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Low flow aortic stenosis

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https://www.readbyqxmd.com/read/29316285/colonic-ischemia-developed-after-laparoscopic-colectomy-for-rectosigmoid-cancer-with-focal-infrarenal-aortic-stenosis
#1
Atsuyo Ikeda, Hidekazu Takahashi, Norikatsu Miyoshi, Naotsugu Haraguchi, Taishi Hata, Chu Matsuda, Hirofumi Yamamoto, Tsunekazu Mizushima, Yuichiro Doki, Masaki Mori
A 69-year-old woman with focal infrarenal aortic stenosis was diagnosed with rectosigmoid cancer. Because radical resection for colon cancer required dissection of vessels that supplied blood flow to the legs, revascularization by aortic stent placement was performed before the colectomy. We subsequently performed laparoscopic low anterior resection without any complications. Two and a half years after colectomy, however, the patient developed colonic ischemia due to thrombosis of the dilated marginal artery that served as a collateral artery before stenting...
January 8, 2018: Asian Journal of Endoscopic Surgery
https://www.readbyqxmd.com/read/29222121/postoperative-reverse-remodeling-and-symptomatic-improvement-in-normal-flow-low-gradient-aortic-stenosis-after-aortic-valve-replacement
#2
COMPARATIVE STUDY
Rasmus Carter-Storch, Jacob E Møller, Nicolaj L Christensen, Akhmadjon Irmukhadenov, Lars M Rasmussen, Redi Pecini, Kristian A Øvrehus, Eva V Søndergård, Niels Marcussen, Jordi S Dahl
BACKGROUND: Severe aortic stenosis (AS) most often presents with reduced aortic valve area (<1 cm2), normal stroke volume index (≥35 mL/m2), and either high mean gradient (≥40 mm Hg; normal-flow high-gradient AS) or low mean gradient (normal-flow low-gradient [NFLG] AS). The benefit of aortic valve replacement (AVR) among NFLG patients is controversial. We compared the impact of NFLG condition on preoperative left ventricular (LV) remodeling and myocardial fibrosis and postoperative remodeling and symptomatic benefit...
December 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29212513/cardiac-amyloidosis-is-prevalent-in-older-patients-with-aortic-stenosis-and-carries-worse-prognosis
#3
João L Cavalcante, Shasank Rijal, Islam Abdelkarim, Andrew D Althouse, Michael S Sharbaugh, Yaron Fridman, Prem Soman, Daniel E Forman, John T Schindler, Thomas G Gleason, Joon S Lee, Erik B Schelbert
BACKGROUND: Non-invasive cardiac imaging allows detection of cardiac amyloidosis (CA) in patients with aortic stenosis (AS). Our objective was to estimate the prevalence of clinically suspected CA in patients with moderate and severe AS referred for cardiovascular magnetic resonance (CMR) in age and gender categories, and assess associations between AS-CA and all-cause mortality. METHODS: We retrospectively identified consecutive AS patients defined by echocardiography referred for further CMR assessment of valvular, myocardial, and aortic disease...
December 7, 2017: Journal of Cardiovascular Magnetic Resonance
https://www.readbyqxmd.com/read/29198984/relation-of-an-echocardiographic-based-cardiac-calcium-score-to-mitral-stenosis-severity-and-coronary-artery-disease-in-patients-with-severe-aortic-stenosis
#4
Siyuan P Sheng, Lucius A Howell, Melissa C Caughey, Michael Yeung, John P Vavalle
Patients with calcific aortic stenosis (AS) often have diffuse cardiac calcification involving the mitral valve apparatus and coronary arteries. We examined the association between global cardiac calcification quantified by a previously validated echocardiographic calcium score (eCS) with the severity of mitral stenosis (MS) and coronary artery disease (CAD) in patients with a clinical diagnosis of severe calcific AS. In this sample of 147 patients (mean age 81 ± 9 years, 50% male), 81 patients (55%) were determined by echocardiography to have some degree of MS...
October 26, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29168539/severe-degenerative-aortic-stenosis-with-preserved-ejection-fraction-does-not-change-adipokines-serum-levels
#5
Katarzyna Mizia-Stec, Tomasz Bochenek, Błażej Kusz, Magdalena Mizia, Agnieszka Sikora-Puz, Klaudia Gieszczyk-Strózik
BACKGROUND: The role of the adipokines in the pathogenesis of aortic stenosis (AS) is not well established. The aim was to evaluate the relationship between adipokines and clinical characteristics as well as echocardiographic indices and noninvasive markers of vascular remodeling in patients with severe AS with preserved ejection fraction (EF). METHODS: Sixty-five patients (F/M: 38/27; age: 68.3 ± 9.0 years; body mass index [BMI]: 29.6 ± 4.3 kg/m²) with severe AS with preserved EF: 33 patients with paradoxical low-flow low-gradient AS (PLFLG AS) and 32 patients with normal flow high-gradient AS (NFHG AS) were prospectively enrolled into the study...
November 23, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/29124471/clinical-outcome-and-functional-characteristics-of-patients-with-asymptomatic-low-flow-low-gradient-severe-aortic-stenosis-with-preserved-ejection-fraction-are-closer-to-high-gradient-severe-than-to-moderate-aortic-stenosis
#6
Mohammad Kavianipour, Amir Farkhooy, Frank A Flachskampf
Asymptomatic "paradoxic" severe low-flow low-gradient aortic stenosis with preserved ejection fraction (PAS) constitutes a challenging condition where the optimal management and follow-up remain elusive. We evaluated the clinical outcome in patients with PAS as compared to asymptomatic patients with moderate (MAS) or classical severe aortic stenosis (CAS). Consecutive asymptomatic moderate or severe aortic stenosis patients without concomitant other heart or lung disease (n = 121) were invited. Participants (n = 74) were assigned to three subgroups with regard to degree of aortic stenosis: MAS (n = 25), CAS (n = 22) and PAS (n = 27)...
November 9, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/29055632/intervention-versus-observation-in-symptomatic-patients-with-normal-flow-low-gradient-severe-aortic-stenosis
#7
Oren Zusman, Gregg S Pressman, Shmuel Banai, Ariel Finkelstein, Yan Topilsky
OBJECTIVES: To describe patients with severe symptomatic aortic stenosis with normal flow and low gradients and determine whether they benefit from intervention. BACKGROUND: Severe symptomatic aortic stenosis is a progressive disease with high mortality. Although surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) are indicated for patients with high gradients (>40 mm Hg) or low gradients due to low flow, the approach for patients with normal flow and low gradients is poorly defined...
October 14, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29040507/aortic-valve-replacement-improves-survival-in-severe-aortic-stenosis-with-gradient-area-mismatch
#8
Yujing Mo, Guy Van Camp, Giuseppe Di Gioia, Emanuele Barbato, Tomas Ondrus, Filip Casselman, Marc Vanderheyden, Bernard De Bruyne, Jozef Bartunek, Martin Penicka
OBJECTIVES: To investigate whether and in which patients with catheter-derived low pressure gradient (PG, <40 mmHg) severe (aortic valve area ≤ 1 cm2) aortic stenosis and preserved left ventricular ejection fraction, early aortic valve replacement (AVR) might improve survival. METHODS: We investigated a total of 506 consecutive patients (age 75 ± 9 years, 58% men) with either moderate aortic stenosis (MAS) or severe aortic stenosis (SAS) and preserved left ventricular ejection fraction (≥50%) as defined at catheterization...
October 13, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29033387/survival-and-cause-of-death-after-transcatheter-aortic-valve-replacement-as-compared-to-an-age-and-sex-matched-background-population
#9
Marie Theut, Julie B Thygesen, Ole De Backer, Lars Søndergaard
AIMS: This study aimed to assess survival and causes of death in a real-world TAVR population as compared to an age- and sex-matched background population. METHODS AND RESULTS: Each aortic stenosis (AS) patient treated with TAVR in Eastern Denmark between 2007 and 2014 (n=617) was matched with 25 age- and sex-matched controls (n=15,425) randomly drawn from the general Danish population. In the total TAVR population, early mortality (≤90 days) was significantly higher (hazard ratio [HR] 3...
October 13, 2017: EuroIntervention
https://www.readbyqxmd.com/read/29029006/large-scale-assessment-of-aortic-stenosis-facing-the-next-cardiac-epidemic
#10
Javier Ramos, Juan Manuel Monteagudo, Teresa González-Alujas, María Eugenia Fuentes, Marta Sitges, María Luisa Peña, Fernando Carrasco-Chinchilla, Tomás Echeverría, Alberto Bouzas, José Francisco Forteza Alberti, Dolores Mesa, Jesús María De La Hera, José Luis Zamorano
Aims: Aortic stenosis (AS) is the most frequent valvular disease in developed countries. As society grows older, the prevalence of AS increases. However, the real burden, current aetiology, severity distribution, and echocardiographic patterns of AS are not fully clear. The aim of the present study is to provide an accurate overall picture of AS, focusing on its epidemiology, aetiology, and echocardiographic features. Methods and results: A total of 29 502 consecutive echocardiograpies were prospectively included in this multicentre study...
September 28, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/29021259/preload-stress-echocardiography-predicts-outcomes-in-patients-with-preserved-ejection-fraction-and-low-gradient-aortic-stenosis
#11
Kenya Kusunose, Hirotsugu Yamada, Susumu Nishio, Yuta Torii, Yukina Hirata, Hiromitsu Seno, Yoshihito Saijo, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata
BACKGROUND: The projected aortic valve area (AVAproj) at a normal transvalvular flow rate using dobutamine is helpful to determine the actual severity of aortic stenosis (AS) and to predict risk of adverse events in low-gradient AS cases with unclear surgical indication. Our study aimed to identify the independent and incremental value of preload stress echocardiography-derived AVAproj to predict outcomes in patients with preserved ejection fraction and low-gradient AS. METHODS AND RESULTS: We prospectively performed echocardiographic studies in 79 patients with low-gradient AS (age, 77±7 years; 30% men) with preload stress echocardiography using leg positive pressure...
October 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29019612/unveiling-transthyretin-cardiac-amyloidosis-and-its-predictors-among-elderly-patients-with-severe-aortic-stenosis-undergoing-transcatheter-aortic-valve-replacement
#12
Adam Castaño, David L Narotsky, Nadira Hamid, Omar K Khalique, Rachelle Morgenstern, Albert DeLuca, Jonah Rubin, Codruta Chiuzan, Tamim Nazif, Torsten Vahl, Isaac George, Susheel Kodali, Martin B Leon, Rebecca Hahn, Sabahat Bokhari, Mathew S Maurer
Aims: Transthyretin cardiac amyloidosis (ATTR-CA) has been reported in patients with aortic stenosis (AS) but its prevalence and phenotype are not known. We examine elderly patients with severe symptomatic AS undergoing transcatheter aortic valve replacement (TAVR) and determine the prevalence and phenotype of ATTR-CA non-invasively. Methods and results: We performed technetium-99m pyrophosphate (99mTc-PYP) cardiac scintigraphy prospectively on patients who underwent TAVR, to screen for ATTR-CA...
October 7, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28994654/impact-of-concomitant-mitral-regurgitation-on-transvalvular-gradient-and-flow-in-severe-aortic-stenosis-a-systematic-ex-vivo-analysis-of-a-subentity-of-low-flow-low-gradient-aortic-stenosis
#13
Felix Katte, Marcus Franz, Christian Jung, Hans R Figulla, David M Leistner, Philipp Jakob, Barbara E Stähli, Daniel Kretzschmar, Alexander Lauten
AIMS: Evaluation of aortic stenosis(AS) is based on measurement of mean transvalvular gradient(MPG), flow velocity(vmax) and aortic valve area(AVA). Objective of the present study was to analyse the impact of systemic hemodynamic variables and concomitant mitral regurgitation(MR) on aortic MPG, vmax and AVA in severe AS. METHODS AND RESULTS: A pulsatile circulatory model was designed to study function and interdependence of stenotic aortic and insufficient mitral prosthetic valves (n=8; effective regurgitation orifice (EROA)<0...
October 10, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28950336/apical-four-chamber-longitudinal-left-ventricular-strain-in-patients-with-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction-analysis-related-with-flow-gradient-pattern-and-association-with-outcome
#14
Erwan Salaun, Anne-Claire Casalta, Erwan Donal, Yohann Bohbot, Elena Galli, Christophe Tribouilloy, Sandrine Hubert, Julien Magne, Julien Mancini, Sebastien Renard, Jean-Francois Avierinos, Laurie-Anne Maysou, Cécile Lavoute, Catherine Szymanski, Julie Haentjens, Gilbert Habib
Aims: To evaluate the prognostic value of apical four-chamber (A4-C) longitudinal strain (LS) in patients with aortic stenosis (AS). Methods and results: In a multicentre cohort, 582 patients (74.3 ± 10.9 years) with moderate or severe AS and preserved left ventricular (LV) ejection fraction (≥50%) were included in this retrospective study. Patients with severe AS were classified in four subgroups according to flow and gradient: low flow (LF) was defined as a stroke volume index <35 mL/m2 compared with normal flow (NF); low-gradient (LG) as a mean gradient <40 mmHg compared with high gradient (HG)...
August 10, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28950322/concomitant-mitral-regurgitation-and-aortic-stenosis-one-step-further-to-low-flow-preserved-ejection-fraction-aortic-stenosis
#15
Giovanni Benfari, Marie-Annick Clavel, Stefano Nistri, Caterina Maffeis, Corrado Vassanelli, Maurice Enriquez-Sarano, Andrea Rossi
Aims: Patients with severe aortic stenosis (AS) and normal ejection fraction (EF) can paradoxically present low-transaortic flow and worse prognosis. The role of co-existing mitral regurgitation (MR) in determining this haemodynamic inconsistency has never been quantitatively explored. The hypothesis is that MR influences forward stroke volume and characterizes the low-flow AS pattern. Methods and results: Consecutive patients with indexed aortic valve area (AVA) ≤0...
July 27, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28941480/a-double-crossover-technique-in-an-obese-patient-undergoing-transfemoral-transcatheter-aortic-valve-implantation-how-to-accomplish-hemostasis-percutaneously
#16
Hirokazu Onishi, Toru Naganuma, Sunao Nakamura
Percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI) is generally an acceptable procedure but may be associated with vascular complications at femoral access sites, particularly in obese patients. This report aimed to describe a case of successful performance of our "double crossover technique" in an obese patient undergoing TF-TAVI with a percutaneous transfemoral intra-aortic balloon pump (TF-IABP). A 75-year-old man presented with heart failure due to a left ventricular ejection fraction of 35% and low-flow, low-gradient severe aortic stenosis...
September 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28917673/b-type-natriuretic-peptide-and-high-sensitivity-cardiac-troponin-for-risk-stratification-in-low-flow-low-gradient-aortic-stenosis-a-substudy-of-the-topas-study
#17
Abdellaziz Dahou, Marie-Annick Clavel, Romain Capoulade, Kim O'Connor, Henrique B Ribeiro, Nancy Côté, Florent Le Ven, Josep Rodés-Cabau, Jean G Dumesnil, Patrick Mathieu, Philippe Pibarot
OBJECTIVES: The objective of this study was to determine the prognostic value of combined measures of B-type natriuretic peptide (BNP) and high-sensitivity cardiac troponin T (hsTnT) in patients with low-flow, low-gradient aortic stenosis (LF-LG AS) who had either a preserved or reduced left ventricular ejection fraction (LVEF). BACKGROUND: An elevated BNP level is associated with increased risk of mortality in patients with LF-LG AS. The incremental prognostic value of hsTnT in these patients is unknown...
September 9, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28901639/predicting-changes-in-flow-category-in-patients-with-severe-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction-on-medical-therapy
#18
Jinghao Nicholas Ngiam, Ivandito Kuntjoro, Benjamin Y Q Tan, Hui-Wen Sim, William K F Kong, Tiong-Cheng Yeo, Kian-Keong Poh
BACKGROUND/OBJECTIVES: Controversy surrounds the prognosis and management of patients with paradoxical low-flow severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). It was not certain if patients in a particular flow category remained in the same category as disease progressed. We investigated whether there were switches in categories and if so, their predictors. METHODS: Consecutive subjects (n = 203) with isolated severe AS and paired echocardiography (>180 days apart) were studied...
September 13, 2017: Echocardiography
https://www.readbyqxmd.com/read/28893490/partial-renal-coverage-in-endovascular-aneurysm-repair-causes-unfavorable-renal-flow-patterns-in-an-infrarenal-aneurysm-model
#19
Lennart van de Velde, Esmé J Donselaar, Erik Groot Jebbink, Johannes T Boersen, Guillaume P R Lajoinie, Jean-Paul P M de Vries, Clark J Zeebregts, Michel Versluis, Michel M P J Reijnen
OBJECTIVE: To achieve an optimal sealing zone during endovascular aneurysm repair, the intended positioning of the proximal end of the endograft fabric should be as close as possible to the most caudal edge of the renal arteries. Some endografts exhibit a small offset between the radiopaque markers and the proximal fabric edge. Unintended partial renal artery coverage may thus occur. This study investigated the consequences of partial coverage on renal flow patterns and wall shear stress (WSS)...
September 8, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28882231/hemodynamic-response-to-nitroprusside-in-patients-with-low-gradient-severe-aortic-stenosis-and-preserved-ejection-fraction
#20
COMPARATIVE STUDY
James W Lloyd, Rick A Nishimura, Barry A Borlaug, Mackram F Eleid
BACKGROUND: Low-gradient severe aortic stenosis (LGSAS) with preserved ejection fraction (EF) is incompletely understood. The influence of arterial afterload and diastolic dysfunction on the hemodynamic presentation of LGSAS remains unknown. OBJECTIVES: The authors sought to determine the acute hemodynamic response to sodium nitroprusside in LGSAS with preserved EF. METHODS: Symptomatic patients with LGSAS and preserved EF underwent cardiac catheterization with comparison of hemodynamic measurements before and after nitroprusside...
September 12, 2017: Journal of the American College of Cardiology
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