Cardiovascular magnetic resonance of quinticuspid aortic valve with aortic regurgitation and dilated ascending aorta.
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ABSTRACT:
SUBMITTER: Meng Y
PROVIDER: S-EPMC2734562 | biostudies-literature | 2009 Aug
REPOSITORIES: biostudies-literature
Publications
Cardiovascular magnetic resonance of quinticuspid aortic valve with aortic regurgitation and dilated ascending aorta.
Meng Yanfeng Y Zhang Lijun L Zhang Zhaoqi Z Wang Yongmei Y Yang Xiaoming X
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance 20090811
We report a rare case of a quinticuspid aortic valve associated with regurgitation and dilation of the ascending aorta, which was diagnosed and post-surgically followed up by cardiovascular magnetic resonance and dual source computed tomography. ...[more]
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Project description:BackgroundAortic regurgitation remains a challenge for transcatheter aortic valve replacement (TAVR), because of the high risk of post-procedural migration or paravalvular leakage resulting from the anatomical and pathophysiological features.Case summaryA 75-year-old male with symptomatic severe aortic regurgitation underwent transfemoral TAVR due to poor physical condition and a Society of Thoracic Surgeons score of 11.3%. However, complete dislodgement of the valve into the ascending aorta occurred during the operation. We performed a modified valve-in-valve technique by using an ablation catheter (instead of performing urgent surgery), and no post-interventional complications were found during hospitalization. The patient was discharged in a stable condition on postoperative Day 12. At the 6-month follow-up, echocardiography showed trivial paravalvular leakage. The left ventricular ejection fraction further improved from 30 to 48%.DiscussionThe management of valve migration can be troublesome. In this case, we performed a modified valve-in-valve technique by using an ablation catheter without post-interventional complications. This is a novel strategy for the management of emergencies, which could avoid surgical thoracotomy. Our strategy may be an alternative option in some cases of valve jumping up to the ascending aorta.
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Project description:BackgroundMedical therapy is often prescribed to reduce the rate of aortic dilatation and prevent aortic dissection in patients with bicuspid aortic valve (BAV) despite a lack of evidence. We conducted an anonymous survey to gain insight into Canadian clinical practice regarding medical therapy used to slow the progression of aortic dilatation in patients with BAV.MethodsA questionnaire was sent to 115 paediatric cardiologists and 18 adult congenital heart disease specialists in Canada.ResultsNinety of 113 paediatric cardiologists (80%) completing the questionnaire reported prescribing medication to reduce the rate of aortic dilatation. Some 75% (61/81) of them reported prescribing medications on the basis of aortic size z scores, and 78% (48/61) considered medication at a z score between ≥ 2 and < 5. The remaining 25% of responders (20/81) reported prescribing medications on the basis of absolute aortic diameter, and 80% (16/20) of them considered initiating medical therapy at an aortic diameter > 40 mm to < 50 mm. For practical purposes, however, 40% of respondents (45/113) would not or rarely consider medical therapy for this indication because of variation in the threshold for initiating treatment. Ten of 14 adult congenital heart disease specialists' responses (71%), reported prescribing medications who were excluded because of missing data.ConclusionThe majority of Canadian paediatric cardiologists reported prescribing medications to slow the rate of aortic dilatation in patients with BAV. However, there is heterogeneity in the criteria to prescribe medical therapy. A multicenter randomized controlled trial is needed to establish the role of medical therapy in this patient population.
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2019-07-11 | GSE84274 | GEO