Valve Disease
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
There has been a real revolution in treatment of aortic calcific stenosis. Surgical aortic valve replacement has been the standard treatment for patients with severe symptomatic aortic stenosis (AS). Transcatheter aortic-valve insertion (TAVI) has now been established as an alternative to surgery in patients with severe aortic stenosis who are at increased risk for death from surgery. These devices have an acceptable safety profile and provide excellent haemodynamic relief of aortic stenosis. In 2002, Dr. Alain Cribier performed the first successful percutaneous aortic valve replacement on an inoperable patient. The first approval of TAVI for severe risk patients came in 2011 with extension to moderate risk patients recently with more trials. In 2015, the indication was expanded to include ‘valve-in-valve’ procedure for failed surgical bioprosthetic valves in both children and adults.20
Cardiology
Fazal-I-Akbar Danish in Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Congenital acyanotic heart diseases:1 Left-to-right shunt: a ASD.b VSD.c PDA.d Coarctation of aorta with associated VSD or PDA.2 Without a shunt: a Congenital aortic stenosis.b Coarctation of aorta without associated VSD or PDA.
Cardiac Disease
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
Aortic stenosis in a younger pregnancy age patient is most often due to bicuspid aortic valve, which can also be associated with both aortopathy and coarctation of the aorta. Aortic stenosis is a fixed outflow obstruction of the left ventricle and is therefore sensitive to preload and hypotension which can result in hemodynamic collapse if not recognized and treated early. Complications can occur in up to 10% of aortic stenosis patients, with heart failure reported as high as 42% in one report; mortality is rare (<1%) [6]. Progressively increasing volume and cardiac output during pregnancy, as well as, postpartum increases in preload are what lead to heart failure from acute pulmonary edema in severe aortic stenosis. In highly symptomatic patients, aortic valve balloon valvuloplasty may be considered if no significant aortic regurgitation. If too late, invasive hemodynamic monitoring with a pulmonary artery catheter may prove useful in the peripartum period. Due to a genetic predisposition for bicuspid aortic valve, fetal echocardiography or postpartum pediatric echocardiography should be offered.
Outcomes of transcatheter aortic valve implantation for intermediate-risk patients in Australia: the SOLACE-AU trial
Published in Journal of Medical Economics, 2019
Peter Lee, Josh Byrnes, Merehau Mervin, Paul Scuffham
Aortic stenosis (AS) is the progressive narrowing of the aortic valve1,2. The ensuing hemodynamic changes further contribute to valvular calcification, stenosis and left-ventricular hypertrophy, worsening cardiac output, and ultimately leading to patient death2. Patients with AS are often asymptomatic, despite significant stenosis. However, upon disease progression, aortic stenosis is associated with high morbidity and mortality; the expected mortality rate is 50% for untreated, symptomatic patients3. In Australia, the prevalence of AS in the general population is estimated to range between 2.9% and 13.6%4. Of this prevalent population, 21.6% were estimated to have severe AS, with the majority (71.1%) of the severe AS population being symptomatic4.
Association between periprocedural myocardial injury and long-term all-cause mortality in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis
Published in Scandinavian Cardiovascular Journal, 2022
Wentao Chen, Yilong Han, Chunlin Wang, Wenqiang Chen
Aortic stenosis (AS) is usually caused by the calcification of a congenitally bicuspid or trileaflet valve, and rheumatic diseases can also cause aortic stenosis. Its pathological process is mainly endothelial damage due to mechanical stress and lipid penetration leading to fibrosis, leaflet thickening, and calcification; the prevalence of AS increases with age [1]. Currently, there is a lack of effective drug treatments for this disease. Surgical aortic valve replacement is the gold standard treatment for this disease. However, with the development and progress of minimally invasive techniques, transcatheter aortic valve replacement (TAVR) has become an option for treating this disease [1]. The most recent European guidelines suggest that TAVR is a better option for older patients with multiple risk factors who can undergo surgery via the femoral artery approach [2]. However, that there will be various complications after TAVR, including periprocedural myocardial injury (PPMI), bleeding, and stroke, most of which will affect the prognosis of patients, should be considered [3]. PPMI may be caused by a variety of factors, such as compression of myocardial tissue caused by balloon valvuloplasty and deployment of the transcatheter valve itself, hypotension during rapid pacing, and mechanical trauma caused by anchoring of the transcatheter valve. If coronary artery occlusion or a rare coronary artery embolism occurs after TAVR, myocardial infarction may occur, which is highly life-threatening [4].
Antihypertensive monotherapy or combined therapy: which is more effective on functional status?
Published in Clinical and Experimental Hypertension, 2018
Liliana C. Baptista, André Pinto Amorim, João Valente-Dos-Santos, Aristides M. Machado-Rodrigues, Manuel Teixeira Veríssimo, Raul A. Martins
Participants were eligible if they were aged 60 or more years, presented the European Society of Hypertension and the European Society of Cardiology (15) criteria for hypertension, used ACEi medication for at least one year to manage hypertension, and presented physically independent functional status, determined by responses to the 12-item of Composite Physical Functioning Scale (20). Participants were defined independent if they were able to perform all basic and all instrumental activities of daily living without assistance (20). Exclusion criteria included: (a) unstable angina; (b) uncontrolled symptomatic heart failure; (c) uncontrolled cardiac dysrhythmias; (d) symptomatic aortic stenosis; (e) not being under regular supervision of the treating physician for the period of the study evaluation; (f) known cancer or limited life expectancy, acute emergencies; (g) Parkinson’s disease; (h) Alzheimer’s disease; (i) dementia; (j) severe visual impairment; (k) further reasons that made it impossible or highly problematic to participate and come to the follow-up visits, completing baseline and follow-up testing (program log ≥ 80%) and (l) using mono-dose of thiazide diuretic medication, calcium channel blockers, angiotensin receptor blockers medication or combined therapy without ACEi or with more than three agents.
Related Knowledge Centers
- Angina
- Aorta
- Aortic Valve
- Shortness of Breath
- Stenosis
- Syncope
- Ventricle
- Heart
- Orthopnea
- Heart Failure
- Shortness of Breath