Differences in Flow-Gradient Patterns Between Severe Bicuspid Aortic Stenosis and Severe Tricuspid Aortic Stenosis  - Mechanistic Insight From Multimodal Imaging.

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. Patients were classified into 4 groups according to stroke volume index and mean pressure gradient across the AV [normal-flow-high-gradient (NF-HG), low-flow-high-gradient, normal-flow-low-gradient, low-flow-low-gradient (LF-LG)]. In 89 patients who underwent cardiac computed tomography (CT), influential structural parameters of the left ventricular outflow tract (LVOT), AV and ascending aorta were assessed. Bicuspid AS was more likely to present a NF-HG pattern (83.5% vs. 64.2%, P
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research

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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
Publication date: Available online 16 April 2019Source: Canadian Journal of CardiologyAuthor(s): Luca Baldetti, Francesco Giannini, Nicolas Van Mieghem, Nahid El Faquir, Didier Tchétché, Chiara De Biase, Anna Sonia Petronio, Cristina Giannini, Giuseppe Tarantini, Chiara Fraccaro, Ariel Finkelstein, Amit Segev, Israel Barbash, Giuseppe Bruschi, Corrado Tamburino, Marco Barbanti, Scott Lim, Ivandito Kuntjoro, Mohamed Abdel-Wahab, Antonio ColomboAbstractBackgroundTranscatheter aortic valve replacement (TAVR) is the gold-standard for severe valvular aortic stenosis in patients at high/prohibitive surgical risk. T...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
AbstractAbout 60% of patients with paradoxical low-flow, low-gradient (PLF-LG) aortic stenosis (AS) have a severe disease that justifies aortic valve replacement (AVR). The first step in patients with symptomatic PLF AS should be to rule out measurement errors and treat hypertension. The second step is to distinguish pseudo-severe from true severe AS (TSAS). The third step is to select the optimal treatment modality at the right time. Regarding the second step, projected aortic valve area calculated using stress echocardiography is superior to traditional severity criteria (AVA
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
We present a case of aortic root rupture caused by unusually fragile aortic wall during TAVI and the lesson from the autopsy results.>
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Conclusion: This case illustrates the value of F-18 FDG PET/CT in the diagnosis of and localization of a periaortic valve abscess in a patient with multiple valve replacements, recurrent fevers/sepsis and inconclusive imaging with transthoracic echocardiogram, transesophageal echocardiogram and Indium-111 WBC scan. The localization of the FDG activity to the posterior aspect of the valve which corresponded to the findings on transthoracic echocardiogram was key. Research Support:
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Educational Exhibits Posters Source Type: research
ConclusionsSheathless use of the Portico valve is feasible and appears to be safe, with excellent rates of complications and mortality in the short‐term. Such an approach has the potential to further expand feasibility of TF TAVR to patients with severe peripheral arterial disease. Feasibility in patients with smaller femoral access and more challenging anatomy has to be proven in further studies. © 2017 Wiley Periodicals, Inc.
Source: Catheterization and Cardiovascular Interventions - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Valvular and Structural Heart Diseases Source Type: research
Aortic stenosis (AS) is the most frequently observed valvular heart disease. During the symptomatic stage, the rate of death increases dramatically, so that a precise diagnostic approach is taken to guide therapeutic options. Of patients with severe AS, 30% to 50% present with low‐flow/low‐gradient AS (LF/LGAS) status. This review focuses on LF/LGAS and the best diagnostic and therapeutic management in either classic LF/LGAS with reduced left ventricular ejection fraction (LVEF) or paradoxical LF/LGAS with preserved LVEF. Current literature demonstrates that in classic LF/LGAS it is crucial to rule out a pseudo‐sever...
Source: Clinical Cardiology - Category: Cardiology Authors: Tags: Review Source Type: research
We report here the case of a patient treated by means of a "minimalist" approach to TAVI allowing a reduction of the risks inherent in the procedure. This simplified strategy relies on an optimal use of CT scan findings prior to TAVI. The procedure is carried out under local anesthesia and the main access site is sutured percutaneously (Proglides). The radial artery is used as a secondary access site. Contrast medium is diluted and stimulation is administered via the intraventricular guidewire. Direct stenting is performed when deemed feasible on the basis of CT scan results. Simplified procedures such as these c...
Source: Annales de Cardiologie et d'Angeiologie - Category: Cardiology Authors: Tags: Ann Cardiol Angeiol (Paris) Source Type: research
Conclusions High TACS was associated with increased LVMI among patients with severe AS. Further, high TACS usefully predicted less regression of LVMI and poor clinical outcomes after AVR. TACS may serve as a useful proxy for predicting LV remodeling and adverse prognosis in patients with severe AS undergoing AVR.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
This study examined whether the thoracic aorta calcium score (TACS) is related to LV hypertrophy and whether it leads to an adverse prognosis in patients with severe aortic stenosis (AS) after aortic valve replacement (AVR). METHODS: We retrospectively reviewed 47 patients (mean age, 64 ± 11 years) with isolated severe AS who underwent noncontrast computed tomography of the entire thoracic aorta and who received AVR. TACS was quantified using the volume method with values becoming log transformed (log[TACS+1]). Transthoracic echocardiography was performed before and 1 year after the operation. RESULTS: Pre...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
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