1.In Vitro Experimental Study on Hemodynamics of Transcatheter Aortic Valve Replacement.
Chinese Journal of Medical Instrumentation 2023;47(4):383-390
The patient-specific aortic silicone model was established based on CTA data. The digital particle image velocimetry (DPIV) test method in the modified ViVitro pulsatile flow system was used to investigate the aortic hemodynamic performance and flow field characteristics before and after transcatheter aortic valve replacement (TAVR). The results showed that the hemodynamic parameters were consistent with the clinical data, which verified the accuracy of the model. From the comparative study of preoperative and postoperative effective orifice area (0.33 cm2 and 1.78 cm2), mean pressure difference (58 mmHg and 9 mmHg), percentage of regurgitation (52% and 8%), peak flow velocity (4.60 m/s and 1.81 m/s) and flow field distribution (eccentric jet and uniform jet), the immediate efficacy after TAVR is good. From the perspective of viscous shear stress and Reynolds shear stress, the risk of hemolysis and thrombotic problems was low in preoperative and postoperative patient-specific models. This study provides a set of reliable DPIV testing methods for aortic flow field, and provides biomechanical basis for the immediate and long-term effectiveness of TAVR from the perspective of hemodynamics and flow field characteristics. It has important application value in clinical diagnosis, surgical treatment and long-term evaluation.
Humans
;
Transcatheter Aortic Valve Replacement/methods*
;
Aortic Valve/surgery*
;
Heart Valve Prosthesis
;
Hemodynamics
;
Aortic Valve Stenosis/diagnosis*
;
Treatment Outcome
2.Role of Transesophageal Echocardiography in the Diagnosis of Paradoxical Low Flow, Low Gradient Severe Aortic Stenosis.
Muaz M ABUDIAB ; Anil PANDIT ; Hari P CHALIKI
Korean Circulation Journal 2017;47(1):82-88
BACKGROUND AND OBJECTIVES: Prior studies indicate that up to 35% of cases of severe aortic stenosis (AS) have paradoxical low flow, low gradient despite preserved left ventricular ejection fraction (LVEF). However, error in left ventricular outflow tract (LVOT) diameter may lead to misclassification. Herein, we determined whether measurement of LVOT diameter by transesophageal echocardiography (TEE) results in reclassification of cases to non-severe AS. SUBJECTS AND METHODS: Patients with severe AS with aortic valve area (AVA) <1 cm2 by transthoracic echocardiography (TTE) within 6 months were studied. Paradoxical low flow, low gradient was defined as mean Doppler gradient (MG) <40 mm Hg and stroke volume index (SVI) ≤35 mL/m². Preserved LVEF was defined as ≥0.50. RESULTS: Among 108 patients, 12 (15%) had paradoxical low flow, low gradient severe AS despite preserved LVEF based on TTE measurement. When LVOT diameter by TEE in 2D was used, only 5 (6.3%) patients had low flow, low gradient severe AS (p<0.001). Coefficients of variability for intraobserver and interobserver measurement of LVOT were <10%. However, the limits of agreement between TTE and TEE measurement of LVOT ranged from 0.43 cm (95% confidence interval [CI]: 0.36 to 0.5) to -0.31 cm (95% CI: -0.38 to -0.23). CONCLUSION: TEE measured LVOT diameter may result in reclassification to moderate AS in some patients due to low prevalence of true paradoxical low flow, low gradient (PLFLG) severe AS.
Aortic Valve
;
Aortic Valve Stenosis*
;
Diagnosis*
;
Echocardiography
;
Echocardiography, Transesophageal*
;
Humans
;
Prevalence
;
Stroke Volume
3.Successful emergency transcatheter aortic valve implantation.
Jung Hee LEE ; Ah Young JI ; Young Ju KIM ; Changho SONG ; Moo Nyun JIN ; Sun Wook KIM ; Myeong Ki HONG ; Geu Ru HONG
Yeungnam University Journal of Medicine 2014;31(2):144-147
Despite the necessity of surgical aortic valve replacement, many patients with symptomatic severe aortic stenosis (AS) cannot undergo surgery because of their severe comorbidities. In these high-risk patients, percutaneous transcatheter aortic valve implantation (TAVI) can be safely accomplished. However, no study has shown that TAVI can be performed for patients with severe AS accompanied by acute decompensated heart failure. In this case report, 1 patient presented a case of severe pulmonary hypertension with decompensated heart failure after diagnosis with severe AS, and was successfully treated via emergency TAVI. Without any invasive treatment, acute decompensated heart failure with severe pulmonary hypertension is common in patients with severe AS, and it can increase mortality rates. In conclusion, TAVI can be considered one of the treatment options for severe as presented as acute decompensated heart failure patients with pulmonary hypertension.
Aortic Valve Stenosis
;
Aortic Valve*
;
Comorbidity
;
Diagnosis
;
Emergencies*
;
Emergency Treatment
;
Heart Failure
;
Heart Valve Prosthesis Implantation
;
Humans
;
Hypertension, Pulmonary
;
Mortality
4.A Case of Supravalvular and Valvular Aortic Stenosis.
Yong HWANG ; Yang Soo JANG ; Kum Soo PARK ; Won Heum SHIN ; Bum Koo CHO
Korean Circulation Journal 1985;15(3):527-532
Supravalvular aortic stenosis may be defined as an obstructive congenital deformity of the ascending aorta which originates just distal to the level of the origins of the coronary arteries. It may be localized or diffuse, and includes a wide spectrum of pathologic changes. A 16 years old school boy was admitted because of exertional dyspnea for 6 years. Clinical diagnosis of supravalvular and valvular aortic stenosis with bicuspid aortic valves and myocardial hypertrophy was made by echocardiography and angiocardiography. Surgical correction was performed successfully. We presented a case of supravalvular and valvular aortic stenosis with a review of literatures.
Adolescent
;
Angiocardiography
;
Aorta
;
Aortic Stenosis, Supravalvular
;
Aortic Valve
;
Aortic Valve Stenosis*
;
Bicuspid
;
Congenital Abnormalities
;
Coronary Vessels
;
Diagnosis
;
Dyspnea
;
Echocardiography
;
Humans
;
Hypertrophy
;
Male
5.Angiographic analysis of congenital aortic stenosis: study in 20 patients excluding valvular stenosis
Seoung Oh YANG ; Kyung Mo YEON ; Man Chung HAN ; Jeong Yeon CHOI ; Chang Yee HONG
Journal of the Korean Radiological Society 1984;20(3):529-539
Twenty patients with congenital aortic stenosis excluding valvular stenosis were studied beween April 1980 and April 1984 at Seoul National University Hospital. The clinical and radiologic findings with the emphasis on the cineangiographies were analyzed separately according to the type of aortic stenosis as subaortic and supravalvular aortic stenosis. The summaries of the analysis are as follows: 1. Among the 20 cases, 12 cases were subaorticstenosis and 8 cases were supravalvular stenosis. 2. The anatomic types of subaoritc stenosis were the discrete membranous type (8 cases), the fibromuscular type (2 cases) and the tunnel type (2 cases). 3. The obstruction of subaoritic types was usually severe, and the median left ventricular to aortic systolic pressure gradient was 60mmHg, and associated cardiac defects were found in 10 cases (84%), an incidence greater than that reported in mostother large series. 4. The anatomic types of 8 cases of supravalvular aortic stenosis were mainly focal type (7cases ) and 1 case of diffuse hypoplastic type. 5. The median left ventricular to aortic systolic pressure gradient of supravalvular stenosis was 75mmHg, and associated anomalies were seen in 6 cases(75%) with 3 cases of suspected mental retardation and facial abnormalities without definite hypercalcemia. 6. For accurate diagnosis of congenital aortic stenosis, retrograde left ventricular angiograms obtainend in axial pojections are of crucial importance in demonstration of anatomic types of stenosis and associated anomalies. And supravalvular aortic injection is sometimes helpful to outline the anatomy of the valve and to evaluate the degree of aortic regurgitation.
Aortic Stenosis, Supravalvular
;
Aortic Valve Insufficiency
;
Aortic Valve Stenosis
;
Blood Pressure
;
Cineangiography
;
Constriction, Pathologic
;
Diagnosis
;
Humans
;
Hypercalcemia
;
Incidence
;
Intellectual Disability
;
Seoul
7.Silent Aortic Regurgitation.
Jae Kyung ROH ; Sung Soon KIM ; Suk Ho CHUNG ; Hong Do CHA
Korean Circulation Journal 1977;7(1):39-45
Aortic regurgitation is a common valvular heart disease, usually the result of rheumatic fever, or syphilis, and rarely of congenital origin. It is frequently associated with other valvular heart disease, especially mitral valve disease. It can be diagnosed by the presence of pulse pressure widening, a Corrigan pulse, and an early decreascendo diastolic murmur at the left sternal border between the second and third intercostal spaces. After the clinical application of cineaortography in the diagnosis of valvular disease, Segal et al (1964) first reported rheumatic aortic regurgitation without an audible murmur in patients having mitral valve disease. The importance of discovering aortic reguritation in patients with predominent mitral disease has begun to be appreciated recently, especially as commisurotomies for the relief of mitral stenosis are performed more frequently. Nowadays eventhough the severity of aortic regurgitation is often not evident preoperatively, aortic regurgitation can become very evident when mitral stenosis is relieved. This study was comprised of seventeen patients with silent aortic regurgitation which was confirmed by cineaortography at Severance Hospital from January, 1970 to August, 1976. 1. Of the seventeen patients, 12 patients were associated with mitral stenosis, 4 with mitral steno-insufficiency, and 1 with mitral insufficiency. 2. Silent aortic regurgitation was suggested from the accompanying clinical features such as chest pain, apical heaving, and left ventficular hypertrophy pattern on both roentgenogram of the chest and electrocardiogram. 3. The severity of the aortic regurgitation was mild to moderate; 7 of the 17 patients being grade I, and 10 patients being grade II on cineaortogram.
Aortic Valve Insufficiency*
;
Blood Pressure
;
Chest Pain
;
Diagnosis
;
Electrocardiography
;
Heart Murmurs
;
Heart Valve Diseases
;
Humans
;
Hypertrophy
;
Mitral Valve
;
Mitral Valve Insufficiency
;
Mitral Valve Stenosis
;
Rheumatic Fever
;
Syphilis
;
Thorax
8.Isolated Left Ventricular Apical Hypoplasia with Infundibular Pulmonary and Aortic Stenosis: a Rare Combination.
Jin Il MOON ; Yeon Joo JEONG ; Geewon LEE ; Jung Hyun CHOI ; Ji Won LEE
Korean Journal of Radiology 2013;14(6):874-877
Isolated left ventricular (LV) apical hypoplasia is a rare congenital cardiac anomaly which is not accompanied by other cardiac abnormalities, with the exception of two cases. We report a case of a 33-year-old male patient with isolated LV apical hypoplasia combined with infundibular pulmonary stenosis and aortic stenosis. We review a literature focusing on the characteristic magnetic resonance features and combined cardiac abnormalities.
Adult
;
Aortic Valve Stenosis/*complications/diagnosis
;
Diagnosis, Differential
;
Echocardiography
;
Electrocardiography
;
Humans
;
Hypoplastic Left Heart Syndrome/*complications/diagnosis
;
Magnetic Resonance Imaging, Cine
;
Male
;
Pulmonary Valve Stenosis/*complications/diagnosis
9.Multiple Papillary Fibroelastomas and Thrombus in the Left Heart.
Guang Won SEO ; Sang Hoon SEOL ; Bo Min PARK ; Tae Jin KIM ; Jae Kyun KIM ; Pil Sang SONG ; Dong Kie KIM ; Ki Hun KIM ; Yeon Mee KIM ; Doo Il KIM
Journal of Cardiovascular Ultrasound 2014;22(1):40-42
Cardiac papillary fibroelastomas (CPF) are benign cardiac tumors and usually discovered incidentally during echocardiography. This report describes the case of a 68-year-old man, referred to cardiology for multiple masses of the left ventricle and left atrium. The transthoracic echocardiography revealed multiple oscillating masses in the left ventricle and aortic valve, non-mobile mass in the left atrium with severe mitral stenosis and moderate aortic regurgitation. The patient underwent surgical resection of the masses with valve replacements. Histopathologic examination confirmed the diagnosis of CPF in the left ventricle and aortic valve, thrombus in the left atrium.
Aged
;
Aortic Valve
;
Aortic Valve Insufficiency
;
Cardiology
;
Diagnosis
;
Echocardiography
;
Heart Atria
;
Heart Neoplasms
;
Heart Ventricles
;
Heart*
;
Humans
;
Mitral Valve Stenosis
;
Thrombosis*
10.Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis.
Eun Jeong CHO ; Sung-Ji PARK ; Sung-A CHANG ; Dong Seop JEONG ; Sang-Chol LEE ; Seung Woo PARK ; Pyo Won PARK
Chinese Medical Journal 2014;127(22):3963-3969
BACKGROUNDAngina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS), even in patients without significant coronary artery disease (CAD). However, the incidence of angina pectoris and related CAD in such patients is controversial. There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS. The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.
METHODSData from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995. Clinical and echocardiographic follow-up data were recorded into the database annually. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.
RESULTSTotally 574 patients with severe AS (mean age, (65.9±9.6) years) were enrolled in this study. Significant CAD was found in 61 patients (10.6%). Factors associated with increased likelihood of CAD were age, hypertension, diabetes mellitus, chronic renal failure, carotid disease, and aorta calcification. In Logistic regression analysis, the independent predictor of the presence of CAD was age (P = 0.011). The incidence of CAD increased significantly at 69.2 years of age. Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.
CONCLUSIONSThere was a low incidence of significant CAD in a population of Korean patients with severe AS. Therefore, coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of age without risk factors for cardiovascular disease.
Aged ; Angina Pectoris ; diagnosis ; epidemiology ; Aortic Valve ; surgery ; Aortic Valve Stenosis ; epidemiology ; surgery ; Coronary Angiography ; Coronary Artery Disease ; diagnosis ; epidemiology ; Echocardiography ; Humans ; Incidence ; Middle Aged