Ascending aortic aneurysm and aortic valve dysfunction in bicuspid aortic valve disease

BACKGROUND: The relationship of aortic valve dysfunction and ascending aortic aneurysm is unclear in adults with bicuspid aortic valve disease. METHODS: We retrospectively studied 134 consecutive out-patients (98 men, 36 women aged 43+/-18years) with bicuspid aortic valve disease. To investigate the relationship of ascending aortic aneurysm and aortic valve dysfunction we exclusively considered severe pathologies that required treatment by surgical or percutaneous intervention. RESULTS: Of 134 patients, 39 had aortic valve dysfunction without concomitant ascending aortic aneurysm which had been treated previously with isolated valve surgery or percutaneous valvuloplasty comprising 25 patients with aortic stenosis (19%) and 14 patients with aortic regurgitation (10%). Conversely, 26 patients had ascending aortic aneurysm which had been treated previously with aortic surgery (19%). Of these, ascending aortic aneurysm was associated with severe aortic stenosis in 13 patients and with severe aortic regurgitation in 7 patients, whereas aneurysm was unrelated to severe aortic valve dysfunction in the remaining 6 patients including 2 without any degree of aortic valve dysfunction. The maximal aortic diameters were similar at the time of aortic surgery irrespective of presence of severe aortic valve dysfunction (P=.527). Other characteristics of patients with ascending aortic aneurysm were also similar irrespective of presence or type of aortic valve dysfunction. CONCLUSION: The majority of patients with bicuspid aortic valve disease exhibit ascending aortic aneurysm in conjunction with severe aortic valve dysfunction. However, in our study 6 of 134 (5%) of persons with bicuspid aortic valve disease developed ascending aortic aneurysm without aortic valve dysfunction

A rare case of suture material obstructing the closure mechanism of a prosthetic aortic valve: a case report

Prosthetic aortic valve dysfunction presenting as aortic regurgitation is a complication of mechanical valve replacement. We describe a case of late valve dysfunction caused by an annular suture of excessive length obstructing the closure mechanism of a bileaflet prosthetic valve

Quadriscupid aortic valve with concurrent aortic stenosis and insufficiency

We present the case of a 22-year-old man with a congenital mixed aortic valve dysfunction who underwent cardiac Magnetic Resonance Imaging (MRI) for the assessment of aortic valve morphology and function prior to valve replacement. Cardiac MRI showed a four-leaf-clover aortic valve morphology, the typical presentation of a quadricuspid aortic valve. The patient underwent a successful Bentall procedure to replace the aortic valve, aortic root and ascending aorta. This case report illustrates the MRI findings of a quadricuspid aortic valve with associated aortic stenosis and regurgitation

Prediction of Turbulent Shear Stresses through Dysfunctional Bileaflet Mechanical Heart Valves using Computational Fluid Dynamics

There are more than 300,000 heart valves implanted annually worldwide with about 50% of them being mechanical valves. The heart valve replacement is often a common treatment for severe valvular disease. However, valves may dysfunction leading to adverse hemodynamic conditions. The current computational study investigated the flow around a bileaflet mechanical heart valve at different leaflet dysfunction levels of 0%, 50%, and 100%, and documented the relevant flow characteristics such as vortical structures and turbulent shear stresses. Studying the flow characteristics through these valves during their normal operation and dysfunction can lead to better understanding of their performance, possibly improved designs, and help identify conditions that may increase the potential risk of blood cell damage. Results suggested that maximum flow velocities increased with dysfunction from 2.05 to 4.49 ms-1 which were accompanied by growing eddies and velocity fluctuations. These fluctuations led to higher turbulent shear stresses from 90 to 800 N.m-2 as dysfunctionality increased. These stress values exceeded the thresholds corresponding to elevated risk of hemolysis and platelet activation. The regions of elevated stresses were concentrated around and downstream of the functional leaflet where high jet velocity and stronger helical structures existed

Dysfunction of Mitral Ball Valve Prosthesis

Three case histories of patients with malfunctions of Smeloff-Cutter mitral ball valve prostheses are presented here - one underwent successful replacement. The clinical diagnosis was made by observing a marked variation in the A2OC interval and intermittent absence of the opening click. Phonocardiograms were diagnostic in all three cases. while echocardiograms and even angiograms did not uniformly diagnose prosthetic valve dysfunction. Periodic phonocardiographic evaluations may be helpful in early detection of the prosthetic valve dysfunction. Once the diagnosis is established, immediate surgical treatment is imperative to prevent sudden death

Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction

Aortic valve replacement is the second most common cardiothoracic procedure in the UK. With an ageing population, there are an increasing number of patients with prosthetic valves that require follow-up. Imaging of prosthetic valves is challenging with conventional echocardiographic techniques making early detection of valve dysfunction or complications difficult. CT has recently emerged as a complementary approach offering excellent spatial resolution and the ability to identify a range of aortic valve replacement complications including structural valve dysfunction, thrombus development, pannus formation and prosthetic valve infective endocarditis. This review discusses each and how CT might be incorporated into a multimodal cardiovascular imaging pathway for the assessment of aortic valve replacements and in guiding clinical management

Anesthetic management of a patient with obstructive prosthetic aortic valve dysfunction -a case report-

We present a 55-year-old female patient who underwent burr-hole drainage due to chronic subdural hematoma, with obstructive prosthetic aortic valve dysfunction. Anesthetic management of a patient with severe obstructive prosthetic aortic valve dysfunction can be challenging. Similar considerations should be given to patients with aortic stenosis with an additional emphasis on thrombotic complication due to discontinuation of anticoagulation, which may further jeopardize the valve dysfunction. This case emphasizes the importance of a comprehensive understanding of the etiology and hemodynamic consequences of obstructive prosthetic valve dysfunction and the adequacy of anticoagulation for patients undergoing noncardiac surgery even after a successful valve replacement.ope

Pocket Size Ultra-Sound versus Cardiac Auscultation in Diagnosing Cardiac Valve Pathologies: A Prospective Cohort

Background: Pocket-size ultrasound devices are used to perform focused ultrasound studies (POCUS). We compared valve malfunction diagnosis rate by cardiac auscultation to POCUS (insonation), both conducted by medical students. Methods: A prospective cohort study was conducted among subjects with and without clinically relevant valve dysfunction. Inclusion criteria for subjects with a clinically relevant valve dysfunction was based on the presence of at least one moderate severity valve pathology identified by echocardiography. Three final-year medical students examined the patients. Each subject underwent auscultation and a POCUS using a pocket-size ultrasound machine. Sensitivity and specificity were calculated. Results: The study included 56 patients. In 18 patients (32%) no valve pathology was found. Nineteen patients (34%) had at least two valvular pathologies. Sixty valve lesions were present in the entire cohort. Students' sensitivity for detecting any valve lesion was 32% and 64% for auscultation and insonation, respectively, and specificity was similar. The sensitivity for diagnosing mitral regurgitation, mitral stenosis, and aortic regurgitation rose significantly by using POCUS compared to auscultation alone. When using POCUS, students identified valvular pathologies in 22 cases (39%) from the patients with at least two valve dysfunctions, and none when using auscultation. Conclusions: Final-year medical students' competency to detect valve dysfunction by performing cardiac auscultation is poor. Cardiac ultrasound-focused training significantly improved medical students' sensitivity for diagnosing a variety of valve pathologies

Outcome Prediction after Surgical Management of Prosthetic Mitral Valve Dysfunction; a single center experience

Background: Prosthetic Mitral valve dysfunction is a serious complication associated with a high mortality rate particularly in obstructive cases. The number of cases undergoing redo mitral valve surgery is increasing. This study aims to identify the risk factors of mortality and morbidity in patients who underwent redo mitral valve surgery for prosthetic mitral valve dysfunction.   Methods: This study was conducted on 80 patients who underwent re-operation for management of prosthetic mitral valve dysfunction from December 2014 to February 2018. Patients’ age ranged between 21 and 58 years with a mean of 36.8±9.60 years, and 53 patients (66.3%) were males. The causes of mitral valve malfunction were thrombus in 67 patients (83.7%) and pannus in 13 patients (16.3%). Results: 53 patients (66.25%) had urgent surgical intervention. Thrombectomy or pannus resection was done in 75 patients (93.75%) and valve replacement in 5 patients (6.25%). Re-exploration was required in 11 patients (13.75%) and was significantly associated with diabetes (p= 0.004), preoperative liver dysfunction (p= 0.04), elevated INR (p= 0.006), trial of thrombolysis (p<0.001) and prolonged ischemic time (p= 0.01). Postoperative renal failure occurred in 11 patients (13.75%) and was associated with diabetes (p< 0.001), preoperative renal dysfunction (p< 0.001), prolonged cardiopulmonary bypass and ischemic times (p< 0.001). 17 patients (21%) required prolonged mechanical ventilation and it was significantly associated with chronic obstructive lung disease (p< 0.001), pulmonary edema (p <0.001), low systolic blood pressure (p <0.001), low ejection fraction (p<0.001) and thrombectomy (p<0.001). Operative mortality occurred in 13 patients (16%) and was significantly associated with preoperative stroke, renal dysfunction, low blood pressure and acute pulmonary edema (p <0.001). Conclusion: Reoperation for prosthetic mitral valve dysfunction is associated with high morbidity and mortality. Outcomes can be predicted based on preoperative clinical status and operative times. Thrombectomy and pannus resection with the repair of the paravalvular leak is a simple and easy technique for management of those patients with a reduction of cardiopulmonary bypass and cross-clamp times

Bioprosthetic Aortic Valve degeneration: a review from a basic science perspective

Introduction: The increase in the prevalence of aortic stenosis due to an aging population has led to an increasing number of surgical aortic valve replacements. Over the past 20 years, there has been a major shift in preference from mechanical to bioprosthetic valves. However, despite efforts, there is still no "ideal" bioprosthesis. It is crucial to understand the structure, biology, and function of native heart valves to design more intelligent, strong, durable, and physiological heart valve tissues. Methods: A comprehensive review of the literature was performed to identify articles reporting the basic mechanisms of bioprosthetic valve dysfunction and the biology of native valve cells. Searches were run in PubMed,MEDLINE (R) (the Medical Literature Analysis and Retrieval System Online), and Google Scholar. Terms for subject heading and keywords search included "biological heart valve dysfunction", "bioprosthesis dysfunction", "bioprosthesis degeneration", and "tissue heart valves". Results: All the relevant findings are summarized in the appropriate subsections. Structural dysfunction is a logical and expected consequence of the chemical, mechanical, and immunological processes that occur during fixation, manufacture, and implantation. Conclusion: Biological prosthesis valve dysfunction is a clinically significant process. It has become a major issue considering the growing rate of bioprosthesis implantation and improved long-term patient survival. Understanding bioprosthetic aortic valve degeneration from a basic science perspective is a key point to improve technologic advances and specifications that lead to a new generation of bioprostheses.info:eu-repo/semantics/publishedVersio