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Low flow aortic stenosis

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https://www.readbyqxmd.com/read/27887818/three-dimensional-morphology-of-the-left-ventricular-outflow-tract-impact-on-grading-aortic-stenosis-severity
#1
Luis Caballero, Daniel Saura, María José Oliva-Sandoval, Josefa González-Carrillo, María Dolores Espinosa, Miguel García-Navarro, Mariano Valdés, Patrizio Lancellotti, Gonzalo de la Morena
BACKGROUND: Left ventricular outflow tract (LVOT) measurement is a critical step in the quantification of aortic valve area. The assumption of a circular morphology of the LVOT may induce some errors. The aim of this study was to assess the three-dimensional (3D) morphology of the LVOT and its impact on grading aortic stenosis severity. METHODS: Fifty-eight patients with aortic stenosis were studied retrospectively. LVOT dimensions were measured using 3D transesophageal echocardiography at three levels: at the hinge points (HP) of the aortic valve and at 4 and 8 mm proximal to the annular plane...
November 22, 2016: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/27875347/severe-low-gradient-aortic-stenosis-with-preserved-ventricular-function-should-it-be-treated
#2
Giuseppe Di Pasquale, Gloria Vassilikì Coutsoumbas, Silvia Zagnoni
Exists a group of patients with small AVA (<0,6 cm/m), and normal LVEF (≥50%) who display a low transvalvular flow (LF) [index stroke volume (SVi)<35 ml/m2] and/or low transvalvular gradient (LG). This condition is called severe paradoxical aortic stenosis (SAO) LFLG. In many studies this condition was associated to increased mortality both with medical therapy and with surgical intervention. Crucial is define correctly the diagnostical criteria of this condition. Indeed there are several specific anatomical and functional characteristics useful in differentiating paradoxical severe aortic stenosis from the other forms of aortic stenosis...
November 19, 2016: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/27795630/high-hemodialysis-vascular-access-flow-and-impaired-right-ventricular-function-in-chronic-hemodialysis-patients
#3
S Yilmaz, M Yetim, B K Yilmaz, T Dogan, E Aksoy, N Yuksel, I Dogan
There are limited data showing right ventricular preload increase due to high-flow arteriovenous fistulas (AVFs). This cross-sectional study investigated whether high AVF flow had an impact on right ventricular function in patients undergoing hemodialysis. Sixty-four patients aged between 18 and 85 years who were on routine hemodialysis with >2 hemodialysis sessions per week for at least 3 months via an AVF were studied. Patients with inadequate flow fistulas, severe chronic obstructive pulmonary disease, history of pulmonary embolism, primary pulmonary hypertension, severe mitral, aortic or pulmonary regurgitation, and/or stenosis were excluded...
September 2016: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/27792660/delayed-time-to-peak-velocity-is-useful-for-detecting-severe-aortic-stenosis
#4
Daisuke Kamimura, Sartaj Hans, Takeki Suzuki, Ervin R Fox, Michael E Hall, Solomon K Musani, Michael R McMullan, William C Little
BACKGROUND: Time to peak velocity (TPV) is an echocardiographic variable that can be easily measured and reflects a late peaking murmur, a classic physical finding suggesting severe aortic stenosis (AS). The aim of this study was to investigate the usefulness of TPV to evaluate AS severity. METHODS AND RESULTS: This study included 700 AS patients, whose aortic valve area (AVA) was <1.5 cm(2), and 200 control patients. The TPV was defined as the time from aortic valve opening to when the flow velocity across the aortic valve reaches its peak...
October 22, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27792655/relationship-between-qt-interval-and-outcome-in-low-flow-low-gradient-aortic-stenosis-with-low-left-ventricular-ejection-fraction
#5
Abdellaziz Dahou, Oumhani Toubal, Marie-Annick Clavel, Jonathan Beaudoin, Julien Magne, Patrick Mathieu, François Philippon, Jean G Dumesnil, Rishi Puri, Henrique B Ribeiro, Éric Larose, Josep Rodés-Cabau, Philippe Pibarot
BACKGROUND: QT interval has been shown to be associated with cardiovascular events. There is no data regarding the association between QT interval and left ventricular (LV) function and prognosis in patients with low LV ejection fraction (LVEF), low-flow, low-gradient aortic stenosis (LF-LG AS). We aimed to examine the relationship between corrected QT interval (QTc) and LV function and outcome in these patients. METHODS AND RESULTS: Ninety-three patients (73±10 years; 74% men) with LF-LG AS (mean gradient <40 mm Hg and indexed aortic valve area ≤0...
October 20, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27753861/br-02-1-management-of-hypertension-in-severe-aortic-stenosis
#6
Yong-Jin Kim
Aortic stenosis (AS) is a common valve disease, affecting nearly 5% of elderly individuals. Because most common etiology of AS is degenerative valve disease, hypertension (HT) is not rare in patients with AS. It was reported that more than 30% of patients with AS had systemic hypertension. Therefore, management of hypertension is an important issue for these patients. There are several effects of combined AS and HT. First, HT increases hemodynamic load of left ventricle and peak systolic left ventricular wall stress...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27741366/the-diverse-outcome-of-early-prenatal-diagnosis-of-pulmonary-stenosis
#7
Moshe Bronshtein, Zeev Blumenfeld, Asaad Choury, Ayala Gover
OBJECTIVES: To assess the natural history and outcome of fetal pulmonary stenosis [PS] detected at 14 to 16 weeks gestation. METHODS: This is a retrospective study, in the years 2004-2015, with serial follow up during pregnancy. Patients referred for complete early fetal ultrasound including all fetal systems and a fetal echocardiogram. Ninety seven percent of the women were low risk, and 3% had risk factors such as maternal type 1 diabetes mellitus, exposure to teratogenic drugs or anomalies in previous pregnancies or in other family members...
October 14, 2016: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27739170/trans-catheter-aortic-valve-implantation-with-the-direct-flow-medical-prosthesis-single-center-short-term-clinical-and-echocardiographic-outcomes
#8
Stephan Kische, Giuseppe D'Ancona, Hüseyin U Agma, Gihan El-Achkar, Martin Dißmann, Jasmin Ortak, Hüseyin Ince
OBJECTIVES: To analyze our single center experience with the Direct Flow Medical (DFM). BACKGROUND: The DFM has been recently introduced to the market and large real world experiences are lacking. METHODS: A total of 126 patients with severe aortic valve stenosis (AVS) were treated by the same team from March 2013 to May 2015. Device success and procedural safety were classified, according to valve academic research consortium (VARC) criteria, for the entire cohort, including patients treated in the early phases of our learning curve...
October 14, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27730780/dobutamine-stress-echocardiography-need-for-a-better-gold-standard
#9
Ankush Sachdeva, Biswajit Paul
Dobutamine stress echocardiography (DSE) has come a long way as establishing itself as a feasible, safe, effective, relatively cheaper non-invasive technique to detect population suffering from coronary artery disease (CAD) and following up patients post revascuralization. Besides these DSE is commonly used to diagnose low gradient, low flow true severe aortic stenosis (AS); differentiating it from pseudo- AS and to follow up patients with dilated cardiomyopathy (DCMP). Various non-invasive techniques have different sensitivity and specificity to accurately judge a viable myocardium and to accurately detect the improvement in regional wall motion abnormality (RWMA) post-revascularization, leading to an overall increase in left ventricular ejection fraction (LVEF)...
February 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27643098/br-02-1-management-of-hypertension-in-severe-aortic-stenosis
#10
Yong-Jin Kim
Aortic stenosis (AS) is a common valve disease, affecting nearly 5% of elderly individuals. Because most common etiology of AS is degenerative valve disease, hypertension (HT) is not rare in patients with AS. It was reported that more than 30% of patients with AS had systemic hypertension. Therefore, management of hypertension is an important issue for these patients. There are several effects of combined AS and HT. First, HT increases hemodynamic load of left ventricle and peak systolic left ventricular wall stress...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27629961/an-adult-case-of-unicommissural-unicuspid-aortic-valve-diagnosed-based-on-the-intraoperative-findings
#11
Tetsuo Yamanaka, Toru Fukatsu, Yoshimaro Ichinohe, Hirotaka Komatsu, Masahiro Seki, Kenichi Sasaki, Hideaki Takai, Takashi Kunihara, Yasunobu Hirata
We herein report an adult case of unicommissural unicuspid aortic valve (UAV). A 59-year-old man, who was noted to have a cardiac murmur at 31 years of age, was admitted to our hospital due to acute heart failure. Severe calcification in the aortic valve with severe low-flow/low-gradient aortic stenosis and moderate aortic regurgitation was observed and thought to be the cause of heart failure, however, the etiology of aortic valve dysfunction was not clear. Aortic valve replacement was subsequently performed, and unicommissural UAV was diagnosed according to the intraoperative findings...
2016: Internal Medicine
https://www.readbyqxmd.com/read/27568123/exercise-testing-in-paradoxical-low-flow-aortic-stenosis-where-is-the-truth
#12
James D Thomas, Nicholas Furiasse
No abstract text is available yet for this article.
August 20, 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27568118/the-functional-significance-of-paradoxical%C3%A2-low-gradient-aortic%C3%A2-valve%C3%A2-stenosis-hemodynamic-findings-during-cardiopulmonary-exercise%C3%A2-testing
#13
Candelas Pérez Del Villar, Raquel Yotti, María Ángeles Espinosa, Enrique Gutiérrez-Ibañes, Alicia Barrio, María José Lorenzo, Pedro Luis Sánchez Fernández, Yolanda Benito, Raquel Prieto, Esther Pérez David, Pablo Martínez-Legazpi, Francisco Fernández-Avilés, Javier Bermejo
OBJECTIVES: The goal of this study was to determine the functional impact of paradoxical low-gradient aortic stenosis (PLGAS) and clarify whether the relevance of the valvular obstruction is related to baseline flow. BACKGROUND: Establishing the significance of PLGAS is particularly challenging. METHODS: Twenty symptomatic patients (77 ± 6 years of age; 17 female subjects) with PLGAS (mean gradient 28 ± 6 mm Hg; aortic valve area 0.8 ± 0...
August 20, 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27562052/can-severity-of-aortic-stenosis-be-determined-despite-absent-contractile-reserve-in-low-flow-low-gradient-aortic-stenosis
#14
Anastasia Vamvakidou, Benoy Shah, Roxy Senior
A 79-year-old man presented with increasing breathlessness and his echocardiogram revealed severe left ventricular systolic dysfunction and low-flow low-gradient aortic stenosis. Low-dose dobutamine stress echocardiography revealed the absence of contractile reserve (increase of stroke volume by ≥20% did not occur). The test would have therefore been inconclusive. However, the attainment of normal flow (FR≥200 mL/s) during dobutamine stress enabled the diagnosis of true severe aortic stenosis.
August 25, 2016: Echocardiography
https://www.readbyqxmd.com/read/27544900/integration-of-flow-gradient-patterns-into%C3%A2-clinical-decision-making-for-patients-with-suspected-severe-aortic-stenosis-and-preserved-lvef-a-systematic-review-of-evidence-and-meta-analysis
#15
Chirag Bavishi, Kiruthika Balasundaram, Edgar Argulian
OBJECTIVES: This study was designed to evaluate the evidence base for the 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for severe aortic stenosis (SAS) and preserved left ventricular ejection fraction by comparing the natural history of the disease in subgroups of low-gradient (LG) aortic stenosis patients with high-gradient (HG) patients. BACKGROUND: The 2014 AHA/ACC valvular disease guidelines recommend estimation of stroke volume index by echocardiography in patients with suspected LG SAS and preserved left ventricular ejection fraction...
November 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27458659/prevalence-clinical-and-echocardiographic-characteristics-of-various-flow-and-gradient-patterns-in-mild-or-moderate-aortic-stenosis-with-normal-left-ventricular-ejection-fraction
#16
Yong-Qiang Benjamin Tan, Jinghao Nicholas Ngiam, William K F Kong, Tiong-Cheng Yeo, Kian-Keong Poh
BACKGROUND/OBJECTIVES: Paradoxical low-flow aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) has only been described in severe AS. Controversy surrounds prognosis and management but no studies have reported this phenomenon in mild or moderate AS. We investigated the prevalence of flow and gradient patterns in this population, characterising their clinical and echocardiographic profile. METHODS: Consecutive subjects (n=1362) with isolated AS: mild (n=462, aortic valve area≥1...
October 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27439217/low-flow-aortic-stenosis-after-transcutaneous-aortic-valve-replacement-it-s-all-about-the-flow
#17
James D Thomas
No abstract text is available yet for this article.
August 1, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27437665/evaluation-of-flow-after-transcatheter-aortic-valve-replacement-in-patients-with-low-flow-aortic-stenosis-a-secondary-analysis-of-the-partner-randomized-clinical-trial
#18
Venkatesh Y Anjan, Howard C Herrmann, Philippe Pibarot, William J Stewart, Samir Kapadia, E Murat Tuzcu, Vasilis Babaliaros, Vinod H Thourani, Wilson Y Szeto, Joseph E Bavaria, Susheel Kodali, Rebecca T Hahn, Mathew Williams, D Craig Miller, Pamela S Douglas, Martin B Leon
IMPORTANCE: Low-flow (LF) severe aortic stenosis (AS) is an independent predictor of mortality in patients undergoing aortic valve replacement (AVR). Little is known about improvement in flow after AVR and its effects on survival. OBJECTIVE: To determine whether higher flow (left-ventricular stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate better clinical outcomes in this at-risk population. DESIGN, SETTING, AND PARTICIPANTS: A substudy analysis of data from the Placement of Aortic Transcatheter Valves (PARTNER) randomized clinical trial and continued-access registry was conducted...
August 1, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27353416/innominate-artery-stenosis-presenting-with-migratory-digital-ischemia
#19
Yen-Yi Juo, Lisbi Rivas Ramirez, Garry Ruben
BACKGROUND: Atherosclerotic lesions of the supra-aortic trunk vessels, including the innominate artery, subclavian artery, or the common carotid artery, tend to present either as low-flow state distal to the lesion or as embolic events. The risk of embolic cerebrovascular event complicates the management of this condition via a pure endovascular approach. A combined operative-endovascular intervention may be a valuable approach in order to reduce the risk of intraoperative stroke and prevent future embolic events...
August 2016: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27296202/two-year-outcomes-in-patients-with-severe-aortic-valve-stenosis-randomized-to-transcatheter-versus-surgical-aortic-valve-replacement-the-all-comers-nordic-aortic-valve-intervention-randomized-clinical-trial
#20
Lars Søndergaard, Daniel Andreas Steinbrüchel, Nikolaj Ihlemann, Henrik Nissen, Bo Juel Kjeldsen, Petur Petursson, Anh Thuc Ngo, Niels Thue Olsen, Yanping Chang, Olaf Walter Franzen, Thomas Engstrøm, Peter Clemmensen, Peter Skov Olsen, Hans Gustav Hørsted Thyregod
BACKGROUND: The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize all-comers with severe native aortic valve stenosis to either transcatheter aortic valve replacement (TAVR) with the CoreValve self-expanding bioprosthesis or surgical aortic valve replacement (SAVR), including a lower-risk patient population than previous trials. This article reports 2-year clinical and echocardiographic outcomes from the NOTION trial. METHODS AND RESULTS: Two-hundred eighty patients from 3 centers in Denmark and Sweden were randomized to either TAVR (n=145) or SAVR (n=135) with follow-up planned for 5 years...
June 2016: Circulation. Cardiovascular Interventions
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