scholarly journals Ascending Aortic Wall Cohesion: Comparison of Bicuspid and Tricuspid Valves

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Jaroslav Benedik ◽  
Kevin Pilarczyk ◽  
Daniel Wendt ◽  
Jiri Indruch ◽  
Radek Flek ◽  
...  
Keyword(s):  
Shear Stress ◽  
Aortic Valve ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Sinotubular Junction ◽  
Custom Made ◽  
Wall Specimen ◽  
Av Malformation ◽  
Group 2 ◽  
Group 1

Objectives. Bicuspid aortic valve (AV) represents the most common form of congenital AV malformation, which is frequently associated with pathologies of the ascending aorta. We compared the mechanical properties of the aortic wall between patients with bicuspid and tricuspid AV using a new custom-made device mimicking transversal aortic wall shear stress.Methods. Between 03/2010 and 07/2011, 190 consecutive patients undergoing open aortic valve replacement at our institution were prospectively enrolled, presenting either with a bicuspid (group 1,n=44) or a tricuspid (group 2,n=146) AV. Aortic wall specimen were examined with the “dissectometer” resulting in nine specific aortic-wall parameters derived from tensile strength curves (TSC).Results. Patients with a bicuspid AV showed significantly more calcified valves (43.2% versus 15.8%,P<0.001), and a significantly thinner aortic wall (2.04±0.42 mm versus2.24±0.41 mm,P=0.008). Transesophageal echocardiography diameters (annulus, aortic sinuses, and sinotubular junction) were significantly larger in the bicuspid group (P=0.003,P=0.02,P=0.01). We found no difference in the aortic wall cohesion between both groups as revealed by shear stress testing (P=0.72,P=0.40,P=0.41).Conclusion. We observed no differences of TSC in patients presenting with tricuspid or bicuspid AVs. These results may allow us to assume that the morphology of the AV and the pathology of the ascending aorta are independent.

scholarly journals Aortic root surgery: Early postoperative results of different surgical techniques

Medicina ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 197 ◽  
Author(s):  
Rimantas Benetis ◽  
Eglė Ereminienė ◽  
Povilas Jakuška ◽  
Dainius Karčiauskas ◽  
Šarūnas Kinduris ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Root ◽  
Surgical Techniques ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Postoperative Results ◽  
Aortic Root Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study was to evaluate early postoperative results of different surgical techniques of aortic root surgery. Material and methods. Between January 2004 and November 2007, a cohort of 83 patients underwent aortic root surgery in the Heart Center, Hospital of Kaunas University of Medicine. Patients were divided into three groups: Group 1 (18 patients) – reimplantation of the aortic valve within a vascular graft (David operation), Group 2 (48 patients) – replacement of the ascending aorta and aortic valve using a valved conduit (Bentall de Bono operation), and Group 3 (17 patients) – biological aortic root replacement. Study protocol included clinical data, operative data, and postoperative major adverse effects: reoperations for bleeding, stroke and lethal outcomes. Results. Patients undergoing biological aortic root replacement were older as compared with other groups. The mean age in the Group 1 was 50.3±3.5 years vs. 57±2.0 years in the Group 2 and 67.8±3.3 years in the Group 3 (P<0.05). The main indication for the aortic root surgery was the aneurysm of the aortic root and ascending aorta in the Group 1 and 2 patients (64.7% and 72%), while in the Group 3, the main indication was fibrocalcinosis of aortic valve, aortic annulus, and ascending aorta (61.1%). The 30-day hospital mortality rates were as follows: 5.8% (n=1), in the Group 1; 10.4% (n=5), in the Group 2; 5.5% (n=1), in the Group 3. In the early postoperative period, 11 reoperations were performed due to bleeding events: in the Group 1, after planned/emergency surgery (n=2/2), and in the Group 2 (n=1/6), respectively. The function of aortic valve improved significantly in all groups of patients early after surgery. In the Group 1, the degree of aortic regurgitation decreased from 2.5±0.8 to 1.1±0.6 (P<0.05); in the Groups 2 and 3, the mean gradient through the aortic valve decreased from 39.9±7.5 to 17.1±5.3 mm Hg and from 48.8±18.0 to 20.1±11.0 mm Hg, respectively (P<0.05). No reoperation for aortic valve failure before the discharge was required in all groups of patients, and neither thromboembolic complications nor stroke events were noted in any group. Conclusions. Different aortic root surgery techniques showed similar postoperative results. New aortic root surgery methods such as aortic root-preserving/sparing procedures and concurrent aortic valve leaflet repair or aortic root replacement with the bioprosthesis can be selected for a diverse class of aortic root pathology with low perioperative mortality rates and good early postoperative results.

scholarly journals Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kaoru Hattori ◽  
Natsuki Nakama ◽  
Jumpei Takada ◽  
Gohki Nishimura ◽  
Ryo Moriwaki ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Pulsatile Flow ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Circulation System ◽  
Resonance Imaging ◽  
Left Posterior ◽  
Flow Circulation ◽  
The Right

AbstractThe characteristics of aortic valvular outflow jet affect aortopathy in the bicuspid aortic valve (BAV). This study aimed to elucidate the effects of BAV morphology on the aortic valvular outflow jets. Morphotype-specific valve-devising apparatuses were developed to create aortic valve models. A magnetic resonance imaging-compatible pulsatile flow circulation system was developed to quantify the outflow jet. The eccentricity and circulation values of the peak systolic jet were compared among tricuspid aortic valve (TAV), three asymmetric BAVs, and two symmetric BAVs. The results showed mean aortic flow and leakage did not differ among the five BAVs (six samples, each). Asymmetric BAVs demonstrated the eccentric outflow jets directed to the aortic wall facing the smaller leaflets. In the asymmetric BAV with the smaller leaflet facing the right-anterior, left-posterior, and left-anterior quadrants of the aorta, the outflow jets exclusively impinged on the outer curvature of the ascending aorta, proximal arch, and the supra-valvular aortic wall, respectively. Symmetric BAVs demonstrated mildly eccentric outflow jets that did not impinge on the aortic wall. The circulation values at peak systole increased in asymmetric BAVs. The bicuspid symmetry and the position of smaller leaflet were determinant factors of the characteristics of aortic valvular outflow jet.

scholarly journals One-stage off pump combined transapical aortic valve replacement and ascending aorta endografting

2020 ◽  
Author(s):  
Gino Gerosa ◽  
Giorgia Cibin ◽  
Michele Antonello ◽  
Augusto D’Onofrio
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Ascending Aorta ◽  
Off Pump ◽  
Stent Grafting ◽  
Transcatheter Aortic Valve ◽  
Custom Made ◽  
Risk Patients

Abstract An 84-year-old patient was referred for severe symptomatic aortic valve stenosis and focal chronic dissection of the ascending aorta. After multidisciplinary discussion, the patient was scheduled for combined transapical transcatheter aortic valve replacement and ascending aorta stent-grafting. The procedure was performed with a balloon aortic valvuloplasty followed by a custom-made stent graft implantation into the ascending aorta and then by balloon-expandable transapical transcatheter aortic valve replacement. The patient had an uneventful hospital stay. In conclusion, in selected high-risk patients, transapical combined ascending aorta stent-grafting and transcatheter aortic valve replacement are feasible and safe.

Abstract 9947: Predictors of Left Ventricular Dysfunction After Aortic Valve Replacement in Patients With Mixed Aortic Valve Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexander Egbe ◽  
Joeseph Poterucha ◽  
Carole Warnes
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular Dysfunction ◽  
Aortic Valve Disease ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Group 2 ◽  
Group 1

Objectives: Predictors of left ventricular dysfunction (LVD) after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) have not been studied. Objective was to determine prevalence and predictors of early and late LVD at 1 and 5 years post-AVR. Methods: Retrospective review of 247 patients (Age 63±8 years, males 81%) with moderate/severe MAVD who underwent AVR at the Mayo Clinic from 1994-2013. Only patients with follow-up data at 1 year post AVR were included (n=239). Cohort divided into 3 groups based on data collected prior to AVR, 1 and 5 years post AVR. LVD was defined as ejection fraction <50%. Results: LVD was present in 11/239 at baseline. At 1-year post AVR, 181 had normal EF (group 1) while 58/239 (24%) had early LVD (group 2). Predictors of LVD were atrial fibrillation (hazard ratio [HR] 1.83 confidence interval [CI] 1.59-1.98, p=0.001), age >70 years (HR: 3.12, CI: 2.33-4.18, p= <0.0001), CABG (HR: 2.17, CI: 2.24-5.93, p= <0.0001), and severe MAVD pre-operatively (HR: 2.87, CI: 2.33-3.17, p= 0.01), and hypertension (HR: 1.83, CI: 1.35-2.46, p= <0.0001). Prevalence of late LVD was 24% (47/197-group 3) and LVMI at 1 year post AVR was predictive of late LVD (HR 1.65, CI 1.11-3.8 per 10 g/ m 2 increment, p= 0.04)). Group 2 had less reverse LV remodeling compared to group 1 at 1 year post AVR (142±39 vs 129±42 g/ m 2 , p=0.02). Conclusions: Risk of LVD was significant even in subset of patients with moderate MAVD. Risk stratification of MAVD should be based on both clinical and echocardiographic parameters. Our data suggest earlier surgical intervention may be required in the MAVD population to prevent postoperative LVD but further studies are needed. Figure legend: FU: follow up

scholarly journals Papillary Fibroelastoma of the Ascending Aorta

2019 ◽  
Vol 7 ◽  
pp. 232470961984037
Author(s):  
Karim M. Al-Azizi ◽  
Mohanad Hamandi ◽  
Ronald Baxter ◽  
Anita Krueger ◽  
Alexander W. Crawford ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Ascending Aorta ◽  
Embolic Stroke ◽  
Papillary Fibroelastoma ◽  
Cardiac Tumors ◽  
Unusual Site ◽  
Sinotubular Junction ◽  
Primary Cardiac Tumors

Papillary fibroelastomas are rare benign primary cardiac tumors. They are typically found on valvular surfaces, most commonly, the aortic valve. In this article, we report a case of papillary fibroelastoma arising from the sinotubular junction of the ascending aorta, a rare and unusual site causing an embolic stroke.

Medium-Term Outcome with Small Size ATS Medical Valves in Aortic Position

1998 ◽  
Vol 6 (3) ◽  
pp. 183-187
Author(s):  
Ufuk Demirkiliç ◽  
Erkan Kuralay ◽  
Ertuğrul Özal ◽  
Hakan Bingöl ◽  
Cemal Sağ ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Term Outcome ◽  
Congenital Aortic Stenosis ◽  
Group 2 ◽  
Valve Prostheses ◽  
Valve Pathology ◽  
Group 1

Records of 33 patients (group 1) who received 19-mm or 21-mm ATS aortic valve prostheses were retrospectively reviewed and compared with those of 26 patients who received 25-mm ATS valves (group 2). Group 1 patients were younger (20 ± 2 years versus 43 ± 15 years) and had a smaller mean body surface area (1.6 m2 versus 1.83 m2). Valve pathology was usually congenital aortic stenosis in group 1 and rheumatic in group 2. There was no operative mortality. The mean postoperative Doppler resting gradient was higher in group 1 (21 mm Hg versus 7 mm Hg). Total follow-up was 294 patient-years. There was no perivalvular leak, valve thrombosis, or endocarditis in either group. In group 2, there was 1 anticoagulant-related hemorrhage and 1 late death due to congestive heart failure. We concluded that in spite of the higher transprosthetic gradient, 19-mm and 21-mm ATS aortic valve prostheses performed satisfactorily in adult patients with a body surface area of less than 1.6 m2. This valve can be used in a small aortic annulus as an alternative to performing an annular enlargement procedure.

scholarly journals Ascending aorta dilation in association with bicuspid aortic valve: A maturation defect of the aortic wall

2014 ◽  
Vol 148 (4) ◽  
pp. 1583-1590 ◽  
Author(s):  
Nimrat Grewal ◽  
Adriana C. Gittenberger-de Groot ◽  
Robert E. Poelmann ◽  
Robert J.M. Klautz ◽  
Johannes H.N. Lindeman ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Wall ◽  
Ascending Aorta ◽  
Maturation Defect
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