Modified Septal Myectomy Using a Curved Knife for Left Ventricular Septal Hypertrophy

2014 ◽  
Vol 17 (5) ◽  
pp. 269
Author(s):  
Shinya Takahashi ◽  
Taiichi Takasaki ◽  
Futoshi Tadehara ◽  
Takahiro Taguchi ◽  
Keijiro Katayama ◽  
...  
Keyword(s):  
Blood Flow ◽  
Chest Pain ◽  
Aortic Valve ◽  
Cross Section ◽  
Left Ventricular ◽  
Chest Discomfort ◽  
Septal Myectomy ◽  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy ◽  
Septal Myocardium

An 86-year-old woman presented with chest pain and discomfort. Echocardiography revealed severe aortic valve stenosis and asymmetric septal hypertrophy. Aortic valve replacement and myectomy were performed using a curved knife. The blade was U-shaped in cross-section, and was curved upward along the long axis. Hypertrophic septal myocardium was removed along the long axis of the left ventricle (LV), and a groove for blood flow was constructed. The patient was discharged uneventfully without recurrence of her chest discomfort. Our result suggested that a curved knife is a reasonable option for transaortic septal myectomy in patients with obstructive LV hypertrophy.

Abstract 18460: Asymmetric Septal Hypertrophy as a Prognostic Indicator During Progression of Aortic Valve Stenosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Eigir Einarsen ◽  
Dana Cramariuc ◽  
Mai Tone Lonnebakken ◽  
Kurt Boman ◽  
Christa Gohlke-Bärwolf ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Cox Regression ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Lipid Lowering ◽  
Cox Regression Analysis ◽  
Asymmetric Septal Hypertrophy ◽  
Septal Hypertrophy

Objective: Asymmetric septal hypertrophy (ASH) in patients with severe aortic stenosis (AS) has been associated with increased perioperative morbidity and mortality in smaller studies with severe aortic stenosis (AS). This association has not been tested in a large, longitudinal study. Methods: Clinical, echocardiographic and outcome data from 1730 patients with asymptomatic AS, participated in the Simvastatin Ezetimibe in Aortic Stenosis study (SEAS), a randomized placebo controlled study evaluating the effect of lipid lowering medications on progression of AS, were used. ASH was considered present if interventricular septal/posterior wall thickness ratio exceeded 1.5. The association of ASH with rate of major cardiovascular (CV) events was tested in time-dependent cox-regression analysis. Results: During a median of 4.3 years follow-up, ASH developed in 17.0 % of patients, and was associated with higher left ventricular mass (LVM) and body mass index (BMI) compared to non-ASH patients (all p<0.05). In time-varying Cox regression analysis, ASH predicted a 50% greater incidence of ischemic CV events (ICE), a 63% greater incidence in the need for coronary artery bypass grafting (CABG) at the time of aortic valve replacement, and a 2-fold higher incidence of hospitalization for heart failure due to progression of AS (CHFAS) independent of important confounders (all p<0.05) (Table). Conclusions: Development of ASH during progression of AS was a strong predictor of major CV events in patients participating in the SEAS-study. Table: Results are presented as Hazard ratio (95% Confidence Interval).

Residual left ventricular hypertrophy with adverse clinical outcomes in patients with severe aortic stenosis and asymmetric septal hypertrophy after aortic valve replacement

2019 ◽  
Vol 56 (2) ◽  
pp. 343-350
Author(s):  
Haitao Xu ◽  
Yabing Duan ◽  
Xin Yuan ◽  
Hengchao Wu ◽  
Yunhu Song ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Independent Predictor ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Lv Mass ◽  
Asymmetric Septal Hypertrophy ◽  
Reverse Remodelling ◽  
Septal Hypertrophy

Abstract OBJECTIVES The aim of this study is to describe the temporal pattern of left atrial (LA) and left ventricular (LV) reverse remodelling and to evaluate the impact of residual LV hypertrophy on the prognosis of patients with severe aortic stenosis and asymmetric septal hypertrophy undergoing aortic valve replacement (AVR). METHODS We retrospectively reviewed 59 consecutive patients who underwent AVR for severe aortic stenosis and asymmetric septal hypertrophy. They were divided into the normal LV mass group and the residual LV hypertrophy group according to the LV mass index (LVMI) 2 years after AVR. Thirty patients were eligible for analysis of the time-dependent changes in LA and LV reverse remodelling. RESULTS The interventricular septal thickness and LVMI gradually decreased and reached their lowest points 2 years after operation, whereas the LA dimension rapidly decreased in the early postoperative period and plateaued at 3 months. The multivariable analysis revealed a higher preoperative LVMI [odds ratio 6.36 (1.678–24.11); P = 0.007] as an independent predictor of residual hypertrophy 2 years after operation. The Cox proportional hazards model showed that a higher postoperative peak velocity [hazard ratio 6.715 (1.405–32.104); P = 0.017] was an independent predictor of long-term non-fatal cardiovascular hospitalization. Patients with residual hypertrophy 2 years after AVR had a higher rate of non-fatal cardiovascular hospitalization (P = 0.014). CONCLUSIONS For patients with severe aortic stenosis and asymmetric septal hypertrophy, maximum LA recovery occurred 3 months after AVR, whereas maximum LV recovery occurred 2 years thereafter. A higher preoperative LVMI may lead to postoperative residual hypertrophy, which is associated with adverse clinical outcomes.

ALTERED LEFT VENTRICULAR BLOOD FLOW PATTERN AND KINETIC ENERGY IN PATIENTS UNDERGOING AORTIC VALVE INTERVENTION

2020 ◽  
Vol 75 (11) ◽  
pp. 1763
Author(s):  
Alaa Elhawaz ◽  
Gareth Archer ◽  
Pankaj Garg ◽  
James Wild ◽  
Ian Hall ◽  
...  
Keyword(s):  
Blood Flow ◽  
Aortic Valve ◽  
Kinetic Energy ◽  
Flow Pattern ◽  
Left Ventricular ◽  
Blood Flow Pattern

scholarly journals P190 Chest pain and syncope in Turner"s syndrome: going beyond the obvious to not miss the critical diagnosis. Role of multimodality imaging approach

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Ruocco ◽  
M Previtero ◽  
N Bettella ◽  
D Muraru ◽  
S Iliceto ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pericardial Effusion ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Dissection ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Rule Out ◽  
Typical Chest Pain

Abstract Clinical Presentation: a 18-year-old woman with Turner’s syndrome (TS), with history of hypothyroidism treated with L-thyroxin, asymptomatic moderately stenotic bicuspid aortic valve (AV) and without any known cardiovascular risk factor, was admitted to our emergency department (ED) because of syncope and typical chest pain after dinner associated with dyspnea. Chest pain lasted for an hour with spontaneous regression. In the ED the patient (pt) was normotensive. An ECG showed sinus rhythm (88 bpm), nonspecific repolarization anomalies (T wave inversion) in the inferior and anterior leads. Myocardial necrosis biomarkers were negative. A 3D transthoracic echocardiography showed normal biventricular systolic function with left ventricular hypertrophy, dilatation of the ascending aorta, unicuspid AV with severe aortic stenosis (peak/mean gradient 110/61 mmHg, aortic valve area 0,88 cm2-0,62 cm2/m2), mild pericardial effusion (Figure Panel A, B, C). Five days after, the pt had a new episode of typical chest pain without ECG changes. A computerized tomography (CT) was performed to rule out the hypothesis of aortic dissection and showed a dilation of the ascending aorta and pericardial effusion localized in the diaphragmatic wall, no signs of dissection or aortic hematoma. However, CT was of suboptimal quality because of sinus tachycardia (120 bpm) and so the pt underwent a coronary angiography and aortography that ruled out coronary disease, confirmed the dilatation of ascending aorta (50 mm) and showed images of penetrating atherosclerotic ulcer of the ascending aorta (Figure panel D). The pt underwent urgent transesophageal echocardiography (TOE) that confirmed the severely stenotic unicuspid AV and showed a localized type A aortic dissection (Figure Panel E, F, G). The pt underwent urgent AV and ascending aorta replacement (Figure Panel H). Learning points Chest pain and syncope are challenging symptoms in pts presenting in ED. AV pathology and aortic dissection should be always suspected and ruled out. TS is associated with multiple congenital cardiovascular abnormalities and is the most common established cause of aortic dissection in young women. 30% of Turner’s pts have congenitally AV abnormalities, and dilation of the ascending aorta is frequently associated. However, unicuspid AV is a very rare anomaly, usually stenotic at birth and requiring replacement. The presence of pericardial effusion in a pt with chest pain and syncope should raise the suspicion of aortic dissection, even if those symptoms usually accompany severe aortic stenosis. Even if CT is the gold standard imaging technique to rule out aortic dissection, the accuracy of a test is critically related to the image quality. When the suspicion of dissection is high and the reliability of the reference test is low, it’s reasonable to perform a different test to rule out the pathology. Aortography and TOE were pivotal to identify the limited dissection of the ascending aorta. Abstract P190 Figure.

Aortic stenosis

2018 ◽  
Author(s):  
Patrick Davey ◽  
Jim Newton
Keyword(s):  
Blood Flow ◽  
Aortic Valve ◽  
Left Ventricle ◽  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Aortic Valve Leaflets ◽  
Reduced Mobility

Aortic stenosis is characterized by thickening and reduced mobility of the aortic valve leaflets and results in restriction to the blood flow from the left ventricle to the aorta, and secondary left ventricular hypertrophy.

scholarly journals P1718 Multi-modal imaging characterization of contained aortic subannular rupture after transcatheter aortic valve implantation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Grilo Diogo ◽  
C X Resende ◽  
A Nunes ◽  
P Araujo ◽  
S Torres ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Root ◽  
Cardiac Ct ◽  
Left Ventricular ◽  
Paravalvular Leak ◽  
Chest Discomfort ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract INTRODUCTION Aortic annular rupture is a potentially catastrophic complication after transcatheter aortic valve implantation (TAVI), with an estimated incidence of 1%. Rupture occurs in the anatomical device landing zone, that extends from the aortic root to the distal left ventricular outflow tract (LVOT). It usually occurs in the context of highly calcified aortic valve and LVOT, implantation of balloon-expandable valves, valve oversizing and overdilation to treat paravalvular leakage. CASE REPORT An 80-year old woman with no past relevant medical history was admitted to our Cardiology Department with decompensated heart failure because of symptomatic severe aortic stenosis, moderate aortic regurgitation and mild left ventricular (LV) dysfunction. She was already in waiting list for TAVI procedure, after being refused for conventional aortic valve replacement due to a "porcelain" aorta. Her pre-operative angiography showed no significant coronary heart disease, and the cardiac computed tomography (cardiac-CT) revealed a severely calcified aortic valve (Agatston score = 4940). An Acurate neo L (27mm) valve was implanted after clinical stabilization with no immediate complications. Because of paravalvular regurgitation, sequential post-dilation was performed with 25mm and 26mm balloons. Post-procedural angiography showed no contrast extravasation (Panel A). In the first hours after the procedure, she was hypotensive with non-specific mild chest discomfort. The EKG showed sinus rhythm with left anterior fascicular block. A transthoracic echocardiogram revealed a moderate pericardial effusion, with no signs of tamponade, and a moderate "paravalvular leak "at the level of the non-coronary cusp to a pulsatile cavity, between the aortic root and the left atrium (Panel B and C). The patient evolved with haemodynamic and electrical stability with no recurrence of chest discomfort. A retrospective cardiac-CT was performed that confirmed the presence of a multilobular cavity below the left coronary artery in continuous with the LVOT, compatible with a contained subannular aortic rupture (Panel E and F), at the level of previous gross calcification in the pre-operative cardiac-CT (Panel D). The case was discussed in Heart Team and a conservative strategy was adopted due to clinical stability and inoperable condition. The patient was discharged at day 28, after CT reavaluation,, that demonstrate similar findings. CONCLUSION We report a rare and potentially fatal complication of TAVI with a self-expandable valve. This clinical case illustrates how balloon post-dilation to treat moderate post-procedural paravalvular regurgitation lead to tearing of a highly calcified aortic annulus. A multi-modality imaging approach, with echocardiography and computer tomography, was essential for full anatomical definition of the subannular rupture, clinical decision-making and for follow-up surveillance. Abstract P1718 Figure. Panel A,B,C,D,E,F.

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