OBJECTIVE: The performance of the Ross procedure in the case of geometric mismatch between pulmonary autograft and a bicuspid aortic root has not yet been fully evaluated. To prevent geometrically caused autograft dysfunction, a modification of the surgical technique is necessary. METHODS: Between January 1996 and January 2007, 50 patients ...

BACKGROUND: Evaluation of aortic valve stenosis is a major clinical application of echocardiography. The widely employed continuity equation requires determination of the left ventricular outflow tract (LVOT) area. We aimed at testing whether direct area measurement in a volume data set is superior to conventional calculation from the LVOT diameter. ...

The paper by Fratz et al. describes the follow-up of 188 children who had balloon aortic valvuloplasty (AoVP) between 1986 and 2004. Moderate or severe aortic regurgitation occurred more often in the 68 neonates--in whom there was significant early mortality--than in the 120 older children; however, AoVP produced a satisfactory ...

Calcific aortic valve stenosis is the result of regulated cell processes. The histological hallmarks are inflammation and a remodelling of the extracellular matrix leading to bone formation. In the last 15 years the view has changed from it being an unmodifiable degenerative disease to an active biological process regulated by ...

BACKGROUND AND AIM OF THE STUDY: Aortic valve sclerosis is fairly common and is currently seen as a marker of systemic atherosclerosis. For unclear reasons only a minority of those sclerotic valves will evolve to become stenotic suggesting that atherogenic factors alone are insufficient to explain the development of valve ...

We report a case with very early antenatal diagnosis of aortico-left ventricular tunnel (ALVT) at 22 weeks of pregnancy. Early recognition of ALVT by antenatal ultrasound allows prompt neonatal management and avoidance of harmful aortic valve regurgitation. The present case is unique because of the conjunction of very early antenatal ...

The prognosis for patients with symptomatic aortic stenosis is poor but is improved significantly by surgical aortic valve replacement. Unfortunately, many patients are refused surgery because of age, comorbidities, and hemodynamic instability. This report describes the successful use of balloon aortic valvuloplasty as a bridge to aortic valve bypass surgery ...

OBJECTIVES: Our purpose was to investigate a new approach to bicommissural repair of regurgitant aortic valves. BACKGROUND: Repair of regurgitant aortic valves is not widely accepted, but interest is increasing, particularly for bicuspid valves. We hypothesize that a systematic, segmental approach to morphology and corresponding morphology-directed repair will improve decision ...

We describe the case of a 53-year-old man with a severely stenotic bicuspid aortic valve combined with an unruptured aneurysm of the left sinus of Valsalva and an aberrant left coronary artery. The patient was successfully treated with aortic valve replacement and closure of the aneurysm. It is well known ...

To establish the normal criterion of ascending aortic diameter (AAOD) measured by 64 multidetector computed tomography (MDCT) and electron beam computed tomography (EBT) based on gender and age. A total of 1442 consecutive subjects who were referred for evaluation of possible coronary artery disease underwent coronary computed tomographic (CT) angiography ...

OBJECTIVE: In clinical practice, 64-MDCT coronary angiography is increasingly being used for exclusion of coronary artery disease. Therefore, the purpose of this study was to evaluate whether aortic valve regurgitation can be diagnosed with 64-MDCT in comparison with transthoracic echocardiography. MATERIALS AND METHODS: Eighty-one consecutive patients were examined with ECG-gated ...

Aortic valve stenosis is a common disease. Despite this, the diagnosis may often be missed; a significant proportion of patients are still identified at post-mortem examination, and 5% of operations are performed at end stage. Unrecognized aortic valve stenosis is an important cause of anesthetic mortality. One reason for failing ...

BACKGROUND: Recent US and European registries have indicated 30% to 60% of patients with critical valvular aortic stenosis (AS) are not treated surgically, usually due to advanced age and comorbidities. We report on a Food and Drug Administration approved feasibility study of a less invasive transcatheter approach to potentially treat ...

We report a case on an early complication of a biological pericardial tissue valve in the aortic position that required emergency replacement. One of the three leaflets of the valve was stuck open in a fixed-open position and would not unfold in diastole. This resulted in severe aortic insufficiency, diagnosed ...

BACKGROUND: Repair of prolapsed aortic valve leaflets has been considered a challenging technique for cardiac surgeons. In this paper we describe our surgical approach, "the chordae technique." It consists of the correction of aortic cusp prolapse by shortening the free margin length and of an adjustment of the leaflets coaptation ...

Calcification of the aortic valve leads to stenosis or regurgitation or both. To clarify the mechanism of heart valve calcification, comparative studies using histological and ultrastructural examinations were performed of calcified aortic valves. These valves were obtained at valve replacement surgery from 11 patients with rheumatic aortic valvular disease (RAVD), ...

BACKGROUND: Unicuspid anatomy of the aortic valve is infrequent but may require intervention by age 40 for severe regurgitation. We propose a new repair technique for the regurgitant unicuspid valve by converting it into a bicuspid aortic valve. METHODS: Between November 2003 and September 2007, 20 patients underwent regurgitant unicuspid ...

A key element to the success of aortic valve reimplantation (David's procedure) is the position of the aortic annulus in the Dacron tube (DuPont, Wilmington, DE). The variable level of the right ventricular insertion can cause technical difficulties, especially when the right ventricular insertion occurs above the aortic annulus. To ...

We describe the case of a 43 year old man with a history of aortic stenosis, for which he had undergone aortic valve replacement in 1991 with a 25-mm Medtronic Hall prosthesis. He presented with several acute episodes of dyspnea and flash pulmonary edema. Transthoracic and transesophageal echocardiography performed to ...

OBJECTIVES: Our goal was to determine the prevalence and characteristics of aortic valve disease in girls and women with monosomy for the X chromosome, or Turner syndrome (TS). BACKGROUND: Complications from congenital aortic valve disease are a major source of premature mortality in TS, but accurate data on the prevalence ...

Giant cell arteritis (GCA) is a well-known entity, creating aortic valve regurgitation secondary to dilatation of the aortic wall. No direct involvement of the aortic valve leaflets has yet been documented. A 75-year-old woman with a history of polymyalgia rheumatica and Horton disease was admitted to the authors' institution with ...

The article by Sack and co-workers published in this issue presents the results of a retrospective study on the treatment of severe calcified aortic stenosis (AS) by means of balloon aortic valvuloplasty (BAV) in the elderly patient. While arguing that BAV should be used in patients unfit for surgical aortic ...

We describe the case of a 70-year-old man who presented with increasing exertional dyspnea. He was found to have an ejection systolic murmur and evidence of right ventricular outflow tract obstruction, with a peak velocity of 4.5 m/s recorded by transthoracic Doppler echocardiography. Cardiovascular magnetic resonance showed right ventricular hypertrophy, ...

OBJECTIVE: Transluminal in vitro resection of severely calcified human aortic valves has already been successfully carried out by our group. The aim of this study was to analyze endovascular laser-assisted resection of human aortic valves in situ in 10 human cadavers. MATERIAL AND METHODS: After anterolateral minithoracotomy, the aortic valve ...

AIMS: Mitral annular calcification (MAC) is characterized by calcium and lipid deposition in the annular fibrosa of the mitral valve. Although individuals with MAC are at increased risk of cardiovascular events, little is known about the significance of this finding in patients with concurrent aortic stenosis (AS). The aim of ...

The 2006 practice guidelines from the American College of Cardiology and the American Heart Association recommend prophylactic aortic replacement for even an asymptomatic patient with a bicuspid aortic valve (BAV) when the aortic dimensions exceed arbitrary ranges based on Marfan syndrome, without comparing risk estimates of aortic dissection with operative ...

Simultaneous en bloc replacement of the ascending aorta and aortic valve by a composite valve graft, as first described by Bentall and De Bono in 1968 and with later modifications, has become the standard surgical technique in the treatment of aneurysms of the aortic root associated with severe aortic valve ...

Quadricuspid aortic valves are rare congenital anomalies, usually diagnosed in adult patients affected by severe aortic regurgitation. We have now encountered three such valves in children undergoing transthoracic echocardiography. All children were asymptomatic. The first child possessed a valve with two larger leaflets, and smaller leaflets of equal size. In ...

A 42-year-old man suffering from massive aortic valve regurgitation with mild stenosis because of a bicuspid valve underwent surgery in May 2007. The surgical procedure was performed through a right anterolateral thoracotomy using the peripheral cannulation method. Cardiac arrest was achieved by direct aortic cross-clamping and selective cardioplegia delivery. The ...

Percutaneous valve replacement is developing into an effective and reproducible therapy for aortic valve stenosis. Initial experience suggests that outcomes compare favorably with conventional valve surgery in selected patients with comorbidities, such as advanced age. Caution is prudent, however, in the future a more mature procedure might represent a viable ...

OBJECTIVES AND BACKGROUND: Percutaneous aortic valve replacement is a new less-invasive alternative for high-risk surgical candidates with aortic stenosis. However, the clinical experience is still limited, and the currently available 'first-generation devices' revealed technical shortcomings, such as lack of repositionability and presence of paravalvular leakages. We report the first-in-man experience ...

In the aortic valve-sparing reimplantation technique, insertion of the anchoring sutures beneath the valve is a crucial but difficult step because the spared aortic cusps obscure the field of view. We present a novel and easy method of placing these anchoring stitches with good exposure of the subvalvular tissue.

Increased life-expectancy has led to a growing elderly population frequently presenting with aortic stenosis. This review focuses on the pathogenesis of calcific aortic stenosis, diagnosis and possible ways to halt the progression to severe symptomatic aortic stenosis, methods of assessing symptoms and severity, and modalities and timing of aortic valve ...

Aortic stenosis (AS) is the most common indication for valve surgery. Recent data suggested an increased risk of cerebral emboli when the aortic valve is crossed to obtain 'pull-back' gradient. We conducted a large questionnaire based study to evaluate current practice in the assessment of aortic valve gradient amongst cardiologists ...

We report, to the best of our knowledge, the first case of fatty infiltration involving a semilunar cardiac valve. A non-obese 79-year-old man had an echogenic mass in the right coronary cusp on transesophageal echocardiography attributed to fatty infiltration. Fat in this location is extraordinary, and may arise from pluripotential ...

OBJECTIVE: Reoperation rates after repair of bicuspid aortic valves are higher than for mitral valve reconstruction. Satisfactory results have been reported for patch augmentation for tricuspid aortic valves. We have applied this technique for the repair of bicuspid aortic valves. METHODS: Autologous pericardium is sutured to the free edge of ...

Alkaptonuria is a rare, inherited defect of homogentisic acid 1,2-dioxygenase that leads to the widespread deposition of polymeric homogentisic acid, and clinical symptoms from degeneration of joints and the aortic valve. Pathological descriptions are few and mainly those of late-stage changes related to joint or valve failure. In this review, ...

BACKGROUND: Aneurysms of the ascending aorta occur as result of intrinsic changes in the aortic wall and have been well documented in patients with bicuspid aortic valve (BAV). In few reported clinical studies, documenting aneurysmal dilatation in unicommissural aortic valves (UAV); there have been no comments on the aortic wall ...

Calcific aortic valve sclerosis is characterized by focal lesions in the valve leaflet. These lesions are rich in myofibroblasts that express α-SMA and cause fibrosis. Lesions tend to occur in regions of the leaflet that are subjected to large bending loads, suggesting a mechanobiological basis for myofibrogenic differentiation and valve ...

Previously, aortic valve stenosis (AS) etiology was usually congenital or due to rheumatic disease. However, the most frequent cause is now degenerative AS, which is often part of a continuum including increased rigidity of the aorta due to atherosclerosis and left ventricular dysfunction due to coronary artery disease. This article ...

A bicuspid aortic valve (BAV) often causes aortic stenosis (AS) or regurgitation (AR). In 54 patients with a BAV (48 +/- 16 years), transthoracic and transesophageal echo were performed to measure aortic annulus diameter (AAD), to evaluate the severity of aortic valve disease (AVD) and to calculate the area eccentricity ...

Quadricuspid aortic valve is the rarest congenital anomaly of the semilunar valves. In the past it has been frequently detected incidentally at autopsy or during cardiac surgery. Recently, the evolution of diagnostic techniques with Doppler analysis has allowed to identify preoperatively this uncommon cardiac abnormality. We report a case of ...

OBJECTIVES: To evaluate the presence and extent of cardiac calcifications and aortic stiffness in patients with end-stage renal disease (ESRD). PATIENTS AND METHODS: The study group consisted of 60 patients with ESRD with a mean age of 51.7 years, treated with peritoneal dialysis. In all patients transthoracic echocardiogram was performed ...

BACKGROUND: Quadricuspid aortic valve is one of the rare forms of congenital cardiac valvular disease. Its diagnosis is often missed, even with the transthoracic echocardiogram. Many of these patients progress to aortic incompetence later in life requiring surgical intervention. In addition, quadricuspid aortic valve can be associated with other congenital ...

BACKGROUND AND AIM OF THE STUDY: Although degenerative calcific aortic valve stenosis is the most common valvular disease among the elderly, neither the etiology underlying the condition nor degeneration of the bioprostheses is yet fully understood. The study aim was to assess the expression profile of those OPG/RANKL/RANK-system determinants known ...

BACKGROUND AND AIM OF THE STUDY: An improved understanding of aortic valvar anatomy could assist in further developing surgical repair of the valve. The study aim was to evaluate the three-dimensional (3-D) geometry of the aortic valve in normal human hearts. METHODS: In eight human cadaver hearts, the aorta and ...

A 43-year-old man came to the hospital because of increasing dyspnea for two weeks. At age nine months the patient was evaluated for failure to thrive, and a diagnosis of valvular aortic stenosis was made. At operation the aortic stenosis was found to be supravalvular, and the ascending aorta was ...

Quadricuspid aortic valve is a rare congenital abnormality; it is usually an isolated lesion, but several concomitant congenital abnormalities have been described. We report a case of congenital quadricuspid aortic valve associated with obstructive hypertrophic cardiomyopathy. Two-dimensional (2D) transthoracic and transesophageal echocardiography and real-time three-dimensional (3D) echocardiography clarified the morphological ...

Aortic valve replacement can produce dramatic benefit in the setting of aortic stenosis. The potential for morbidity and mortality associated with thoracotomy, cardiopulmonary bypass, and aortotomy has fostered a search for alternatives. Early experience with transcatheter endovascular aortic valve implantation demonstrated feasibility and durability, but the procedure was difficult to ...

OBJECTIVE: To establish a classification of bicuspid aortic valve (BAV) that includes both leaflet morphology and aortic shape. SETTING: Two academic medical centres of the University of Washington, Seattle. PATIENTS: 191 adult patients with BAV. INTERVENTIONS: Review of clinical data and transthoracic echocardiograms. MAIN OUTCOME MEASURES: Assessment of leaflet morphology; ...