China
Africa
Explore chapters and articles related to this topic
Paper 1
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Aortic regurgitation is commonly caused by rheumatic heart disease, endocarditis, aortic dissection and congenital defects. Rarely, it is associated with Ehler’s–Danlos, Osteogenesis Imperfecta and Marfan’s disease. Symptoms include dyspnoea and palpitations. Characteristic signs include a collapsing pulse (water hammer); visible neck pulsations (Corrigan’s sign); head nodding (De Musset’s sign), and visible capillary pulsations (Quincke’s sign). The murmur is a mid-diastolic murmur. Valve replacement should be done early to prevent further impairment of left ventricular function. Prophylactic antibiotics are required against endocarditis.
Aortic Regurgitation
Published in Takahiro Shiota, 3D Echocardiography, 2020
Agnès Pasquet, Jean-Louis Vanoverschelde
During the two last decades, surgical techniques to repair the aortic valve have emerged as a valuable alternative to replacement in case of aortic regurgitation. Besides the tremendous advantage of avoiding complications related to anticoagulation, and offering a lower risk for endocarditis, these techniques required more surgical skills and perfect comprehension of the mechanism leading to aortic regurgitation. This may explain the growing interest in understanding the mechanism underlying aortic regurgitation and the interaction of the different aortic root components. Careful echographic assessment plays a key role in identifying the mechanism of aortic regurgitation and thus guiding the surgical procedure.1
Common cardiac conditions, drugs and methods of assessment
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Aortic regurgitation occurs when the aortic valve does not close properly and blood leaks back into the left ventricle (seeFigure 3.2). This backflow can lead to a left ventricular volume overload, with the heart having to work harder with each heartbeat, and may result in heart failure. It can be due to congenital abnormality of valves, rheumatic fever, endocarditis or systemic vasculitis – for example, rheumatoid arthritis or systemic lupus erythematosus (SLE) (Elkayam and Bitar, 2005). It is usually well tolerated in pregnancy. If symptomatic with left ventricular dysfunction, drug therapy may be needed. Antibiotics are usually prescribed for labour. In the postnatal period a residual valve dilation may result from the pregnancy, and this will need observation, monitoring and, perhaps, surgery.
Pre-implantation genetic testing for Marfan syndrome using mini-sequencing
Published in Journal of Obstetrics and Gynaecology, 2022
Sirivipa Piyamongkol, Krit Makonkawkeyoon, Vorasuk Shotelersuk, Opas Sreshthaputra, Tawiwan Pantasri, Rekwan Sittiwangkul, Theera Tongsong, Wirawit Piyamongkol
Marfan syndrome (MFS1, OMIM#154700) is the most common connective tissue disorder. MFS1 is inherited in an autosome dominant manner. Its incidence is about 2–3 in 10,000. It was first clinically described in 1896 (Marfan 1896). Major phenotypes include skeletal, ocular and cardiovascular system involvement. Anterior chest and vertebral column deformity, disproportionately tall stature, arachnodactyly and joint laxity are common skeletal manifestations. Ectopia lentis is a key ocular characteristic. Cardiovascular manifestations are the leading cause of the morbidity and mortality associated with Marfan syndrome. Aortopathy, i.e. aortic root dilatation, aortic regurgitation secondary from aortic dilatation, and fatal aortic dissection are the major causes. A family history of aortic dissection is the most important predicting factor for the risk of aortic dissection in affected offspring (Pyeritz 1993).
Determinants of changes in pulmonary artery pressure in patients with severe aortic stenosis treated by transcatheter aortic valve implantation
Published in Acta Cardiologica, 2021
Mihai Strachinaru, Ben Ren, Bas M. van Dalen, Nicolas Van Mieghem, Peter P. T. De Jaegere, Lennart van Gils, Tjebbe W. Galema, Marcel L. Geleijnse
In our study, there was an overall statistically significant improvement in PAP, but only 59% really improved, and only 21% normalised the PAP. The value of the PAP was unchanged or even worsened in 41%. This may explain the little overall variation of the mean PAP. There was also a significant improvement in transaortic gradient without significant changes in the ejection fraction and the overall degree of mitral and aortic insufficiency. The effect of TAVI on the ejection fraction has indeed been reported as either neutral or positive [22–24]. In a recent meta-analysis, a non-significant trend towards a reduction in mitral regurgitation was reported [25], consistent with our findings. The change in aortic regurgitation is of course, very variable, depending on the baseline characteristics of each patient as well as numerous technical factors [26].
Treatment strategies for mixed aortic valve disease in nonelderly patients
Published in Expert Review of Cardiovascular Therapy, 2019
Maria Von Stumm, J. Petersen, D. Westermann, Hermann Reichenspurner, Evaldas Girdauskas
Bioprosthetic and mechanical aortic valve replacement is associated with major limitations in the nonelderly patients (i.e. oral anticoagulation-related complications, expedited bioprosthesis degeneration, and subsequent re-operation). By contrast, the Ross procedure has been established as a viable treatment option for young MAVD patients over the last five decades and is associated with excellent life expectancy [15]. Due to the presence of aortic valve stenosis in MAVD patients which is commonly associated with severe cusp degeneration, aortic valve repair is usually not applicable in patients with moderate to severe MAVD. However, if aortic regurgitation is the predominant lesion without relevant calcification, aortic valve repair might still be feasible and should be considered as an alternative treatment option in very young patients [16].