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El-Nashar H, Sabry M, Tseng YT, Francis N, Latif N, Parker KH, Moore JE, Yacoub MH. Multiscale structure and function of the aortic valve apparatus. Physiol Rev 2024; 104:1487-1532. [PMID: 37732828 DOI: 10.1152/physrev.00038.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
Whereas studying the aortic valve in isolation has facilitated the development of life-saving procedures and technologies, the dynamic interplay of the aortic valve and its surrounding structures is vital to preserving their function across the wide range of conditions encountered in an active lifestyle. Our view is that these structures should be viewed as an integrated functional unit, here referred to as the aortic valve apparatus (AVA). The coupling of the aortic valve and root, left ventricular outflow tract, and blood circulation is crucial for AVA's functions: unidirectional flow out of the left ventricle, coronary perfusion, reservoir function, and support of left ventricular function. In this review, we explore the multiscale biological and physical phenomena that underlie the simultaneous fulfillment of these functions. A brief overview of the tools used to investigate the AVA, such as medical imaging modalities, experimental methods, and computational modeling, specifically fluid-structure interaction (FSI) simulations, is included. Some pathologies affecting the AVA are explored, and insights are provided on treatments and interventions that aim to maintain quality of life. The concepts explained in this article support the idea of AVA being an integrated functional unit and help identify unanswered research questions. Incorporating phenomena through the molecular, micro, meso, and whole tissue scales is crucial for understanding the sophisticated normal functions and diseases of the AVA.
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Affiliation(s)
- Hussam El-Nashar
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Malak Sabry
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Yuan-Tsan Tseng
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nadine Francis
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Najma Latif
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - James E Moore
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Magdi H Yacoub
- Aswan Heart Research Centre, Magdi Yacoub Foundation, Cairo, Egypt
- Heart Science Centre, Magdi Yacoub Institute, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Giebels C, Schulze-Berge J, Wagenpfeil G, Groß R, Ehrlich T, Schäfers HJ. Prolapse repair for aortic regurgitation in tricuspid aortic valves. J Thorac Cardiovasc Surg 2024; 168:1025-1034.e3. [PMID: 37302467 DOI: 10.1016/j.jtcvs.2023.06.002] [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: 03/15/2023] [Revised: 05/24/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Cusp prolapse is an important cause of aortic regurgitation (AR) in tricuspid aortic valves (TAVs) and can be caused by myxomatous degeneration or cusp fenestration. Long-term data for prolapse repair in TAVs are scarce. We analyzed the results of aortic valve repair in patients with TAV morphology and AR caused by prolapse and compared the results for cusp fenestration and myxomatous degeneration. METHODS Between October 2000 and December 2020, 237 patients (221 male; 15-83 years) underwent TAV repair for cusp prolapse. Prolapse was associated with fenestrations in 94 (group I) and myxomatous degeneration in 143 patients (group II). Fenestrations were closed using a pericardial patch (n = 75) or suture (n = 19). In myxomatous degeneration, prolapse was corrected by free margin plication (n = 132) or triangular resection (n = 11). Follow-up was 97% complete (cumulatively 1531, mean 6.5, median 5.8 years). Cardiac comorbidities were present in 111 patients (46.8%), and more frequent in group II (P = .003). RESULTS Ten-year survival was better in group I (I: 84.5%; II: 72.4%; P = .037), and patients without cardiac comorbidities (89.2% vs 67.0%; P = .002). Ten-year freedom from reoperation (P = .778), moderate or greater AR (P = .070), and valve-related complications (P = .977) were similar in both groups. AR at discharge was the only significant predictor for reoperation (P = .042). The type of annuloplasty did not affect repair durability. CONCLUSIONS Repair of cusp prolapse in TAVs with preserved root dimensions can be performed with acceptable durability, even in the presence of fenestrations.
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Affiliation(s)
- Christian Giebels
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Julia Schulze-Berge
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometrics, Epidemiology and Medical Computer Science, Saarland University Medical School, Homburg, Saar, Germany
| | - Raphael Groß
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Tristan Ehrlich
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany.
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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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Tsampasian V, Victor K, Bhattacharyya S, Oxborough D, Ring L. Echocardiographic assessment of aortic regurgitation: a narrative review. Echo Res Pract 2024; 11:1. [PMID: 38167345 PMCID: PMC10762934 DOI: 10.1186/s44156-023-00036-7] [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: 10/09/2023] [Accepted: 11/08/2023] [Indexed: 01/05/2024] Open
Abstract
Aortic regurgitation (AR) is the third most frequently encountered valve lesion and may be caused by abnormalities of the valve cusps or the aorta. Echocardiography is instrumental in the assessment of AR as it enables the delineation of valvular morphology, the mechanism of the lesion and the grading of severity. Severe AR has a major impact on the myocardium and carries a significant risk of morbidity and mortality if left untreated. Established and novel echocardiographic methods, such as global longitudinal strain and three-dimensional echocardiography, allow an estimation of this risk and provide invaluable information for patient management and prognosis. This narrative review summarises the epidemiology of AR, reviews current practices and recommendations with regards to the echocardiographic assessment of AR and outlines novel echocardiographic tools that may prove beneficial in patient assessment and management.
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Affiliation(s)
| | | | | | - David Oxborough
- Research Institute of Sports and Exercise Science and Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
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Singh A, Khurana KV, Kumar J, Agrawal G, Lohakare A, Gutte R, Chaturvedi A. An Extremely Rare Case of Isolated Aortic Valve Prolapse Causing Aortic Regurgitation in the Absence of Any Other Pre-existing Cardiovascular or Non-cardiovascular Condition. Cureus 2023; 15:e46144. [PMID: 37900545 PMCID: PMC10612996 DOI: 10.7759/cureus.46144] [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] [Received: 08/04/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
In this case report, we present an extremely rare case of isolated aortic valve prolapse causing aortic regurgitation having no association with any comorbid conditions that are commonly seen with aortic valve prolapse. A 27-year-old female patient presented with chief complaints of dyspnea on exertion (New York Heart Association grade III) for 20 days, decreased appetite for 15 days, and a history of significant weight loss for one and a half years. Transthoracic and transesophageal echocardiography revealed a trileaflet floppy aortic valve with prolapsing non-coronary and right coronary cusps, associated with moderate aortic regurgitation. The incidence of aortic valve prolapse is roughly around 1%. Exceptionally, very few cases of isolated aortic valve prolapse with moderate-to-severe aortic regurgitation without any associated pathology have been reported to date.
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Affiliation(s)
- Aayushi Singh
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kanishk V Khurana
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayanth Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajendra Agrawal
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash Lohakare
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rahul Gutte
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anuj Chaturvedi
- Cardiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ruan Y, Liu X, Meng X, Zhang H, He Y. Prognostic factors associated with postoperative adverse outcomes in patients with aortic valve prolapse. Medicine (Baltimore) 2020; 99:e19827. [PMID: 32332629 PMCID: PMC7220789 DOI: 10.1097/md.0000000000019827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
BACKGROUND AND AIM Aortic valve (AV) cusp prolapse and subsequent aortic insufficiency (AI) are 2 of factors leading to left ventricular (LV) enlargement and decreased LV function. Aortic valve replacement (AVR) has been the standard surgical procedure for AI. However, few data is available on the prognosis of these patients undergoing AVR procedure, especially in Chinese population. The study aims to evaluate the potential risk factors affecting the mid-term adverse outcomes after AVR. METHODS One hundred thirty-four patients (mean age: 46.7 years old) with AV cusp prolapse and severe AI who all received surgical aortic valve replacement were recruited in our hospital between January 1, 2009 and December 30, 2017. The clinical characteristics, echocardiography parameters, as well as operative parameters were obtained. The primary endpoint included death, heart failure development, and reoperation. RESULTS There were 14 adverse events altogether with the primary endpoint during a median follow-up of 8.6 (6-10) months. The multivariable Cox regression analysis revealed that baseline LVEDD (hazard rate, HR = 1.08, 95% CI: 1.01-1.15, P = .021), moderate pulmonary hypertension (HR = 9.36, 95% CI: 1.81-48.28, P = .008), and the time of assisted mechanical ventilation (HR = 1.01, 95% CI: 1.00-1.01, P = .022) were independently associated with the primary endpoint. Kaplan-Meier survival curve showed a significant worse survival free of the endpoint for patients with LVEDD≥70 mm, indexed LVEDD≥37.3 mm/m (the mean in this study), indexed LVESD≥25 mm/m or baseline LVEF <50% (all P<.05). CONCLUSION Baseline enlarged LV dimensions, low LV function, moderate pulmonary hypertension, and prolonged assisted mechanical ventilation may predict the poor mid-term postoperative outcomes for AV cusp prolapse patients undergoing AVR procedure.
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Affiliation(s)
| | | | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Hagendorff A, Evangelista A, Fehske W, Schäfers HJ. Improvement in the Assessment of Aortic Valve and Aortic Aneurysm Repair by 3-Dimensional Echocardiography. JACC Cardiovasc Imaging 2019; 12:2225-2244. [DOI: 10.1016/j.jcmg.2018.06.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/31/2018] [Accepted: 06/14/2018] [Indexed: 11/25/2022]
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Hagendorff A, Stoebe S, Tayal B. A systematic approach to 3D echocardiographic assessment of the aortic root. Glob Cardiol Sci Pract 2018; 2018:12. [PMID: 30083542 PMCID: PMC6062762 DOI: 10.21542/gcsp.2018.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/18/2018] [Indexed: 12/25/2022] Open
Abstract
[first paragraph of article]Severe aortic regurgitation (AR) and/or severe abnormalities of the aortic root and the tubular ascending aorta (TAA) are indications for surgical treatment. The correct diagnosis, the choice of optimal treatment, as well as optimal timing of surgery, mainly depend on findings obtained by echocardiography - which is usually the initial diagnostic modality applied in clinical practice. Therefore, an appropriate morphological and functional quantification of the aortic valve (AV) and the aortic root complex is required. Aside from the need of standardization to provide a precise objective evaluation, the use of modern echocardiographic technologies - especially 3D-echocardiography -are less often implemented in clinical routine. The present manuscript focuses on the advantages of transthoracic and transesophageal 3D-echocardiography (TTE, TEE) for an improved assessment of the AV and the aortic root complex to provide accurate and comprehensive measurements for making the correct diagnosis and defining further therapeutic strategies.
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Affiliation(s)
| | - Stephan Stoebe
- Dep. of Cardiology, University Hospital Leipzig, Germany
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Liu H, Lu FX, Zhou J, Yan F, Qian SC, Li XY, Zheng SQ, Chen JQ, Zhong JS, Feng QL, Ding T, Fan J, Gu HT, Liu XC. Minimally invasive perventricular versus open surgical ventricular septal defect closure in infants and children: a randomised clinical trial. Heart 2018; 104:2035-2043. [DOI: 10.1136/heartjnl-2017-312793] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/21/2018] [Accepted: 05/30/2018] [Indexed: 11/04/2022] Open
Abstract
BackgroundRobust evidence is lacking regarding the clinical efficacy, safety and cardiopulmonary performance of perventricular closure. This study investigated the perioperative efficacy, safety and cardiorespiratory performance of perventricular closure of perimembranous ventricular septal defects (pmVSDs).MethodsOperation-naïve infants and young children aged 5–60 months with isolated pmVSDs were randomised to receive either standard open surgical or minimally invasive perventricular closure via direct entry into the ventricle with a catheter from a subxiphoid incision. The primary outcomes included complete closure at discharge, major and minor adverse events and the changes in perioperative cardiorespiratory performance from baseline. Complete closure was mainly analysed in the modified intention-to-treat (mITT) population, with sensitivity analyses for the ITT, per-protocol (PP) and as-treated (AT) populations (non-inferiority margin −5.0%).ResultsWe recruited 200 patients with pmVSDs for this study (mean age 24.38 months, range 7–58 months, 104 girls), of whom 100 were randomly allocated to one of the study groups. The non-inferiority of perventricular to surgical closure regarding complete closure at discharge was not shown in the ITT (absolute difference −0.010 (95% CI −0.078 to 0.058)) and mITT populations (−0.010 (95% CI −0.069 to 0.048)), but was shown in the PP (0.010 (95% CI −0.043 to 0.062)) and AT populations (0.048 (95% CI −0.009 to 0.106)). Perventricular closure reduced the rate of compromising cardiac haemodynamics, electrophysiological responses, cardiomyocyte viability, respiratory mechanics, ventilatory and gas exchange function and oxygenation and tissue perfusion compared with surgical closure (all between-group P<0.05).ConclusionsFor infants and young children with pmVSD, perventricular closure reduced the rate of postoperative cardiorespiratory compromise compared with surgical closure, but the non-inferiority regarding complete closure should be interpreted in the context of the specific population.Trial registration numberNCT02794584 ;Results.
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Iwashima S, Uchiyama H, Ishikawa T, Takigiku K, Takahashi K, Toyono M, Inoue N, Nii M. Measurement of Aortic Valve Coaptation and Effective Height Using Echocardiography in Patients with Ventricular Septal Defects and Aortic Valve Prolapse. Pediatr Cardiol 2017; 38:608-616. [PMID: 28108755 DOI: 10.1007/s00246-016-1555-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 12/21/2016] [Indexed: 01/13/2023]
Abstract
Decreased coaptation height in adults has been identified as a marker of early valve failure. We evaluated aortic valve coaptation and effective height in healthy children and in children with a ventricular septal defect (VSD) with aortic cusp prolapse (ACP), using echocardiography. We included 45 subjects with VSD with ACP, 27 did not develop aortic regurgitation (AR) by ACP and 18 developed AR by ACP, and 83 healthy children as controls. Aortic root anatomy was estimated using the parasternal long-axis view. We measured the diameter of aortic valve (AV), coaptation height (CH), and effective height (EH) of the aortic valve. We defined the ACH (CH/AV ratio) and AEH (EH/AV ratio) indices as follows: [Formula: see text]. There were significant differences in ACH and AEH between the groups (control vs VSD with ACP vs VSD with ACP and AR, median ACH [%], 35.1 vs 32.0 vs 22.1; median AEH [%], 52.0 vs 48.0 vs 34.4, respectively; P < 0.01]). Intra-cardiac repair (ICR) was performed in 15 cases. Significant increases were observed in ACH and AEH before and after ICR (median ACH [%], before: 27.0, after: 32.7, P < 0.05; median AEH (%), before 38.5, after 45.8, P < 0.05). Measurement of ACH and AEH may allow direct and non-invasive assessment of the severity of VSD with ACP, which could aid clinicians in determining the need and timing for surgical intervention.
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Affiliation(s)
- Satoru Iwashima
- Department of Pediatrics, Chutoen General Medical Center, Syoubugauraike 1-1, Kakegawa City, 436-8555, Japan.
| | - Hiroki Uchiyama
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takamichi Ishikawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyohiro Takigiku
- Department of Pediatric Cardiology, Nagano Children's Hospital, Azumino, Japan
| | - Ken Takahashi
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Bunkyo, Japan
| | - Manatomo Toyono
- Department of Pediatrics, Akita University Faculty of Medicine, Akita, Japan
| | - Nao Inoue
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Masaki Nii
- Department of Pediatric Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
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Gupta SK, Ananthakrishnan R. 'Aortic valve prolapse' in rheumatic heart disease. J Echocardiogr 2014; 12:83-4. [PMID: 27279057 DOI: 10.1007/s12574-014-0209-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 02/06/2014] [Accepted: 03/04/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, Room No. 23, 7th Floor, C N Centre, New Delhi, 110029, India.
| | - Ramamoorthy Ananthakrishnan
- Department of Cardiology, All India Institute of Medical Sciences, Room No. 23, 7th Floor, C N Centre, New Delhi, 110029, India
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12
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Jodati A, Kazemi B, Safaei N. Rheumatic aortic regurgitation in a patient with large congenital fenestrations in all three leaflets. J Cardiovasc Thorac Res 2014; 6:61-3. [PMID: 24753835 PMCID: PMC3992735 DOI: 10.5681/jcvtr.2014.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/14/2014] [Indexed: 11/17/2022] Open
Abstract
Fenestrations of the aortic valve rarely produce significant valvular regurgitation. These are typically described as incidental findings with little clinical significance because they generally lie above their closing edges. Rarely however, when unusually large or multiple, they can lead to massive aortic regurgitation (AR), mostly in patients with chronic hypertension and/or aortic annular dilation. We operated a 52 year old normotensive male with chronic rheumatic AR and found large fenestrations in all three aortic cusps, hardly ever reported in rheumatic valvular involvement in the literature.
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Affiliation(s)
- Ahmadreza Jodati
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Kazemi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Safaei
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Sousa A, Almeida J, Madureira A, Casanova J, Ramos I, Maciel MJ, Pinho P. An unusual pattern of aortic regurgitation in a bicuspid aortic valve. Can J Cardiol 2013; 29:1015.e11-2. [PMID: 23333165 DOI: 10.1016/j.cjca.2012.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 11/13/2012] [Accepted: 11/14/2012] [Indexed: 10/27/2022] Open
Affiliation(s)
- Alexandra Sousa
- Cardiology Department, Centro Hospitalar São João, Porto, Portugal.
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14
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Hallowell GD, Bowen M. Reliability and identification of aortic valve prolapse in the horse. BMC Vet Res 2013; 9:9. [PMID: 23311963 PMCID: PMC3547808 DOI: 10.1186/1746-6148-9-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 01/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives were to determine and assess the reliability of criteria for identification of aortic valve prolapse (AVP) using echocardiography in the horse. RESULTS Opinion of equine cardiologists indicated that a long-axis view of the aortic valve (AoV) was most commonly used for identification of AVP (46%; n=13). There was consensus that AVP could be mimicked by ultrasound probe malignment. This was confirmed in 7 healthy horses, where the appearance of AVP could be induced by malalignment. In a study of a further 8 healthy horses (5 with AVP) examined daily for 5 days, by two echocardiographers standardized imaging guidelines gave good to excellent agreement for the assessment of AVP (kappa>0.80) and good agreement between days and observers (kappa >0.6). The technique allowed for assessment of the degree of prolapse and measurement of the prolapse distance that provided excellent agreement between echocardiographers, days and observers (kappa/ICC>0.8). Assessments made using real-time zoomed images provided similar measurements to the standard views (ICC=0.9), with agreement for the identification of AVP (kappa>0.8). Short axis views of the AoV were used for identification of AVP by fewer respondents (23%), however provided less agreement for the identification of AVP (kappa>0.6) and only adequate agreement with observations made in long axis (kappa>0.5), with AVP being identified more often in short axis (92%) compared to long axis (76%). Orthogonal views were used by 31% of respondents to identify the presence of AVP, and 85% to identify cusp. Its identification on both views on 4 days was used to categorise horses as having AVP, providing a positive predictive value of 79% and negative predictive value of 18%. Only the non-coronary cusp (NCC) of the AoV was observed to prolapse in these studies. Prolapse of the NCC was confirmed during the optimisation study using four-dimensional echocardiography, which concurred with the findings of two-dimensional echocardiography. CONCLUSIONS This study has demonstrated reliable diagnostic criteria for the identification and assessment of AVP that can be used for longitudinal research studies to better define the prevalence and natural history of this condition.
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Affiliation(s)
- Gayle D Hallowell
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Leicestershire, UK.
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Alegret JM, Ligero C, Vernis JM, Beltrán-Debón R, Aragonés G, Duran I, Palazón O, Hernández-Aparicio A. Factors related to the need for surgery after the diagnosis of bicuspid aortic valve: one center´s experience under a conservative approach. Int J Med Sci 2013; 10:176-82. [PMID: 23329890 PMCID: PMC3547216 DOI: 10.7150/ijms.5399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/02/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND AIM Bicuspid aortic valve (BAV) increases the risk of aortic valve dysfunction and ascending aorta aneurysm and, consequently, the need for aortic valve replacement and/or aortic repair. However, there is no universal consensus about the surgical criteria and the predictors for surgery. The aim of this study was to investigate related factors to the need for surgery in the setting of a strict long-term follow-up with relatively conservative surgical criteria. METHODS We prospectively followed 120 patients after the diagnosis of BAV. Predisposing factors for a future need for aortic valve replacement and ascending aorta repair were assessed. Aortic surgery was indicated when the ascending aorta diameter was ≥ 55 mm and was recommended based on patient characteristics and in the presence of a severe aortic valve dysfunction with an aortic diameter ≥ 50 mm. RESULTS During follow-up (mean, 86 months), 34 patients (28%) (mean age, 56 ± 12 years) were surgically treated. Aortic valve dysfunction (n=22; 64%) and ascending aorta dilatation (n=12; 36%) were the indications for surgery. Aortic regurgitation was the most frequent valve dysfunction at the time of diagnosis for BAV, but aortic stenosis was the most frequent indication for surgery. The presence at surgery of either aortic regurgitation or stenosis was clearly related to age, with regurgitation predominating in patients under 55 years, and aortic stenosis in older patients.Multivariate Cox analysis showed that aortic stenosis (hazard ratio 4.1, p=0.001), indexed ascending aorta dilatation (hazard ratio 3.0, p=0.03) and left ventricular end-diastolic diameter ≥ 60 mm (hazard ratio=4.0, p=0.01) at diagnosis were factors associated with future surgery. Aortic dissection was not observed in patients that did not undergo surgery. CONCLUSIONS A relatively conservative approach for the indication of ascending aortic surgery in BAV is safe. In this setting, the presence of aortic or left ventricle dilatation and aortic stenosis at diagnosis of BAV were predictive of the need for surgery in the follow-up.
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Affiliation(s)
- Josep M Alegret
- Secció de Cardiologia. Hospital Universitari de Sant Joan. Institut d'Investigació Sanitària Pere Virgili. Universitat Rovira i Virgili, Reus, Spain.
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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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17
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Echocardiographic evaluation of left ventricular outflow tract hemodynamics in healthy children with anomalous left ventricular band. Int J Cardiol 2011; 152:262-5. [DOI: 10.1016/j.ijcard.2011.07.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 07/29/2011] [Indexed: 11/18/2022]
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18
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Boodhwani M, de Kerchove L, Watremez C, Glineur D, Vanoverschelde JL, Noirhomme P, El Khoury G. Assessment and repair of aortic valve cusp prolapse: Implications for valve-sparing procedures. J Thorac Cardiovasc Surg 2011; 141:917-25. [DOI: 10.1016/j.jtcvs.2010.12.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 09/14/2010] [Accepted: 12/04/2010] [Indexed: 11/24/2022]
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19
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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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Schäfers HJ, Langer F, Glombitza P, Kunihara T, Fries R, Aicher D. Aortic valve reconstruction in myxomatous degeneration of aortic valves: Are fenestrations a risk factor for repair failure? J Thorac Cardiovasc Surg 2010; 139:660-4. [DOI: 10.1016/j.jtcvs.2009.06.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Revised: 03/26/2009] [Accepted: 06/23/2009] [Indexed: 12/01/2022]
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21
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Cusp Prolapse Repair in Trileaflet Aortic Valves: Free Margin Plication and Free Margin Resuspension Techniques. Ann Thorac Surg 2009; 88:455-61; discussion 461. [DOI: 10.1016/j.athoracsur.2009.04.064] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 04/15/2009] [Accepted: 04/16/2009] [Indexed: 11/19/2022]
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22
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Sonoda M, Takenaka K, Uno K, Ebihara A, Nagai R. A Larger Aortic Annulus Causes Aortic Regurgitation and a Smaller Aortic Annulus Causes Aortic Stenosis in Bicuspid Aortic Valve. Echocardiography 2008; 25:242-8. [DOI: 10.1111/j.1540-8175.2007.00588.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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23
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Aicher D, Langer F, Adam O, Tscholl D, Lausberg H, Schäfers HJ. Cusp repair in aortic valve reconstruction: Does the technique affect stability? J Thorac Cardiovasc Surg 2007; 134:1533-8; discussion 1538-9. [DOI: 10.1016/j.jtcvs.2007.08.023] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Revised: 08/09/2007] [Accepted: 08/27/2007] [Indexed: 01/17/2023]
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24
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Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg 2006; 132:436-8. [PMID: 16872982 DOI: 10.1016/j.jtcvs.2006.04.032] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2006] [Accepted: 04/05/2006] [Indexed: 12/18/2022]
Affiliation(s)
- Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, University Hospitals of Saarland, Homburg/Saar, Germany.
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25
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Alegret JM, Vernis JM, Palazón O, Borràs X, Duran I. Factors related to aortic regurgitation in the presence of a dilated aortic root. Am J Cardiol 2005; 95:417-20. [PMID: 15670560 DOI: 10.1016/j.amjcard.2004.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 09/27/2004] [Accepted: 09/24/2004] [Indexed: 11/20/2022]
Abstract
The relation among aortic regurgitation (AR) and aortic root diameter, anthropometric variables, and aortic valve morphology was assessed in 142 patients with dilated aortic roots. The diameter of the aortic root indexed for body surface area and aortic valve sclerosis were related to the presence and severity of AR.
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Affiliation(s)
- Josep M Alegret
- Secció de Cardiologia, Department de Medicina Interna, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, Reus, Spain.
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26
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Meier JH, Seward JB, Miller FA, Oh JK, Enriquez-Sarano M. Aneurysms in the left ventricular outflow tract: clinical presentation, causes, and echocardiographic features. J Am Soc Echocardiogr 1998; 11:729-45. [PMID: 9692530 DOI: 10.1053/je.1998.v11.a91047] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We present a descriptive compendium of anatomically interrelated aneurysms and aneurysmal-like structures arising in and around the left ventricular outflow tract. Images selected from the Mayo Clinic echocardiography database illustrate classic or typical examples of each entity. Essential morphologic features of each lesion are described. Clinical presentation, causes, and diagnostic echocardiographic features taken together can improve recognition and clinical management of this diverse group of anomalies.
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Affiliation(s)
- J H Meier
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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27
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Kai H, Koyanagi S, Takeshita A. Aortic valve prolapse with aortic regurgitation assessed by Doppler color-flow echocardiography. Am Heart J 1992; 124:1297-304. [PMID: 1442499 DOI: 10.1016/0002-8703(92)90415-r] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The incidence of and the Doppler color-flow echocardiographic characteristics of aortic valve prolapse with nonrheumatic aortic regurgitation were examined. Aortic valve prolapse was observed in 21 of 243 patients (15 men and 6 women) with aortic regurgitation as detected by Doppler color-flow echocardiography (rheumatic, 112; nonrheumatic, 131) in 1247 consecutive patients. Patients with aortic valve prolapse included three patients with essential hypertension and one with annuloaortic ectasia. The remaining 17 patients (7% of those with aortic regurgitation) had no other associated cardiovascular disease (idiopathic aortic valve prolapse). Prolapse of the mitral or the tricuspid valve or both was associated with aortic valve prolapse in seven patients. Aortic regurgitation jet was markedly deviated from the axis of left ventricular outflow tract toward the anterior mitral leaflet or the interventricular septum in 17 of 21 (81%) patients with aortic valve prolapse, whereas 28 of 110 (25%) patients with nonrheumatic aortic regurgitation without prolapse and 17 of 112 (15%) patients with rheumatic aortic regurgitation without prolapse showed the deviation of regurgitant jet (p < 0.001). In conclusion, idiopathic aortic valve prolapse is one of the significant causes of aortic regurgitation, and a marked deviation of regurgitant jet is a characteristic Doppler color-flow echocardiographic finding of aortic regurgitation that results from aortic valve prolapse.
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Affiliation(s)
- H Kai
- Research Institute of Angiocardiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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28
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Hirata K, Triposkiadis F, Sparks E, Bowen J, Boudoulas H, Wooley CF. The Marfan syndrome: cardiovascular physical findings and diagnostic correlates. Am Heart J 1992; 123:743-52. [PMID: 1539526 DOI: 10.1016/0002-8703(92)90515-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Correlations among cardiac symptoms and auscultatory and phonoechocardiographic findings in Marfan syndrome have not been completely defined. A total of 24 patients with Marfan syndrome (16 men and 8 women; mean age 28.2 +/- 8.6 years) were studied. Mitral valve prolapse was noted in 22, of whom 19 had either nonejection systolic click or mitral regurgitation murmur. Mitral regurgitation was noted in 12 patients by Doppler imaging. Aortic root dilatation was noted in 20 patients and aortic regurgitation in six, five of whom had aortic regurgitation murmur (5 of 20 patients had undergone surgery). Proximal aortic dissection was noted in two. Dyspnea (n = 12) was associated with progressive mitral or aortic regurgitation in four, but in the others dyspnea could not be explained by valvular or ventricular abnormalities. Chest pain was related to pneumothorax in five and aortic dissection in two but was not associated with either in 15 patients. Palpitations (n = 12) and lightheadedness (n = 6) were not associated with specific arrhythmias. In conclusion, mitral valve prolapse and aortic root dilatation were the most common cardiovascular abnormalities in Marfan syndrome. Mitral valve prolapse was frequently associated with typical auscultatory findings and symptoms including dyspnea, chest pain, palpitations, and lightheadedness, whereas aortic root dilatation could be clinically silent unless complicated by aortic regurgitation or aortic dissection.
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Affiliation(s)
- K Hirata
- Division of Cardiology, Ohio State University, Columbus
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29
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Guiney TE, Davies MJ, Parker DJ, Leech GJ, Leatham A. The aetiology and course of isolated severe aortic regurgitation: a clinical, pathological, and echocardiographic study. Heart 1987; 58:358-68. [PMID: 3676022 PMCID: PMC1277268 DOI: 10.1136/hrt.58.4.358] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Seventy two consecutive patients with severe isolated aortic regurgitation were evaluated by preoperative echocardiographic and angiographic assessment of the aortic root. Biopsy specimens of the aortic wall were taken at operation. Two major groups of patients were found: those with cusp derangement but normal aortic roots and those with normal cusps but dilated aortic roots. Of the 42 cases of abnormal cusps, 20 were rheumatic, 15 were infective, and six were bicuspid. One patient had a tear in an otherwise normal cusp. Of the 30 cases of abnormal roots but normal cusps, six had inflammatory changes (syphilis, Reiter's disease, giant cell aortitis) and 24 had root dilatation caused by non-inflammatory destruction of elastic laminae. Echocardiographic measurement of the aorta at the level of the top of the commissures predicted the findings at pathology. In 37 of 39 patients with cusp disease the measurement was less than 37 mm. In 27 of 33 patients with root disease the measurement was greater than or equal to 37 mm. This difference was statistically significant. There was no difference in the sizes of the prosthesis used in each group, suggesting that it was the diameter of the junction of the aorta with the sinuses rather than the junction of the sinuses with the ventricle that was important in aortic regurgitation. Clinical progression in patients with non-inflammatory aortic root disease is slower than in patients with infective disease but faster than in those with rheumatic cusp disease.
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Affiliation(s)
- T E Guiney
- South West Thames Regional Cardiothoracic Unit, St. George's Hospital and Medical School, London
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