Common cardiac conditions, drugs and methods of assessment
Judy Bothamley, Maureen Boyle in 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.
Diseases of the Aortic Valve
Mano Thubrikar in The Aortic Valve, 2018
Aortic insufficiency has been observed to occur either by itself or in association with aortic stenosis. In recent studies by Olson et al.6 the following causes of pure aortic insufficiency were observed: Postinflammatory disease of rheumatic origin in 46% of patientsAortic root dilatation in 21 %Incomplete closure of congenital bicuspid valve in 20%Infective endocarditis in 9%Quadricuspid valve in 1%
Special Situations
Wayne E. Richenbacher in Mechanical Circulatory Support, 2020
If the aortic valve is replaced, the patient will be at risk for systemic thromboembolization for the duration of LVAD support. Most of the blood passes from the left side of the heart through the LVAD. As the aortic valve rarely opens, thrombus will form on a valve prosthesis even if the patient is fully anticoagulated. This is true regardless of whether a bioprosthesis or mechanical valve is employed. Thrombus that occurs on the valve can be ejected if the native heart contracts. The ideal solution to this clinical problem is unknown. Attempts to obliterate the left ventricular outflow tract by sewing the native aortic valve leaflets together at the time of LVAD insertion have been unsuccessful. The “repair” usually disrupts during the period of LVAD support. The most reasonable management approach for the patient with severe aortic insufficiency is to remove the native aortic valve and replace it with a bioprosthesis. Prior to implantation the bioprosthesis is modified by sewing an occlusive pericardial patch (Periguard pericardium, 4 × 4 cm; Bio-Vascular, Inc., Saint Paul, MN) over the left ventricular side of the valve (Fig. 7.2). The left ventricular outflow tract is thereby obliterated with a relatively nonthrombogenic well supported “valve prosthesis”. Thrombus may still form on the aortic side of the prosthesis, thus long-term anticoagulation is appropriate. If the LVAD were to suddenly fail the native ventricle can still eject through the LVAD itself provided left ventricular apex cannulation was employed.
Aortic Valve Neocuspidization (Ozaki technique) for Pediatric Patients: An Early Single Center Experience
Published in Structural Heart, 2020
David Blitzer, Damien Lapar, Daniel Montana, Anne Ferris, David Solowiejczyk, Lindsay Freud, Thomas Starc, Michael Snyder, Emile Bacha, David Kalfa
Results: There were 11 patients included (male=7). Median age at surgery was 15.8 years (Range 11.0-21.5). Aortic lesions were aortic insufficiency (AI) in 6 patients, aortic stenosis (AS) in 4 and mixed lesions in 1. Three patients had a previous balloon aortic valvuloplasty and one had a prior arterial switch operation for transposition of the great arteries. All three leaflets were replaced in all cases. Glutaraldehyde-treated autologous pericardium or a decellularized bovine pericardial patch was used in 8 and 3 patients respectively. At discharge, one patient had a mild to moderate AI and none had AS. There was no early and late mortality. Median follow-up was 1.1 years (range 0.2-1.4 years). One patient developed a dehiscence of a Photofix© patch 6 weeks after surgery, then underwent a redo AVNeo and has no AI or AS 1.2 years after reoperation. There was no other reoperation. At last follow-up, no patients had AS greater than mild and none had AI greater than mild.
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).
Valve Repair for Isolated Aortic Insufficiency is not Associated with Greater Valve-related Morbidity than Replacement: A Propensity-matched Analysis
Published in Structural Heart, 2020
Giovanni Battista Luciani, Giovanni Benafari, Vincenzo Giambruno, Angela Murari, Faggian Giuseppe
Methods: All consecutive adult patients (n=320) with isolated aortic insufficiency having elective valve repair (Group 1) or replacement (Group 2) between 01/2002 and 12/2013 were prospectively studied. Treatment choice was non-random. Group 1 (n=76) and Group 2 (n=244) patients had comparable age (mean 58±16 vs. 61±14 years, p=0.2) and gender distribution (16/76 vs. 53/244 female, p=0.9), but congenital valve disease (37/76 vs. 73/244, p=0.02) and ascending aortic graft replacement (46/76 vs. 65/244, p=0.001) were more prevalent in Group 1. To accommodate for patient heterogeneity, propensity matching was performed based on age, gender, etiology, associated ascending aortic procedure, and 48 pairs were identified. Study end-points were survival, freedom from MACCE, freedom from AVR, and functional status at follow-up.
Related Knowledge Centers
- Aorta
- Aortic Valve
- Paroxysmal Nocturnal Dyspnoea
- Shortness of Breath
- Diastole
- Ventricle
- Heart
- Orthopnea
- Signs & Symptoms
- Heart Failure
- Shortness of Breath