Aortic Valve ; pathology ; Aortic Valve Stenosis ; genetics ; Calcinosis ; genetics ; Humans

Aortic Valve ; abnormalities ; pathology ; Aortic Valve Stenosis ; pathology ; surgery ; Echocardiography ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Treatment Outcome

BACKGROUND AND OBJECT: A considerable proportion of patients who require mitral valve (MV) replacement present with a coexisting pathology of the aortic valve (AV). However, combined AV and MV replacement is associated with higher operative risk and poorer long-term survival than MV replacement (MVR) only. Little is known about the natural history of AV disease in patients undergoing MV surgery. The purpose of this study was to analyze long-term clinical outcome and the need for subsequent AV replacement (AVR) in patients with mild to moderate AV disease at the time of MV surgery. MATERIALS AND METHODS: One hundred forty-one patients (97 female, mean age 43 years) with mild to moderate AV disease and severe rheumatic MV disease were treated with MV surgery. The patients were followed for an average period of 8+/-3 years (range 1-16) after MV surgery. Primary outcomes (death and subsequent AVR) were evaluated. METHODS: At the time of MV surgery, 104 patients (73.8%) had mild aortic regurgitation (AR), 37 patients (26.2%) moderate AR, 5 patients (3.5%) mild aortic stenosis (AS) and 2 patients (1.4%) moderate AS. At the end of follow-up period, only one patient had severe AR. Eight patients (5.7%) died during the follow-up, and four patients (2.8%) treated with AVR after a mean period of 9 years. Survival analysis with Kaplan-Meier method revealed 10-year survival rates of 95.5% and 10-year event free survival rates of 93.6%. CONCLUSION: In most patients with mild to moderate rheumatic AV disease at the time of MV surgery, subsequent AVR is rarely needed after a long follow-up period. These data may support the decision not to recommend prophylactic AVR at the time of MV surgery in these patients.
Aortic Valve Insufficiency ; Aortic Valve Stenosis ; Aortic Valve* ; Disease Progression ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Mitral Valve* ; Natural History ; Pathology ; Rheumatic Heart Disease* ; Survival Rate

BACKGROUND: Patients with severe aortic valve disease frequently display mitral valve regurgitation (MR). In such patients, the clinical course of MR after isolated aortic valve replacement (AVR) may be important for determining the treatment strategies. After isolated AVR, the change of the concomitant moderate degree or less of MR according to the type of aortic valve disease is not known well. The aim of this study was to analyze the postoperative changes of MR after performing AVR in those patients with severe AS (Group S) and those with severe AR (Group R). MATERIAL AND METHOD: We retrospectively evaluated 43 patients with severe aortic disease and a moderate degree or less of mitral valve regurgitation, and these patients underwent isolated aortic valve replacement from January 1996 to June 2005. The patients were divided into two groups: the aortic valve stenosis group (n = 29) and the aortic valve regurgitation group (n = 14). The patients underwent transthoracic echocardiography preoperatively and at 7 days, 6~10 months and more than 18 months (mean follow-up duration: 38 months) postoperatively. RESULT: The mean age was 60.9 years (Group S: 62 years, Group R: 52.5 years) and 60% (Group S=55%, Group R=71%) of the patients were male. The preoperative MR was mild in 29 (67.5%), mild to moderate in 11 (25.5%), and moderate in 3 (6.9%) patients. In the Group S patients, MR improved in 16 (55%) patients at the immediate postoperative days and in 17 (59%) patients at more than 18 months postoperatively. On the other hand, all the Group R patients exhibited earlier improvement. The decrease of LA size had a similar pattern to the MR change, but there were no significant differences in the change of the ejection fraction of the two groups. CONCLUSION: In the patients with severe aortic valve disease and concomitant low grade MR, the MR after AVR improved earlier and more effectively in the patients with AR than in those patients with AS.
Aortic Diseases ; Aortic Valve Stenosis ; Aortic Valve* ; Echocardiography ; Follow-Up Studies ; Hand ; Heart Valve Diseases ; Humans ; Male ; Mitral Valve Insufficiency* ; Pathology* ; Retrospective Studies

Repair of the aortic valve has received considerably less attention than repair of the mitral or tricuspid valves. Reasons for this may include the greater incidence of stenosis in the aortic valve relative to insufficiency, the degenerative processes that lead to valvular dysfunction reducing the number of potentially repairable valves, and the presence of a wider variety of valve substitutes with lower thromboembolic potential and greater longevity than for the mitral position. Furthermore, the functional structure and redundancy of the mitral and tricuspid valves may be more amenable to plastic techniques. Most surgeons treat all aortic valve pathology with a replacement. In part, this management strategy is justified by the excellent long-term results with available prostheses. Since valve replacement in the younger adult has the inherent problems associated with anticoagulation and/or prosthesis durability, repair, if durable, has the potential for a good solution in this patient population. We reviewed the surgical indications, techniques, clinical results, and current status of aortic valve repair.
Adult ; Aortic Valve Insufficiency ; Aortic Valve* ; Constriction, Pathologic ; Humans ; Incidence ; Longevity ; Pathology ; Plastics ; Prostheses and Implants ; Prosthesis Failure ; Tricuspid Valve

Repair of the aortic valve has received considerably less attention than repair of the mitral or tricuspid valves. Reasons for this may include the greater incidence of stenosis in the aortic valve relative to insufficiency, the degenerative processes that lead to valvular dysfunction reducing the number of potentially repairable valves, and the presence of a wider variety of valve substitutes with lower thromboembolic potential and greater longevity than for the mitral position. Furthermore, the functional structure and redundancy of the mitral and tricuspid valves may be more amenable to plastic techniques. Most surgeons treat all aortic valve pathology with a replacement. In part, this management strategy is justified by the excellent long-term results with available prostheses. Since valve replacement in the younger adult has the inherent problems associated with anticoagulation and/or prosthesis durability, repair, if durable, has the potential for a good solution in this patient population. We reviewed the surgical indications, techniques, clinical results, and current status of aortic valve repair.
Adult ; Aortic Valve Insufficiency ; Aortic Valve* ; Constriction, Pathologic ; Humans ; Incidence ; Longevity ; Pathology ; Plastics ; Prostheses and Implants ; Prosthesis Failure ; Tricuspid Valve

Aortic Valve ; pathology ; Calcinosis ; Heart Defects, Congenital ; pathology ; Heart Valve Diseases ; pathology ; Humans

BACKGROUND: In this study, we investigated the risk factors for the development or progression of aortic regurgitation(AR) in patients with type I ventricular septal defect (VSD) to determine the optimal surgical timing and strategy. MATERIAL AND METHOD: Three-hundred and ten patients with type I VSD with or without AR were included. The mean of age was 73.7+/-114.7 (1~37) months. One hundred and eighty six patients (60%) had no AR, 83 (27%) had mild AR, 25 (8%) had moderate AR and 16 (5%) had severe AR. Aortic valve was repaired in 5 patients and replaced in 11 patients with closure of VSD in the first operation. Four patients required redo aortic valve repair and 11 patients required redo aortic valve replacement. Age at operation, association with aortic valve prolapse, Qp/Qs, systolic pulmonary arterial pressure, VSD size and systolic pulmonary artery to aortic pressure ratio(s[PAP/AP]) were included as risk factors analysis for the development of AR. The long-term result of aortic valve repair and aortic valve replacement were compared. RESULT: Older age at operation, association with aortic valve prolapse, high Qp/Qs, and s[PAP/AP] were identified as risk factors for the development of AR (p<0.05, Table 2). The older the patient at the time of operation, the higher the severity of preoperative AR and the incidence of postoperative AR (p<0.05, Table 1, Fig. 1). For the older patients at operation, aortic valve repair had higher occurrence of AR compared to those who had aortic valve replacement (p<0.05, Fig. 2). CONCLUSION: From the result of this study, we can concluded that early primary repair is recommended to decrease the progression of AR. Aortic valve repair is not always a satisfactory option to correct the aortic valve pathology, which may suggest that aortic valve replacement should be considered when indicated.
Aortic Valve ; Aortic Valve Insufficiency ; Aortic Valve Prolapse ; Arterial Pressure ; Heart Septal Defects ; Heart Septal Defects, Ventricular* ; Humans ; Incidence ; Pathology ; Pulmonary Artery ; Risk Factors

Adolescent ; Aortic Valve ; abnormalities ; Aortic Valve Insufficiency ; complications ; pathology ; surgery ; Aortic Valve Stenosis ; complications ; pathology ; surgery ; Child ; Endocarditis ; complications ; pathology ; surgery ; Female ; Heart Defects, Congenital ; complications ; pathology ; surgery ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Rheumatic Heart Disease ; complications ; pathology ; surgery

The Ross operation, a procedure of replacement of the diseased aortic valve with an autologous pulmonary valve, has many advantages such as no need for anticoagulation therapy and similar valve function and growth potential as native valves. However secondary aortic disease has emerged as a significant complication and indication for reoperation. We report a 48-year-old woman who had Ross operation in 1997 for a damaged bicuspid aortic valve and severe aortic regurgitation due to subacute bacterial endocarditis complicated by aortic root abscess. In 2009, 12 years later, progressive severe aortic regurgitation with incomplete coaptation and mild dilatation of the aortic root was shown on echocardiography and contrasted CT, while the pulmonary homograft retained normal function. She subsequently underwent aortic valve replacement. Histopathological examination of the explanted neo-aortic valve and neo-arterial wall revealed pannus formation at the nodulus Arantii area of the three valve cusps, ventricularis, and arterialis. The amount of elastic fibres in the neo-aorta media was less than usual for an aorta of this patient's age but was similar to a pulmonary artery. The pathological findings were not different from other studies of specimens removed between 7 to 12 years after Ross operation. However, the pathophysiology and long-term implications of these findings remain debatable. Considering the anatomical and physiological changes induced by the procedure, separate mechanisms for aortic dilatation and regurgitation are worthy of consideration.
Aorta/*pathology ; Aortic Valve/*surgery ; Aortic Valve Insufficiency/*etiology ; Cardiovascular Surgical Procedures/*adverse effects ; Dilatation, Pathologic ; Heart Valve Diseases/*surgery ; Prostheses and Implants ; Pulmonary Valve/*transplantation