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Arnold Z, Elnekheli A, Geisler D, Aschacher T, Lenz V, Winkler B, Moidl R, Grabenwöger M. Left Ventricular Reverse Remodeling after Surgical Aortic Valve Replacement for Aortic Regurgitation-An Explorative Study. Diseases 2024; 12:191. [PMID: 39195190 DOI: 10.3390/diseases12080191] [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: 07/09/2024] [Revised: 08/11/2024] [Accepted: 08/20/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND The timing of treatment for chronic aortic valve regurgitation (AR), especially in asymptomatic patients, is gaining attention since less invasive strategies have become available. The aim of the present study was to evaluate left ventricular reverse remodeling after aortic valve replacement (AVR) for severe AR. METHODS Patients (n = 25) who underwent surgical AVR for severe AR with left ventricular ejection fraction (LVEF) less than 55% were included in this study. Preprocedural and follow-up clinical and echocardiographic measurements of LVEF and left ventricular (LV) diameters were retrospectively analyzed. RESULTS Mean LVEF increased significantly following surgical AVR (p < 0.0001). LV diameters showed a clear regression (p = 0.0088). Younger patients and those receiving a mechanical valve tended to have less improved LVEF on follow-up than patients over 60 years or the ones who were implanted with a biological prosthesis (p = 0.0239 and p = 0.069, respectively). Gender had no effect on the degree of LVEF improvement (p = 0.4908). CONCLUSIONS We demonstrated significant LV reverse remodeling following AVR for AR. However, more data are needed on LV functional and geometrical improvement comparing the different types of valve prostheses to provide an optimal treatment strategy.
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Affiliation(s)
- Zsuzsanna Arnold
- Department of Cardiovascular Surgery, Clinic Floridsdorf, 1210 Vienna, Austria
- Institute of Cardiovascular Research, Karl Landsteiner Society, 1210 Vienna, Austria
| | | | - Daniela Geisler
- Department of Cardiovascular Surgery, Clinic Floridsdorf, 1210 Vienna, Austria
- Institute of Cardiovascular Research, Karl Landsteiner Society, 1210 Vienna, Austria
| | - Thomas Aschacher
- Department of Cardiovascular Surgery, Clinic Floridsdorf, 1210 Vienna, Austria
- Institute of Cardiovascular Research, Karl Landsteiner Society, 1210 Vienna, Austria
| | - Verena Lenz
- Department of Cardiovascular Surgery, Clinic Floridsdorf, 1210 Vienna, Austria
- Institute of Cardiovascular Research, Karl Landsteiner Society, 1210 Vienna, Austria
| | - Bernhard Winkler
- Department of Cardiovascular Surgery, Clinic Floridsdorf, 1210 Vienna, Austria
- Institute of Cardiovascular Research, Karl Landsteiner Society, 1210 Vienna, Austria
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
| | - Reinhard Moidl
- Department of Cardiovascular Surgery, Clinic Floridsdorf, 1210 Vienna, Austria
- Institute of Cardiovascular Research, Karl Landsteiner Society, 1210 Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Clinic Floridsdorf, 1210 Vienna, Austria
- Institute of Cardiovascular Research, Karl Landsteiner Society, 1210 Vienna, Austria
- Medical Faculty, Sigmund Freud University, 1020 Vienna, Austria
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2
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Kilaru V, Patel S, Patel H, Ghasemzadeh N. An Unusual Case of Bicuspid Aortic Valve With Prolapse Masquerading as Cusp Perforation. Cureus 2024; 16:e60562. [PMID: 38887341 PMCID: PMC11181233 DOI: 10.7759/cureus.60562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/20/2024] Open
Abstract
We present a unique clinical scenario of a 58-year-old male with a past medical history of hypertension who initially presented with chest pain and was ruled in for non-ST elevation myocardial infarction (NSTEMI) but rapidly developed respiratory failure secondary to aortic insufficiency complicated by cardiogenic shock (CS), attributed to aortic valve prolapse. Intriguingly, the patient had a normal ECG on presentation, underscoring the dynamic nature of valvular pathology. The development of CS highlights the importance of early recognition, prompt diagnosis, and interdisciplinary management in such complex cases.
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Affiliation(s)
- Vikas Kilaru
- Internal Medicine, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Sharvil Patel
- Internal Medicine, Northeast Georgia Medical Center Gainesville, Gainesville, USA
| | - Hely Patel
- Pediatrics, Emory University, Atlanta, USA
| | - Nima Ghasemzadeh
- Interventional Cardiology, Georgia Heart Institute, Gainesville, USA
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3
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Nath SS, Parashar S. Perioperative management of patients with prosthetic heart valves-A narrative review. Ann Card Anaesth 2022; 25:254-263. [PMID: 35799551 PMCID: PMC9387617 DOI: 10.4103/aca.aca_109_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Worldwide, about 13% of the 200,000 annual recipients of prosthetic heart valves (PHV) present for various surgical procedures. Also, more and more females are opting for pregnancies after having PHV. All patients with PHV present unique challenges for the anesthesiologists, surgeons and obstetricians (in case of deliveries). They have to deal with the perioperative management of anticoagulation and a host of other issues involved. We reviewed the English language medical literature relevant to the different aspects of perioperative management of patients with PHV, particularly the guidelines of reputed societies that appeared in the last 20 years. Regression of cardiac pathophysiology following valve replacement is variable both in extent and timeline. The extent to which reverse remodeling occurs depends on the perioperative status of the heart. We discussed the perioperative assessment of patients with PHV, including focused history and relevant investigations with the inferences drawn. We examined the need for prophylaxis against infective endocarditis and management of anticoagulation in such patients in the perioperative period and the guidelines of reputed societies. We also reviewed the conduct of anesthesia, including general and regional anesthesia (neuraxial and peripheral nerve/plexus blocks) in such patients. Finally, we discussed the management of delivery in this group of high-risk patients. From the discussion of different aspects of perioperative management of patients with PHV, we hope to guide in formulating the comprehensive plan of management of safe anesthesia in such patients.
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Affiliation(s)
- Soumya Sankar Nath
- Department of Anesthesiology and Critical Care Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Samiksha Parashar
- Department of Anesthesiology and Critical Care Medicine, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Grund FF, Kristensen CB, Bahrami HSZ, Mogelvang R, Hassager C. Layer-specific longitudinal strain detects transmural dysfunction in chronic severe aortic regurgitation before and after aortic valve surgery. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:979-989. [PMID: 34928462 DOI: 10.1007/s10554-021-02492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
To assess if layer-specific longitudinal strain (LS) provides incremental diagnostic and prognostic value compared to global longitudinal strain (GLS) in patients with chronic severe aortic regurgitation (AR) scheduled for aortic valve surgery. Forty-one patients were examined with speckle tracking echocardiography before surgery along with 15 healthy age-matched controls. Paired strain analyses before and after surgery were available in 31 patients. Layer-specific LS analysis enabled assessment of epicardial GLS (GLSepi), endocardial GLS (GLSendo), and conventional GLS. Strain parameters were indexed to end-diastolic volume (EDV; GLS/EDV) to account for increased preload. The prognostic value of layer-specific LS was evaluated using the primary outcome of persistent LV dilatation (LVEDV ≥ 175 mL) three months after surgery. Absolute (GLS, GLSepi, GLSendo) and EDV-indexed layer-specific LS (GLS/EDV, GLSepi/EDV, GLSendo/EDV) were impaired in severe AR compared to controls at baseline (GLS:17.0 ± 3.2 vs. 20.6 ± 2.0; GLSepi:14.6 ± 2.8 vs. 18.1 ± 1.9; GLSendo:20.2 ± 3.7 vs. 23.8 ± 2.2%; GLS/EDV:0.09 ± 0.05 vs. 0.21 ± 0.05; GLSepi/EDV:0.08 ± 0.04 vs. 0.18 ± 0.04; GLSendo/EDV:0.11 ± 0.06 vs. 0.24 ± 0.05%/mL; all p < 0.001). In severe AR, GLS, GLSepi and GLSendo decreased after surgery whereas GLS/EDV, GLSepi/EDV and GLSendo/EDV increased (all p < 0.001). Impaired absolute and EDV-indexed layer-specific LS were all associated with the primary outcome (all p ≤ 0.01). Area under the curve analysis revealed similar prognostic value of GLSepi, GLSendo and GLS (GLS:0.86; GLSepi:0.87; GLSendo:0.86; p = n.s.). EDV-indexed LS did not improve the predictive value significantly (GLS/EDV:0.93; GLSepi/EDV: 0.93; GLSendo/EDV:0.92; p = n.s.). Layer-specific LS detects transmural dysfunction in chronic severe AR and predicts persistent LV dilation after surgery. Layer-specific LS or EDV-indexed LS does not provide incremental prognostic value compared to conventional GLS.
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Affiliation(s)
- Frederik Fasth Grund
- Department of Cardiology, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | | | | | - Rasmus Mogelvang
- Department of Cardiology, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
- Cardiovascular Research Unit, University of Southern Denmark, Baagoees Àlle 15, 5700, Svendborg, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
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5
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Zhang MK, Li LN, Xue H, Tang XJ, Sun H, Wu QY. Left ventricle reverse remodeling in chronic aortic regurgitation patients with dilated ventricle after aortic valve replacement. J Cardiothorac Surg 2022; 17:8. [PMID: 35034651 PMCID: PMC8762957 DOI: 10.1186/s13019-022-01754-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 01/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aortic valve replacement (AVR) for chronic aortic regurgitation (AR) with a severe dilated left ventricle and dysfunction leads to left ventricle remodeling. But there are rarely reports on the left ventricle reverse remodeling (LVRR) after AVR. This study aimed to investigate the LVRR and outcomes in chronic AR patients with severe dilated left ventricle and dysfunction after AVR. METHODS We retrospectively analyzed the clinical datum of chronic aortic regurgitation patients who underwent isolated AVR. The LVRR was defined as an increase in left ventricular ejection fraction (LVEF) at least 10 points or a follow-up LVEF ≥ 50%, and a decrease in the indexed left ventricular end-diastolic diameter of at least 10%, or an indexed left ventricular end-diastolic diameter ≤ 33 mm/m2. The changes in echocardiographic parameters after AVR, survival analysis, the predictors of major adverse cardiac events (MACE), the association between LVRR and MACE were analyzed. RESULTS Sixty-nine patients with severe dilated left ventricle and dysfunction underwent isolated AVR. LV remodeling in 54 patients and no LV remodeling in 15 patients at 6-12 months follow-up. The preoperative left ventricular dimensions and volumes were larger, and the EF was lower in the LV no remodeling group than those in the LV remodeling group (all p < 0.05). The adverse LVRR was the predictor for MACE at follow-up. The mean follow-up period was 47.29 months (range 6 to 173 months). The rate of freedom from MACE was 94.44% at 5 years and 92.59% at 10 years in the remodeling group, 60% at 5 years, and 46.67% at 10 years in the no remodeling group. CONCLUSIONS The left ventricle remodeling after AVR was the important predictor for MACE. LV no remodeling may not be associated with benefits from AVR for chronic aortic regurgitation patients with severe dilated LV and dysfunction.
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Affiliation(s)
- Ming-Kui Zhang
- Heart Center, First Hospital of Tsinghua University, No. 6 1st Street, Jiuxianqiao, Chaoyang District, Beijing, 100016, China.
| | - Li-Na Li
- Heart Center, First Hospital of Tsinghua University, No. 6 1st Street, Jiuxianqiao, Chaoyang District, Beijing, 100016, China
| | - Hui Xue
- Heart Center, First Hospital of Tsinghua University, No. 6 1st Street, Jiuxianqiao, Chaoyang District, Beijing, 100016, China
| | - Xiu-Jie Tang
- Heart Center, First Hospital of Tsinghua University, No. 6 1st Street, Jiuxianqiao, Chaoyang District, Beijing, 100016, China
| | - He Sun
- Heart Center, First Hospital of Tsinghua University, No. 6 1st Street, Jiuxianqiao, Chaoyang District, Beijing, 100016, China
| | - Qing-Yu Wu
- Heart Center, First Hospital of Tsinghua University, No. 6 1st Street, Jiuxianqiao, Chaoyang District, Beijing, 100016, China
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6
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Bastos MB, Burkhoff D, Maly J, Daemen J, den Uil CA, Ameloot K, Lenzen M, Mahfoud F, Zijlstra F, Schreuder JJ, Van Mieghem NM. Invasive left ventricle pressure-volume analysis: overview and practical clinical implications. Eur Heart J 2021; 41:1286-1297. [PMID: 31435675 PMCID: PMC7084193 DOI: 10.1093/eurheartj/ehz552] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/22/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022] Open
Abstract
Ventricular pressure–volume (PV) analysis is the reference method for the study of cardiac mechanics. Advances in calibration algorithms and measuring techniques brought new perspectives for its application in different research and clinical settings. Simultaneous PV measurement in the heart chambers offers unique insights into mechanical cardiac efficiency. Beat to beat invasive PV monitoring can be instrumental in the understanding and management of heart failure, valvular heart disease, and mechanical cardiac support. This review focuses on intra cardiac left ventricular PV analysis principles, interpretation of signals, and potential clinical applications. ![]()
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Affiliation(s)
- Marcelo B Bastos
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | | | - Jiri Maly
- Department of Cardiac and Transplant Surgery, IKEM, Prague, Czech Republic
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Corstiaan A den Uil
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands.,Department of Intensive Care Medicine, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Koen Ameloot
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Mattie Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Jan J Schreuder
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Office Nt 645, Dr Molewaterplein 40 3015 GD, Rotterdam, The Netherlands
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7
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Vollema EM, Singh GK, Prihadi EA, Regeer MV, Ewe SH, Ng ACT, Mertens BJA, Klautz RJM, Ajmone Marsan N, Bax JJ, Delgado V. Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation. Eur Heart J Cardiovasc Imaging 2020; 20:1105-1111. [PMID: 30932153 PMCID: PMC6753383 DOI: 10.1093/ehjci/jez049] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
Aims Pressure overload in aortic stenosis (AS) and both pressure and volume overload in aortic regurgitation (AR) induce concentric and eccentric hypertrophy, respectively. These structural changes influence left ventricular (LV) mechanics, but little is known about the time course of LV remodelling and mechanics after aortic valve surgery (AVR) and its differences in AS vs. AR. The present study aimed to characterize the time course of LV mass index (LVMI) and LV mechanics [by LV global longitudinal strain (LV GLS)] after AVR in AS vs. AR. Methods and results Two hundred and eleven (61 ± 14 years, 61% male) patients with severe AS (63%) or AR (37%) undergoing surgical AVR with routine echocardiographic follow-up at 1, 2, and/or 5 years were evaluated. Before AVR, LVMI was larger in AR patients compared with AS. Both groups showed moderately impaired LV GLS, but preserved LV ejection fraction. After surgery, both groups showed LV mass regression, although a more pronounced decline was seen in AR patients. Improvement in LV GLS was observed in both groups, but characterized by an initial decline in AR patients while LV GLS in AS patients remained initially stable. Conclusion In severe AS and AR patients undergoing AVR, LV mass regression and changes in LV GLS are similar despite different LV remodelling before AVR. In AR, relief of volume overload led to reduction in LVMI and an initial decline in LV GLS. In contrast, relief of pressure overload in AS was characterized by a stable LV GLS and more sustained LV mass regression.
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Affiliation(s)
- E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands.,Department of Cardiology, Antwerp Cardiovascular Center, ZNA Middelheim, Lindendreef 1, Antwerp, Belgium
| | - Madelien V Regeer
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, 199 Ipswich Rd, Woolloongabba QLD, Australia
| | - Bart J A Mertens
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
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8
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Soesanto AM, Suastika LOS. Echocardiography Screening for Latent Rheumatic Heart Disease: What Can We Do in Indonesia? Front Surg 2020; 7:46. [PMID: 32974379 PMCID: PMC7466630 DOI: 10.3389/fsurg.2020.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022] Open
Abstract
Rheumatic heart disease (RHD), a sequela of acute rheumatic fever (ARF), is a preventable disease but remains a significant health problem, especially in developing countries. It causes disability, poor quality of life, early mortality, and national economic burden. The World Heart Federation (WHF) aimed to achieve a 25% reduction in premature deaths from ARF and RHD among individuals aged <25 years by 2025. Primordial and primary prophylaxis of RHD is aimed to prevent the occurrence of ARF, while the goal of secondary and tertiary prophylaxis is to limit the progression and reduce the consequences of RHD. Early recognition of RHD is important for early prophylaxis strategies to inhibit any progression to advanced stages. In 2012, WHF introduced the latest echocardiographic criteria to recognize the early stage of RHD. This includes the evaluation of pathological regurgitation jet and morphological features of RHD based on 2D, color, and spectral Doppler criteria. In remote areas, portable echocardiography is preferable for RHD screening. Previous portable devices were only capable of producing 2D and color images. Hence, a simplified echocardiographic criterion without spectral Doppler evaluation is needed in selected areas. Indonesia is a developing country, an archipelago with a population of over 250 million. Currently, there are no data on ARF incidence and RHD prevalence nationwide. The only data available are the number of patients in advanced stages who came to referral centers for further management. The screening program has to be introduced in Indonesia as part of national RHD prophylaxis.
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Affiliation(s)
- Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Luh Oliva Saraswati Suastika
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Udayana University Hospital, Denpasar, Indonesia
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9
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Cordeiro C, Trehan S, Heaton JN, Bezwada P, Garyali S. Intermittent Recovery of Severe Acute Aortic Regurgitation Arising From Infective Endocarditis. Cureus 2020; 12:e10462. [PMID: 33083165 PMCID: PMC7566985 DOI: 10.7759/cureus.10462] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This case reports a 47-year-old male with a history of IV drug abuse, presenting with one week of left lower back pain. During the initial treatment, the patient became hemodynamically unstable, requiring vasopressor support. Transthoracic echocardiography (TTE) revealed a 1 cm x 1 cm aortic valve vegetation with severe aortic regurgitation and potential perforation of the valve leaflet. After hemodynamic stability was achieved, the patient left against medical advice, refusing urgent valvular surgery. Subsequent follow-up unveiled repeated recurrence of symptoms and surgical repair of the aortic valve.
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Affiliation(s)
| | - Siddhant Trehan
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | - Joseph N Heaton
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, USA
| | - Prema Bezwada
- Cardiology, The Brooklyn Hospital Center, Brooklyn, USA
| | - Samir Garyali
- Cardiology, The Brooklyn Hospital Center, Brooklyn, USA
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10
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Reversal of a rheologic cardiomyopathy following hematopoietic stem cell transplantation for sickle cell disease. Blood Adv 2020; 3:2816-2824. [PMID: 31578191 DOI: 10.1182/bloodadvances.2019000387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/29/2019] [Indexed: 02/01/2023] Open
Abstract
Cardiac complications have been well-described in sickle cell disease; however, it has been rare to see improvements in cardiac abnormalities following any interventions. Previous work has shown no significant structural changes after treatment with hydroxyurea. The cardiac effects of red blood cell exchange transfusion (RBCx) and hematopoietic stem cell transplantation (HSCT) have not been well described. We studied 56 patients undergoing HSCT (41 HLA-matched, 15 haploidentical), of whom 32 had RBCx within 3 months before HSCT. Echocardiograms and laboratory parameters were obtained at baseline, and at 3, 6, and 12 months following HSCT. Although hemolytic parameters and anemia improved following RBCx, there was a small increase in left ventricular volume index. Following successful HSCT, however, there were significant improvements in cardiac size, function, and diastolic filling parameters at 3 months followed by continued smaller improvements up to 1 year. There was a significant improvement in N-terminal pro B-type natriuretic peptide levels and a trend toward improvement in 6-minute walk time 1 year after HSCT. The magnitude of cardiac improvement seen following HSCT was comparable to that observed following correction of a volume overload state as seen in pregnancy or after repair of chronic valvular regurgitation. Further studies in sickle cell disease patients will help delineate which cardiac complications and what level of severity should be considered indications for HSCT.
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11
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Spencer C, Khatri N, Smeltz AM. Determinants of Discrepancy in the Left Ventricular Systolic Function Evaluation Between Preoperative and Intraoperative Evaluations. Semin Cardiothorac Vasc Anesth 2020; 24:321-327. [PMID: 32605429 DOI: 10.1177/1089253220936784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Unexpectedly decreased left ventricular global systolic function can be difficult to manage, even for patients undergoing elective cardiac surgery, and should prompt a multidisciplinary discussion. Therefore, in this review, we discuss the evidence describing key perioperative variables expected to influence left ventricular systolic function to facilitate this discussion.
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Affiliation(s)
- Chad Spencer
- University of North Carolina at Chapel Hill, NC, USA
| | - Nasir Khatri
- University of North Carolina at Chapel Hill, NC, USA
| | - Alan M Smeltz
- University of North Carolina at Chapel Hill, NC, USA
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12
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Imanaka M, Amano M, Izumi C, Nishimura S, Kuroda M, Harita T, Nishiuchi S, Sakamoto J, Tamaki Y, Enomoto S, Miyake M, Tamura T, Kondo H, Yamanaka K, Nakagawa Y. Subacute aortic regurgitation due to traumatic tear in the aortic wall. J Cardiol Cases 2018; 18:1-4. [PMID: 30279898 DOI: 10.1016/j.jccase.2018.02.006] [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: 11/25/2017] [Revised: 02/07/2018] [Accepted: 02/26/2018] [Indexed: 11/24/2022] Open
Abstract
A 37-year-old man presented with heart failure caused by severe aortic regurgitation (AR). He had a history of being involved in a traffic accident 3 months earlier. Imaging tests at admission detected no abnormalities in the aortic valve or aortic wall; however, the left coronary cusp prolapsed slightly on transthoracic echocardiography. He underwent aortic valve replacement because of uncontrolled heart failure and severe AR. Intraoperatively, the intima of the aortic wall just above the commissure of the left and right coronary cusps was torn to the short axial direction. Local aortic tear was the final diagnosis for the subacute AR. <Learning objective: Acute or subacute aortic regurgitation (AR) is comparatively rare, and it is sometimes difficult to clinically recognize. The tear in the aortic wall just above the commissure caused by a traffic accident led to the gradual progression of AR, and the diagnosis of the cause of AR was difficult despite using transesophageal echocardiography and contrast-enhanced computed tomography. We should recognize that the detection of subacute AR caused by a local aortic tear can be challenging.>.
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Affiliation(s)
- Miyako Imanaka
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Masashi Amano
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | | | - Maiko Kuroda
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Takeshi Harita
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | | | - Jiro Sakamoto
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Yodo Tamaki
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | | | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | | | - Hirokazu Kondo
- Department of Cardiology, Tenri Hospital, Tenri, Nara, Japan
| | - Kazuo Yamanaka
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Nara, Japan
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Deng MD, Wei X, Zhang XL, Li XD, Liu GY, Zhu D, Guo YQ, Tang H. Changes in left ventricular function in patients with aortic regurgitation 12 months after transapical transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2018; 35:99-105. [PMID: 30264363 DOI: 10.1007/s10554-018-1445-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for high surgical risk aortic stenosis patients; in recent years, it has also been used in patients with pure/dominant aortic regurgitation (AR). This study aimed to determine the impact of transapical TAVI on left ventricle myocardial mechanics in AR patients. Thirty AR patients (70% men; mean age, 72.8 ± 4.3 years) were enrolled. Conventional echocardiography was performed on all patients before and 12 months after TAVI. Three-dimensional speckle tracking was accomplished in 20 AR patients for the evaluation of global longitudinal strain, global circumferential strain, twist, torsion, apical rotation and basal rotation. Preoperative left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), twist, torsion and apical rotation were impaired in AR patients compared with controls. Mean left ventricular (LV) end-diastolic diameter (from 62.9 ± 7.3 to 52.0 ± 6.8 mm, p < 0.001), LV end-diastolic volume (from 199.4 ± 55.0 to 130.1 ± 48.9 mL, p < 0.001), and LV mass index (179.8 ± 52.2-134.4 ± 42.5 g/m2, p = 0.001) decreased 12 months after TAVI. Interestingly, GLS (from - 17.2 ± 3.2 to - 18.9 ± 3.7, p = 0.007) and GCS (from - 23.9 ± 4.9 to - 25.7 ± 5.0, p = 0.008) improved significantly, but LVEF did not significantly improve. In terms of the rotational mechanics, twist, rotation and basal rotation remained almost unchanged, whereas apical rotation (from 7.4 ± 4.0 to 5.5 ± 3.9, p = 0.009) was significantly impaired after transapical TAVI. Our results indicate that LV function was improved in terms of myocardial deformation but worsened in terms of apical rotation 12 months after TAVI in AR patients. Three-dimensional speckle tracking echocardiography appears to be a sensitive method for detecting subtle cardiac remodeling after TAVI.
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Affiliation(s)
- Ming-Dan Deng
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Ling Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Dong Li
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Gu-Yue Liu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Da Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China.
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Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg 2018; 155:885-894.e3. [DOI: 10.1016/j.jtcvs.2017.10.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 09/26/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022]
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