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https://www.readbyqxmd.com/read/27867460/percutaneous-dual-valve-intervention-in-a-high-risk-patient-with-severe-aortic-and-mitral-stenosis
#1
Blaz Mrevlje, Mohamad Aboukura, Christoph A Nienaber
Aortic stenosis is the most frequent and mitral stenosis is the least frequent native single-sided valve disease in Europe. Patients with the combination of severe symptomatic degenerative aortic and mitral stenosis are very rare. Guidelines for the treatment of heart valve diseases are clear for single-valve situations. However, there is no common agreement or recommendation for the best treatment strategy in patients with multiple valve disease and severe concomitant comorbidities. A 76-year-old female patient with the combination of severe degenerative symptomatic aortic and mitral stenosis and several comorbidities including severe obesity, who was found unsuitable surgical candidate by the heart team and unsuitable for two-time general anesthesia in the case of two-step single-valve percutaneous approach by anesthesiologists, underwent successful percutaneous dual-valve single-intervention (transcatheter aortic valve implantation and percutaneous mitral balloon commissurotomy)...
July 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/27617906/does-the-different-type-of-pulmonary-hypertension-cause-the-same-effect-on-right-heart-and-serum-asymmetrical-dimethylarg%C3%A4-n%C3%A4-ne-levels-in-female-patients
#2
G Taçoy, H D Başer, A Çengel, K Başer, Ö Kuş, A F Tuncel, A Bolayır, H Paşaoğlu, B Boyaci, R Yalçın
Objective: Right heart function is a major determinant of clinical outcome in patients with elevated pulmonary artery pressure due to pulmonary venous hypertension (PVH) and pulmonary arterial hypertension (PAH). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. In our study, we aimed to evaluate if different type of pulmonary hypertension (PH) cause the same effect on right heart functions and serum asymmetric dimethylarginine (ADMA) levels in female patients...
March 14, 2016: West Indian Medical Journal
https://www.readbyqxmd.com/read/27541718/the-use-of-standard-gastrointestinal-endoscopic-ultrasound-to-assess-cardiac-anatomy
#3
Kinza Sentissi, Mandeep S Sawhney, Douglas Pleskow, Paul Sepe, Jose M Mella, Benjamin Kwittken, Gyanprakash Ketwaroo, Balachundhar Subramaniam
In this prospective observational study, conducted at an academic medical center, we evaluated the feasibility of performing a basic transesophageal echocardiography (TEE) examination using endoscopic ultrasound (EUS) technology to determine what cardiac structures could be assessed. This may be potentially beneficial during hemodynamic emergencies in the endoscopy suite resulting from hypovolemia, depressed ventricular function, aortic dissection, pericardial effusions, or aortic stenosis. Of the 20 patients enrolled, 18 underwent EUS with a linear echoendoscope for standard clinical indications followed by a cardiac assessment performed under the guidance of a TEE-certified cardiac anesthesiologist...
September 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27502864/defining-nonvalvular-atrial-fibrillation-a-quest-for-clarification
#4
REVIEW
Raphaël P Martins, Vincent Galand, Edouard Colette, Nathalie Behar, Dominique Pavin, Christophe Leclercq, Jean-Claude Daubert, Philippe Mabo
Non-vitamin K oral anticoagulants (NOACs) are currently recommended for patients with nonvalvular atrial fibrillation since the publication of the 4 major pivotal trials evaluating the efficacy and safety of factor IIa and factor Xa inhibitors. The definition of nonvalvular atrial fibrillation is unclear, varying from one trial to another and even between North American and European guidelines, which is a source of uncertainties in clinical practice. However, many patients with atrial fibrillation present signs of valvular involvement, and clarification of this term is needed to not deny NOACs to patients based on the wrong perception that they may have valvular atrial fibrillation...
August 2016: American Heart Journal
https://www.readbyqxmd.com/read/27490591/aortic-and-mitral-valve-disease-and-left-ventricular-dysfunction-in-children
#5
Kevin O Maher, James S Tweddell
OBJECTIVES: In this review, we will discuss aortic stenosis, aortic regurgitation, mitral regurgitation, and mitral stenosis. We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. Age and lesion specific treatments are outlined based on the severity of valve disease with an aim at long-term preservation of left ventricular function. DATA SOURCE: MEDLINE and PubMed. CONCLUSIONS: Mitral and aortic valve disease leads to unique hemodynamic burdens that can impact left ventricular function, quality of life, and longevity...
August 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27326236/a-mechanical-heart-valve-is-the-best-choice
#6
Iqbal H Jaffer, Richard P Whitlock
The choice of prosthesis type in patients with valvular heart disease should always be individualised. The treating heart team must weigh the concerns surrounding durability of bioprosthetic valves compared with mechanical valves and the need for lifelong anticoagulation required with mechanical valves. In general, guidelines recommend that patients under the age of 60 would benefit from a mechanical valve, and those over 70 would benefit from a bioprosthetic valve. We would argue, in this context, that the most appropriate choice for this patient would be undertaking a mitral valve replacement with a mechanical prosthesis...
2016: Heart Asia
https://www.readbyqxmd.com/read/26874705/evaluation-and-management-of-concomitant-hypertrophic-obstructive-cardiomyopathy-and-valvular-aortic-stenosis
#7
John Shenouda, David Silber, Mythri Subramaniam, Basil Alkhatib, Richard K Schwartz, John A Goncalves, Srihari S Naidu
The dilemma of the patient with both AS and LVOTO is now commonly encountered in clinical practice; indeed, physicians must be aware of the complex interaction and coexistent nature of both diseases, especially as both HOCM and TAVR have increased in awareness and prevalence. Importantly, the clinician must be aware of the complex interplay hemodynamically, with the two diseases confusing the TTE imaging and potentially affecting each other anatomically and clinically. There is no set guideline on how to approach this from a surgical or percutaneous approach, but we have outlined a set of recommendations which should serve the clinician and patient well...
March 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/26649912/discordance-in-grading-methods-of-aortic-stenosis-by-pre-cardiopulmonary-bypass-transesophageal-echocardiography
#8
George Whitener, Jeff McKenzie, Igor Akushevich, William D White, Ishwori B Dhakal, Alina Nicoara, Madhav Swaminathan
BACKGROUND: Current guidelines define severe aortic valve stenosis (AS) as an aortic valve area (AVA) ≤1.0 cm by the continuity equation and mean gradient (ΔPm) ≥ 40 mm Hg. However, these measurements can be discordant when classifying AS severity. Approximately one-third of patients with normal ejection fraction and severe AS by AVA have nonsevere AS by ΔPm when measured by preoperative transthoracic echocardiography (TTE). Given the use of positive pressure ventilation and general anesthesia in the pre-cardiopulmonary bypass (pre-CPB) period, we hypothesized that discordance between ΔPm and AVA during pre-CPB transesophageal echocardiography (TEE) would be higher than previously reported by TTE...
April 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26455017/-moderate-or-severe-aquired-valvular-heart-disease-in-pregnancy-what-does-determine-the-management-experence-intuition-or-guidelines
#9
REVIEW
Lidia Greszata, Janina Stępińska
Epidemiology of acquired valvular heart diseases has changed significantly over last decades. Degenerative aortic valve stenosis is the most common acquired valvular disease with high prevalence in elderly population. Another common disorder is ischemic mitral regurgitation secondary to myocardial infarction. Both above-mentioned heart disorders are not typical for women in reproductive age. Rheumatic heart valve disease has become infrequent in Polish population. Mitral stenosis, the most prevalent of rheumatic valvular disorders, affects 5% of pregnant women with heart disease and rheumatic aortic stenosis is responsible for 0...
2015: Przegla̧d Lekarski
https://www.readbyqxmd.com/read/26184867/how-to-define-valvular-atrial-fibrillation
#10
REVIEW
Laurent Fauchier, Raphael Philippart, Nicolas Clementy, Thierry Bourguignon, Denis Angoulvant, Fabrice Ivanes, Dominique Babuty, Anne Bernard
Atrial fibrillation (AF) confers a substantial risk of stroke. Recent trials comparing vitamin K antagonists (VKAs) with non-vitamin K antagonist oral anticoagulants (NOACs) in AF were performed among patients with so-called "non-valvular" AF. The distinction between "valvular" and "non-valvular" AF remains a matter of debate. Currently, "valvular AF" refers to patients with mitral stenosis or artificial heart valves (and valve repair in North American guidelines only), and should be treated with VKAs. Valvular heart diseases, such as mitral regurgitation, aortic stenosis (AS) and aortic insufficiency, do not result in conditions of low flow in the left atrium, and do not apparently increase the risk of thromboembolism brought by AF...
October 2015: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/26138578/evaluation-of-acquired-valvular-heart-disease-by-the-pediatrician-when-to-follow-when-to-refer-for-intervention-part-ii
#11
Anita Saxena
Lesions of the heart valves are the commonest acquired cardiac abnormalities seen in pediatric age group. Aortic regurgitation (AR) results from abnormality of the valve leaflets or of the aortic root. Mitral valve lesion may be associated in patients with rheumatic heart disease (RHD). Left ventricle dilates and may develop dysfunction in advanced states. Coronary perfusion also tends to suffer in severe AR. The symptoms develop later and include dyspnea and palpitations. An early diastolic, high pitched murmur, best heard at base of the heart is the hallmark of AR...
November 2015: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/26060121/clinical-impact-and-evolution-of-mitral-regurgitation-following-transcatheter-aortic-valve-replacement-a-meta-analysis
#12
REVIEW
Luis Nombela-Franco, Hélène Eltchaninoff, Ralf Zahn, Luca Testa, Martin B Leon, Ramiro Trillo-Nouche, Augusto D'Onofrio, Augusto D Onofrio, Craig R Smith, John Webb, Sabine Bleiziffer, Benedetta De Chiara, Martine Gilard, Corrado Tamburino, Francesco Bedogni, Marco Barbanti, Stefano Salizzoni, Bruno García del Blanco, Manel Sabaté, Antonella Moreo, Cristina Fernández, Henrique Barbosa Ribeiro, Ignacio Amat-Santos, Marina Urena, Ricardo Allende, Eulogio García, Carlos Macaya, Eric Dumont, Philippe Pibarot, Josep Rodés-Cabau
OBJECTIVES: Mitral regurgitation (MR) is a common entity in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but its influence on outcomes remains controversial. The purpose of this meta-analysis was to assess the clinical impact of and changes in significant (moderate-severe) MR in patients undergoing TAVR, overall and according to valve design (self-expandable (SEV) vs balloon-expandable (BEV)). METHODS: All national registries and randomised trials were pooled using meta-analytical guidelines to establish the impact of moderate-severe MR on mortality after TAVR...
September 2015: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/25994754/prognostic-value-of-cha2ds2-vasc-score-in-patients-with-non-valvular-atrial-fibrillation-and-valvular-heart-disease-the-loire-valley-atrial-fibrillation-project
#13
Raphael Philippart, Anne Brunet-Bernard, Nicolas Clementy, Thierry Bourguignon, Alain Mirza, Dominique Babuty, Denis Angoulvant, Gregory Y H Lip, Laurent Fauchier
AIMS: The CHA2DS2VASc score is a clinical risk stratification tool which estimates the risk of stroke and thromboembolism in non-valvular atrial fibrillation (AF). We aimed to establish the value of this score for risk evaluation in patients with non-valvular AF and valvular heart disease. METHODS AND RESULTS: Among 8053 patients with non-valvular AF (ESC guidelines definition), patients were categorized into Group 1 (no valve disease, n = 6851; 85%) and Group 2 (valve disease with neither rheumatic mitral stenosis nor valve prothesis, n = 1202; 15%)...
July 21, 2015: European Heart Journal
https://www.readbyqxmd.com/read/25981195/assessment-of-mitral-valve-disease-a-review-of-imaging-modalities
#14
Shweta R Motiwala, Francesca N Delling
Mitral valve disease (MVD) related to mitral valve prolapse (MVP), coronary artery disease (CAD), and calcific mitral stenosis, is increasing in prevalence across the USA and Europe in the context of a longer life expectancy and aging population. In developing countries, rheumatic heart disease remains a major cause of MVD. Echocardiography represents the primary diagnostic modality for assessment of the mitral valve (MV). With the implementation of three-dimensional imaging, echocardiography has become an indispensable tool to evaluate the morphology, geometry, and function of the MV apparatus in the pre-operative setting...
July 2015: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/25908277/-offer-early-attention-and-intervention-to-patients-with-valvular-heart-disease
#15
Shengli Jiang, Chonglei Ren
As a key feature of the updates, early intervention of valvular heart disease is highlighted in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. This article reviewed the new guideline in regards to the issue of early intervention of diseases such as aortic stenosis, aortic insufficiency, mitral stenosis, mitral insufficiency, tricuspid insufficiency, and infective endocarditis, with discussion on the related topics according to the authors' understanding and practical experience in China...
February 2015: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/25855679/effect-of-tricuspid-regurgitation-and-the-right-heart-on-survival-after-transcatheter-aortic-valve-replacement-insights-from-the-placement-of-aortic-transcatheter-valves-ii-inoperable-cohort
#16
RANDOMIZED CONTROLLED TRIAL
Brian R Lindman, Hersh S Maniar, Wael A Jaber, Stamatios Lerakis, Michael J Mack, Rakesh M Suri, Vinod H Thourani, Vasilis Babaliaros, Dean J Kereiakes, Brian Whisenant, D Craig Miller, E Murat Tuzcu, Lars G Svensson, Ke Xu, Darshan Doshi, Martin B Leon, Alan Zajarias
BACKGROUND: Tricuspid regurgitation (TR) and right ventricular (RV) dysfunction adversely affect outcomes in patients with heart failure or mitral valve disease, but their impact on outcomes in patients with aortic stenosis treated with transcatheter aortic valve replacement has not been well characterized. METHODS AND RESULTS: Among 542 patients with symptomatic aortic stenosis treated in the Placement of Aortic Transcatheter Valves (PARTNER) II trial (inoperable cohort) with a Sapien or Sapien XT valve via a transfemoral approach, baseline TR severity, right atrial and RV size and RV function were evaluated by echocardiography according to established guidelines...
April 2015: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/25843026/guideline-adherence-for-echocardiographic-follow-up-in-outpatients-with-at-least-moderate-valvular-disease
#17
Raymond H Chan, Jaime L Shaw, Thomas H Hauser, Lawrence J Markson, Warren J Manning
BACKGROUND: Attention to resource utilization has led to increased scrutiny of the appropriateness of initial diagnostic imaging studies on the basis of current guidelines. Far less attention has been paid to examining the lack of appropriate follow-up studies. METHODS: A retrospective cross-sectional analysis was performed of 3,781 consecutive outpatients referred for transthoracic echocardiography (TTE) from July to December 2008. Data from the electronic medical records were extracted to see if patients with at least moderate left-sided valvular stenosis or regurgitation underwent subsequent echocardiographic studies within 60 days of the period recommended by the 2006 American College of Cardiology and American Heart Association valve guidelines document...
July 2015: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/25819185/tricuspid-regurgitation-is-associated-with-increased-risk-of-mortality-in-patients-with-low-flow-low-gradient-aortic-stenosis-and-reduced-ejection-fraction-results-of-the-multicenter-topas-study-true-or-pseudo-severe-aortic%C3%A2-stenosis
#18
MULTICENTER STUDY
Abdellaziz Dahou, Julien Magne, Marie-Annick Clavel, Romain Capoulade, Philipp Emanuel Bartko, Jutta Bergler-Klein, Mario Sénéchal, Gerald Mundigler, Ian Burwash, Henrique B Ribeiro, Kim O'Connor, Patrick Mathieu, Helmut Baumgartner, Jean G Dumesnil, Raphael Rosenhek, Eric Larose, Josep Rodés-Cabau, Philippe Pibarot
OBJECTIVES: This study sought to examine the impact of tricuspid regurgitation (TR) on mortality in patients with low-flow, low-gradient (LF-LG) aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF). BACKGROUND: TR is often observed in patients with LF-LG AS and low LVEF, but its impact on prognosis remains unknown. METHODS: A total of 211 patients (73±10 years of age; 77% men) with LF-LG AS (mean gradient<40 mm Hg and indexed aortic valve area [AVA]≤0...
April 20, 2015: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/25589164/novel-oral-anticoagulants-and-valvular-atrial-fibrillation-are-they-always-contraindicated
#19
Giuseppe Di Pasquale, Silvia Zagnoni, Letizia Riva
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia, and is associated with an increased risk of death, stroke, and other thromboembolic events. Valvular heart disease (VHD) frequently coexists with AF, mostly in elderly patients. After the introduction of novel oral anticoagulants (NOACs) approved for the prevention of stroke in non-valvular atrial fibrillation (NVAF) on the basis of recent trials, the importance of a universal definition of NVAF was raised in clinical practice. In the most recent guidelines, the term valvular AF is used to imply that AF is related to rheumatic valvular disease (predominantly mitral stenosis), or prosthetic heart valves...
February 2015: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/25055475/-ischemic-stroke-the-cardiac-workup
#20
REVIEW
Thierry Grandjean, Lucien Weiss, Roman Sztajzel, Jean-Jacques Perrenoud
The cardiac workup of stroke often includes a 24 hours Holter and an echocardiography looking for cardiac sources of emboli (atrial fibrillation (AF), intracardiac thrombus, mitral stenosis, recent myocardial infarction, endocarditis, dilated cardiomyopathy...) which would lead to a change of treatment (secondary prevention) aiming at decreasing the risk of recurrence. In case of a stroke with AF, the secondary prevention strategy is well defined (anticoagulants). It is less clear for the other causes. The diagnostic yield of these examinations is limited and there is a lack of consensus in their utility...
June 25, 2014: Revue Médicale Suisse
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