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Aortic Regurgitation
Published in Takahiro Shiota, 3D Echocardiography, 2020
Agnès Pasquet, Jean-Louis Vanoverschelde
Aortic regurgitation may be due to abnormalities of the aortic valve, aortic root, or a combination of both. Because of the tight relation between the component of the aortic root and the aortic valve dilatation of the root, sinotubular junction or sinus will displace the valve commissures so the leaflets could not properly coapt during diastole and may lead to aortic regurgitation. Moreover, the sizes of the aortic root and annulus change during the cardiac cycle with the largest dimensions obtained during the first third of systole and the smallest during isovolumic relaxation.12 Morphological valve abnormalities (see Section “Assessment of Aortic Valve”) could also lead to aortic regurgitation.
Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Aortic stenosis, as the name implies, is a narrowing of the aortic valve opening (see Figure 2.10). It can be caused by a congenital defect whereby the aortic valve has two cusps instead of three, or following damage to the valve from an episode of rheumatic fever.
Common cardiac conditions, drugs and methods of assessment
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Aortic stenosis, as the name implies, is a narrowing of the aortic valve opening (seeFigure 3.3). It can be caused by a congenital defect whereby the aortic valve has two cusps instead of three, or it may occur following damage to the valve from an episode of rheumatic fever. However, complications from aortic stenosis are rare in pregnancy.
Contemporary Review of the Ross Procedure
Published in Structural Heart, 2021
Vincent Chauvette, Laurence Lefebvre, Marie-Ève Chamberland, Elbert E. Williams, Ismail El-Hamamsy
The aortic valve is often considered a passive structure, which opens and shuts in response to changes in trans-valvular pressures. Instead, the aortic valve, a component part of the aortic root, is a dynamic and living structure with many important functions which contribute to optimizing coronary flow reserve, reducing left ventricular workload during systole and ensuring perfect hemodynamics across the aortic root both at rest and with exercise.9 In addition, aortic valve cusps are covered by a monolayer of endothelial cells, which produce nitric oxide, thereby inhibiting platelet aggregation.10 Along with interstitial cells in the body of the cusps, they can also mount an inflammatory reaction in response to bacterial organisms in the bloodstream, limiting the risk of infective endocarditis in normal aortic valves.2,11,12 Finally, the cellular components allow the valve to repair itself and reorganize its extracellular matrix over a lifetime without wear (~2.5 billion cardiac cycles in a normal lifetime).12
Bicuspid aortopathy – molecular involvement of microRNAs and MMP-TIMP
Published in Biomarkers, 2020
Shiho Naito, Johannes Petersen, Tatiana Sequeira-Gross, Niklas Neumann, Jorge Duque Escobar, Tanja Zeller, Hermann Reichenspurner, Evaldas Girdauskas
Our study population included a total of 65 consecutive BAV patients referred to our institution for elective aortic valve surgery with or without concomitant proximal aortic surgery. Demographics and baseline variables of our study group are summarised in Table 1. Briefly, a relatively young, predominantly male cohort with a low perioperative risk was analyzed. Two-thirds of our study population had predominant aortic valve stenosis, while the remaining 23 (34%) patients presented with an isolated aortic regurgitation. 29 (45%) patients had a simultaneous bicuspid aortopathy, defined as a maximal proximal aortic diameter ≥ 40 mm. Two patients had a unicuspid aortic valve disease with predominant aortic stenosis. Aortic valve replacement was performed in 47 (72%) patients, while the remaining 18 (28%) patients underwent aortic valve repair procedure. The concomitant proximal aortic replacement was required in 25 (39%) patients.
Cardiac Amyloidosis is Underdiagnosed in Patients Undergoing Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2020
Michael Megaly, Paul Sorajja, Santiago Garcia, John Lesser, Mario Gössl, Mathew Maurer, Thomas Treibel, João L. Cavalcante
A high level of suspicion and awareness is required to identify patients with CA with severe AS undergoing either TAVR or surgical aortic valve replacement, especially in older patients with low-flow low-gradient severe AS. However, this approach using red flags and a high index of suspicision might underestimate the true prevalence of CA in patients with severe AS. A more systematic approach, such as performing bone scintigraphy or cardiac magnetic resonance imaging on all patients with planned aortic valve replacement, might be warranted but this testing strategy needs further investigation. Although the futility of aortic valve replacement in patients with concomitant CA has been debated, recent studies demonstrated that the presence of CA did not significantly affect mortality within two years after TAVR.5 Moreover, about 10–15% of patients post-TAVR could potentially benefit from new ATTR therapies. Identification of these patients is essential for informed decision making regarding treatment options. It is time to raise awareness for the importance of this dual-pathology as emerging therapeutic options for ATTR provide an opportunity for sequential treatment.