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Low flow aortic stenosis

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https://www.readbyqxmd.com/read/29762932/pulmonary-hypertension-as-a-possible-cause-of-paradoxical-low-flow-low-gradient-aortic-stenosis
#1
Yuta Watanabe, Haruhiko Higashi, Katsuji Inoue, Jun Aono, Takafumi Okura, Jitsuo Higaki, Shuntaro Ikeda
Paradoxical low-flow, low-gradient aortic stenosis (LFLG AS) is recognized as a subtype of aortic stenosis. A small left ventricular (LV) cavity with marked LV concentric remodeling leads to a reduced stroke volume in this condition. The case is reported of a paradoxical LFLG AS patient who was undergoing treatment for pulmonary hypertension (PH) and interstitial pneumonia associated with scleroderma. Echocardiography demonstrated enlargement of the right ventricle and a diminished LV cavity. Moreover, the aortic valve opening was restricted despite a preserved LV ejection fraction (61%)...
September 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/29721704/workup-and-management-of-patients-with-paradoxical-low-flow-low-gradient-aortic-stenosis
#2
REVIEW
Mohamed-Salah Annabi, Marine Clisson, Marie-Annick Clavel, Philippe Pibarot
About 60% of patients with paradoxical low-flow, low-gradient (PLF-LG) aortic stenosis (AS) have a severe disease that justifies aortic valve replacement (AVR). The first step in patients with symptomatic PLF AS should be to rule out measurement errors and treat hypertension. The second step is to distinguish pseudo-severe from true severe AS (TSAS). The third step is to select the optimal treatment modality at the right time. Regarding the second step, projected aortic valve area calculated using stress echocardiography is superior to traditional severity criteria (AVA < 1...
May 2, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29698407/a-novel-echocardiographic-hemodynamic-index-for-predicting-outcome-of-aortic-stenosis-patients-following-transcatheter-aortic-valve-replacement
#3
Altayyeb Yousef, Benjamin Hibbert, Joshua Feder, Jordan Bernick, Juan Russo, Zachary MacDonald, Christopher Glover, Alexander Dick, Munir Boodhwani, Buu-Khanh Lam, Marc Ruel, Marino Labinaz, Ian G Burwash
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) reduces left ventricular (LV) afterload and improves prognosis in aortic stenosis (AS) patients. However, LV afterload consists of both valvular and arterial loads, and the benefits of TAVR may be attenuated if the arterial load dominates. We proposed a new hemodynamic index, the Relative Valve Load (RVL), a ratio of mean gradient (MG) and valvuloarterial impedance (Zva), to describe the relative contribution of the valvular load to the global LV load, and examined whether RVL predicted patient outcome following TAVR...
2018: PloS One
https://www.readbyqxmd.com/read/29688181/saline-induced-pd-pa-ratio-predicts-functional-significance-of-coronary-stenosis-assessed-using-fractional-flow-reserve
#4
Yoshiharu Fujimori, Tomoko Baba, Kyohei Yamazaki, Satoshi Hashimoto, Yasushi Yamanaka, Kenichiro Ebisuda, Kazuto Kurihara, Naoki Koike, Nao Takeuchi, Shigeru Nishiyama, Yuya Terasawa, Tadamasa Wakabayashi, Taku Imai
AIMS: Fractional flow reserve (FFR), assessed using distal coronary pressure/aortic pressure (Pd)/(Pa) ratio, functionally evaluates coronary stenosis. An assessment method without vasodilators would be helpful. A single intracoronary bolus of saline decreases Pd because of the speculated low-viscosity effect. We hypothesized that saline-induced Pd/Pa ratio (SPR) could functionally evaluate coronary stenosis. This study aimed to test the accuracy and utility of SPR for predicting FFR ≤0...
April 24, 2018: EuroIntervention
https://www.readbyqxmd.com/read/29668339/in-hospital-outcomes-after-rotational-atherectomy-in-patients-with-low-ejection-fraction
#5
Yusuke Watanabe, Toru Naganuma, Hiroyoshi Kawamoto, Hisaaki Ishiguro, Sunao Nakamura
OBJECTIVES: This study evaluated angiographic success and in-hospital outcomes of percutaneous coronary intervention (PCI) with rotational atherectomy (RA) in patients with low left ventricular ejection fraction (LVEF). DESIGN: Between January 2010 and March 2014, 272 consecutive patients with heavily calcified lesions underwent elective PCI with RA. Of these, 33 patients had LVEF ≤35% (low LVEF group), whereas 237 patients had LVEF >35% (preserved LVEF group)...
April 18, 2018: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/29622096/management-of-patients-with-aortic-valve-stenosis
#6
REVIEW
Amrit Kanwar, Jeremy J Thaden, Vuyisile T Nkomo
With increased life expectancy and aging of the population, aortic stenosis is now one of the most common valvular heart diseases. Early recognition and management of aortic stenosis are of paramount importance because untreated symptomatic severe disease is universally fatal. The advent of transcather aortic valve replacement technologies provides exciting avenues of care to patients with this disease in whom traditional surgical procedures could not be performed or were associated with high risk. This review for clinicians offers an overview of aortic stenosis and updated information on the current status of various treatment strategies...
April 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29605969/latent-myopathy-is-more-pronounced-in-patients-with-low-flow-versus-normal-flow-aortic-stenosis-with-normal-left-ventricular-ejection-fraction-who-are-undergoing-surgical-aortic-valve-replacement-multicenter-study-with-a-brief-review-of-the-literature
#7
Azhar Supariwala, Monica Sanchez-Ross, Valentin Suma, Karthik Seetharam, Daniel Marrero, Daniel Swistel, Sandhya Balaram, Farooq A Chaudhry
BACKGROUND: Midwall fibrosis and low stroke volume are independent predictors of mortality in severe aortic stenosis (AS) with preserved LV ejection fraction (LVEF). The role of speckle tracking echocardiography (STE) to identify latent myopathy pre- and post- aortic valve replacement (AVR) in high risk AS patients with normal LVEF is limited. METHODS: Demographic, 2D echocardiographic, and STE data were analyzed in patients with severe AS and preserved LVEF who underwent tissue AVR...
April 1, 2018: Echocardiography
https://www.readbyqxmd.com/read/29572249/take-home-messages-with-cases-from-focused-update-on-echocardiographic-assessment-of-aortic-stenosis
#8
REVIEW
Judy Hung, Sheila Liu Klassen, Javier Bermejo, John Boyd Chambers
Echocardiography plays an important role in the assessment of valvular aortic stenosis. Updated recommendations focusing on a stepwise approach to evaluating aortic stenosis have recently been published by the European Association of Cardiovascular Imaging and the American Society of Echocardiography. This review uses illustrative cases to demonstrate technical aspects of aortic stenosis assessment and use of the new proposed classification scheme for aortic stenosis. Key points from the updated recommendations reviewed in this paper are: (1) technical considerations and sources of error in measurement of peak velocity, mean aortic valve gradient and aortic valve area by continuity equation...
March 23, 2018: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29566813/low-flow-low-gradient-aortic-stenosis-tavr-in-dobutamine-stress-echocardiography-out
#9
EDITORIAL
Philippe Généreux
No abstract text is available yet for this article.
March 27, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29566812/transcatheter-aortic-valve-replacement-in-patients-with-low-flow-low-gradient-aortic-stenosis-the-topas-tavi-registry
#10
Henrique Barbosa Ribeiro, Stamatios Lerakis, Martine Gilard, João L Cavalcante, Raj Makkar, Howard C Herrmann, Stephan Windecker, Maurice Enriquez-Sarano, Asim N Cheema, Luis Nombela-Franco, Ignacio Amat-Santos, Antonio J Muñoz-García, Bruno Garcia Del Blanco, Alan Zajarias, John C Lisko, Salim Hayek, Vasilis Babaliaros, Florent Le Ven, Thomas G Gleason, Tarun Chakravarty, Wilson Y Szeto, Marie-Annick Clavel, Alberto de Agustin, Vicenç Serra, John T Schindler, Abdellaziz Dahou, Rishi Puri, Emilie Pelletier-Beaumont, Melanie Côté, Philippe Pibarot, Josep Rodés-Cabau
BACKGROUND: Few data exist on patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR). Also, very scarce data exist on the usefulness of dobutamine stress echocardiography (DSE) before TAVR in these patients. OBJECTIVES: The authors sought to evaluate clinical outcomes and changes in left ventricular ejection fraction (LVEF) following TAVR in patients with classical LFLG-AS. METHODS: This multicenter registry included 287 patients with LFLG-AS undergoing TAVR...
March 27, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29561991/an-alternative-method-to-calculate-simplified-projected-aortic-valve-area-at-normal-flow-rate
#11
Joana Sofia Silva Moura Ferreira, Nádia Moreira, Rita Ferreira, Sofia Mendes, Rui Martins, Maria João Ferreira, Mariano Pego
BACKGROUND: Simplified projected aortic valve area (EOAproj) is a valuable echocardiographic parameter in the evaluation of low flow low gradient aortic stenosis (LFLG AS). Its widespread use in clinical practice is hampered by the laborious process of flow rate (Q) calculation. OBJETIVE: This study proposes a less burdensome, alternative method of Q calculation to be incorporated in the original formula of EOAproj and measures the agreement between the new proposed method of EOAproj calculation and the original one...
February 2018: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/29561987/low-flow-low-gradient-and-low-ejection-fraction-aortic-stenosis-and-projected-aortic-valve-area-calculation-so-important-but-so-complicated-let-us-just-keep-it-simple
#12
EDITORIAL
Wilson Mathias Junior
No abstract text is available yet for this article.
February 2018: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/29558902/emergency-transcatheter-aortic-valve-replacement-for-a-patient-with-decompensated-severe-aortic-stenosis-accompanied-by-cardiorenal-syndrome-a-case-report
#13
Hongju Kim, Jung-Hee Lee
BACKGROUND: Severe aortic stenosis (AS) may lead to acute decompensated heart failure resistant to medical treatment. Here, we report a successful emergent transcatheter aortic valve replacement (TAVR) in a patient presenting with decompensated severe AS accompanied by cardiorenal syndrome. CASE PRESENTATION: A 82-year-old man presented at our emergency department with aggravated dyspnea. His chest X-ray showed bilateral pulmonary edema, and laboratory examination revealed acute kidney injury...
March 20, 2018: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29550325/transaortic-flow-rate-versus-stroke-volume-index-in-low-gradient-aortic-stenosis
#14
EDITORIAL
Crochan J O'Sullivan, Ernest Spitzer
No abstract text is available yet for this article.
March 9, 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29550315/low-transvalvular-flow-rate-predicts-mortality-in-patients-with-low-gradient-aortic-stenosis-following-aortic-valve-intervention
#15
Anastasia Vamvakidou, Wenying Jin, Oleksandr Danylenko, Navtej Chahal, Rajdeep Khattar, Roxy Senior
OBJECTIVES: This study aimed to assess the value of low transvalvular flow rate (FR) for the prediction of mortality compared with low stroke volume index (SVi) in patients with low-gradient (mean gradient: <40 mm Hg), low aortic valve area (<1 cm2 ) aortic stenosis (AS) following aortic valve intervention. BACKGROUND: Transaortic FR defined as stroke volume/left ventricular ejection time is also a marker of flow; however, no data exist comparing the relative prognostic value of these 2 transvalvular flow markers in patients with low-gradient AS who had undergone valve intervention...
March 9, 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29547988/impact-of-low-stroke-volume-on-mortality-in-patients-with-severe-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction
#16
Dan Rusinaru, Yohann Bohbot, Anne Ringle, Sylvestre Maréchaux, Momar Diouf, Christophe Tribouilloy
Aims: In patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), low flow (LF) is currently defined using Doppler-echocardiography by a stroke volume index (SVi)<35 mL/m2. However, the relationship between LF and outcome remains unclear as data on normal reference values defining LF are scarce, and previous studies did not explore the risk associated with other SVi cut-points. We analysed the relationship between LF and mortality in severe AS to establish prognostic LF values associated with mortality risk...
March 13, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29522643/anatomic-estimation-of-aortic-stenosis-severity-vs-fusion-of-data-from-computed-tomography-and-doppler-echocardiography
#17
Nikolaus Jander, Susanne Wienecke, Stephan Dorfs, Philipp Ruile, Franz-Josef Neumann, Gregor Pache, Jan Minners
AIM: Two-dimensional, transthoracic echocardiography does not account for the noncircular anatomy of the left ventricular outflow tract (LVOT) and may therefore underestimate LVOT area. Fusion of computed tomography (CT)-derived LVOT area and Doppler-derived flow data has been proposed to improve assessment of aortic valve area (AVA) and classification of aortic stenosis severity. For hemodynamic reasons, effective AVA has to be smaller than anatomic AVA. The aim of the study was to test the "fusion approach" by comparing effective CT-derived AVA with anatomic AVA from CT planimetry...
March 9, 2018: Echocardiography
https://www.readbyqxmd.com/read/29468351/large-calibre-self-expanding-stents-for-pulmonary-stenosis-after-the-arterial-switch-a-low-risk-solution-to-a-low-flow-situation
#18
Gareth J Morgan, Kuberan Pushparajah, Srinivas Narayan, Eric Rosenthal
Branch pulmonary artery stenosis is one of the most common complications late after the arterial switch operation. The pathophysiology of stenosis in these circumstances is very different to that encountered in with normally related great vessels. The LeCompte manoeuvre leaves the pulmonary arteries straddled and stretched over the aortic root which contributing significantly to the degree of stenosis encountered. Unilateral branch pulmonary artery stenosis rarely leads to significant symptoms in young patients with biventricular repairs; however, significant discrepancies in the split flows between right and left lung may place the patient in an unfavourable physiological position as they move in to middle age...
April 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29455849/relationship-between-proximal-aorta-morphology-and-progression-rate-of-aortic-stenosis
#19
Romain Capoulade, Jonathan G Teoh, Philipp E Bartko, Eliza Teo, Jan-Erik Scholtz, Lionel Tastet, Mylene Shen, Christos G Mihos, Yong H Park, Julio Garcia, Eric Larose, Eric M Isselbacher, Thoralf M Sundt, Thomas E MacGillivray, Serguei Melnitchouk, Brian B Ghoshhajra, Philippe Pibarot, Judy Hung
BACKGROUND: The aim of this study was to examine the association between abnormal morphology of the proximal aorta and aortic stenosis (AS) progression rate. The main hypothesis was that morphologic changes of the proximal aorta, such as effacement of the sinotubular junction (STJ), result in increased biomechanical stresses and contribute to calcification and progression of AS. METHODS: Between 2010 and 2012, 426 patients with mild to moderate AS were included in this study...
May 2018: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/29439881/prospective-assessment-of-the-frequency-of-low-gradient-severe-aortic-stenosis-with-preserved-left-ventricular-ejection-fraction-critical-impact-of-aortic-flow-misalignment-and-pressure-recovery-phenomenon
#20
Anne Ringle, Anne-Laure Castel, Caroline Le Goffic, François Delelis, Camille Binda, Yohan Bohbot, Pierre Vladimir Ennezat, Raphaëlle A Guerbaai, Franck Levy, André Vincentelli, Pierre Graux, Christophe Tribouilloy, Sylvestre Maréchaux
BACKGROUND: The frequency of paradoxical low-gradient severe aortic stenosis (AS) varies widely across studies. The impact of misalignment of aortic flow and pressure recovery phenomenon on the frequency of low-gradient severe AS with preserved left ventricular ejection fraction (LVEF) has not been evaluated in prospective studies. AIMS: To investigate prospectively the impact of aortic flow misalignment by Doppler and lack of pressure recovery phenomenon correction on the frequency of low-gradient (LG) severe aortic stenosis (AS) with preserved LVEF...
February 10, 2018: Archives of Cardiovascular Diseases
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