Early Identification of Decompensated Aortic Regurgitation With Stress Echocardiography.
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ABSTRACT:
SUBMITTER: Latifi AN
PROVIDER: S-EPMC8712953 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundDobutamine stress echocardiography (DSE) in classical low-flow, low-gradient (LFLG) aortic stenosis (AS) is recommended in recent guidelines to differentiate true-severe AS from pseudo-severe AS. However, DSE for patients with concomitant significant mitral regurgitation (MR) is often inaccurate or inconclusive.Case summaryA 73-year-old man with a history of coronary artery bypass grafting was referred to our institution with congestive heart failure. Transthoracic echocardiogram showed severe functional MR and LFLG AS. The results of DSE to determine the severity of AS were inconclusive owing to the absence of flow reserve, usually defined as stroke volume increase of ≥20%. In addition, calcium score by computed tomography scan was also inconclusive. Our heart team decided to reassess the severity of AS after percutaneous edge-to-edge mitral valve repair (PMVR), considering the patient's high surgical risk. Percutaneous edge-to-edge mitral valve repair was uneventful, resulting in marked reduction of MR from severe to trivial. Dobutamine stress echocardiography after PMVR revealed true-severe AS with the presence of flow reserve. Transcatheter aortic valve implantation (TAVI) was performed, and the patient ambulatorily discharged.DiscussionThe coexistence of significant AS may lead to overestimation of the severity of MR, and reportedly, concomitant MR improves in the majority of patients after TAVI, especially MR of functional aetiology. However, the coexistence of significant MR often leads to inconclusive DSE results because dobutamine stress may worsen MR and fail to increase the stroke volume. In our case, DSE after PMVR was useful to diagnose the true-severe AS for the patient with LFLG AS and severe functional MR.
| S-EPMC8189303 | biostudies-literature
Project description:Iatrogenic valvular regurgitation following cardiac surgery has been reported as a result of leaflet perforation or entrapment. Due to its central location, the aortic valve is one of the most vulnerable structures for iatrogenic injuries. Proper assessment of the aortic valve by transesophageal echocardiography (TEE) should be done after a cardiac surgery in the periaortic area. We hereby report a case of iatrogenic aortic regurgitation which was developed after primary closure of perimembranous ventricular septal defect. It was timely diagnosed by TEE after termination of cardiopulmonary bypass and helped in further management.
| S-EPMC7034207 | biostudies-literature
Project description:Over the past 10 years there has been intense research in the development of volumetric visualization of intracardiac flow by cardiac magnetic resonance (CMR).This volumetric time resolved technique called CMR 4D flow imaging has several advantages over standard CMR. It offers anatomical, functional and flow information in a single free-breathing, ten-minute acquisition. However, the data obtained is large and its processing requires dedicated software. We evaluated a cloud-based application package that combines volumetric data correction and visualization of CMR 4D flow data, and assessed its accuracy for the detection and grading of aortic valve regurgitation using transthoracic echocardiography as reference. Between June 2014 and January 2015, patients planned for clinical CMR were consecutively approached to undergo the supplementary CMR 4D flow acquisition. Fifty four patients(median age 39 years, 32 males) were included. Detection and grading of the aortic valve regurgitation using CMR4D flow imaging were evaluated against transthoracic echocardiography. The agreement between 4D flow CMR and transthoracic echocardiography for grading of aortic valve regurgitation was good (j = 0.73). To identify relevant,more than mild aortic valve regurgitation, CMR 4D flow imaging had a sensitivity of 100 % and specificity of 98 %. Aortic regurgitation can be well visualized, in a similar manner as transthoracic echocardiography, when using CMR 4D flow imaging.
| S-EPMC4737795 | biostudies-literature
Project description:The incidence aortic valve injury during percutaneous coronary intervention is scarce, mostly resulting in acute aortic regurgitation. However, rarely patients may remain asymptomatic in the immediate post-procedure period and present latter with chronic aortic regurgitation. Determining etiology of such an aortic regurgitation may be challenging. We present a case of a 51-year-old man with history of percutaneous coronary intervention for coronary artery disease and moderate aortic regurgitation scheduled for coronary artery bypass grafting and aortic valve replacement. Intra-operative transesophageal echocardiography was instrumental in deciding etiology of aortic regurgitation that change surgical management of the patient.
| S-EPMC8404607 | biostudies-literature
Project description: Not available
| S-EPMC10899714 | biostudies-literature
Project description:AimsAlthough surgical aortic valve replacement (SAVR) is currently the recommended intervention for patients with native AR without aortic stenosis, a significant proportion of Asian patients undergo transcatheter aortic valve replacement (TAVR), which has not been studied fully for safety and outcomes. This systematic review aims to examine the characteristics and outcomes of Asian patients with pure native aortic regurgitation (AR) undergoing TAVR.Methods and resultsPubMed, Embase, Scopus, Web of Science and Cochrane CENTRAL were systematically searched for randomised controlled trials, observational studies and case reports published from inception to 2 April 2020, involving patients of Asian ethnicity with pure native aortic regurgitation who had undergone TAVR. Our primary outcome was all-cause mortality, with secondary outcomes including all major complications. Five studies (n=274 patients) and eight case reports were included. Device success was reported in 94.9% of the patients, the all-cause mortality rate was 4.4%, 2.5% were converted to SAVR, 1.7% had post-operative paravalvular leak and 6.7% required permanent pacemaker implantation.ConclusionsTAVR has demonstrated acceptable safety and efficacy in Asian patients with pure AR displaying low mortality rates and few adverse outcomes.
| S-EPMC8670568 | biostudies-literature
Project description: Not available
| S-EPMC1768968 | biostudies-literature
Project description:To compare the ability of cardiac magnetic resonance tomography (CMR) and transthoracic echocardiography (TTE) to predict the need for valve surgery in patients with chronic aortic regurgitation on a mid-term basis. 66 individuals underwent assessment of aortic regurgitation (AR) both in CMR and TTE between August 2012 and April 2017. The follow-up rate was 76% with a median of 5.1 years. Cox proportional hazards method was used to assess the association of the time-to-aortic-valve-surgery, including valve replacement and reconstruction, and imaging parameters. A direct comparison of most predictive CMR and echocardiographic parameters was performed by using nested-factor-models. Sixteen patients (32%) were treated with aortic valve surgery during follow-up. Aortic valve insufficiency parameters, both of echocardiography and CMR, showed good discriminative and predictive power regarding the need of valve surgery. Within all examined parameters AR gradation derived by CMR correlated best with outcome [χ2 = 27.1; HR 12.2 (95% CI: 4.56, 36.8); (p < 0.0001)]. In direct comparison of both modalities, CMR assessment provided additive prognostic power beyond echocardiographic assessment of AR but not vice versa (improvement of χ2 from 21.4 to 28.4; p = 0.008). Nested model analysis demonstrated an overall better correlation with outcome by using both modalities compared with using echo alone with the best improvement in the moderate to severe AR range with an echo grade II out of III and a regurgitation fraction of 32% in CMR. This study corroborates the capability of CMR in direct quantification of AR and its role for guiding further treatment decisions particularly in patients with moderate AR in echocardiography.
| S-EPMC8494718 | biostudies-literature
Project description:BackgroundBehcet's disease (BD)-related aortic regurgitation (AR) is known to be associated with paravalvular leakage (PVL) after successful aortic valve (AV) surgery. This study aimed to determine predictors of PVL after successful AV surgery in BD patients. We retrospectively collected data of 35 patients (42.1 ± 9.1 years, 27 men) who underwent surgery for severe BD-related AR at two tertiary centers. The diagnosis was established based on echocardiographic, surgical, and/or pathological findings in conjunction with the International Study Group criteria for BD. A total of 76 cases of AV surgery in 35 patients were analyzed.ResultsA median follow-up duration was 8.0 years (interquartile range, 5.4-14.3 years). PVL developed in 18 patients (51.4%) within 2 years after the first surgery. Six patients who met the diagnostic criteria for BD did not develop PVL, in whom 5 patients took immunosuppressive therapy (IST). However, 4 of 9 patients (44.4%) who did not meet the diagnostic criteria developed PVL, in whom four (44.4%) patients took IST. On multivariable analysis, postoperative IST and concomitant aortic root replacement (ARR) were two independent predictors for less PVL development (HR 0.38, 95% CI 0.17-0.89, p = 0.025 for postoperative IST; HR 0.17, 95% CI 0.08-0.36, p < 0.001 for concomitant ARR). Preoperative IST use did not determine PVL development (p = 0.75).ConclusionsPostoperative, but not preoperative, IST and concomitant ARR were independent predictors of less development of PVL. Special attention is required for early diagnosis BD-related AR, especially in patients not satisfying the current diagnostic criteria.
| S-EPMC6558675 | biostudies-literature
Project description:A 46-year-old man with a history of hypertension, chronic kidney disease, and chronic aortic dissection classified as DeBakey type IIIB was referred to our hospital with chest and back pain. The patient underwent 64-row multidetector computed tomography (MDCT), which revealed new-onset DeBakey type II aortic dissection. The intimal flap prolapsed into left ventricle in the diastolic phase of cardiac cycle and stuck to the right coronary cusp (RCC) of the aortic valve. He also underwent transesophageal echocardiography (TEE) to assess the relationship between the intimal flap and aortic valve in detail. The intimal flap overlaid the RCC and prolapsed into the left ventricle outflow tract in the diastolic phase. These images suggested that the circumferential intimal flap stuck to the aortic valve, resulting in severe aortic regurgitation. One day after the admission, the patient underwent replacement of ascending aorta with a prosthetic graft. Intraoperative observation exhibited the intimal flap inverted to the left ventricle. MDCT could detect the flat movement, as well as TEE, in addition to the extent of aortic dissection. <Learning objective: Acute aortic regurgitation is one of the complications in aortic dissection involving the ascending aorta. The mechanisms are aortic root dilatation, asymmetry of the aortic root, and diastolic prolapse of the intimal flap into the left ventricle. Evaluation of the mechanism is beneficial for surgical procedure and TEE is a useful tool. With the advancement of MDCT, MDCT could also detect the flap movement and become a useful tool for evaluating mechanism, in addition to the extent of aortic dissection.>.
| S-EPMC6275397 | biostudies-literature