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Valvular Heart Disease and Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Kali Polytarchou, Constantina Aggeli
Echocardiography can provide information about the underlying etiology as well as the severity. The American Heart Association uses the same severity cutoffs for primary and secondary MR,20 whereas the European Society of Cardiology recommends lower EROA >20 mm2 and RV >30 mL as limits for severe FMR with worse prognosis.21 In patients with reduced LVEF, absolute regurgitant volume may be low due to reduced stroke volume and increased LV and LA pressure. However, regurgitant fraction is increased, indicating severe valvular disease. A recent ESC joint position paper for the management of FMR reconciles the findings of the COAPT and MITRA-FR trials and suggests the use of the COAPT criteria for severe FMR, based on EROA ≥30 mm2, or Rvol ≥45 mL and/or RF ≥40% when EROA is smaller.33
Physiological interpretation of pressure waveforms
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
This is leakage of blood from the ascending aorta into the LV during diastole and is usually progressive and chronic although at times may be sudden or acute. Forward blood flow is reduced by an amount equivalent to the regurgitant fraction. The degree or amount of regurgitation depends upon: Size of the valve openingDiastolic duration (filling period)Diastolic aortic pressure
The cardiac patient presenting for non-cardiac surgery
Published in Daniel Cottle, Shondipon Laha, Peter Nightingale, Anaesthetics for Junior Doctors and Allied Professionals, 2018
The basic haemodynamic principle is ‘fast and loose’. Bradycardia should be avoided, as it increases LV end diastolic pressure and can precipitate heart failure.These patients tend to tolerate general anaesthesia well, as a reduction in SVR reduces the regurgitant fraction.LV function must be assessed preoperatively with echocardiography. If the ejection fraction is low (>30%), then these patients are at high risk for cardiac complications. The risk and benefits should be balanced and surgery is best avoided, if possible.
Quantitative assessment of aortic regurgitation following transcatheter aortic valve replacement
Published in Expert Review of Cardiovascular Therapy, 2021
Mitsunobu Kitamura, Maximilian Von Roeder, Mohamed Abdel-Wahab
In the 1980’s, feasibility of videodensitometric aortography for human AR evaluation was reported [31–33]. Recently, Schultz et al. demonstrated the utility of videodensitometric angiography as an objective and reproducible method for quantification of AR after TAVR, using semi-automated quantification of contrast opacification in the LV and the aortic root (CAAS A-valve® 2.0.2, Pie medical, Maastricht, The Netherlands) [34]. This software automatically describes time-density curves in the region of interest, and calculates the area under the curve. The quantitative regurgitation analysis index weighs the summated pixel density in the entire LV over three cardiac cycles, in comparison with that of the aortic root using a dedicated algorithm. In this method, regurgitant fraction is estimated as the relative area under the curve (RAUC), which is calculated as the area under the curve of the entire LV divided by that of the aortic root as a reference. During acquisition, an overlap-free projection is required to avoid overlap of contrast opacification in the descending aorta and the region of interest. To improve image quality in AR quantification, standardized aortography has been proposed in terms of angiographic setting, pigtail position, and motion artifacts [34].
Mitral Valve Chordal Force Redistribution Before and After Repair of Mitral Valve Prolapse with Edge-Edge Repair
Published in Structural Heart, 2020
Samantha Zhan-Moodie, Kirthana Sreerangathama Suresh, Alison Stauffer, Muralidhar Padala
Results: P2 prolapse is clearly evident in the photographs, with its correction after EE repair (Fig A2). Regurgitant fraction was 0% at baseline, 8.06±6.51% after prolapse, and decreased to 0.97±1.78% after repair (Fig A3). Variability in valve geometry and chordal lengths resulted in prolapsing of posterior leaflet towards posteromedial side in 4 out of 6 valves, introducing variability into the chordal force distribution. Peak forces in the AL strut chordae increased after prolapse, but were normalized to baseline after EE repair (Fig. B1). Peak forces in the AL marginal chordae were not altered with P2 prolapse, but increased after EE repair (Fig B2). Peak forces in the PL strut chordae slightly increased after prolapse, but significantly after EE repair (Fig. B3).
Safety and efficacy of repeat transcatheter aortic valve replacement for the treatment of transcatheter prosthesis dysfunction
Published in Expert Review of Medical Devices, 2020
Laurent Faroux, Alberto Alperi, Guillem Muntané-Carol, Josep Rodes-Cabau
Hemodynamic characteristics of the aortic valve as well as sinus of Valsalva flow are modified following TAVR implantation [44], and TAVR-in-TAVR may be associated with a further increase in turbulent flow. Hatoum et al. [45,46] performed a hemodynamic bench-test of different TAVR-in-TAVR configuration. EOA varied from 1.50 to 2.07cm2, with largest EOA obtained when the first THV was a 26 mm Evolut (23 mm Sapien or 23 mm Evolut as second THV) while the smallest EOA corresponded to a 23 mm Sapien as first THV (and 23 mm Sapien or 23 mm Evolut as second THV). Thus, EOA remained relatively large whatever the configuration, suggesting a low probability of patient-prosthesis mismatch. Regurgitant fraction was about 10% in all configurations, with the exception of the 26 mm Evolut-in-26 mm Evolut configuration where the regurgitant fraction reached 22%. The largest risk of leaflet degradation (as assessed by the pinwheeling index) was obtained with the Sapien-in-Sapien configuration, followed by Evolut-in-Sapien, Sapien-in-Evolut and Evolut-in-Evolut. Reynolds shear stress is correlated with platelet activation and reflects the shear stress between fluid layers when fluid particles decelerate or accelerate while changing direction. Overall, shear stress in TAVR-in-TAVR was up to 3-fold greater than with a single TAVR [44,45], suggesting a possible increased risk of valve thrombosis following TAVR-in-TAVR. Thus, some concerns arise regarding THV durability and the risk of valve thrombosis following repeat TAVR, but the clinical relevance of these findings will need to be clinically confirmed. Finally, the sinus washout in TAVR-in-TAVR was similar to valve-in-valve TAVR (TAVR in surgical valve dysfunction) and isolated TAVR [46].