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Critical aortic stenosis

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https://www.readbyqxmd.com/read/29126689/the-feasibility-and-impact-of-routine-combined-limited-transthoracic-echocardiography-and-lung-ultrasound-on-diagnosis-and-management-of-patients-admitted-to-icu-a-prospective-observational-study
#1
Kavi Haji, Darsim Haji, David J Canty, Alistair G Royse, Dhaksha Tharmaraj, Meor Azraee, Lynda Hopkins, Collin F Royse
OBJECTIVES: Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. DESIGN: Prospective observational study. SETTINGS: Tertiary ICU. PARTICIPANTS: Ninety-three critically ill participants within 24 hours of admission to ICU. METHODS: A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound...
August 18, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29062752/technical-pitfalls-and-tips-for-the-valve-in-valve-procedure
#2
REVIEW
Vinayak Bapat
Transcatheter aortic valve implantation (TAVI) has emerged as a viable treatment modality for patients with severe aortic valve stenosis and multiple co-morbidities. More recent indications include the use of transcatheter heart valves (THV) to treat degenerated bioprosthetic surgical heart valves (SHV), which are failing due to stenosis or regurgitation. Valve-in-valve (VIV) procedures in the aortic position have been performed with a variety of THV devices, although the balloon-expandable SAPIEN valve platform (Edwards Lifesciences Ltd, Irvine, CA, USA) and self-expandable CoreValve platform (Medtronic Inc...
September 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29025747/uncoupling-protein-2-inhibits-myointimal-hyperplasia-in-preclinical-animal-models-of-vascular-injury
#3
Yan Zhang, Yaolei Zhang, Wei Li, Peijian Wang, Rui Gu, Yaxing Feng, Shujie Wei, Ke Peng, Yunrong Zhang, Linan Su, Qiang Wang, De Li, Dachun Yang, Wing Tak Wong, Yongjian Yang, Shuangtao Ma
BACKGROUND: Intracoronary stent restenosis, characterized by excessive smooth muscle cell (SMC) proliferation and myointimal hyperplasia, remains a clinical challenge. Mitochondrial membrane potential has been linked to the proliferative rate of SMCs. This study aimed to screen a critical gene regulating mitochondrial potential and to confirm its effects on myointimal formation in preclinical animal models. METHODS AND RESULTS: We performed transcriptome screening for genes differentially expressed in ligated versus unligated mouse carotid arteries...
October 12, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28967728/evolution-of-surgical-techniques-for-a-progressive-risk-reduction
#4
Bruno Amato, Mario Santoro, Raffaele Izzo, Giuseppe Servillo, Rita Compagna, Lorenza Di Domenico, Veronica Di Nardo, Giuseppe Giugliano
Advanced age is a strong predictor of high perioperative mortality in surgical patients and patients aged 75 years and older have an elevated surgical risk, much higher than that of younger patients. Progressive advances in surgical techniques now make it possible to treat high-risk surgical patients with minimally invasive procedures. Endovascular techniques have revolutionized the treatment of several vascular diseases, in particular carotid stenosis, aortic pathologies, and severely incapacitating intermittent claudication or critical limb ischemia...
July 18, 2017: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
https://www.readbyqxmd.com/read/28956773/metoprolol-reduces-hemodynamic-and-metabolic-overload-in-asymptomatic-aortic-valve-stenosis-patients-a-randomized-trial
#5
RANDOMIZED CONTROLLED TRIAL
Nils Henrik Hansson, Jens Sörensen, Hendrik Johannes Harms, Won Yong Kim, Roni Nielsen, Lars Poulsen Tolbod, Jørgen Frøkiær, Kirsten Bouchelouche, Karen Kaae Dodt, Inger Sihm, Steen Hvitfeldt Poulsen, Henrik Wiggers
BACKGROUND: Currently, no pharmacological treatment can modify the natural history of aortic valve stenosis (AS). This underlines the critical need to explore novel treatment strategies, which could postpone or prevent the need for aortic valve replacement in patients with asymptomatic AS. The objectives of this study were to investigate whether metoprolol reduce the hemodynamic and metabolic burden imposed by AS. METHODS AND RESULTS: In a double-blinded design, 40 patients with moderate-severe asymptomatic AS (aortic valve area, 0...
October 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28893830/assessment-of-paravalvular-leakage-after-transcatheter-aortic-valve-implantation-add-clinical-signs-to-echocardiographic-data
#6
Corstiaan A den Uil, Mihai Strachinaru, Ben van der Hoven, J Han J Meeder
A 62-year old male with pulmonary fibrosis and aortic valve stenosis underwent TAVI (Corevalve Evolut XL 34 mm) in the build-up for lung transplantation (LuTx). Following post-dilation for a large annular perimeter, moderate paravalvular aortic regurgitation (AR) was observed. After 6 weeks, he was admitted to the ICU with respiratory failure(A). TTE demonstrated residual mild AR (based on a small excentric paravalvular AR jet, <10% circumferential extent, pressure half-time was not reliably measured) and together with borderline elevated NT-pro-BNP, the consultant cardiologist authorized LuTx listing...
September 11, 2017: Echo Research and Practice
https://www.readbyqxmd.com/read/28882282/acute-success-of-balloon-aortic-valvuloplasty-in-the-current-era-a-national-cardiovascular-data-registry-study
#7
Brian A Boe, Jeffrey D Zampi, Kevin F Kennedy, Natalie Jayaram, Diego Porras, Susan R Foerster, Aimee K Armstrong
OBJECTIVES: The aim of this study was to evaluate practice patterns and outcomes of a contemporary group of patients undergoing balloon aortic valvuloplasty (BAV) for congenital aortic stenosis (AS). BACKGROUND: BAV is the most common treatment for isolated congenital AS. METHODS: Within the IMPACT (Improving Pediatric and Adult Congenital Treatments) Registry, all BAV procedures performed between January 2011 and March 2015 were identified...
September 11, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28870876/prevalence-and-impact-of-critical-limb-ischemia-on-in-hospital-outcome-in-transcatheter-aortic-valve-implantation-in-germany
#8
Nasser M Malyar, Klaus Kaier, Eva Freisinger, Florian Lüders, Gerrit Kaleschke, Helmut Baumgartner, Lutz Frankenstein, Holger Reinecke, Jochen Reinöhl
AIMS: Peripheral artery disease (PAD) is common in patients with aortic valve stenosis (AS). We assessed the prevalence of critical limb ischemia (CLI) and its impact on in-hospital outcome in patients undergoing transcatheter aortic valve implantation (TAVI) for severe AS. METHODS AND RESULTS: All isolated TAVI in Germany between 2007 and 2013 for AS were analysed regarding stage specific prevalence of PAD, comorbidities, in-hospital complications and mortality using diagnostic and procedural codes...
September 5, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28866972/comparison-of-continous-wave-doppler-ultrasound-monitor-and-echocardiography-to-assess-cardiac-output-in-intensive-care-patients
#9
COMPARATIVE STUDY
Ahmad Elgendy, Ian M Seppelt, Andrew S Lane
BACKGROUND: Continuous-wave Doppler (CWD) ultrasound through the left ventricular outflow tract is one modality used for non-invasive cardiac output measurement. The ultrasonic cardiac output monitor (USCOM) is a relatively new monitor which uses a small, transcutaneous ultrasound probe to measure cardiac output with CWD via the suprasternal window. It is faster and less complex to train new users than conventional echocardiography. In addition to stroke volume (SV), the USCOM can calculate stroke volume variation (SVV) and the Smith-Madigan inotropy index (SMII), which is an estimate of the pre-load independent contractility of the myocardium...
September 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28831765/validation-of-transpulmonary-thermodilution-variables-in-hemodynamically-stable-patients-with-heart-diseases
#10
Matthias Peter Hilty, Daniel Peter Franzen, Christophe Wyss, Patric Biaggi, Marco Maggiorini
BACKGROUND: Transpulmonary thermodilution is recommended in the treatment of critically ill patients presenting with complex shock. However, so far it has not been validated in hemodynamically stable patients with heart disease. METHODS: We assessed the validity of cardiac output, global end-diastolic volume index (GEDVI), an established marker of preload thought to reflect the volume of all four heart chambers, global ejection fraction (GEF) and cardiac function index (CFI) as variables of cardiac function, and extravascular lung water index (EVLWI) as indicator of pulmonary edema in 29 patients undergoing elective left and right heart catheterization including left ventricular angiography with stable coronary heart disease and normal cardiac function (controls, n = 11), moderate-to-severe aortic valve stenosis (AS, n = 10), or dilated cardiomyopathy (DCM, n = 8)...
August 22, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28814237/statins-in-aortic-stenosis
#11
Karl Norrington, Emmanuel Androulakis, Evangelos Oikonomou, Georgia Vogiatzi, Dimitris Tousoulis
Calcific aortic stenosis (AS) is the most common form of valvular heart disease in Europe and North America. It is a progressive disease with a prolonged period of asymptomatic latency which eventually leads to critical left ventricular outflow tract obstruction necessitating surgical replacement of the valve. Statins are lipid-lowering drugs with a robust evidence base demonstrating clinical benefit in atherosclerotic coronary artery disease. There has therefore been significant interest in the potential benefit of statins in AS...
August 15, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28776389/congenital-aortic-stenosis-treatment-outcomes-in-a-nationwide-survey
#12
Merja Kallio, Otto Rahkonen, Ilkka Mattila, Jaana Pihkala
OBJECTIVE: To evaluate treatment outcomes of pediatric valvar aortic stenosis (AS) in a nationwide follow-up. DESIGN: Balloon aortic valvuloplasty (BAV) has been the preferred treatment for congenital AS in Finland since the year 2000. All children treated due to isolated AS during 2000-2014 were included in this retrospective study. Treatment outcomes were categorized into Optimal: residual gradient  ≤35 mmHg and trivial or no aortic regurgitation (AR), Adequate: gradient ≤35 mmHg with mild AR, or Inadequate: gradient >35 mmHg and/or moderate to severe AR...
October 2017: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/28770396/mitro-aortic-pathology-a%C3%A2-point-of-view-for-a%C3%A2-fully-transcatheter-staged-approach
#13
REVIEW
G D'Ancona, L Paranskaya, A Öner, S Kische, H Ince
Severe aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) often coexist. Although a fully percutaneous treatment for the two conditions, by means of transcatheter aortic valve implantation (TAVI) followed by MitraClip, can be appealing in selected high-risk candidates, critical and strategical reasoning should be applied. In a 3-year period we have developed a single-centre experience of 14 patients who were managed with a staged percutaneous approach to treat severe AVS and MVR. The average interval from TAVI to MitraClip repair was 101 ± 12 days...
November 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28748765/biomarkers-in-aortic-valve-stenosis-and-their-clinical-significance-in-transcatheter-aortic-valve-implantation
#14
Konstantinos Toutouzas, Konstantinos Stathogiannis, George Latsios, Andreas Synetos, Maria Drakopoulou, Vicky Penesopoulou, Archontoula Michelongona, Eleftherios Tsiamis, Dimitris Tousoulis
Aortic valve stenosis is one of the most common valvular heart disorders and the prevalence will rise as the population ages. Once symptomatic, patients with aortic valve stenosis tend to fare worse with high mortality rates. Aortic valve replacement is indicated in these patients and besides the standard surgical replacement; a less invasive approach, transcatheter aortic valve implantation, has gained momentum and has showed promising and solid results in patients with high surgical risk. An important aspect of evaluating patients with aortic valve stenosis is the ability to choose the best possible candidate for the procedure...
July 27, 2017: Current Medicinal Chemistry
https://www.readbyqxmd.com/read/28728652/accuracy-of-fractional-flow-reserve-measurements-in-clinical-practice-observations-from-a-core-laboratory-analysis
#15
Mitsuaki Matsumura, Nils P Johnson, William F Fearon, Gary S Mintz, Gregg W Stone, Keith G Oldroyd, Bernard De Bruyne, Nico H J Pijls, Akiko Maehara, Allen Jeremias
OBJECTIVES: The aim of this study was to compare site-reported measurements of fractional flow reserve (FFR) with FFR analysis by an independent core laboratory (CL). BACKGROUND: FFR is an index of coronary stenosis severity that has been validated in multiple trials and is widely used in clinical practice. However, the incidence of suboptimal FFR measurements is unknown. METHODS: Patients undergoing FFR assessment within the CONTRAST (Can Contrast Injection Better Approximate FFR Compared to Pure Resting Physiology) study had paired, repeated measurements of multiple physiological metrics per local practice...
July 24, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28687561/impact-of-vascular-hemodynamics-on-aortic-stenosis-evaluation-new-insights-into-the-pathophysiology-of-normal-flow-small-aortic-valve-area-low-gradient-pattern
#16
Nancy Côté, Louis Simard, Anne-Sophie Zenses, Lionel Tastet, Mylène Shen, Marine Clisson, Marie-Annick Clavel
BACKGROUND: About 50% of normal-flow/low-gradient patients (ie, low mean gradient [MG] or peak aortic jet velocity and small aortic valve area) have severe aortic valve calcification as measured by computed tomography. However, they are considered to have moderate aortic stenosis (AS) in current American College of Cardiology/American Heart Association guidelines. The objective was thus to evaluate the effect of hypertension and reduced arterial compliance (rAC) on MG and Vpeak measurements...
July 7, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28684393/critical-aortic-stenosis-presenting-as-stemi
#17
Ying X Gue, Sanjay S Bhandari, Damian J Kelly
A 73-year-old male was brought into hospital with chest pain and inferior ST elevation on ECG. The patient immediately proceeded to the catheter lab for primary percutaneous coronary intervention. Angiography did not identify any culprit lesions to account for the patient's electrocardiographic changes and ongoing symptoms of chest pain. Bedside echocardiography revealed critical aortic stenosis. Intra-aortic balloon pump (IABP) was inserted, resulting in resolution of chest pain and ST-segment changes. The patient underwent successful aortic valve (AV) replacement without the need for coronary intervention...
September 2017: Echo Research and Practice
https://www.readbyqxmd.com/read/28683542/feasibility-and-applicability-of-static-vascular-outline-roadmapping-during-tavi
#18
Navid Madershahian, Carolyn Weber, Payman Majd, Tanja Rudolph, Elmar Kuhn, Maximilian Scherner, Yeong-Hoon Choi, Kaveh Eghbalzadeh, Volker Rudolph, Cherif Sahyoun, Thorsten Wahlers
BACKGROUND: We investigated the application and feasibility of a novel software tool designed for the visualization of the aortic root during transcatheter aortic valve implantation (TAVI). The final positioning of the device prior deployment remains the most critical phase during TAVI. METHODS: Philips "Vascular Outlining" prototype application was used during balloon expandable Edwards Lifesciences SapienXT valve deployment. It processes any angiographic sequences, extracting the static outline of vessels and projecting the two- dimensional vessel margins as a roadmap on live fluoroscopy...
July 5, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28659550/significant-prognostic-value-of-acute-preload-stress-echocardiography-using-leg-positive-pressure-maneuver-for-patients-with-symptomatic-severe-aortic-stenosis-awaiting-aortic-valve-intervention
#19
Hiroki Matsuzoe, Kensuke Matsumoto, Hidekazu Tanaka, Yutaka Hatani, Keiko Hatazawa, Hiroyuki Shimoura, Junichi Ooka, Hiroyuki Sano, Keiko Ryo-Koriyama, Toshiro Shinke, Hirotsugu Yamada, Yutaka Okita, Ken-Ichi Hirata
BACKGROUND: Although aortic valve intervention is recommended for virtually all symptomatic patients with aortic stenosis (AS), how urgently the intervention should be performed remains controversial. The aim of this study was thus to determine whether the preload reserve in response to leg-positive pressure (LPP) maneuver could serve for decision-making for AS patients awaiting aortic valve intervention.Methods and Results:Sixty-eight patients with symptomatic AS, who were referred for aortic valve intervention, were recruited...
June 28, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28651163/ex-vivo-assessment-of-valve-thickness-calcification-of-patients-with-calcific-aortic-stenosis-in-relation-to-in-vivo-clinical-outcomes
#20
Ching-Li Cheng, Hsiao-Huang Chang, Pei-Jung Huang, Wei-Chen Wang, Shan-Yang Lin
Calcific aortic stenosis (AS) plays a critical role in the risk of cardiovascular disease. This preliminary study examined the relationship between the ex vivo valve thickness/calcification and in vivo clinical outcomes of Chinese patients with calcific AS. Six Chinese patients (3 patients with tricuspid aortic valves (TAV)) and 3 patients with. bicuspid aortic valves (BAV) with calcific AS undergoing heart valve replacement were initially chosen for this study. In vivo medical imaging of these calcific AS patients was evaluated using computed tomography and echocardiography...
October 2017: Journal of the Mechanical Behavior of Biomedical Materials
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