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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
On the other hand, systemic diseases, e.g., rheumatic fever, degenerative, autoimmune diseases, Marfan's syndrome, or infective endocarditis can affect multiple valves. In these cases, individual valvular disease severity may be under- or overestimated. For example, AR might underestimate MS severity and AS may overestimate MR severity.21 In a patient with combined valve stenosis and regurgitation, it is very important to characterize which is the more severe, based on valve morphology and the consequences on the atrium and ventricle.
Nature of Flow of a Liquid
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
In patients with aortic valvular disease, disturbed or turbulent blood flow is markedly increased compared with patients with normal valves (Stein and Sabbah, 1976). In patients with pure aortic insufficiency, the intensity of turbulence was approximately three times greater than in patients with a normal aortic valve (Stein and Sabbah, 1976). In these patients, flow disturbances may be attributed to an increased forward flow across the valve productive of high velocities during ejection. Peak aortic velocities in the range of 231–256 cm/s were recorded in these patients, as were prominent levels of turbulence extended to the mid-ascending aorta and proximal aortic arch. In patients with aortic stenosis, the level of turbulence was approximately ten times that observed in normal subjects (Stein and Sabbah, 1976). Peak velocities ranged from 308 to 459 cm/s (Stein and Sabbah, 1976). Disturbances occurred before peak velocities were reached and extended throughout systole.
Transcatheter Aortic Valve Implantation (TAVI)
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Amalia Winters, Jessica Forcillo, Vinod H Thourani
Nearly 15 years after this operation was pioneered, we have seen a major change in direction in treatments for valvular disease, with all four heart valves being treated via transcatheter procedures, as well as the valve-in-valve TAVRs for failing bioprosthetic valves. TAVR has become the standard of care for patients with severe symptomatic AS deemed high- or extreme-risk and is now approved for those who are at intermediate risk. The PARTNER 3 trial will give us more insight on moving TAVI towards low-risk patient groups. While most procedures are performed via a transfemoral or transapical approach, the access options such as transaortic, transcaval, transcarotid and subclavian approaches are narrowing the list of anatomic exclusions to TAVR and have served to make this procedure more accessible to a wide variety of patients. Now that the learning curve has been passed in most large centers, future studies may be better able to elucidate differences between the different access options for TAVR.
Hemodynamic changes during aortic valve surgery among patients with aortic stenosis
Published in Scandinavian Cardiovascular Journal, 2022
Rasmus Carter-Storch, Søren Mose Hansen, Jordi S. Dahl, Kasper Enevold, Nils Sofus Borg Mogensen, Henrik Berg, Marie-Annick Clavel, Jacob E. Møller
Aortic valve stenosis (AS) is the most common valvular disease in the Western World [1]. It is caused by progressive calcification of the aortic valve, leading to reduced aortic valve area (AVA). Increased valvular resistance leads to the buildup of a transvalvular gradient, causing left ventricular (LV) pressure overload. To counterbalance this and attempt to maintain a normal LV wall stress, LV wall thickness increases. However, this occurs at the expense of reduced LV compliance and increased myocardial oxygen demand [2]. When AS becomes severe and symptoms occur, aortic valve surgery (AVR) is indicated, unless comorbidities preclude this, and potential high-risk non-cardiac surgery is usually postponed until after AVR is performed [3]. However, non-cardiac surgery is sometimes performed on severe AS, when it is imperative not to delay this till after AVR.
Antihypertensive treatment and risk factors for syncope in asymptomatic aortic stenosis patients with hypertension
Published in Clinical and Experimental Hypertension, 2022
Meihua Wu, Ping Gu, Qianqiang Cao, Aibin Gong, Wenliang Tan, Dezhi Hong
AS is a common valvular disease, affecting 2 to 4% of adults older than age 65 years (13). It is a progressive disease with a long asymptomatic phase, but once symptoms develop, the prognosis is poor (14). Systemic HTN is present in about 9%-76% of patients with AS in different studies (1). Despite the recognition that HTN is an important medical problem that requires effective treatment to minimize cardiovascular morbidity and mortality, there has been reluctance to treat (or at least adequately treat) HTN in patients with AS (15). This reluctance stems from the now outdated notion that obstruction at the valve level is the overwhelmingly dominant cause of increased LV load and that, in the face of this fixed afterload, cardiac output cannot be augmented (16). However, it is misleading to think of AS as a disease with “fixed afterload.” Indeed, increased vascular afterload serves as an additional load on the left ventricle and is associated with increased hypertrophic remodeling and LV dysfunction in patients with AS (1).Increased global LV load – measured as the Zva(see above) – also portends a worse outcome (17). In fact, a growing body of literature has reported that a high percentage of patients with significant AS do take antihypertensive and vasoactive medications without evident adverse effects (18–20). Among the 158 AS patients included in our study, ninety patients had hypertension. The prevalence of hypertension was 56.9%; 77 of them were using antihypertensive agents; 36% of patients with treated HTN had normal blood pressures (<140/90 mmHg); about 29% had blood pressures ≥150/100 mmHg.
Anatomic and Functional Determinants of Atrial Functional Mitral Regurgitation
Published in Structural Heart, 2021
Milad Matta, Chadi Ayoub, Ossama K. Abou Hassan, Habib Layoun, Paul C. Cremer, Ayman Hussein, Paul Schoenhagen, Walid I. Saliba, Leonardo L. Rodriguez, Brian P. Griffin, Samir R. Kapadia, Serge C. Harb
Standard echocardiographic examination was performed and interpreted by experienced cardiologists in compliance with ASE guidelines.17 The severity of MR was graded using a multi-parametric approach, as advocated by the ASE guidelines, including measurement of the effective regurgitant orifice area (EROA), the regurgitation volume (RV), and the regurgitant fraction (RF).25 We also described the jet origin (central, medial, lateral) based on the parasternal short axis and apical two-chamber views, and the jet direction (central, anterior, posterior) according to the parasternal long axis and apical three-chamber views. Concomitant valvular disease and its severity were noted. Significant valvular disease was defined as moderate or more in severity. Cardiac chambers’ size and function were also measured by standard ASE recommendations.17 The right ventricular systolic pressure (RVSP) was estimated based on tricuspid regurgitation (TR) jet maximum velocity and predicted right atrial pressure.27 All echocardiographic examinations were thoroughly reviewed to ensure the lack of primary mitral valve leaflet pathology, including degenerative changes (e.g., prolapse, flail, myxomatous changes, leaflet calcifications …), infectious disease, or rheumatic changes.