Ventricular Septal Defect and Aortic Valve Regurgitation: Pathophysiology and Indications for Surgery

2006 ◽  
Vol 9 (1) ◽  
pp. 147-152 ◽  
Author(s):  
James S. Tweddell ◽  
Andrew N. Pelech ◽  
Peter C. Frommelt
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Indications For Surgery ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation

Surgery on a Patient with Iatrogenic Aortic Valve Leaflet Perforation after Repair of a Congenital Ventricular Septal Defect

2015 ◽  
Vol 16 (2) ◽  
pp. 103 ◽  
Author(s):  
Tao Zhang ◽  
Shengli Jiang ◽  
Yao Wang ◽  
Mingyan Cheng ◽  
Tingting Cheng ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Valve Leaflet ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Iatrogenic Perforation ◽  
Aortic Valve Leaflet ◽  
Cardiac Operations ◽  
Successful Repair

Aortic valve regurgitation caused by a leaflet perforation occurs most often with infective endocarditis involving the aortic valve. Although rare, leaflet perforation can be caused by suture-related injury during cardiac operations, such as mitral valve replacement, ventricular septal defect (VSD) repair, and repair of an ostium primum atrial septal defect. Few reports have described this form of iatrogenic aortic valve leaflet perforation. We used a pericardial patch in a successful repair of an iatrogenic perforation in an aortic valve leaflet that occurred after simple VSD repair.

A Case of Unicuspid Aortic Valve Associated with a Single Coronary Artery and Ventricular Septal Defect

Choonpa Igaku ◽  
2006 ◽  
Vol 33 (1) ◽  
pp. 75-81
Author(s):  
Hiroko ISHIGAMI ◽  
Masatsugu IWASE ◽  
Keiko HYOUDO ◽  
Idumi AOYAMA ◽  
Mamoru ITO ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Single Coronary Artery

scholarly journals Aortic valve replacement due to granulomatosis with polyangiitis: a case series

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Gilles Uijtterhaegen ◽  
Laura De Donder ◽  
Eline Ameloot ◽  
Kristof Lefebvre ◽  
Jo Van Dorpe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Granulomatosis With Polyangiitis ◽  
Surrounding Tissue ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Severe Aortic Regurgitation

Abstract Background Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a systemic inflammatory process predominantly affecting upper and lower respiratory tract and kidneys. Valvular heart disease is a rare manifestation of GPA. Case summary We report two cases of acute valvular heart disease mimicking acute endocarditis caused by GPA. Both patients were middle-aged females with acute aortic valve regurgitation suggestive of possible infective endocarditis. In their recent medical history, atypical otitis and sinusitis were noted. The first patient was admitted with heart failure and the second patient because of persisting fever. Echocardiogram revealed severe aortic regurgitation with an additional structure on two cusps, suggestive of infective endocarditis in both patients. Urgent surgical replacement was performed; however, intraoperative findings did not show infective endocarditis, but severe inflammatory changes of the valve and surrounding tissue. In both patients, the valve was replaced by a prosthetic valve. Microscopic examination of the valve/myocardial biopsy showed diffuse acute and chronic inflammation with necrosis and necrotizing granulomas, compatible with GPA after infectious causes were excluded. Disease remission was obtained in both patients, in one patient with Rituximab and in the other with Glucocorticoids and Cyclophosphamide. Both had an uneventful follow-up. Discussion Granulomatosis with polyangiitis can be a rare cause of acute aortic valve regurgitation mimicking infective endocarditis with the need for surgical valve replacement. Atypical ear, nose, and throat symptoms can be a first sign of GPA. Symptom recognition is important for early diagnosis and appropriate treatment to prevent further progression of the disease.

scholarly journals More in, better out? Successful valve-in-valve procedure of an iatrogenic ventricular septal defect following transcatheter aortic valve replacement: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Klaus-Dieter Hönemann ◽  
Steffen Hofmann ◽  
Frank Ritter ◽  
Gerold Mönnig
Keyword(s):  
Aortic Valve ◽  
Ventricular Septal Defect ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Septal Defect ◽  
Left Ventricular ◽  
Heart Team ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve

Abstract Background A rare, but serious, complication following transcatheter aortic valve replacement (TAVR) is the occurrence of an iatrogenic ventricular septal defect (VSD). Case summary We describe a case of an 80-year-old female who was referred with severe aortic stenosis for TAVR. Following thorough evaluation, the heart team consensus was to proceed with implantation via a transapical approach of an ACURATE neo M 25 mm valve (Boston Scientific, Natick, MA, USA). The valve was deployed harnessing transoesophageal echocardiographic (TOE) guidance under rapid pacing with post-dilation. Directly afterwards a very high VSD close to the aortic annulus was detected. As the patient was haemodynamically stable, the procedure was ended. The next day another TOE revealed a shunt volume (left-to-right ventricle) between 50% and 60%. Because the defect was partly located between the stent struts of the ACURATE valve decision was made to fix this leakage with implantation of a further valve and we chose an EVOLUT Pro 29 mm (Medtronic Inc., Minneapolis, MN, USA). The valve-in-valve was implanted 2–3 mm below the lower edge of the first valve, more towards the left ventricular outflow tract (LVOT) with excellent result: VSD was reduced to a very small residual shunt without any hemodynamic relevance. Discussion We suggest that an iatrogenic VSD located near the annulus may be treated percutaneously in a bail-out situation with implantation of a second valve that should be implanted slightly more into the LVOT to cover the VSD.

scholarly journals Comparison of bicuspid and tricuspid aortic valve repair

2020 ◽  
Author(s):  
Radosław Gocoł ◽  
Jarosław Bis ◽  
Marcin Malinowski ◽  
Joanna Ciosek ◽  
Damian Hudziak ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hazard Ratio ◽  
Aortic Valve Repair ◽  
Pericardial Patch ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Valve Repair ◽  
Tricuspid Aortic Valve ◽  
Valve Annulus ◽  
Annulus Diameter

Abstract   OBJECTIVES The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair. METHODS We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified. RESULTS From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44–56.61); P < 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96–37.53); P = 0.004] and aortic valve annulus diameter >27.5 mm [hazard ratio 3.07 (0.99–9.58); P = 0.053]. CONCLUSIONS BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.

scholarly journals Perioperative management with biologics on severe aortic valve regurgitation caused by Behçet syndrome: the experience from a single center

2021 ◽  
Vol 12 ◽  
pp. 204062232110267
Author(s):  
Luxi Sun ◽  
Jinjing Liu ◽  
Xiufeng Jin ◽  
Zhimian Wang ◽  
Lu Li ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Perioperative Management ◽  
Perioperative Period ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Behçet Syndrome ◽  
Reactive Protein ◽  
Behcet Syndrome ◽  
Sparing Effect ◽  
Median Interval

Background: To investigate the efficacy and safety of biologics in the perioperative management of severe aortic valve regurgitation (AR) caused by Behçet syndrome (BS). Methods: We retrospectively analyzed 20 patients with severe AR caused by BS who were all treated with biologics during the perioperative period of cardiac surgeries in our center between February 2016 and October 2020. Results: A total of 20 patients with severe AR were enrolled, including 19 males and 1 female, with a mean age of 39.1 ± 8.8 years and a median course of 8 [interquartile range (IQR) 5.25–10.00] years. Before biologic administration, 92.9% of the patients who underwent aortic valve replacement had failed conventional therapy and developed postoperative paravalvular leakage (PVL) at a median interval of 4 months. Biologics were administered with background glucocorticoids (GCs) and immunosuppressants during the perioperative period for 22 aortic valve surgeries, including preoperatively with a median interval of 3.5 (IQR 2.75–4.25) months in 13 cases and within 3 months postoperatively in 9 cases. After a median follow up of 21 (IQR 15–32) months, 2 out of 13 cases (15.4%) preoperatively, and 1 out of 9 cases (11.1%) postoperatively treated with biologics developed PVL, and the rest were event free. The Behçet’s Disease Current Activity Form score improved significantly (7 versus 0, median, p < 0.0001). Decrease of erythrocyte sedimentation rate [25.0 (IQR 11.00–36.25) mm/h versus 6.5 (IQR 4.0–8.8) mm/h, p < 0.001], and C-reactive protein [20.77 (IQR 7.19–29.58) mg/l versus 1.53 (IQR 0.94–2.92) mg/l, p = 0.001] were achieved rapidly and effectively. The GC dosage tapered from 40 (IQR 30–60) mg/d to 10 (IQR 5–11.25) mg/d, p < 0.0001. Immunosuppressants were tapered in number and dosage in 6 (30%) and 20 patients (100%), respectively. No serious adverse event was observed. Conclusion: Our study suggests that biologics were effective and well tolerated for the perioperative management of severe and refractory AR caused by BS, which significantly reduced the occurrence of postoperative PVL and had favorable GC- and immunosuppressant-sparing effect.

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