343820 DOI: 10.1016/j.amjcard.2018.08.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 11/18/2022]
Abstract
Few reports have appeared describing patients with a purely regurgitant congenitally bicuspid aortic valve (BAV) unassociated with active or healed infective endocarditis or with acute or healed aortic dissection. This report describes a large group of such patients who had replacement of the purely regurgitant BAV with or without concomitant resection of the ascending aorta. Operatively excised purely regurgitant BAVs were examined and then their clinical records were examined to confirm that the valves indeed were purely regurgitant. The patients were aged 21 to 86 years (median 50). Of the 133 patients, 114 (86%) were men. The degree of aortic regurgitation (AR) ranged from 1+ to 4+/4+. Of the 133 patients, 52 (39%) had simultaneous resection of the ascending aorta, its frequency varying inversely with the degree of AR. Histologic study of sections of the operatively excised aortas disclosed that 28 (54%) had a normal or nearly normal aorta (0-1+ loss of medial elastic fibers) and that 24 (46%) had an abnormal loss (grade 2+ -4+/4+). In conclusion, the congenitally BAV, unassociated with either infective endocarditis or aortic dissection, is a common cause of pure AR in adults in the Western World undergoing AVR for AR. About half the patients had a dilated ascending aorta and those resected were histologically abnormal half the time. Why one BAV becomes stenotic, another purely regurgitant, another the site of infective endocarditis, and another functions normally for an entire lifetime remains unclear.
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Affiliation(s)
- William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas; Department(s) of Internal Medicine and Pathology, Baylor University Medical Center, Dallas, Texas.
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De Martino A, Ballestracci P, Faggioni L, Pratali S, Morganti R, Pucci A, Bortolotti U. Incidence of Aortitis in Surgical Specimens of the Ascending Aorta Clinical Implications at Follow-Up. Semin Thorac Cardiovasc Surg 2018; 31:751-760. [PMID: 30414447 DOI: 10.1053/j.semtcvs.2018.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/30/2018] [Indexed: 01/01/2023]
Abstract
The objectives of this study are to evaluate the incidence of aortitis on a surgical population, establish any relationship with systemic diseases, verify early and late surgical results and provide clinical and radiological follow-up to determine factors potentially predicting progression of the disease and influencing late outcome. From 2009 to 2017, 237 patients underwent elective operations on the ascending aorta. Segments of the excised tissues were routinely sent for histologic evaluation, providing adequate data in 178 (75%) for a clinical and pathologic correlation. Patients with aortitis (Group 1) (n = 26) were compared with 152 with atherosclerotic or degenerative disease (Group 2). Incidence of aortitis was 15%, being clinically isolated in 73%. In 24 patients (92%), a giant cell aortitis was found. Actuarial survival at 3 years is 88% in Group 1 and 98% in Group 2 and 74% and 98% at 5 years, respectively (P = 0.016). A control angio-computed tomography revealed an increased descending aorta diameter in 2 out of 14 late survivors. A positron emission tomography showed presence of arteritis in other vascular segments in 3 patients. Clinically isolated aortitis is extremely frequent in patients with inflammatory aortic disease. The diagnosis is often difficult and may be supported by routine pathologic evaluation of surgical explants and by multimodality imaging. The latter should be employed to allow adequate patient follow-up and to disclose potential recurrences in untreated aortic segments.
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Affiliation(s)
| | | | | | - Stefano Pratali
- Section of Cardiac Surgery, University Hospital, Pisa, Italy
| | | | - Angela Pucci
- Division of Histopathology, University Hospital, Pisa, Italy
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Kayatta MO, Leshnower BG, McPherson L, Zhang C, Lasanajak Y, Chen EP. Valve Sparing Root Replacement Provides Similar Midterm Outcomes in Bicuspid and Trileaflet Valves. Ann Thorac Surg 2018; 107:54-60. [PMID: 30240765 DOI: 10.1016/j.athoracsur.2018.07.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Valve-sparing aortic root replacement (VSRR) is an established treatment for aortic root pathology for trileaflet valves. The safety and durability of VSRR in bicuspid aortopathy is unclear. In this study, outcomes of performing VSRR in the setting of bicuspid and trileaflet valves were compared. METHODS An institutional database identified 294 patients who underwent VSRR from 2005 to 2017. Of these, 225 had trileaflet valves and 69 had bicuspid valves. Patients were followed prospectively and had annual postoperative echocardiograms. Propensity-matched comparisons were made between trileaflet and bicuspid valve patients. RESULTS The average patient age for trileaflet valves was 46.0 ± 13.5 versus 42.7 ± 12.2 years for bicuspid patients (p = 0.07). There was a higher presence of preoperative >2+ aortic insufficiency (AI) present in bicuspid patients (63.8%) compared with trileaflet patients (31.1%) (p < 0.01). Mean follow-up was 39 months and was 98% complete. At 5 years, the cumulative incidence of >2+ AI and aortic valve replacement (AVR) was 2.0% and 4.3% in trileaflet patients and 7.7% (p = 0.75) and 7.7% (p = 0.81) in bicuspid patients. Preoperative >2+ AI was not predictive of >2+ postoperative AI (p = 0.62) nor AVR (p = 0.49). Five-year survival was no different between groups (trileaflet: 98%, bicuspid: 84%, p = 0.24). CONCLUSIONS VSRR can be safely and effectively performed in patients with trileaflet and bicuspid valves. Operative outcomes and valve function were equivalent in bicuspid and trileaflet patients in midterm follow-up. Performance of VSRR is a viable term option in the setting bicuspid aortic valve aortopathy.
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Affiliation(s)
- Michael O Kayatta
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - LaRonica McPherson
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Chao Zhang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
| | - Yi Lasanajak
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
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Das R, Puri R. Transcatheter Treatment of Bicuspid Aortic Valve Disease: Imaging and Interventional Considerations. Front Cardiovasc Med 2018; 5:91. [PMID: 30073170 PMCID: PMC6060433 DOI: 10.3389/fcvm.2018.00091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/25/2018] [Indexed: 01/27/2023] Open
Abstract
Patients with bicuspid aortic valve disease have systematically been excluded from large randomized clinical trials investigating transcatheter aortic valve implantation (TAVI) due to their younger age, lower surgical risk and complex aortic anatomy. The asymmetric nature of the bicuspid valve orifice often accompanied by heavy regional calcification has led to concerns regarding valve positioning and expansion. Bicuspid aortic valve disease patients are at heightened risk of TAVI-related complications including coronary occlusion, aortic dissection and annular rupture, as well as the known risks of progressive aortopathy in these patients. These unique anatomical characteristics pose challenges for TAVI operators. However, with recent and ongoing refinements in implantation technique, improvements in pre-procedural imaging and iterations in device design, TAVI is emerging as a safe and feasible treatment option in this population. Paravalvular aortic regurgitation and high pacemaker rates have been the Achilles Heel for TAVI in bicuspid valve patients, yet newer generation devices are yielding promising results. Further studies are required before TAVI ultimately emerges as a viable option in low and intermediate surgical-risk patients with bicuspid valve disease. This review comprehensively summarizes the epidemiology, pathology and current evidence for TAVI in patients with bicuspid aortic valve disease. We also outline some practical tips for performing TAVI in these patients.
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Affiliation(s)
- Rajiv Das
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
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Li HY, Zhao YF, Dai L, Xu SJ, Zhang HJ, Jiang WJ. Ascending aortic dilation in adult patients with congenital ventricular septal defect: An observational study. Medicine (Baltimore) 2018; 97:e0383. [PMID: 29642196 PMCID: PMC5908605 DOI: 10.1097/md.0000000000010383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Many adult patients with congenital ventricular septal defect (VSD) also developed ascending aortic dilation, but few report the clinical features and surgical management of these patients. This study was designed to study ascending aortic dilation in adult patients with congenital VSD, and summarized the treatment experience and prognosis.To assess the clinical features and surgical management, we performed a retrospective analysis on preoperative data, intraoperative data, and postoperative data from the adult patients with congenital VSD who developed ascending aortic dilation in our institution from February 2010 to December 2016.From February 2010 to December 2016, we operated on 13 adult patients (12 males, 92.31%) with VSD who developed ascending aortic dilation. Median age was 37 (interquartile range 14) years. All patients suffered from perimembranous VSD and received surgical treatment. Their symptoms were all improved after surgery, no deaths occurred.Surgery is feasible for the ascending aortic dilation in adult patients with congenital VSD. Both proper perioperative treatment and close monitoring are required for the successful surgery.
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Affiliation(s)
- Hai-Yang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Yuan-Fei Zhao
- Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Lu Dai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Shi-Jun Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Hong-Jia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
| | - Wen-Jian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases
- Beijing Lab for Cardiovascular Precision Medicine
- Beijing Aortic Disease Center, Cardiovascular Surgery Center
- Beijing Engineering Research Center for Vascular Prostheses, Beijing, China
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Yuan SM. Quadricuspid Aortic Valve: A Comprehensive Review. Braz J Cardiovasc Surg 2017; 31:454-460. [PMID: 28076624 PMCID: PMC5407143 DOI: 10.5935/1678-9741.20160090] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/25/2016] [Indexed: 01/19/2023] Open
Abstract
Quadricuspid aortic valve (QAV) is a rare congenital heart disease. The
functional status of QAV is predominantly a pure aortic regurgitation. Clinical
manifestations of patients with a QAV depend on the functional status of the QAV
and the associated disorders. Significant valvular regurgitation and (or)
stenosis is often present with subsequent operation performed at the fifth to
sixth decade of life. The functional status of QAV is predominantly regurgitant;
whereas pure stenotic QAV can be as few as in only 0.7% of the patients. QAV is
usually an isolated anomaly, but other congenital heart defects can be present
in 18-32% of the patients. About one-fifth of them require a surgical operation.
Tricuspidalization is a preferred technique for QAV repair. As not all the
patients with a QAV necessarily warrant a surgical operation, decision-making in
patient selection and surgical procedure of choice are crucial. Antibiotic
prophylaxis against infective endocarditis is necessary in the QAV patients with
unequal-sized cusps.
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Affiliation(s)
- Shi-Min Yuan
- The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, China
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21
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Yang Y, Chen YD, Feng B, Ji ZXD, Mao W, Zhi G. Factors Related to Ventricular Size and Valvular Regurgitation in Healthy Tibetans in Lhasa. Chin Med J (Engl) 2017; 130:2316-2320. [PMID: 28937038 PMCID: PMC5634082 DOI: 10.4103/0366-6999.215327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lhasa is the main residence of Tibetans and one of the highest cities in the world. Its unique geography and ethnic population provide the chance to investigate the interactions among high altitude, ethnicity, and cardiac adaptation. Meanwhile, echocardiographic data about healthy Tibetans on a large scale are not available. This study aimed to analyze physiological factors related to ventricular size and valvular function in healthy Tibetans in Lhasa. METHODS A representative sample of residents in Tibet was recruited using a multistage cluster random sampling method. Two-dimensional echocardiographic measurements and Doppler evaluation for valvular function were performed. Healthy Tibetans in Lhasa constituted the study population. Associations between physiological parameters and ventricular dimensions in healthy Tibetans were analyzed by canonical correlation analysis. Factors related to valvular regurgitations were determined by logistic regression analysis. RESULTS The 454 healthy Tibetans (340 females and 114 male) in Lhasa were included in the final analysis. Canonical correlation analysis revealed that weight was positively correlated with the proximal right ventricular outflow diameter and the basal left ventricular linear dimension in both genders. Weight and pulse were negatively related to mild tricuspid regurgitation. Age was a positive factor for pulmonary and aortic regurgitations. The same was found between systolic blood pressure and mitral regurgitation. CONCLUSIONS Weight is associated with ventricular size and valvular regurgitation in healthy Tibetans. It should be of more concern in research of high altitude population.
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Affiliation(s)
- Ying Yang
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Yun-Dai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Bin Feng
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Zha-Xi-Duo Ji
- Department of Ultrasound Diagnosis, Tibet Second People's Hospital, Lhasa, Tibet 850000, China
| | - Wei Mao
- Department of Internal Medicine, People's Hospital of Doilungdeqen County, Lhasa, Tibet 850000, China
| | - Guang Zhi
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
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Fattouch K, Moscarelli M, Castrovinci S, Murana G, Dioguardi P, Guccione F, Nasso G, Speziale G, Lancellotti P. Mid-term results of bicuspid aortic valve repair guided by morphology and function assessment. Interact Cardiovasc Thorac Surg 2017; 25:83-88. [DOI: 10.1093/icvts/ivx027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Malviya A, Jha PK, Ashwin, Mishra J, Srivastava P, Mishra A. Quadricuspid aortic valve – A case report and literature review. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hamatani Y, Ishibashi-Ueda H, Nagai T, Sugano Y, Kanzaki H, Yasuda S, Fujita T, Kobayashi J, Anzai T. Pathological Investigation of Congenital Bicuspid Aortic Valve Stenosis, Compared with Atherosclerotic Tricuspid Aortic Valve Stenosis and Congenital Bicuspid Aortic Valve Regurgitation. PLoS One 2016; 11:e0160208. [PMID: 27479126 PMCID: PMC4968844 DOI: 10.1371/journal.pone.0160208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background Congenital bicuspid aortic valve (CBAV) is the main cause of aortic stenosis (AS) in young adults. However, the histopathological features of AS in patients with CBAV have not been fully investigated. Methods and Results We examined specimens of aortic valve leaflets obtained from patients who had undergone aortic valve re/placement at our institution for severe AS with CBAV (n = 24, CBAV-AS group), severe AS with tricuspid aortic valve (n = 24, TAV-AS group), and severe aortic regurgitation (AR) with CBAV (n = 24, CBAV-AR group). We compared the histopathological features among the three groups. Pathological features were classified using semi-quantitative methods (graded on a scale 0 to 3) by experienced pathologists without knowledge of the patients’ backgrounds. The severity of inflammation, neovascularization, and calcium and cholesterol deposition did not differ between the CBAV-AS and TAV-AS groups, and these four parameters were less marked in the CBAV-AR group than in the CBAV-AS (all p<0.01). Meanwhile, the grade of valvular fibrosis was greater in the CBAV-AS group, compared with the TAV-AS and CBAV-AR groups (both p<0.01). In AS patients, thickness of fibrotic lesions was greater on the aortic side than on the ventricular side (both p<0.01). Meanwhile, thickness of fibrotic lesions was comparable between the aortic and ventricular sides in CBAV-AR patients (p = 0.35). Conclusions Valvular fibrosis, especially on the aortic side, was greater in patients with CBAV-AS than in those without, suggesting a difference in the pathogenesis of AS between CBAV and TAV.
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Affiliation(s)
- Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- * E-mail:
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Isolated quadricuspid aortic valve referred with diagnosis of rheumatic carditis. Indian Heart J 2015; 67:459-61. [PMID: 26432735 DOI: 10.1016/j.ihj.2015.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 05/24/2015] [Accepted: 06/04/2015] [Indexed: 11/23/2022] Open
Abstract
Quadricuspid aortic valve is a rare congenital malformation of the aortic valve. It appears often isolated or sometimes associated with other truncal anomalies, and approximately 50% of patients have aortic regurgitation. In this article we reported an eight-years-old boy referred with diagnose of rheumatic carditis from the outer medical center.
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Abstract
The quadricuspid aortic valve is a very rare congenital defect that may be an isolated entity or associated with a multitude of cardiovascular abnormalities. Isolated cases usually manifest late in life with the complication of aortic regurgitation, which can be delayed by early valve replacement. We present a case of quadricuspid aortic valve associated with truncus arteriosus, ventricular septal defect, and interrupted aortic arch.
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Affiliation(s)
- Arie Franco
- Department of radiology, University of California, Los Angeles, USA
| | - Simon Gabriel
- Department of radiology, University of California, Los Angeles, USA
| | - Stefan G Ruehm
- Department of radiology, University of California, Los Angeles, USA
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Rönnerfalk M, Tamás É. Structure and function of the tricuspid and bicuspid regurgitant aortic valve: an echocardiographic study. Interact Cardiovasc Thorac Surg 2015; 21:71-6. [PMID: 25840434 DOI: 10.1093/icvts/ivv072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/09/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The emerging new treatment options for aortic valve disease call for more sophisticated diagnostics. We aimed to describe the echocardiographic pathophysiology and characteristics of the purely regurgitant aortic valve in detail. METHODS Twenty-nine men, with chronic aortic regurgitation without concomitant heart disease referred for aortic valve intervention, underwent 2D transoesophageal echocardiographic (TEE) examination prior to surgery according to a previously published matrix. Measurements of the aortic valve apparatus in long and short axis view were made in systole and diastole and analysed off-line. The aortic valves were grouped as tricuspid (TAV) or bicuspid (BAV), and classified by regurgitation mechanism. RESULTS Twenty-four examinations were eligible for analysis of which 13 presented TAV and 11 BAV. The regurgitation mechanism was classified as dilatation of the aorta in 6 cases, as prolapse in 11 cases and as poor cusp tissue quality or quantity in 7 cases. The ventriculo-aortic junction (VAJ) and valve opening were closely related (TAV r = 0.5, BAV r = 0.73) but no correlation was found between the VAJ and the maximal sinus diameter (maxSiD) or the sinotubular junction (STJ). However, the STJ and maxSiD were significantly related (TAV vs BAV: systole r = 0.9, r = 0.8; diastole r = 0.9, r = 0.7), forming an entity. The conjoined BAV cusps were shorter than the anterior cusps when closed (P = 0.002); the inter-commissural distances of the cusps in the BAV group were significantly different (P = 0.001 resp. 0.03) in both systole and diastole. CONCLUSIONS The VAJ was independent of other aortic dimensions and should thereby be considered as a separate entity with influence on valve opening. The detailed 2D TEE measurements of this study add further important information to our knowledge about the function and echocardiographic anatomy of the pathological aortic valve and root either as a stand-alone examination or as a benchmark and complement to 3D echocardiography. This may have an impact on decisions regarding repairability of the native aortic valve.
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Affiliation(s)
- Mattias Rönnerfalk
- Department of Clinical Physiology, University of Linköping, Linköping, Sweden Department of Cardiothoracic Surgery, Heart and Medicine Centre, Linköping, Sweden Division of Cardiovascular Medicine, Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
| | - Éva Tamás
- Department of Cardiothoracic Surgery, Heart and Medicine Centre, Linköping, Sweden Division of Cardiovascular Medicine, Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
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29
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Savino K, Quintavalle E, Ambrosio G. Quadricuspid Aortic Valve: A Case Report and Review of the Literature. J Cardiovasc Echogr 2015; 25:72-76. [PMID: 28465938 PMCID: PMC5353411 DOI: 10.4103/2211-4122.166077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The quadricuspid aortic valve (QAV) is a rare malformation; often isolated, sometimes associated with other heart diseases. Before the era of echocardiography, the diagnosis was made incidentally at autopsy or during surgery of valve replacement. The extensive use of echocardiography has allowed an early and accurate diagnosis of this malformation. In many cases, the transthoracic approach is suitable for the diagnosis but, transesophageal echocardiography is a tool for the accurate definition of the valve anatomy. This review analyzes, after the presentation of a clinical case, the current knowledge on embryogenesis, classification, diagnosis and clinical course of QAV.
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Affiliation(s)
- Ketty Savino
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Elisa Quintavalle
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Giuseppe Ambrosio
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
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Aortic valve reconstruction using autologous pericardium for patients aged less than 60 years. J Thorac Cardiovasc Surg 2014; 148:934-8. [DOI: 10.1016/j.jtcvs.2014.05.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/10/2014] [Accepted: 05/16/2014] [Indexed: 11/17/2022]
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Holubec T, Zacek P, Jamaliramin M, Emmert MY, Tuna M, Nedbal P, Dominik J, Harrer J, Falk V, Vojacek J. Valve cuspidity: a risk factor for aortic valve repair? J Card Surg 2014; 29:585-92. [PMID: 24919866 DOI: 10.1111/jocs.12382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to analyze short- and mid-term results after aortic valve (AV) repair with particular regard to the impact of valve cuspidity (bicuspid versus tricuspid aortic valve). METHODS One hundred patients with aortic regurgitation (AR) undergoing aortic valve repair between November 2007 and October 2012 were included in the study. Sixty patients had bicuspid AV (BAV group; 11 females) and 40 patients had tricuspid AV (TAV group; 13 females). AR > grade 2 was present in 47 (78%) patients in the BAV and in 35 (88%) patients in the TAV group. Follow-up was complete in 100% and median was 25 months. RESULTS Isolated aortic valve repair was performed in 27 (45%) of BAV patients and in six (15%) of TAV patients. Replacement of the ascending aorta and/or aortic root was performed in 33 (55%) of BAV patients and in 34 (86%) of TAV patients. There was no death within 30 days postoperatively, while two patients died (TAV group) during the follow-up period. There was no statistical difference between BAV and TAV groups with regard to the survival (100 ± 0% vs. 95 ± 4%, p = 0.102), the three-year freedom from AV-related reoperation (90 ± 5% vs. 89 ± 6%, p = 0.456), and the three-year freedom from AR grade > 2 (86 ± 6% vs. 82 ± 7%, p = 0.866), respectively. CONCLUSIONS This study demonstrates no difference in mid-term results after regurgitant bicuspid and tricuspid aortic valve repair, suggesting that bicuspid valve may not be a risk factor for aortic valve repair.
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Affiliation(s)
- Tomas Holubec
- Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic; Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience. Indian Heart J 2014; 66:320-6. [PMID: 24973838 DOI: 10.1016/j.ihj.2014.03.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 03/07/2014] [Accepted: 03/23/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo). METHODS Among the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort. RESULTS In RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease. CONCLUSION RHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases.
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Affiliation(s)
- C N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - P Srinivas
- PG, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Jaya Nagar 9th Block, Bannerghatta Road, Bangalore 560069, Karnataka, India.
| | - K S Ravindranath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | - C Dhanalakshmi
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
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Garg P, Kamaruddin H, Orme R, Watt V. Type F Congenital Quadricuspid Aortic Valve: A Very Rare Case Diagnosed by 3-dimenional Transoesophageal Echocardiography. Open Cardiovasc Med J 2014; 8:23-5. [PMID: 24707324 PMCID: PMC3975634 DOI: 10.2174/1874192401408010023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 11/25/2022] Open
Abstract
Congenital quadricuspid aortic valve (QAV) is a rare cardiac anomaly. Several different anatomical variations of a quadricuspid aortic valve have been described. Aortic regurgitation is the predominant valvular dysfunction associated with QAV and patients tend to present in their 5th or 6th decade of life. This anomaly is rarely picked up by transthoracic echocardiogram (TTE). A comprehensive transoesophageal echocardiography (TOE) study is more likely to diagnose it. We describe a very rare type of QAV – Type F in a 52-year-old lady who presented with symptoms of shortness of breath and pre-syncope. We include TOE images and intra-operative valve images.
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Affiliation(s)
- Pankaj Garg
- Cardio-thoracic Unit, Chesterman Wing, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, England S5 7AU
| | - Hazlyna Kamaruddin
- Cardio-thoracic Unit, Chesterman Wing, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, England S5 7AU
| | - Rachel Orme
- Cardio-thoracic Unit, Chesterman Wing, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, England S5 7AU
| | - Victoria Watt
- Cardio-thoracic Unit, Chesterman Wing, Northern General Hospital, Herries Road, Sheffield, South Yorkshire, England S5 7AU
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Ozaki S, Kawase I, Yamashita H, Uchida S, Nozawa Y, Takatoh M, Hagiwara S, Kiyohara N. Reconstruction of bicuspid aortic valve with autologous pericardium--usefulness of tricuspidization. Circ J 2014; 78:1144-51. [PMID: 24614492 DOI: 10.1253/circj.cj-13-1335] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study describes the surgical treatment of bicuspid aortic valve with original aortic valve reconstruction. METHODS AND RESULTS Aortic valve reconstruction was done in 102 patients with bicuspid aortic valve from April 2007 through September 2011. Thirty-four patients with ascending aortic diameter >45 mm underwent hemi-arch aortic replacement concomitantly. Seventy-seven patients had aortic stenosis, and 25 had aortic regurgitation (AR). Mean age was 63.7±10.0 years old. There were 55 men and 47 women. Harvested pericardium is treated with 0.6% glutaraldehyde solution. The distance between commissures is measured with an original sizing instrument. For bicuspid valve with raphe, the raphe is considered as a commissure in order to measure the distance between each commissure. Without a raphe, we create a new annular margin and commissure using coronary ostium and the sizing instrument as a guide. Then, pericardium is trimmed with original template. Three cusps are sutured independently. The preoperative averaged peak pressure gradient of 71.1±39.0 mmHg was decreased to 16.2±8.8, 13.3±6.0, and 13.9±5.6 mmHg, respectively 1 week, 1 year, and 3 years after operation. AR was trivial. One reoperation was recorded. Mean follow-up was 733 days. There were 5 late mortalities. No thromboembolic event was recorded. CONCLUSIONS Medium-term results were excellent. Tricuspidization gave good opening and closure of aortic valve with excellent hemodynamics.
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Affiliation(s)
- Shigeyuki Ozaki
- Department of Cardiovascular Surgery, Toho University Ohashi Medical Center
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Song MG, Yang HS, Lee DH, Shin JK, Chee HK, Kim JS. Mid-term results in patients having tricuspidization of the quadricuspid aortic valve. J Cardiothorac Surg 2014; 9:29. [PMID: 24506947 PMCID: PMC3922268 DOI: 10.1186/1749-8090-9-29] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 02/05/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Quadricuspid aortic valve (QAV) is a rare congenital anomaly. We investigate the mid-term results of aortic valve reconstruction by tricuspidization in patients with QAV. METHODS We analyzed the outcome of eight consecutive patients who underwent aortic valve reconstruction surgery (AVRS) with pericardial leaflets with symptomatic quadricuspid aortic valve (QAV) disease between December 2007 and May 2012. AVRS consists of leaflet reconstruction and fixation of the sino-tubular junction in order to maintain coaptation of the new valve. RESULTS Six males and two females were included; ages ranged from 19 to 63 years (mean age, 51 years). According to Hurwitz and Roberts's classification, three patients had type A, three patients had type B, one patient had type C, and one patient had type E. All patients had significant aortic regurgitation (AR): moderate in three patients, moderate to severe in one patient, and severe in four patients. Concomitant ascending aorta wrapping with an artificial vascular graft was performed in one case. There was no occurrence of mortality during the follow-up period (42.4 ± 18.0 months). No redo-operation was required. The NYHA functional class showed improvement from 2.1 ± 0.2 to 1.1 ± 0.2 (p= 0.008). The latest echocardiograms showed AR absent or trivial in seven patients, and mild in one patient. The aortic valve orifice area index (AVAI) was 1.03 ± 0.49 cm2/m2. Compared with preoperative echocardiograms, the left ventricular (LV) ejection fraction showed improvement from 57.6 ± 17.0 to 63.7 ± 13.2% (p=0.036); the end-diastolic and end-systolic LV dimensions showed a significant decrease, from 63.5 ± 9.6 to 49.5 ± 3.1 mm (p=0.012) and 43.6 ± 11.8 to 32.1 ± 5.4 mm (p=0.012), respectively. CONCLUSION In patients with QAV, AVRS with tricuspidization showed satisfactory early and mid-term results. Long-term follow-up will be necessary in order to study the durability of AVRS; however, it can be considered as a potential standard procedure.
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Affiliation(s)
| | | | - Dong Hyup Lee
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namgu, Daegu 705-035, South Korea.
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Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther 2014; 6:235-48. [DOI: 10.1586/14779072.6.2.235] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Anomalous Cord From the Raphe of a Congenitally Bicuspid Aortic Valve to the Aortic Wall Producing Either Acute or Chronic Aortic Regurgitation. J Am Coll Cardiol 2014; 63:153-7. [DOI: 10.1016/j.jacc.2013.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 08/30/2013] [Accepted: 09/10/2013] [Indexed: 11/15/2022]
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Can a Central Stitch over the Arantius' Nodules Provide a Solution for Pre-Operative Severe Native AI in LVAD Patients? Int J Artif Organs 2013; 36:220-4. [DOI: 10.5301/ijao.5000200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate the evolution of aortic valve insufficiency (AI) after Park's central stitch in patients with severe, pre-operative, native aortic valve insufficiency. Methods We retrospectively studied 71 continuous flow LVAD patients between January 2004 and December 2010. Four patients with AI≥3/4 were treated with a central stitch. An intensive review of the literature was performed to debate the use of the central stitch in this population. Results The AI at baseline (AI = 2.75 ± 0.5) and AI at last measurement (AI = 0.75 ± 0.65) is statistically different after central stitch (p<0.05) with mean follow up of 198.25 (± 146.70) days. Total cross clamp-time during the placement of the stitch was 15.5 minutes (± 13.062). CVA was not diagnosed in our cohort. Conclusions Park's central stitch can be successfully performed on patients with severe native AI (≥3/4) with good long-term results. Short ischemic time and simple application of the stitch are the biggest advantages. Due to the progression of AI in longstanding LVAD, the central stitch may be beneficial for LVAD in destination therapy. Since this is a small group of patients and also an early experience, more cases will be necessary to confirm these positive results.
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Chandra S, Rajamannan NM, Sucosky P. Computational assessment of bicuspid aortic valve wall-shear stress: implications for calcific aortic valve disease. Biomech Model Mechanobiol 2013; 11:1085-96. [PMID: 22294208 DOI: 10.1007/s10237-012-0375-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 01/14/2012] [Indexed: 01/11/2023]
Abstract
The bicuspid aortic valve (BAV) is associated with a high prevalence of calcific aortic valve disease (CAVD). Although abnormal hemodynamics has been proposed as a potential pathogenic contributor, the native BAV hemodynamic stresses remain largely unknown. Fluid-structure interaction models were designed to quantify the regional BAV leaflet wall-shear stress over the course of CAVD. Systolic flow and leaflet dynamics were computed in two-dimensional tricuspid aortic valve (TAV) and type-1 BAV geometries with different degree of asymmetry (10 and 16% eccentricity) using an arbitrary Lagrangian–Eulerian approach. Valvular performance and regional leaflet wallshear stress were quantified in terms of valve effective orifice area (EOA), oscillatory shear index (OSI) and temporal shear magnitude (TSM). The dependence of those characteristics on the degree of leaflet calcification was also investigated. The models predicted an average reduction of 49% in BAV peak-systolic EOA relative to the TAV. Regardless of the anatomy, the leaflet wall-shear stress was side-specific and characterized by high magnitude and pulsatility on the ventricularis and low magnitude and oscillations on the fibrosa. While the TAV and non-coronary BAV leaflets shared similar shear stress characteristics, the base of the fused BAV leaflet fibrosa exhibited strong abnormalities, which were modulated by the degree of calcification (6-fold, 10-fold and 16-fold TSM increase in the normal, mildly and severely calcified BAV, respectively, relative to the normal TAV). This study reveals the existence of major differences in wall-shear stress pulsatility and magnitude on TAV and BAV leaflets. Given the ability of abnormal fluid shear stress to trigger valvular inflammation, the results support the existence of a mechano-etiology of CAVD in the BAV.
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Affiliation(s)
- Santanu Chandra
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, 143 Multidisciplinary Research Building, Notre Dame, IN 46556-5637, USA
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Vohra HA, Whistance RN, De Kerchove L, Punjabi P, El Khoury G. Valve-preserving surgery on the bicuspid aortic valve. Eur J Cardiothorac Surg 2013; 43:888-98. [DOI: 10.1093/ejcts/ezs664] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Castonguay MC, Burner KD, Edwards WD, Baddour LM, Maleszewski JJ. Surgical pathology of native valve endocarditis in 310 specimens from 287 patients (1985–2004). Cardiovasc Pathol 2013; 22:19-27. [DOI: 10.1016/j.carpath.2012.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/30/2012] [Accepted: 05/30/2012] [Indexed: 11/17/2022] Open
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Abstract
Anatomy of the native cardiac valves, reasons for surgical excision and examination, and a summary of the gross examination and documentation are presented. Aortic stenosis, aortic valve regurgitation, tricuspid and pulmonary valve pathology, mitral stenosis, and mitral insufficiency are each presented with an overview, focused anatomy, and discussion of pathologic diagnosis by gross examination and histology.
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Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson J, Maguire G, Marijon E, Mirabel M, Mocumbi AO, Mota C, Paar J, Saxena A, Scheel J, Stirling J, Viali S, Balekundri VI, Wheaton G, Zühlke L, Carapetis J. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline. Nat Rev Cardiol 2012; 9:297-309. [PMID: 22371105 DOI: 10.1038/nrcardio.2012.7] [Citation(s) in RCA: 505] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.
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Affiliation(s)
- Bo Reményi
- Green Lane Pediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand.
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Quadricuspid aortic valve by cardiac magnetic resonance imaging: a case report and review of the literature. J Comput Assist Tomogr 2011; 35:637-41. [PMID: 21926862 DOI: 10.1097/rct.0b013e318224a129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Quadricuspid aortic valve (QAV) is a rare congenital cardiac entity. The recognition of QAV has clinical significance as it causes aortic valve dysfunction, commonly aortic regurgitation, and is often associated with other congenital cardiac abnormalities. We showed the important role played by cardiac magnetic resonance imaging in detecting QAV and review the available literature to explain its incidence, diagnosis, classifications, embryology, correlation between morphology of the QAV and its function, associated conditions, and management.
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Kiefer TL, Wang A, Hughes GC, Bashore TM. Management of Patients With Bicuspid Aortic Valve Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:489-505. [DOI: 10.1007/s11936-011-0152-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Are bicuspid aortic valves a limitation for aortic valve repair? Eur J Cardiothorac Surg 2011; 40:1097-104. [PMID: 21420874 DOI: 10.1016/j.ejcts.2011.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 01/31/2011] [Accepted: 02/01/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To compare the mid-term results after aortic valve (AV) repair in bicuspid AVs with those in tricuspid AVs. METHODS Between 2000 and 2010, 100 patients (mean age 47.2 years) underwent AV repair procedures for insufficient bicuspid AV (n=43) and tricuspid AV (n=57). Aortic regurgitation (AR) more than moderate was present in 31/43 and 21/57 patients in the bicuspid AV and the tricuspid AV group, respectively. Concomitant root replacement by either the reimplantation or the remodeling technique was performed in 42 patients (bicuspid AV 17/43, tricuspid AV 25/57). All patients were prospectively studied with postoperative and further annual clinical assessment and echocardiography. Follow-up was 99% complete with a mean follow-up time of 22 months. RESULTS Three patients died during the initial hospitalization, all due to postoperative cardiac failure. Overall actuarial 3 years' survival was 93±4.2% without significant differences between the two groups. Overall actuarial 3 years' freedom from AV-related reoperation was 86±5.1% without significant differences between the groups (85±9.7% for bicuspid AV, 86±6.0% for tricuspid AV; log-rank test: p=0.98). Overall actuarial 3 years' freedom from recurrent AR≥moderate was 100% and AR>trace was 71.3±8.2% without significant differences between the groups (76.5±11.7% for bicuspid AV, 71.4±9.4 for tricuspid AV; log-rank test: p=0.97). CONCLUSIONS The mid-term outcome in terms of survival, freedom from reoperation or recurrent AR is similar for both groups of patients after AV repair procedures. Therefore, we advocate valve repair also in patients presenting with an insufficient bicuspid AV.
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Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HJ. Valve Configuration Determines Long-Term Results After Repair of the Bicuspid Aortic Valve. Circulation 2011; 123:178-85. [DOI: 10.1161/circulationaha.109.934679] [Citation(s) in RCA: 273] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Reconstruction of the regurgitant bicuspid aortic valve has been performed for >10 years, but there is limited information on long-term results. We analyzed our results to determine the predictors of suboptimal outcome.
Methods and Results—
Between November 1995 and December 2008, 316 patients (age, 49±14 years; male, 268) underwent reconstruction of a regurgitant bicuspid aortic valve. Intraoperative assessment included extent of fusion, root dimensions, circumferential orientation of the 2 normal commissures (>160°, ≤160°), and effective height after repair. Cusp pathology was treated by central plication (n=277), triangular resection (n=138), or pericardial patch (n=94). Root dilatation was treated by subcommissural plication (n=100), root remodeling (n=122), or valve reimplantation (n=2). All patients were followed up echocardiographically (cumulative follow-up, 1253 years; mean, 4±3.1 years). Clinical and morphological parameters were analyzed for correlation with 10-year freedom from reoperation with the Cox proportional hazards model. Hospital mortality was 0.63%; survival was 92% at 10 years. Freedom from reoperation at 5 and 10 years was 88% and 81%; freedom from valve replacement, 95% and 84%. By univariable analysis, statistically significant predictors of reoperation were age (hazard ratio [HR]=0.97), aortoventricular diameter (HR=1.24), effective height (HR=0.76), commissural orientation (HR=0.95), use of a pericardial patch (HR=7.63), no root replacement (HR=3.80), subcommissural plication (HR=2.07), and preoperative aortic regurgitation grade 3 or greater. By multivariable analysis, statistically significant predictors for reoperation were age (HR=0.96), aortoventricular diameter (HR=1.30), effective height (HR=0.74), commissural orientation (HR=0.96), and use of a pericardial patch (HR=5.16).
Conclusions—
Reconstruction of bicuspid aortic valve can be performed reproducibly with good early results. Recurrence and progression of regurgitation, however, may occur, depending primarily on anatomic features of the valve.
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Affiliation(s)
- Diana Aicher
- From the Department of Thoracic and Cardiovascular Surgery (D.A., T.K., O.A.I., B.B., H.-J.S.) and Institute of Medical Biometry, Epidemiology and Medical Informatics, (S.G.) University Hospital of Saarland, Homburg, Germany
| | - Takashi Kunihara
- From the Department of Thoracic and Cardiovascular Surgery (D.A., T.K., O.A.I., B.B., H.-J.S.) and Institute of Medical Biometry, Epidemiology and Medical Informatics, (S.G.) University Hospital of Saarland, Homburg, Germany
| | - Omar Abou Issa
- From the Department of Thoracic and Cardiovascular Surgery (D.A., T.K., O.A.I., B.B., H.-J.S.) and Institute of Medical Biometry, Epidemiology and Medical Informatics, (S.G.) University Hospital of Saarland, Homburg, Germany
| | - Brigitte Brittner
- From the Department of Thoracic and Cardiovascular Surgery (D.A., T.K., O.A.I., B.B., H.-J.S.) and Institute of Medical Biometry, Epidemiology and Medical Informatics, (S.G.) University Hospital of Saarland, Homburg, Germany
| | - Stefan Gräber
- From the Department of Thoracic and Cardiovascular Surgery (D.A., T.K., O.A.I., B.B., H.-J.S.) and Institute of Medical Biometry, Epidemiology and Medical Informatics, (S.G.) University Hospital of Saarland, Homburg, Germany
| | - Hans-Joachim Schäfers
- From the Department of Thoracic and Cardiovascular Surgery (D.A., T.K., O.A.I., B.B., H.-J.S.) and Institute of Medical Biometry, Epidemiology and Medical Informatics, (S.G.) University Hospital of Saarland, Homburg, Germany
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