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Cardiac surgery and percutaneous cardiac interventions
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
This subset of patients rejected for surgical intervention has formed the basis for development of alternative approaches to the correction of aortic valve stenosis. Use of balloon aortic valvuloplasty was trialed, and it demonstrated lowered gradients and clinical and functional improvement.6 However, high rates of restenosis within months to years, and the recurrence of aortic regurgitation limited any mortality benefit and its widespread use. The next stage in the evolution of non-surgical percutaneous therapies was the development of transcatheter aortic valve implantation or replacement (TAVI/TAVR).
Pediatric And Adult Congenital Cardiac Interventions
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Sawsan M. Awad, Qi-Ling Cao, Ziyad M. Hijazi
Balloon aortic valvuloplasty is a safe initial treatment in most patients with congenital aortic valve stenosis (see Figure 47.2). Patients with severely dysplastic valves may have less favorable results with balloon aortic valvuloplasty, but in most patients, the results are similar to those obtained with surgical valvotomy.10, 11 The overall goal, especially in neonates and infants, is to relieve the aortic valve obstruction to a degree sufficient to normalize LV systolic function without inducing significant valve insufficiency. Achievement of this goal typically entails performing a conservative balloon valvuloplasty by reducing the peak-to-peak systolic gradient by 50%. Balloon diameters are usually 85%-90% of the aortic valve annulus dimension measured via aortic angiography. If an unsatisfactory result is encountered and no significant increase in aortic regurgitation is noticed, additional valvuloplasty is performed with larger balloon size. In critically ill patients, surgical backup and circulatory support in the form of an ECMO should be available.
Bicuspid aortic valve and diseases of the aorta
Published in Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček, Congenital Heart Disease in Adults, 2008
Jana Popelová, Erwin Oechslin, Harald Kaemmerer, Martin G St John Sutton, Pavel Žáček
In childhood, aortic valve stenosis is most often managed by balloon valvuloplasty and/or surgical valvulotomy. The Ross procedure is performed rarely. Prosthetic valves are used only exceptionally in older children. In contrast, prosthetic valves are used predominantly in adult patients given the progression of degenerative changes involving the aortic valve. The prostheses may be mechanical (most often bileaflet); biological, made from a porcine aortic valve or pericardium (heterograft, xenograft); or human aortic valves (homograft, allograft). In some cases, the Ross procedure, with implantation of the patient’s own pulmonary autograft into the aortic position and a homograft into the pulmonary position, is also performed in adults. The advantage of this operation is that patients do not need anticoagulation.
Heart failure and excess mortality after aortic valve replacement in aortic stenosis
Published in Expert Review of Cardiovascular Therapy, 2023
Nikoo Aziminia, Christian Nitsche, Rok Mravljak, Jonathan Bennett, George D Thornton, Thomas A Treibel
Outcomes following AVR remain a key focus of study and may inform management strategies to enhance these, such as for post-operative arrhythmias and heart failure (Table 2). Medical therapeutic options for management of the aortic valve stenosis itself have failed to emerge despite decades of randomized trials [108]. In contrast, myocardial remodeling and AS-associated myocardial damage could be attenuated with pharmacotherapy prior to or after AVR (Figure 2). Targets for intervention range from myocardial hypertrophy to inflammation and diffuse myocardial fibrosis, with better understanding of the factors and pathways driving heart failure post AVR required. Whereas there is a wealth of evidence for drug intervention targeting these pathways, and novel medical therapies currently emerging, there is limited (if any) trial data in patients with severe valvular heart disease before or after intervention, as this patient group was most excluded from previous trials [109].
Aortic valve: anatomy and structure and the role of vasculature in the degenerative process
Published in Acta Cardiologica, 2021
Vasiliki Katsi, Nikolaos Magkas, Alexios Antonopoulos, Georgios Trantalis, Konstantinos Toutouzas, Dimitrios Tousoulis
Degeneration of the aortic valve is a condition that covers a wide spectrum, ranging from mild, asymptomatic aortic sclerosis to severe aortic stenosis [6]. In aortic sclerosis thickening and nodular calcification of the valve leaflets impair leaflet motion, but they do not cause LVOT obstruction or pressure gradient between LV and aorta [6]. It is estimated that only 9% of sclerotic aortic valves will present progression to any degree of stenosis within 5 years [13]. Aortic valve stenosis is characterised by extensive thickening, calcification and fibrosis of the valve and restricted valve motion, resulting, in severe cases, in reduced orifice area and, eventually, in symptoms of heart failure [6,10]. Aortic stenosis is classified as mild, moderate and severe and is generally considered severe when orifice area is below 1 cm2 (normal values 3–4 cm2); severe aortic stenosis is potentially lethal if left untreated [14,15]. Bicuspid aortic valve is much more prone to calcification and stenosis, which occurs considerably earlier in life compared with the three-cusp aortic valve [6,10].
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.