Coral Reef Aorta - A rare occlusive disease of the aorta complicating decision making for severe aortic stenosis treatment

Publication date: Available online 29 April 2019Source: Canadian Journal of CardiologyAuthor(s): Ottavia Cozzi, Damiano Regazzoli, Enrico Citterio, Alexia Rossi, Mauro Chiarito, Giulio G. Stefanini, Renato Bragato, Lucia Torracca, Gianluigi Condorelli, Paolo Pagnotta, Bernhard ReimersAbstractThe incidental finding of a severe occlusive disease of the aorta (“coral reef aorta”) during the assessment for TAVR of a 75-year-old woman with severe aortic stenosis, complicated the Heart Team process and lead to consider different access route in order to find the safest and most appropriate strategy of intervention. A successful transapical TAVR was eventually performed. Coral reef aorta, though rare, is associated with great morbidity and mortality, and it needs to be recognized when planning intravascular procedures, both for a safer selection of treatment approach, and for the prevention of intraprocedural and postprocedural morbidity.A 75-year-old woman was admitted to our department due to worsening effort dyspnea. Her past medical history comprised mild chronic obstructive pulmonary disease, hypertension and dyslipidaemia.Transthoracic echocardiography showed severe aortic valve stenosis (mean gradient 40 mmHg, peak velocity 4,2 m/s) and associated mild regurgitation; left ventricle contractility was normal as were mitral and tricuspid valves.Subsequent diagnostic evaluation included carotid duplex ultrasound, that showed moderate bilateral internal carotid arterie...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research

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This study sought to assess the relation between PAP and clinical and echocardiographic parameters in elderly patients with severe AS, as well as to identify the determinants of the change in PAP after transcatheter aortic valve implantation (TAVI).Methods: The study included 170 subjects (age 81 ± 7 years, 45% men) with symptomatic severe AS who were treated by TAVI. They underwent a clinical evaluation and a transthoracic echocardiography before the TAVI procedure and 6 months after.Results: In a multivariable analysis, the independent predictors for baseline PAP were the body mass index (B...
Source: Acta Cardiologica - Category: Cardiology Tags: Acta Cardiol Source Type: research
CONCLUSION: In this study, we could not detect an advantage in survival when SAVR or TAVR were utilized in intermediate to high surgical risk patients needing aortic valve replacement for severe aortic stenosis. PMID: 31596707 [PubMed - in process]
Source: The Heart Surgery Forum - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Heart Surg Forum Source Type: research
A 57-year-old male presented to clinic with a history of moderate aortic stenosis (AS), diabetes mellitus (A1c 8.7), hypertension, hyperlipidemia, tobacco abuse, and chronic obstructive pulmonary disease. Symptoms included worsening shortness of breath and lower extremity edema. Echocardiogram revealed worsening AS with a mean gradient of 51 mm Hg, ejection fraction (EF) of 10%, and severe aortic calcification with ascending dilation. Aortic valve replacement was considered given his estimated mortality risk was 1.287%.
Source: Seminars in Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ADULT – Case Report Source Type: research
A 57 year-old male presented to clinic with a history of moderate aortic stenosis (AS), diabetes mellitus (A1c 8.7), hypertension, hyperlipidemia, tobacco abuse, and chronic obstructive pulmonary disease. Symptoms included worsening shortness of breath and lower extremity edema. Echocardiogram revealed worsening AS with a mean gradient of 51 mmHg, ejection fraction (EF) of 10%, and severe aortic calcification with ascending dilation. Aortic valve replacement was considered given his estimated mortality risk was 1.287%.
Source: Seminars in Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: ADULT – Case Report Source Type: research
We report a 70-year-old female, who presented with uncontrolled hypertension and acute decompensated heart failure (ADHF) and was found to have severe CoA, severe bicuspid aortic valve (BAV) stenosis, and significant proximal left anterior descending (LAD) coronary artery disease. In a multidisciplinary heart team meeting, we decided to perform an endovascular repair of both cardiac and vascular pathologies using a two-stage approach due to the significant comorbidities; mainly uncontrolled hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and severe calcifications of the ascending aorta. The p...
Source: Journal of the Saudi Heart Association - Category: Cardiology Source Type: research
Older patients with depression may be at greater risk of death following a procedure to replace a damaged aortic valve of the heart, reports astudy published today inJAMA Cardiology.“The clinical implications of our findings support active screening for depression before and after aortic valve procedures to identify patients who may benefit from further psychiatric evaluation for the diagnosis and treatment of a depressive disorder,” wrote Jonathan Afilalo, M.D., M.Sc., of Jewish General Hospital, Montreal, and colleagues.The study included patients who were at least 70 years of age with symptomatic aortic sten...
Source: Psychiatr News - Category: Psychiatry Tags: aortic stenosis aortic valve replacement cerebrovascular disease COPD depression diabetes Geriatric Depression Scale Short Form hypertension Jonathan Afilalo kidney disease Source Type: research
Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information This test series requires login for attempting. You can login easily with your Facebook account (Use the CONNECT WITH icon on the upper part of right sidebar displaying t...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
Background and Hypothesis: The sensitivity of LVH analysis by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied. LVH is expected in the TAVR population and would be reflected in voltage criteria by ECG.Methods: A retrospective chart review was conducted in 176 consecutive TAVR patients without ventricular-paced rhythm. ECG data was collected and analyzed by Sokolow-Lyon and Cornell Voltage criteria. Results were compared to transthoracic echocardiogram. Analyses of variation, correlation, chi-square, and logistic regression ...
Source: Circulation: Cardiovascular Quality and Outcomes - Category: Cardiology Authors: Tags: Session Title: Poster Session II Source Type: research
Authors: Gayed M, Yadak N, Qamhia W, Daralammouri Y, Ohlow MA Abstract Elderly people represent the fastest growing portion of cardiovascular patients. We aimed to analyze the clinical presentation, risk factors, co-morbidities, complications, and mortality in patients 90 years or more who underwent coronary angiography and intervention.We retrospectively studied 108 (0.25% of 43,385) consecutive patients ≥ 90 years undergoing cardiac catheterization and/or intervention in a tertiary specialist hospital between 2003 and 2014.Most patients (68.5%) were introduced on an emergency basis, especially with acute coron...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
CONCLUSION:The variables that interplay in cases of severe aortic stenosis are what cause these patients to be so difficult to manage, and specific therapies targeted to fix one issue often worsen the effects of another issue. If someone is in respiratory distress, their airway and breathing needs to be secured, either through non-invasive or invasive means. Next, the patient ’s blood pressure needs to be stabilized. Oftentimes the most appropriate agent will be a positive inotrope, with consideration of a vasoactive agent in persistent hypotension. Once a patient is stabilized, determining the extent of damage to th...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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