Challenges of recognizing bicuspid aortic valve in elderly patients undergoing TAVR

AbstractRecognition of bicuspid aortic valve (BAV) may be challenging in elderly patients with heavily calcified aortic valves undergoing transcatheter aortic valve replacement (TAVR). In this subset, the diagnostic value of pre-procedural echocardiography in clinical routine is unknown. From a total of 2583 patients undergoing TAVR in our center, we determined the rate of BAV detected by routine echocardiography as documented in the medical records. Pre-procedural multidetector computed tomography (MDCT) images were retrospectively analyzed for the presence of BAV and served as reference standard. Using MDCT criteria, BAV was found in 235 (9.1%) (age 80.1  years [interquartile range 76.4; 83.4], 44.3% female). Of these, only 27/235 (11.5%) had been identified as BAV according to echocardiography reports, whereas 6/2348 (0.3%) with TAV had been wrongly diagnosed as BAV (p 
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research

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This study sought to derive and validate a systematic method enabling AVC quantification using computed tomography angiography (CTA) in patients with AS.Methods134 consecutive patients with AS who underwent both NCCT and CTA were included in the study and sub-divided into derivation (n=71) and validation cohorts (n=63). On NCCT, AVC was quantified using Agatston method utilizing the software developed for semi-automatic assessment of coronary calcium. On CTA, mean contrast attenuation of aorta (AortaHU) and standard deviation (SD) was measured in the region-of-interest at level of sinotubular junction.ResultsUsing an adjus...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
This article will review the most common complications described in literature and focuses on the role of multidetector computed tomography (CT) in their evaluation either exclusively, or complementary to other imaging methods.
Source: Clinical Radiology - Category: Radiology Authors: Tags: Review Source Type: research
AbstractAortic valvular calcium score (AVCS) can identify severe aortic stenosis (AS) and provide powerful prognostic information. In severe and symptomatic AS, patients can be referred for a transcatheter aortic valve replacement (TAVR). The aim of this study was to determine whether AVCS, measured on the preoperative contrast enhanced multislice computed tomography (MSCT), is associated with device success (DS), major adverse cardiac events (MACEs) and paravalvular leak (PVL) after TAVR. Three hundred and fifty-two consecutive patients who underwent TAVR with a preoperative standardised contrast enhanced MSCT were includ...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research
Computed tomography angiography derived global longitudinal strain (CTA-GLS) has been shown to be feasible, however its prognostic value remains unclear in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). We evaluated the association of baseline CTA-GLS with outcomes including all-cause mortality and composite endpoint of death and heart failure hospitalization in 223 patients treated with TAVR. Patients with normal LVEF but reduced CTA-GLS had similar event rate to those with impaired LVEF, and higher than those with normal LVEF and preserved CTA-GLS. Baseline CTA-GLS assessme...
Source: Journal of Cardiovascular Computed Tomography - Category: Radiology Authors: Source Type: research
AbstractAortic stenosis (AS) represents a major healthcare issue because of its ever-increasing prevalence, poor prognosis, and complex pathophysiology. Echocardiography plays a central role in providing a comprehensive morphological and hemodynamic evaluation of AS. The diagnosis of severe AS is currently based on three hemodynamic parameters including maximal jet velocity, mean pressure gradient (mPG) across the aortic valve, and aortic valve area (AVA). However, inconsistent grading of AS severity is common when the AVA is  
Source: Journal of Medical Ultrasonics - Category: Radiology Source Type: research
Differences in Flow-Gradient Patterns Between Severe Bicuspid Aortic Stenosis and Severe Tricuspid Aortic Stenosis - Mechanistic Insight From Multimodal Imaging. Circ J. 2019 Nov 30;: Authors: Kim D, Shim CY, Kim YJ, Nam K, Hong GR, Lee SH, Lee S, Ha JW Abstract BACKGROUND: We investigated the flow-gradient pattern characteristics and associated factors in severe bicuspid aortic stenosis (AS) compared with severe tricuspid AS.Methods and Results:A total of 252 patients with severe AS (115 bicuspid vs. 137 tricuspid) who underwent aortic valve (AV) replacement were retrospectively analyzed. Patie...
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
AbstractPurpose of ReviewAortic stenosis is the most prevalent valvular heart disease. The purpose of this paper is to review the epidemiology, pathophysiology, and diagnosis of aortic valve stenosis.Recent FindingsThe diagnosis of aortic stenosis has evolved over time. Originally diagnosed with cardiac catheterization and echocardiography, more advance imaging techniques including computed tomography, magnetic resonance imaging, and 3D printing have improved our understanding of the physiology and hemodynamic effects of aortic stenosis.SummaryValvular heart disease affects a broad patient population, and the most common f...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research
CONCLUSIONS: A tortuous abdominal aorta was found to be a predictor of the occurrence of a complication in patients undergoing transfemoral transcatheter aortic valve replacement. This computed tomography variable should therefore be taken into account when choosing the approach, especially for patients at intermediate and low surgical risk. PMID: 31732445 [PubMed - as supplied by publisher]
Source: Archives of Cardiovascular Diseases - Category: Cardiology Authors: Tags: Arch Cardiovasc Dis Source Type: research
Bicuspid aortic valve (BAV) disease is the most common congenital cardiac anomaly and is a prominent risk factor for premature aortic valve disease, most commonly aortic stenosis [1]. BAV has historically been detected using 2-dimensional echocardiography; however, compared with pathologic analysis of BAV removed at the time of surgery, echocardiography detects only congenital BAV morphology in 58 –66% of cases [2,3]. Therefore, the use of three-dimensional imaging, mainly ECG-gated computed tomography (CT), is fundamentally required in the diagnosis and definition of the complex [4] and variable BAV anatomy (Fig.
Source: International Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Publication date: Available online 4 October 2019Source: Journal of Cardiology CasesAuthor(s): Toru Yoshizaki, Toru Naganuma, Sunao NakamuraAbstractA 69-year-old female Jehovah’s Witness was diagnosed with symptomatic severe aortic stenosis (AS). Because the patient, who refused blood transfusion for religious reasons, had multiple comorbidities, such as thrombocytopenia due to liver cirrhosis, esophageal varices, and an old cerebral infarction, a decision to perform transcatheter aortic valve implantation (TAVI) was made. Preprocedural computed tomography showed a small aortic root and severe leaflet calcification, ...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
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