[Aortic valve disease, aortic valve prolapse syndrome].
Explore the source record for details and available documents.
Aortic Valve Insufficiency↗
SEARCH · Search PubMed
Results for “AORTIC VALVE DISEASES”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Reconstructive techniques for rheumatic aortic valve disease.
Aortic valve reconstruction is still at an early stage of development. We report techniques that can be applied in the repair of rheumatic aortic valve disease in patients with concomitant mitral valve disease. The techniques described are: (1) commissurotomy, (2) cusp free edge unfolding, (3) annuloplasty, and (4) supraaortic crest enlargement. Fifty patients operated on between January 1974 and January 1986 with a hospital mortality of 6% were followed for a mean period of 7.7 years. Reoperation due to failure of mitral surgery was required in twelve patients, tricuspid regurgitation in two, and significant aortic regurgitation in four. These techniques, although applicable to a limited number of patients, have enabled us to avoid the problems of aortic valve replacement in many patients.
Adolescent↗
[Risk factors influencing the prognosis of severe aortic valve disease following aortic valve replacement].
As a result of improvement in intraoperative and postoperative management, severe aortic valve disease can be cured by operation, however, late cardiogenic sudden death after aortic valve replacement (AVR) has been existed as one of the important unsolved problem. This report is aimed to predict the risk factors influencing the postoperative prognosis of severe aortic valve disease. Twenty-three cases with aortic regurgitation (AR) and 20 cases with aortic stenosis (AS) were selected by postoperative period over 12 months. In 18 AR cases with normal coronary artery substantiated by selective coronary angiography, cross sectional area index of left ventricular wall (CSAI) and ST depression in left chest leads of electrocardiogram correlated well as the CSAI increased, so decreased the ST segment. This shows the increment of CSAI leads left ventricular endocardial ischemia. By means of introduction of this indicator, 23 AR and 20 AS patients were divided into two groups as group C-I having CSAI over 20 cm2/m2 and group C-II under 20 cm2/m2. Left ventricular ejection fraction (EF) was selected as an predictive indicator of left ventricular function. As same as CSAI, AVR cases were divided into two groups as group E-I having EF under 50% and E-II over 50%. Each group was compared concerning with the complication rate of postoperative low cardiac output syndrome (LOS) and late cardiogenic sudden death. In C-I group of AR, 55% cases accompanied with LOS, 18% died due to LOS and 18% died suddenly from late cardiogenic cause, however, none of cases in C-II group had these complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Regression of myocardial hypertrophy in aortic valve disease following aortic valve replacement].
In patients with aortic valve disease successful valve replacement leads to a significant decrease in left ventricular angiographic mass, which 14-15 months postoperatively ranges between 31 and 37% of the preoperative value. Postoperative normalization of angiographic mass occurs in 2/3 of the patients with aortic stenosis and in 1/3 of the patients with aortic insufficiency. The degree of preoperative hypertrophy determines whether angiographic mass does or does not normalize after valve replacement. In patients with aortic stenosis and combined lesions, left ventricular end-diastolic wall thickness decreases postoperatively and remains unchanged in the patients with aortic insufficiency. Muscle fiber diameter decreases significantly in the first two years after valve replacement and thereafter remains unchanged. The upper limit of normal (20 mu) is not reached. Relative interstitial fibrosis increases early after surgery whereas left ventricular fibrous content remains unchanged during the first two years after valve replacement. Five years postoperatively there was a significant decrease in left ventricular fibrous content both in patients with aortic stenosis and with aortic insufficiency. Hence there appears to be no longer any validity in the earlier concept that a once established interstitial fibrosis in patients with concentric and eccentric hypertrophy is irreversible after removal of the abnormal hemodynamic burden.
Aortic Valve Insufficiency↗
Management of aortic valve disease during aortic surgery.
BACKGROUND: Alternative management strategies for aortic valve disease and aortic operation include valve preservation and aortic repair (VPR), composite valve graft (CVG), or separate valve and aortic repair (SVR). We evaluated these approaches. METHODS: Of 250 ascending/arch operations, 151 patients had aortic valvular disease and dissection (n = 56, 37%) or aneurysms operated between November 1990 and January 1998. Sixty-seven patients underwent CVG insertion, 50 SVR, 13 VPR, and 21 only aortic repair alone (RA). Sixty (40%) patients also had aortic arch repairs and 53 (35%) coronary artery bypasses. RESULTS: The early 30-day survival and stroke rates were 99% (150 of 151) and 0% (0 of 151), respectively: CVG 100% (67 of 67), 0%; VPR 100% (13 of 13), 0%; SVR 98% (49 of 50), 0%; RA 100% (21 of 21), 0% (p = not significant [NS]). On late follow-up of all patients (5 to 92 months; 96% complete 1998), 3 CVG, 2 VPR, 6 SVR, and 0 RA patients died with respective 5-year Kaplan-Meier survival rates of 88.4%, 70%, 69%, and 100% (p = 0.07, log-rank test). The respective linear rates for stroke were 0%, 5.5% (n = 1), 0%, and 0%; for hemorrhage were 0%, 0%, 0%, and 0%; and for endocarditis were 2.2% (n = 3), 0%, 0%, and 0% (p = NS). There were 11 late deaths and no patient required reoperation or ruptured the ascending aorta or the aortic arch. CONCLUSIONS: With careful selection of the appropriate method excellent early and late results can be achieved.
Adult↗
[Severe aortic valve diseases and aortic isthmus stenosis in adults. Incidence, clinical aspects and long-term results of surgical treatment].
Severe aortic valve disease is a rare complication of coarctation in adults. Between 1961 and 1990 aortic valve replacement was performed after or combined with the operation of coarctation in 24 adults (4% of entire population operated for coarctation). Bicuspid aortic valves were present in 2/3 of patients. In 10 patients (7/10 with aortic stenosis) coarctation was operated early (mean age 24 years) and aortic valve late (mean age 40 years): in 14 (10/14 with aortic regurgitation, mean age 40 years) aortic valve and coarctation were operated simultaneously (8 patients) or staged within 6 months (6 patients). Additional surgical interventions on the dilated aorta ascendens were performed in 8, mitral valve replacement in 2 and aorto-coronary bypass in 1 patients. Early mortality was 2/24 (8%) and was similar in simultaneously (1/8) and staged (1/14) operated cases: 10 year survival was lower than in an age-matched group of 72 patients with aortic valve disease of similar severity operated during the same period (70% vs 88%, p < 0.01): 6/7 late deaths were cardiac; 5/5 pts with preoperatively severely increased end-diastolic (> 199 ml/m2) and 4/4 with end-systolic (> 90 ml/m2) left ventricular volumes and 2/2 with ejection fraction < 41% died late postoperatively. Severe aortic valve disease arised in 4% of adults with coarctation or after coarctation resection. The results of valve replacement in these patients were less successful due to high late mortality in cases with severe preoperative left ventricular dilatation and/or decrease of ejection fraction. Thus, close surveillance of patients after coarctation surgery, especially those with bicuspid valves, is mandatory for early detection of valvular disease and appropriate timing of valve replacement before left ventricular function begins to deteriorate.
Adolescent↗
Natural history and management of chronic aortic valve disease.
Chronic aortic valve disease involving stenosis, regurgitation or both is insidious and progressive. Severe valvular dysfunction may be present for years without symptoms, but functional deterioration is often rapid once congestive heart failure, angina or syncope with effort is present. As the severity of aortic stenosis may not be easy to assess clinically, the relative usefulness of various tests is considered in this paper. The difficulty with chronic aortic regurgitation lies not in diagnosing the problem but in detecting early left ventricular dysfunction in time to perform the surgery that can prevent further functional deterioration. Patients with significant aortic valve disease should undergo surgery when the important symptoms of dyspnea, angina or syncope with effort first appear. Surgery should also be considered in selected patients with aortic regurgitation in whom left ventricular function has diminished even without symptoms.
Aortic Valve Insufficiency↗
Limitations in the echocardiographic assessment of aortic root dimensions in the presence of aortic valve disease.
Aortic root M-mode echocardiograms were evaluated in 79 patients who had aortic valve replacement. Echocardiographic measurements of aortic root dimensions correlated poorly with surgical estimates. Inclusion of a portion of the sinuses of Valsalva in the former set of estimates probably accounts for this discrepancy.
Aorta↗
[Case study of circulatory diseases. 3. Multiple valve disease (mitral and aortic valve diseases)--heart sound and hemodynamics].
Explore the source record for details and available documents.
Adult↗
Ventricular arrhythmias in aortic valve disease before and after aortic valve replacement.
In order to evaluate the effect of aortic valve replacement on the incidence of ventricular arrhythmias in patients with aortic valve disease, 24-hour ambulatory electrocardiographic recordings were obtained before surgery in 96 patients without coronary artery disease (aortic stenosis n = 50, combined aortic stenosis and regurgitation n = 19 and aortic regurgitation n = 27). Following aortic valve replacement, repeat recordings were obtained after 13 +/- 4 days and 18 +/- 7 months. Ventricular arrhythmias were in all cases classified according to Lown and were compared with clinical, echocardiographic and hemodynamic data. Preoperatively, ventricular premature beats were observed in 85 patients (89%) and were frequent (greater than 30 ventricular premature beats/hour) in 20 (21%). Multiformity was found in 27 (28%), couplets in 18 (19%) and ventricular tachycardia in 11 (11.5%). The occurrence of ventricular arrhythmias was not related to the type or severity of valve lesions. Patients with severe ventricular arrhythmias (Lown class 3 or 4: 37%) had a greater thickness of their interventricular septum 13.9 +/- 2.5 mm, vs 11.7 +/- 2.6 (p less than 0.05); a higher LV mass 176 +/- 34 g/m2, vs 134 +/- 39 (p less than 0.05) and a lower left ventricular ejection fraction 47 +/- 12%, vs 57 +/- 11, (p less than 0.01). Two weeks postoperatively, the incidence and severity of ventricular arrhythmias had increased: ventricular premature beats were noted in 92% and were severe in 50%. No correlation was found between ventricular arrhythmias and preoperative or operative data. Eighteen months after surgery, ventricular premature beats were still observed in 81% of patients but remained frequent in 7% only. Severe ventricular arrhythmias were noted in 27%. Patients with severe ventricular arrhythmias had at the time of this late recording a lower radionuclide left ventricular ejection fraction 57 +/- 14%, vs 73 +/- 9 (p less than 0.02) and a higher enddiastolic diameter 63 +/- 15 mm, vs 48 +/- 7, (p less than 0.01). This study indicates that ventricular arrhythmias are common in patients with aortic valve disease. The severity of arrhythmias is influenced by the LV consequences of valve lesion both pre- and late postoperatively. The frequency and severity of ventricular arrhythmias increase early after surgery and do not correlate with preoperative or operative data.
Adult↗
[Spontaneous course of aortic valve disease and indications for aortic valve replacement].
190 adult patients with aortic valve disease have been followed up after initial cardiac catheterization until death or aortic valve replacement (event-free survival). Neither hemodynamic severity nor symptoms alone were reliable predictors of survival, but the combination of both was very helpful. In the presence of hemodynamically and symptomatically severe aortic stenosis and aortic regurgitation only 40% of patients survived for two years, but patients with hemodynamically severe aortic stenosis but with few or no symptoms had 100% survival at two years and 75% were event free at five years. In hemodynamically severe aortic regurgitation two asymptomatic patients died within the first two years (94% survival at two years) and 65% were event free at five years. In the absence of coronary artery disease there was no mortality within the first two years in moderate or mild stenosis and regurgitation regardless of symptomatic status. Hemodynamically and symptomatically severe aortic stenosis and regurgitation have a very poor prognosis and require immediate valve surgery. Asymptomatic and mildly symptomatic patients with hemodynamically severe aortic stenosis are at low risk and surgical treatment can be postponed until marked symptoms appear without significant risk of sudden death. In severe aortic regurgitation, the decision to perform surgery should depend not only on symptoms but should be considered in patients with few or no symptoms because of the risk of sudden death. In the absence of coronary artery disease, hemodynamically moderate aortic valve disease does not require valve surgery on prognostic grounds.
Adolescent↗
Replacement of the aortic root with a pulmonary autograft in children and young adults with aortic-valve disease.
BACKGROUND: The optimal substitute for severely diseased aortic valves in children and young adults is unknown. The use of a mechanical prosthesis requires permanent treatment of the patient with anticoagulants and is associated with thromboembolic and hemorrhagic complications. Aortic-valve allografts and porcine bioprostheses, which do not necessitate anticoagulant therapy, may deteriorate and have limited durability. METHODS: We therefore evaluated the use of the autologous pulmonary valve (i.e., the patient's own pulmonary valve) and the adjacent pulmonary artery as a replacement for the aortic valve and aortic sinuses in 33 patients. Five of the patients were from 8 to 16 years of age, and 28 were from 20 to 47 years of age. The pulmonary valve and the main pulmonary artery were used to replace the diseased aortic valve and the adjacent aorta. The coronary arteries were detached from the aorta and implanted into the pulmonary artery. The pulmonary valve and artery were replaced with a cryopreserved pulmonary allograft. RESULTS: There were no deaths during follow-up of up to 48 months (mean, 21 months). There were no episodes of infective endocarditis, and no reoperations on the aortic root were necessary. Also, there was no evidence on echocardiography of progressive dilatation of the autografts. With color-flow Doppler imaging, 22 patients were found to have only trivial regurgitation or none, 9 patients to have mild regurgitation, and no patients to have moderate or severe regurgitation across the autograft at the most recent follow-up visit. The mean peak velocity of flow across the autograft was 1.3 m per second (upper limit of normal, 1.8), indicating the absence of stenosis. One patient required reoperation for stenosis of the pulmonary allograft. CONCLUSIONS: Although the pulmonary-autograft procedure is more complex than simple aortic-valve replacement, it has been safely applied in selected patients, including young adults. Intermediate follow-up indicates satisfactory function of the autografts, with no dilatation or progressive valvular regurgitation. Pulmonary-root autografts may thus be the best available substitute for diseased aortic valves in children and young adults.
Adolescent↗
Aortic valve disease.
AORTIC STENOSIS Clinical suspicion of significant aortic stenosis even in the presence of a normal chest X-ray and electrocardiogram should lead to careful 2-D echocardiographic examination. The lesion can be adjudged mild and the subject probably certificated if the recording shows normal septal and posterior wall thickness, normal left ventricular dimensions and fractional shortening and a valve opening greater than 15 mm. In cases of doubt or where technically satisfactory echocardiograms are unobtainable, cardiac catheterization is likely to be mandatory. For unrestricted certification the peak systolic gradient across the valve should be less than 20 mmHg and the LV end-diastolic pressure less than 12 mmHg at rest, and both must remain within these limits on exercise to three times resting oxygen consumption. AORTIC REGURGITATION Any abnormality of electrocardiogram at rest or on exercise, or of the chest X-ray, any increase in left ventricular dimensions on echocardiography, a diastolic pressure below 65 mmHg and/or pulse pressure greater than 55 mmHg is likely to lead to cardiac catheterization. For full certification any angiographic regurgitation should be trivial.
Adult↗
The natural history of aortic valve disease after mitral valve surgery.
OBJECTIVES: The present study evaluates the long-term course of aortic valve disease and the need for aortic valve surgery in patients with rheumatic mitral valve disease who underwent mitral valve surgery. BACKGROUND: Little is known about the natural history of aortic valve disease in patients undergoing mitral valve surgery for rheumatic mitral valve disease. In addition there is no firm policy regarding the appropriate treatment of mild aortic valve disease while replacing the mitral valve. METHODS: One-hundred thirty-one patients (44 male, 87 female; mean age 61+/-13 yr, range 35 to 89) were followed after mitral valve surgery for a mean period of 13+/-7 years. All patients had rheumatic heart disease. Aortic valve function was assessed preoperatively by cardiac catheterization and during follow-up by transthoracic echocardiography. RESULTS: At the time of mitral valve surgery, 59 patients (45%) had mild aortic valve disease: 7 (5%) aortic stenosis (AS), 58 (44%) aortic regurgitation (AR). At the end of follow-up, 96 patients (73%) had aortic valve disease: 33 AS (mild or moderate except in two cases) and 90 AR (mild or moderate except in one case). Among patients without aortic valve disease at the time of the mitral valve surgery, only three patients developed significant aortic valve disease after 25 years of follow-up procedures. Disease progression was noted in three of the seven patients with AS (2 to severe) and in six of the fifty eight with AR (1 to severe). Fifty two (90%) with mild AR remained stable after a mean follow-up period of 16 years. In only three patients (2%) the aortic valve disease progressed significantly after 9, 17 and 22 years. In only six patients of the entire cohort (5%), aortic valve replacement was needed after a mean period of 21 years (range 15 to 33). In four of them the primary indication for the second surgery was dysfunction of the prosthetic mitral valve. CONCLUSIONS: Our findings indicate that, among patients with rheumatic heart disease, a considerable number of patients have mild aortic valve disease at the time of mitral valve surgery. Yet most do not progress to severe disease, and aortic valve replacement is rarely needed after a long follow-up period. Thus, prophylactic valve replacement is not indicated in these cases.
Adolescent↗
The Ross procedure: Is it the ideal operation for the young with aortic valve disease?
BACKGROUND: Aortic valve prosthesis with adequate hemodynamic performance should allow more complete left ventricular mass regression and normalize left ventricular function. This possibly affects long-term prognosis after aortic valve replacement. OBJECTIVE: Assessment of hemodynamic performance of pulmonary autograft in the aortic position and the regression of left ventricular mass after the Ross procedure. METHODS: Between May 1995 and March 1996, 45 patients with mean age of 27.1 years underwent a Ross procedure. Doppler echocardiography and cardiac catheterization were performed on all patients before hospital discharge to evaluate the hemodynamic performance of auto- and homografts, as well as to evaluate left ventricular mass and function. Fourteen patients with follow-up longer than six months were submitted to dobutamine stress echocardiography to study the hemodynamic performance of auto- and homografts during exercise. RESULTS: Hospital mortality was 6%. After a mean follow-up of 12.8 months (1-23 months) there was one late sudden death. No valve-related event was observed during this period. Immediate and late hemodynamic performance of the pulmonary autografts were normal with an average mean gradient of 1.8 +/- 0.6 mmHg and an average maximum instantaneous gradient of 2.9 +/- 0.9 mmHg. Valvular insufficiency was insignificant. Even during exercise, gradients did not increase significantly with an average mean gradient of 4.3 +/- 2.5 mmHg and an average maximum gradient of 10.4 +/- 6.1 mmHg. Homografts used for right ventricular reconstruction showed excellent immediate hemodynamic performance. However, at late follow-up an increase in flow speed was observed with an average to mean gradient of 10 +/- 7.1 mmHg at rest and 26 +/- 13.2 mmHg during exercise. Left ventricular mass index was normal at rest and during exercise in the majority of patients. CONCLUSION: Given the normal hemodynamic function of pulmonary autografts, the reduction of ventricular mass and normalization of left ventricular function, in addition to the excellent late follow-up of the patients, the Ross procedure is considered the operation of choice for young patients requiring aortic valve replacement.
Adolescent↗
[Acquired valvular diseases. 3. Aortic valve disease].
Explore the source record for details and available documents.
Adult↗
Aortic valve disease.
Management of aortic valve disease follows traditional algorithms: initial gross diagnosis, noninvasive imaging and quantitation, possible catheterization or angiography, and medical treatment until symptoms of prognosis prediction indicates surgery. Most advances in this subject reflect improved technology and additional data collection therefrom, and subsequent analysis. Noninvasive imaging, especially Doppler echocardiography and nuclear magnetic resonance imaging, enjoy continued refinement. Diastolic dysfunction, a particular pathophysiologic feature of aortic valve disease, has become more clearly characterized. New data reaffirm the old truth that heart failure in infective endocarditis foretells the need for surgery. Though we know more about aortic balloon valvotomy, it is only a temporary treatment. Surgeons still seek the perfect valve prosthesis. Lastly, technology has not lessened the high incidence of rheumatic heart disease in impoverished countries.
Aortic Valve↗
Association of Paget's disease of bone with calcific aortic valve disease.
To test the hypothesis that Paget's disease of bone is associated with a greater incidence of calcific aortic valve disease, a computer-generated list was obtained of all autopsy subjects from the Johns Hopkins Hospital in whom Paget's disease was diagnosed (n = 92). The severity of Paget's disease and cardiac valvular lesions was graded on a scale of 0 to 3, with 3 as the most severe. Two control cases were obtained for each case of Paget's disease. Each was the case either immediately before or after the Paget's case, and was matched for age, race, sex, and extent of autopsy. The incidences of moderate (10.9 percent) and severe (5.4 percent) calcific aortic valve disease were both fourfold greater than in the control group (chi-square analysis, p less than 0.01 and p less than 0.05, respectively). Additionally, the frequency of advancing grades of calcific aortic valve disease was greater in more advanced stages of Paget's disease. In fact, there was a dose-response effect of Paget's disease upon calcific aortic valve disease (trend analysis for proportion, p less than 0.01). These data therefore support the hypothesis that Paget's disease is associated with calcific aortic valve disease in a dose-response manner.
Aged↗