TAVI in bicuspid aortic valve stenosis

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

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This article summarizes current guidelines and best practices for the management of low-flow, low-gradient aortic stenosis. Summary Low-flow, low-gradient aortic stenosis is a difficult entity to diagnose and treat. Various diagnostic modalities are needed to accurately determine the severity of aortic stenosis and potential treatment benefit. True-severe classical and paradoxical low-flow, low-gradient aortic stenosis can be distinguished from pseudo-severe aortic stenosis by dobutamine stress echocardiography and/or multidetector computed tomography. Once the distinction is made, aortic valve replacement results in be...
Source: Current Opinion in Cardiology - Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
We present extensive in vitro durability and stability testing of a novel polymeric TAVR valve (PolyNova valve) using 1) accelerated wear testing (AWT, ISO 5840); 2) calcification susceptibility (in the AWT)—compared with clinically used tissue valves; and 3) extended crimping stability (valves crimped to 16 Fr for 8 days). Hydrodynamic testing was performed every 50M cycles. The valves were also evaluated visually for structural integrity and by scanning electron microscopy for evaluation of surface damage in the micro-scale. Calcium and phosphorus deposition was evaluated using micro-computed tomography (μCT) an...
Source: ASAIO Journal - Category: Medical Devices Tags: Biomedical Engineering Source Type: research
Abstract PURPOSE: We investigated the utility of trunk muscle cross-sectional area to predict length of hospitalization after surgical aortic valve replacement (AVR) for aortic stenosis (AS). METHODS: Adult AS patients who underwent isolated AVR at a single institution were studied. The cross-sectional area of the erector spinae muscles (ESM) at the first and second lumbar vertebrae and that of the psoas muscle (PM) at the third and fourth lumbar vertebrae were measured on preoperative computed tomography (CT). Each was indexed to body surface area. Risk factors for prolonged postoperative hospitalization (&g...
Source: Annals of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Cardiovasc Surg Source Type: research
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 study sought to derive and validate a systematic method enabling AVC quantification using computed tomography angiography (CTA) in patients with AS. METHODS: 134 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. RESULTS...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg 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
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