OBJECTIVE: This study evaluates the feasibility of off-pump native aortic valve removal in preparation for transapical aortic valve replacement. Off-pump aortic valve replacement is performed by balloon predilatation of the native valve followed by insertion of a stented prosthesis. In patients with calcified annuli and cusps, particulate embolization, suboptimal prosthesis ...

Since their introduction in 1990, modern stentless aortic prostheses have by now obtained wide acceptance in the treatment of aortic valve disease. Despite the favourable results of using different techniques, concerns still remain about the durability of this device, especially regarding mineralisation. We present the first report, to our knowledge, ...

Aortic stenosis (AS) will likely become increasingly frequent with the aging of the American population. The difficulties in treating elderly patients with critical AS emphasize the potential value of a strategy to slow the advancement of aortic valve calcification. Recent prospective trials of statins and angiotensin-converting enzyme inhibitors have been ...

In this study, the correlation dimension analysis has been applied to the aortic valve Doppler signals to investigate the complexity of the Doppler signals which belong to aortic stenosis (AS) and aortic insufficiency (AI) diseases and healthy case. The Doppler signals of 20 healthy subjects, ten AS and ten AI ...

Apico-aortic conduit (AAC) is an alternative to conventional aortic valve replacement (AVR) in selected high-risk patients. It involves the interposition of a vascular graft with a prosthetic valve from the left ventricular (LV) apex to the descending thoracic aorta. Its use is uncommon but increasing. We describe the complication of ...

Treatment of hyperlipidemia produces functional and structural improvements in atherosclerotic vessels. However, the effects of treating hyperlipidemia on the structure and function of the aortic valve have been controversial, and any effects could be confounded by pleiotropic effects of hypolipidemic treatment. The goal of this study was to determine whether ...

OBJECTIVE: Transluminal resection of the aortic valve was already successfully carried out by our group. The aim of this study was the analysis of the gross anatomy and the histology of the surrounding tissue after resection. METHODS: Aortic valve resection was performed in postmortem human hearts (endoluminal (EL) n=9, transapical ...

Blood and/or blood product transfusions are common during and after complicated cardiac procedures. Replacement of the aortic valve, ascending aorta, and coronary implantation requiring circulatory arrest are high-risk procedures. Blood product transfusions only add to the morbidity and mortality rates associated with these types of procedures. Perfusion strategies must be ...

OBJECTIVES: Percutaneous aortic valve insertion is an emerging treatment option for selected patients with severe aortic stenosis and may be done from a transfemoral or transapical approach. Concomitant atherosclerotic peripheral artery disease limits transfemoral access. We evaluated the potential role of multidetector computed tomography in preoperative assessment of vascular anatomy. ...

The case is reported of a 32-year-old male with an aortic valve injury received in a high-speed traffic accident. Several non-cardiac concomitant injuries were present, none of them life-threatening. Cardiac surgery was performed on day 2 due to a grade III aortic valve insufficiency. The presence of a large tear ...

Aortic valvular stenosis remains the most common debilitating valvular heart lesion. Despite the benefit of aortic valve (AV) replacement, many high-risk patients cannot tolerate surgery. AV implantation treats aortic stenosis without subjecting patients to sternotomy, cardiopulmonary bypass (CPB), and aorta cross-clamping. This transcatheter procedure is performed via puncture of the ...

OBJECTIVE: Aortic stenosis is the most common valvular heart disease in the Western world and the proportion of patients unsuitable for conventional surgery is increasing as a result of aging and comorbidities. We report our early experience with transcatheter aortic valve implantation in high-risk patients with severe symptomatic aortic stenosis. ...

BACKGROUND AND AIM OF THE STUDY: The incidence of bicuspidity and quadricuspidity of arterial valves in donor hearts has been assessed in the European Homograft Bank. METHODS: Morphologically unacceptable donor valves for clinical use were assessed for cusp or leaflet malformation, identifying the different valve types. The state of the ...

The mitro-aortic intervalvular fibrosa (MAIF) connects the anterior mitral leaflet to the posterior portion of the aortic annulus. The aneurysms of MAIF represent a complication of aortic valve endocarditis, but blunt chest trauma, aortic valve replacement and congenital heart disease have also been reported as a cause. We describe a ...

Surgical aortic valve replacement (AVR) is the standard of care for patients with symptomatic severe aortic stenosis (AS), providing relief of symptoms and prolonging survival. However, many patients are either denied or not offered surgery due to high surgical risk or non-operability for open AVR. The technology of percutaneous aortic ...

OBJECTIVES: Reimplantation valve-sparing aortic root replacement has been increasingly performed with improving perioperative and mid-term results. The success of this operation primarily depends on preserving the highly sophisticated dynamic function of the aortic valve by recreating an anatomical three-dimensional configuration similar to the normal aortic root, thus minimizing the mechanical ...

BACKGROUND: Bicuspid aortic valve (BAV) is a heritable condition that has been linked by an unknown mechanism to a predisposition for ascending aortic aneurysm. Matrix metalloproteinases have been implicated in this predisposition. Metallothionein is a poorly characterized, metal-binding protein that regulates matrix metalloproteinases and is an antioxidant known to be ...

OBJECTIVE: The Ross procedure offers good autograft function and low reoperation rates for the neoaortic valve; however, the rate of conduit dysfunction in the right ventricular outflow tract remains a concern. This study assessed percutaneous pulmonary valve implantation in this setting. METHODS: We retrospectively analyzed outcomes of 12 patients (mean ...

OBJECTIVES: The aim of this study was to evaluate the role of valve endothelium in regulating the mechanical properties of aortic valve cusps. BACKGROUND: Mechanical properties of valve cusps are key to their function and durability; however, little is known about the regulation of valve biomechanics. METHODS: Mechanical properties of ...

Calcific aortic stenosis is the most common cause of aortic valve replacement in developed countries, and this condition increases in prevalence with advancing age. The fibrotic thickening and calcification are common eventual endpoint in both non-rheumatic calcific and rheumatic aortic stenoses. New observations in human aortic valves support the hypothesis ...

PURPOSE: The purpose of this study was to evaluate the effect of aortic valve replacement on electrocardiogram (ECG) in patients with aortic valve stenosis. METHODS: Serial 12-lead ECGs were obtained in 15 patients with aortic valve stenosis who underwent aortic valve replacement. Three ECG indexes for left ventricular hypertrophy were ...

Percutaneous aortic valve replacement is an emerging alternative to palliative medical therapy for nonsurgical patients with severe aortic valve stenosis. The impossibility of repositioning of the current transcatheter prosthesis in case of suboptimal placement is the main limit of these devices. Here, we report on a case of an 84-year-old ...

To assess the midterm follow-up of reduction aortoplasty with external wrapping associated with aortic valve replacement in high risk patients. Six patients with ascending aortic aneurysm and aortic valve disease were included in this study. Four of them were male. The age ranged from 61 to 70 years (mean 65.7 ...

BACKGROUND/AIMS: Severe aortic stenosis (AS) is associated with hypertrophy of the left ventricle (LVH), which is linked to adverse clinical outcomes. To date, the effects of the novel technology of percutaneous aortic valve replacement (PAVR) on LVH in severe AS have not been described. We sought to test the hypothesis ...

Bicuspid aortic valve (BAV) is associated with annuloaortic ectasia, dissection and ascending aortic aneurysm. The high incidence of this congenital malformation and aortic disease suggests a close correlation between the two phenomena. Abnormalities in different phases of cell migration of the neural crest might be responsible for the occurrence of ...

The incidence of aortic valve stenosis is growing rapidly in the elderly. Nonetheless, many symptomatic patients are not referred for surgery usually because of high surgical risk. Unfortunately, percutaneous balloon valvuloplasty is unsatisfactory due to high recurrence rates. In 2002, Cribier and colleagues were the first to describe percutaneous aortic ...

BACKGROUND: Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety ...

In this case report we illustrate our experience with a perforation of the pulmonary trunk during a transapical aortic valve implantation in a single case. The patient suffered from an aortic valve stenosis and was accepted for a minimally invasive procedure because of multiple comorbidities. After unproblematic transapical placement of ...

Aortic valve disease is a common valvular heart disease but the underlying pathology that leads to the severe dysfunction of the aortic valve is unclear. There is increasing interest in the role of hypercholesterolaemia in the causation and progression of aortic valve disease. Apolipoprotein E is an essential component of ...

The inflammatory process of aortic stenosis involves the differentiation of aortic valve myofibroblasts into osteoblasts. Osteopontin, a proinflammatory glycoprotein, both stimulates differentiation of myofibroblasts and regulates the deposition of calcium by osteoblasts. Osteopontin levels are increased in patients with such conditions as end-stage renal disease, ectopic calcification, and autoimmune disease. ...

Most studies concerning aortic valve structure in patients having aortic valve replacement have utilized the valve structure (unicuspid, bicuspid, tricuspid) as that called by the cardiac surgeon performing the operation. We determined valve structure of 744 operatively excised stenotic aortic valves submitted to the surgical pathology laboratory of a single ...

We report on an 81-year old man with decompensated severe aortic regurgitation due to a large paravalvular leakage of mechanical aortic valve prosthesis. Because of relevant co- morbidities the patient was unable to undergo cardiovascular surgery. Non- invasive imaging allowed exact localization of the leakage and sizing of the defect ...

A 67-year-old male who had received an aortic porcine bioprosthesis 15 years previously, presented with unstable angina. The patient underwent percutaneous coronary intervention with the resolution of chest pain. A limited predischarge echocardiogram showed evidence of a newly severely elevated left ventricular filling pressure and new eccentric aortic regurgitation. Six ...

OBJECTIVE: The purpose of this study was to review the management of anesthesia for transapical transcatheter aortic valve implantation. DESIGN: Retrospective review of collected data. SETTING: University-affiliated heart center. PARTICIPANTS: One hundred consecutive patients with severe aortic stenosis. INTERVENTIONS: General anesthesia followed by an established fast-track protocol. MATERIALS AND METHODS: ...

We present a fundamental theoretical framework for analysis of energy dissipation in any component of the circulatory system and formulate the full energy budget for both venous and arterial circulations. New indices allowing disease-specific subject-to-subject comparisons and disease-to-disease hemodynamic evaluation (quantifying the hemodynamic severity of one vascular disease type to ...

Aortic valve (AV) sparing procedures are increasingly being used to treat aortic root pathology. Reimplantation of the aortic valve, first described by Dr Tirone David, is a technically demanding procedure whose long-term results are critically dependent on perfect intraoperative restoration of valve anatomy and function. There exists significant variation in ...

The association between gastrointestinal (GI) bleeding due to angiodysplasia of the large intestine and calcific aortic stenosis (AS) has been a matter of debate. Recent studies suggest that this association is related to subtle alterations in plasma coagulation factors. von Willebrand factor is the strongest possible link between aortic stenosis ...

We report the case of a 79-year-old man with low-flow, low-gradient aortic stenosis who underwent transapical aortic valve implantation. The deployment of a 26-mm Edwards SAPIEN valve (Edwards Lifesciences Inc, Irvine, CA) was complicated with the occurrence of severe central aortic regurgitation that was successfully treated with the implantation of ...

We investigated the relative contribution of hemodynamic and clinical factors to serum natriuretic peptide elevation in seventy-one patients with either aortic stenosis or aortic regurgitation. We found that pulmonary hypertension, heart failure and renal failure are the most powerful independent predictors of natriuretic peptide elevation in patients with aortic valve ...

The morbidity and mortality burden of heart valve disease is increasing in the developing world, especially among the elderly. Whereas surgery remains the standard of care in fit patients with degenerative aortic stenosis, percutaneous aortic valve replacement could become an effective alternative to surgery in selected higher risk patients. The ...

We report here on a surgical case of acquired left ventricular right atrial communication (LV-RA communication) and aortic regurgitation (AR) caused by infective endocarditis (IE). We successfully treated the patient with composite patches made from polytetrafluoroethylene (PTFE) and autologous pericardium. In general, LV-RA communication is a rare congenital cardiac anomaly ...

Decompensated aortic valve stenosis is a life-threatening condition. Aortic valve replacement in patients with cardiogenic shock due to critical aortic stenosis is a high-risk procedure and is associated with increased operative mortality. We describe the clinical course of a patient who was transferred to our institution in cardiogenic shock and ...

AIMS: Continuity equation to evaluate aortic valve area (AVA(CE)) is critically dependent on accurate measurement of left ventricular outflow tract diameter and velocity. To circumvent these limitations, the present study aimed to generate nomograms for a facilitated estimation of aortic valve area using peak aortic valve pressure gradient (DeltapAv) and ...

Aortic stenosis is a common finding at echocardiography. This review describes the assessment of the aortic valve, the left ventricle, and the rest of the heart. It discusses grading the stenosis including cases in which there are discrepancies between the different echocardiographic measurements. It discusses the indications for and interpretation ...

We report a case of a fast-growing cardiac papillary fibroelastoma (CPF) arising in the aortic valve. A 71-year-old woman was referred to a cardiologist for investigation of palpitations. Cardiac catheterization, coronary angiography, and echocardiography showed no stenosis of the coronary arteries, nor any other cardiovascular abnormalities. However, 12 months later ...

Transcatheter aortic valve implantation (TAVI) is a new technology that treats severe aortic stenosis. The technology has specific and mandatory technical requirements that must be met to allow safe and successful procedures. The echocardiographic method for diagnosis of aortic stenosis, anatomical case selection, procedural guidance and management of complications is ...

Acquired aortic stenosis (AS) resulting from calcification of the aortic valve is the most frequent acquired valve disease in Europe. Due to the increasing average life expectancy the population in the western industrial world is aging, and consequently the prevalence of AS requiring aortic valve replacement (AVR), particularly in older ...

BACKGROUND: Cardiovascular magnetic resonance (CMR) can potentially quantify aortic valve area (AVA) in aortic stenosis (AS) using a single-slice phase contrast (PC) acquisition at valve level: AVA = aortic flow/aortic velocity-time integral (VTI). However, CMR has been shown to underestimate aortic flow in turbulent high velocity jets, due to intra-voxel ...

The surgical management of porcelain aorta in patients requiring aortic valve replacement or coronary artery surgery carries a high morbidity and mortality and remains controversial. We report a successful transapical aortic valve implantation in combination with on-pump coronary artery bypass grafting in a young patient with severe aortic stenosis, left ...

We present a case with the previously unreported finding of an a-dip in the M-mode tracing of the aortic valve. An a-dip is commonly seen in the M-mode tracing of the pulmonic valve motion, and represents near equalization of pulmonary artery and right ventricular end- -diastolic pressures during atrial contraction. ...