Aortic Regurgitation Publications (22686)


Aortic Regurgitation Publications


There are limited mechanical circulatory support options for patients with single ventricle (SV) anatomy. This is a multicenter, retrospective study of the Impella pump to support the systemic ventricle in a cohort of SV patients with Fontan circulation.
Patients with SV anatomy supported with an Impella device from 2012 to 2015 were included. Read More

Demographic information, indication for support, adverse events and short-term outcome data were collected.
Ten patients were included. The median age and weight at implant was 26 years (4-38 years) and 64 kg (15-102 kg). Indications for support were systemic ventricular failure with cardiogenic shock (n = 8) or high-risk electrophysiology (EP) procedures (n = 2). The median duration of support was 49 hr (2.7-264 hr). Support was discontinued for ventricular recovery in five patients, transition to another device in two patients, completion of EP procedure in two patients and death in one patient. Survival to hospital discharge was 80%. Adverse events occurred in 4 patients. There were two cases of hemolysis, one case of increasing aortic valve insufficiency with implant and one asymptomatic access site thrombus. There were no bleeding or thromboembolic events.
Impella devices can provide temporary support for the systemic ventricle in SV patients as a bridge to recovery or additional device. Procedural survival and adverse event profiles are favorable. © 2017 Wiley Periodicals, Inc.

Interact Cardiovasc Thorac Surg
Interact Cardiovasc Thorac Surg 2017 Jan 22. Epub 2017 Jan 22.
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany.

A partial upper sternotomy has become established as a less invasive approach mainly for single and double valve surgery. This report evaluates the clinical outcomes of triple valve surgery performed through a partial upper sternotomy.
We reviewed the medical records of 37 consecutive patients (28 men, 76%) who underwent triple valve surgery through a partial upper sternotomy between 2005 and 2015. Read More

The patients' mean age was 67 ± 17 years; 27 (73%) were in New York Heart Association Class III or IV. Aortic and mitral valve insufficiency was more common than stenosis. Ninety-three percent of surviving patients were followed for a mean period of 58 ± 24 months.
Aortic valve procedures consisted of 24 (65%) replacements and 13 (35%) repairs. The mitral valve was repaired in 28 (76%) patients, whereas tricuspid valve repair was feasible in all patients. No conversion to full sternotomy was necessary. Myocardial infarction was not observed. Chest tube drainage was 330 ± 190 ml, and 4 patients required reopening for bleeding (1, 3%) or tamponade (3, 8%). One stroke was observed due to heparin-induced thrombocytopaenia after initial unremarkable neurological recovery. Early mortality included 5 (13.5%) patients. Actuarial survival at 5 years was 52 ± 10%.
A partial upper sternotomy provides adequate exposure to all heart valves. We did not experience technical limitations with this approach. Wound dehiscence, postoperative bleeding, intensive care unit and hospital stay and early deaths were low compared to data from other published series of triple valve surgery through a full median sternotomy. Early and mid-term outcomes were not adversely affected by this less invasive approach.

J Card Surg
J Card Surg 2017 Jan 22. Epub 2017 Jan 22.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.

We present a case of aortic coarctation combined with ascending-descending aorta dilatation and concomitant aortic valve regurgitation. The technique involved using endovascular stenting, a two-stage balloon dilation procedure post-stent implantation and a Bentall procedure. Read More

JACC Cardiovasc Interv
JACC Cardiovasc Interv 2017 Jan 11. Epub 2017 Jan 11.
Heart Center Brandenburg, Department of Cardiology, Medical School Brandenburg, Bernau, Germany. Electronic address:
J. Vet. Intern. Med.
J Vet Intern Med 2017 Jan 21. Epub 2017 Jan 21.
Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.

Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease.
To describe the use of pulsed-wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease.
Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD. Read More

Echocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one-way ANOVA and Dunnett's test.
A complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ETm (-118.5 [-154.1 to -82.9] ms; mean difference [95% CI of difference of means]), increased PEPm /ETm (0.11 [0.05 to 0.17]), prolonged IMPm (0.28 [0.18 to 0.37]), increased S1 (8.9 [5.2 to 12.6] cm/s), and decreased E1 (-2.6 [-4.7 to -0.5] cm/s), Em (-14.2 [-19.9 to -8.5] cm/s), and Em /Am ratio (-1.6 [-2.6 to -0.6]).
Pulsed-wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.

We sought to investigate a new angiographic method for aortic regurgitation (AR) severity assessment in the setting of transcatheter aortic valve implantation (TAVI).
AR after TAVI is common but challenging to quantitate, especially in the cath-lab.
In 228 patients, AR was quantitated before and after TAVI by echocardiography and by video-densitometric analysis of aortograms. Read More

Contrast time-density curves for the aortic root (the reference region) and the left ventricular outflow tract, LVOT were generated. LVOT-AR was calculated as the area under the curve of the LVOT as a fraction of the area under the curve of the reference region.
LVOT-AR was 0.10 ± 0.08, 0.13 ± 0.10 and 0.28 ± 0.14 in none-trace, mild and moderate-severe post-TAVI AR as defined by echocardiography (P < 0.001) and a cutpoint of >0.17 corresponded to moderate-severe AR on echocardiography (area under the curve = 0.84). At follow-up (median, 496 days), patients with LVOT-AR ≤ 0.17 showed a significant reduction of LV mass index (LVMi; 121 [95-148] vs. 140 [112-169] g/m(2) , P = 0.009) and the prevalence of LV hypertrophy (LVH; 64 vs. 88%, P = 0.001) compared to baseline. In patients with LVOT-AR > 0.17, LVMi (149 [121-178] vs. 166 [144-188] g/m(2) , P = 0.14) and the prevalence of LVH (74 vs. 87%, P = 0.23) did not show a significant change. Compared to patients with LVOT-AR ≤ 0.17, those with LVOT-AR > 0.17 had an increased 30-day (16.4% vs. 7.1%, P = 0.035) and one year mortality (32.9 vs. 14.2%, log rank P value = 0.001; HR: 2.690 [1.461-4.953], P = 0.001).
LVOT-AR > 0.17 corresponds to greater than mild AR as defined by echocardiography and predicts impaired LV reverse remodeling and increased early and midterm mortality after TAVI. © 2017 Wiley Periodicals, Inc.


The aim of this study was to investigate the mutual influence of valvular calcifications and transcatheter aortic valve stent geometry during and after implantation of a balloon-expandable SAPIEN(®)/SAPIEN XT(®) prostheses. Aortic valve calcification has been linked with adverse complications after transcatheter aortic valve implantation (TAVI). However, little is known about the fate of the calcifications after TAVI as well as its influence on transcatheter heart valve geometry. Read More

Thirty one patients underwent cardiac dual source computed tomography (DSCT) before and after a TAVI with the Edwards SAPIEN/SAPIEN XT(®) prostheses. Detailed DSCT image analysis was performed with Mimics(®) and 3Matic(®) (both Materialise, Leuven, Belgium).
Implanted stents reached an average degree of expansion of 84% and achieved good circularity despite the presence of fairly oval native annuli and a heterogeneous degree of valvular calcification. Both, the degree of stent expansion and the degree of stent eccentricity were inversely related to the degree of oversizing, but independent of the degree of valvular calcification and native annular ovality. Visualization of the position of calcific debris before and after TAVI showed that calcifications were shifted upwards and outwards as a consequence of the implantation procedure. The degree of stent eccentricity was related to residual aortic regurgitation grade ≥2.
The SAPIEN(®)/SAPIEN XT(®) prostheses achieved good degrees of stent expansion and circularity regardless of the morphology of the landing zone. Increased stent ovality was associated with an elevated risk for aortic regurgitation. The total calcification volume, degree of annular ovality and stent expansion were not associated with residual AR.

Turk Kardiyol Dern Ars
Turk Kardiyol Dern Ars 2017 Jan;45(1):102
Department of Cardiology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey.