Critical Aortic Valve Stenosis Research Articles

Surgical outcome of the borderline hypoplastic left ventricle: impact of the left ventricle rehabilitation strategy.

This study aims to assess the surgical outcome of borderline hypoplastic left ventricle before and after the induction of the left ventricle rehabilitation strategy. A retrospective review investigated patients with borderline hypoplastic left ventricle who underwent surgical intervention between 2012 and 2022. The patient cohort was stratified into two groups based on the initiation of left ventricle rehabilitation: an early-era group (E group, 2012-2017) and a late-era group (L group, 2018-2022). Left ventricle rehabilitation was defined as palliation combined with other procedures aimed at promoting left ventricular growth such as restriction of atrial septal defect, relief of inflow/outflow obstructive lesions, and resection of endocardial fibroelastosis. A total of 58 patients were included. Primary diagnosis included 12 hypoplastic left heart syndromes, 11 critical aortic valve stenosis, and others. A total of 9 patients underwent left ventricle rehabilitation, 8 of whom underwent restriction of atrial septal defect. As for clinical outcomes, 9 of 23 patients achieved biventricular repair in the E group, whereas in the L group, 27 of 35 patients achieved biventricular repair (39% vs. 77%, p = 0.004). Mortality did not differ statistically between the two groups (log-rank test p = 0.182). As for the changes after left ventricle rehabilitation, left ventricular growth was observed in 8 of 9 patients. The left ventricular end-diastolic volume index (from 11.4 to 30.1 ml/m2, p = 0.017) and left ventricular apex-to-right ventricular apex ratio (from 86 to 106 %, p = 0.014) significantlyincreased after left ventricle rehabilitation. The introduction of the left ventricle rehabilitation strategy resulted in an increased proportion of patients achieving biventricular repair without a concomitant increase in mortality. Left ventricle rehabilitation was associated with enhanced left ventricular growth and the formation of a well-defined left ventricle apex. Our study underscores the significance of left ventricle rehabilitation strategies facilitating successful biventricular repair. The data suggest establishing restrictive atrial communication may be a key factor in promoting left ventricular growth.

Cardiac surgery and acute hepatitis B - Use of the Seraph™ 100 hemofilter.

We present a case of a 55-year-old male, presenting with angina symptoms with electrocardiographic changes and a panfocal systolic murmur radiating to the carotids. He had a primary HBV infection 8 months ago, without antiviral treatment. Echocardiography showed critical aortic valve stenosis (area: 0.53 cm2/m2). No coronary lesions were found on coronary angiography. Blood analysis revealed AST/GOT of 96 U/L and ALT/GPT 150 U/L. The serological profile revealed positive IgM anti-HBc, anti-HBc, anti-HBs and anti-HBe antibodies, with an increasing viral load (VL). The abdominal ultrasound identified mild hepatic fibrosis (F3) with minimal steatosis. Mechanical aortic prosthetic valve replacement was performed under CPB. The Seraph™ 100 filter was incorporated into the CPB circuit to reduce the risk of HBV contamination, infection and liver failure. The postoperative VL was monitored (Table 1). Liver function tests showed peak levels of bilirubin 0.66 mg/dL, AST/GOT 58 U/L, ALT/GPT 74 U/L at 6 hours post-surgery, with recovery of normal ranges at 48 hours post-surgery.

Long-Term Results of Percutaneous Balloon Aortic Valvuloplasty in Children With Aortic Stenosis: A Single-Center Experience.

Congenital aortic stenosis is a common pathology in the childhood age group and its clinical spectrum varies between asymptomatic and severe heart failure. In our study, we planned to evaluate the long-term results of patients who underwent balloon aortic valvuloplasty (BAV) due to critical aortic valve stenosis in our clinic. Patients aged 0-18 years who underwent aortic balloon valvuloplasty due to aortic stenosis in our clinic between January 2002 and January 2022 were retrospectively evaluated. Among the 48 patients who underwent balloon valvuloplasty due to aortic stenosis, 13 (27%) were female, and 35 (73%) were male. The median age at the time of the procedure was 27.5 months (IQR: 4-96), the median weight was 9.9 kg (IQR: 5.40-29.50), and the median height was 79 cm (IQR: 54-133). The median follow-up duration was 93.5 months (IQR: 38-132). Angiographic assessments in all patients revealed a median left ventricular pressure of 160 mmHg (IQR: 140-200) and a median pressure gradient between the left ventricle and the aorta of 60 mmHg (IQR: 42-80). The median balloon diameter used was 10 mm (IQR: 8-12). Post-procedural measurements showed a median mean gradient of 30 mmHg (IQR: 20-35) between the left ventricle and the aorta. The procedure was successful in 45 (93.5%) patients. During follow-up, 11 patients required surgical intervention. Ross procedure was performed in five patients, homograft in five patients, and mechanical valve implantation in one patient. Risk factors for the need for surgical intervention were evaluated in detail. During the follow-up, the risk factor for intervention was determined to be aortic insufficiency. Aortic valve balloon valvuloplasty is a safe and successful treatment method for critical aortic stenosis. It should be the first choice of treatment option in suitable patients.

Balloon Valvuloplasty in Congenital Critical Aortic Valve Stenosis in Neonates and Infants: A Rescue Procedure for the Left Ventricle.

Congenital critical aortic valve stenosis (CAVS) is a life-threatening disease requiring urgent treatment. First-line therapy is still controversial. The aim of our study was (1) to analyze retrospectively the patients of our institution who underwent balloon aortic valvuloplasty (BAV) due to CAVS and (2) describe the techniques for improved feasibility of intervention using microcatheters and retrieval loops. Twelve patients underwent 23 BAVs: 1 BAV was performed in 3 patients, 2 BAVs were performed in 7 patients, and 3 BAVs were performed in 2 patients. The peak trans-valvular pressure gradient (Δp) and left ventricular shortening fraction (LVSF) improved significantly in the first two interventions. In the first BAV, Δp decreased from 73.7 ± 34.5 mmHg to 39.8 ± 11.9 mmHg (p = 0.003), and the LVSF improved from 22.3 ± 13.5% to 31.6 ± 10.2% (p = 0.001). In the second BAV, Δp decreased from 73.2 ± 33.3 mmHg to 35.0 ± 20.2 mmHg (p < 0.001), and the LVSF increased from 26.7 ± 9.6% to 33.3 ± 7.4% (p = 0.004). Cardiac surgery during the neonatal period was avoided for all children. The median time to valve surgery was 5.75 years. Few complications occurred, namely mild-to-moderate aortic regurgitation, one remediable air embolism, and one intimal injury to the ascending aorta. We conclude that BAV is a successful emergency treatment for CAVS, resulting in left ventricular relief, clinical stabilization, and a time gain until cardiac surgery.

"From the simple to the complex through the combined". Case report

Every day, doctors are faced with severe patients with various diseases, which is aggravated due to comorbidities. However, the management of such patients is complicated due to severe surgical pathologies, the treatment of which involves exclusively surgical intervention. The case describes a patient with critical aortic valve stenosis, hemodynamically significant coronary stenosis, metabolic and hematological disorders, as well as respiratory pathology. In order to achieve an optimal result, the patient’s diabetes therapy was adjusted, specific therapy for secondary erythrocytosis was prescribed, and CPAP therapy for severe sleep apnea was initiated, which made it possible to perform simultaneous stenting of the affected coronary arteries and transcatheter aortic valve implantation.

Emergency Hybrid Correction in a Newborn with Critical Aortic Valve Stenosis with Acute Pulmonary Edema in the First Hour after Birth

Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth. We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life. The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum (aortic and mitral valves stenosis variant), that led to the cardiogenic shock and acute pulmonary edema. The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum. The surgery was performed through a median sternotomy.

Case report of a multidisciplinary approach to one-time treatment of a patient with critical aortic valve stenosis, lesion of the left main coronary artery and bleeding stomach cancer

Aortic valve stenosis and bleeding gastric cancer are formidable diseases characterized by high mortality. For a long time, the gold standard for treating patients with aortic stenosis has been open-heart surgery — aortic valve replacement. However, the endovascular operation that appeared in 2002 — transcatheter aortic valve implantation (TAVI) has become the standard of care for patients with high surgical risk. Gastric cancer is one of the major severe oncological diseases in which surgery is the only way to cure. The combination of these two diseases significantly worsens the prognosis and is a difficult clinical task for choosing the optimal tactics for treating a patient. Given the lack of developed standards for the treatment of multimorbid patients, the treatment plan is determined by an interdisciplinary consultation. But with a combination of these diseases, there is no generally accepted approach in the known recommendations. The purpose of this report is to present a clinical case of a patient with critical aortic stenosis, concomitant severe coronary artery disease, and bleeding stomach cancer, who underwent a successful one-stage operation — percutaneous coronary intervention, TAVI and open gastrectomy with Roux-loop reconstruction with one anesthetic aid by the decision of a multidisciplinary team. The patient was discharged in a satisfactory condition. In the late follow-up period, angina pectoris returned with restenosis of the stent in the anterior interventricular branch (LAD), which required repeated intervention in the form of LAD restenting with a good clinical result. A hybrid approach in the treatment of patients with critical aortic valve stenosis in combination with coronary artery disease and bleeding gastric cancer can be accepted as one of the possible strategies, but further research is needed in this direction. Received 15 October 2021. Revised 20 January 2022. Accepted 31 January 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: N.L. Irodova, L.G. GeletsyanDrafting the article: N.G. Karapetyan, N.N. MeleshenkoCritical revision of the article: B.G. Alekyan, A.Sh. RevishviliSurgical treatment: B.G. Alekyan, D.V. Ruchkin, N.G. Karapetyan, N.N. MeleshenkoFinal approval of the version to be published: B.G. Alekyan, D.V. Ruchkin, N.G. Karapetyan, N.L. Irodova, N.N. Meleshenko, L.G. Geletsyan, A.Sh. Revishvili

Balloon aortic valvuloplasty in neonates: short- and long-term effects and predictors of successful outcome.

IntroductionBalloon aortic valvuloplasty (BAV) is a common treatment method of aortic valve (AV) stenosis in neonates. Long-term BAV effects are suboptimal, and their predictors are not well acknowledged.AimTo identify predictors of suboptimal short- and long-term BAV results.Material and methodsThe study group comprised forty-three neonates (8 females; weight 3.34 ±0.56 kg) who underwent BAV between 1998 and 2021. Seventeen patients (39.53%) had critical AV stenosis. AV was bicuspid in 22 patients, tricuspid in 12, unicuspid in 2, and undefined in 7 patients. The mean balloon/annulus ratio was 0.9 ±0.07. Catheterization, clinical, and follow-up data were analysed.ResultsThe peak-to-peak gradient decreased from 67.5 ±26.3 to 21.3 ±12.6 mm Hg. Twenty-eight patients (65.1%) had adequate early outcome. Aortic regurgitation (AR) occurred in 13 (30.2%) patients. No predictors of inadequate early outcome were found. Twenty-year survival was 90.7%. Eleven (35.5%) patients underwent reintervention at a median of 12 (1–215) months; BAV in 5 patients, surgical valvuloplasty in 2, Ross operation in 2, AV replacement in 1, and Norwood operation in 1 patient. Fifteen-year freedom from reintervention (FFR) was 48%. Adequate early outcome resulted in higher FFR (71% vs. 22%), and so did no significant AR (60% vs. 30%).ConclusionsBAV provides satisfying early results. AR remains a significant aftermath of BAV. Risk factors and procedural techniques improving the outcome of BAV are unclear. Further research is needed to improve FFR.

Bicuspid Aortic Valve in Infants, Children, and Adolescents: A Review for Primary Care Providers.

1. Talha Niaz, MBBS* 2. Jonathan N. Johnson, MD*,† 3. Frank Cetta, MD*,† 4. Timothy M. Olson, MD*,† 5. Donald J. Hagler, MD*,† 1. *Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and 2. †Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN * Abbreviations: AHA : : American Heart Association BAV : : bicuspid aortic valve TTE : : transthoracic echocardiography Bicuspid aortic valve is the most common congenital heart defect in children, adolescents, and adults. Primary care providers play an important role in screening, referral, and follow-up of these patients and should be aware of the family screening guidelines, sports participation recommendations, and periodic follow-up requirements for adequate surveillance of the complications that arise from bicuspid aortic valve. After reading this article, readers should be able to: 1. Describe the epidemiology and anatomy of bicuspid aortic valve (BAV). 2. Understand the clinical presentation and diagnosis of BAV in infants, children, and adolescents. 3. Identify the various complications of BAV disease. 4. Discuss the management and follow-up requirements for BAV. 5. Analyze the family screening and sports participation guidelines for patients with BAV. Bicuspid aortic valve (BAV) is the most common congenital heart defect in children, adolescents, and adults. (1) It is a heterogeneous disease that affects both the aortic valve and the aorta. It can lead to many complications, including aortic valve stenosis, regurgitation, or endocarditis. (2)(3) It also can lead to dilation of the aorta, predisposing individuals to a significantly higher risk of aortic aneurysm and dissection. (4) Although most individuals with BAV present with these long-term complications during adulthood, a considerable number of patients may also present during childhood and adolescence with early-onset disease; that may require interventions in up to 12% to 15% of the patients. (5)(6) Therefore, patients with BAV require lifelong follow-up and surveillance. BAV has multiple implications in terms of sports participation and family screening, making it an important subject for primary care providers. This article reviews the anatomy, genetics, presentation, diagnosis, …

Pattern of Intervention in Congenital Heart Disease: Single Centre Analysis of Cases over Five Years in Bangladesh

Introduction: In Bangladesh, 25/1000 cases of neonates are born with mild to severe type of congenital heart disease. Significant numbers of cases from new born to adult age group are reporting to OPD clinics with broad spectrum of congenital and grown up untreated heart diseases. This study will cover pattern of diseases among cases selected for cardiac catheterization and intervention in study group in a cardiac hospital with limited facility for children.&#x0D; Objectives: To analyze all the cases who had cardiac catheterization and intervention in said period and to see the outcome.&#x0D; Materials and Methods: It is a retrospective study conducted in a cardiac hospital from December 2014 to December 2019. All cases of cardiac catheterization and interventions were included in the study. Pattern of diseases, interventions, management and outcomes were analyzed.&#x0D; Results: Out of 1179 cases, 44.87% were male and 55.13% were female. Two hundred fifty four cases(21.54%) were in 0-1 year age group, 44.02% were in &gt;01-05 year age group, 18.66% cases were in &gt; 5 to 10 year , 8.48% cases were in &gt;10 to 20 years, 4.83% cases were in&gt; 20 to 30 years and 2.46% cases were in more than 30 year age group. Among trans-catheter closure patent ductus arteriosus (PDA) was the commonest type of intervention (44.68%), followed by atrial septal defect (ASD) (25.20%), ventricular septal defect (VSD) (11.83%) and balloon valvoplasty (BVP) for pulmonary stenosis (11.63%). Neonatal interventions were minimum as the coronary care unit used as post cathward had limited facility for neonatal care. PDA stenting was performed in 0.81% cases and BAS in 0.91% cases. Many patients underwent more than one intervention at a time; most common was ASD device closure and pulmonary valvoplasty. Cardiac Catheterization studies were minimum in this series and most of the cath study cases were VSD or/with other combinations (4.48%). Among infants (254), PDA device closure was the commonest intervention (64.56%) followed balloon valvoplasty for PS (15.35%) and balloon dilation of Coarctation on aorta (7.87%). Among implants, most commonly used were 8/6 mm (14.59%) Amplatzer Duct occluder (ADO), 6/4 ADOII, MF-Konar (9.79%) device and most common balloon used for valve or vessel dilation was 10x3 mm Tyshak II (3.26%). Only one mortality was noticed in a case of double intervention of critical Aortic and pulmonary valve stenosis.&#x0D; Conclusion: Commonest and established interventions were performed in this study other than few life saving interventions in neonates and outcome was excellent. Skilled team of pediatric cardiologist and technician in catheterization laboratory can bring success at the end of the day in spite of challenges.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 3-9

Zabiegi kardiologii interwencyjnej u noworodków

In the last 30 years, a great progress has been made in the treatment of congenital heart defects by interventional cardiology procedures. Cardiac catheter interventions are implemented in fetuses with critical aortic stenosis and pulmonary atresia with intact ventricular septum to promote the growth and improve function of the left or right ventricle. In a case of aortic stenosis it could prevent the evolution to hypoplastic left heart syndrome. Balloon atrial septostomy or stent placement is a lifesaving procedure in fetuses with hypoplastic left heart syndrome and highly restrictive or intact atrial septum. The majority of cardiac catheter interventional procedures in neonates are palliative and lifesaving. They include: balloon atrial septostomy or static balloon dilation or cutting balloon septostomy or stenting of the atrial septum in congenital heart defects with duct-dependent blood mixing, balloon valvuloplasty in neonates with critical aortic valve stenosis, stent implantation into the right ventricular outflow tract or arterial duct in cyanotic neonates with duct-dependent pulmonary circulations, angioplasty for stenotic vessels. The therapeutic cardiac interventions in neonatal period are: pulmonary valvuloplasty in patients with critical pulmonary stenosis and challenging transcatheter ductus arteriosus closure in preterm and extremely low birth weight infants.

1644 Unusual management of dislodged TAVR prosthesis, Nightmare in Cath lab

Abstract Introduction The Trans aortic valve replacement( TAVR) is well established technique that is basically designed for patient with sever aortic stenosis with high surgical risk. We describe a TAVR procedure was complicated with valve dislodgment and treated without surgical intervention Case report 75 year old Female Patient hypertensive, diabetic, Hypothyroidism and Atrial Fibrillation on oral anticoagulation. Her transthoracic echocardiography(TTE) showed sever critical aortic valve stenosis and calculated aortic valve are was 0.6 cm² and Peak gradient is 68mmhg and mean 46 mmHg , sever Left ventricular dysfunction and estimated EF 25 % . The CT Aortogram showed The aortic annulus maximum transverse diameter measures was 30 mm and the anteroposterior diameter was 25 mm. The sinus of Valsalva measures 37 mm was Sino tubular junction measures 24 mm and the proximal ascending aorta measures 39 mm. There is no evidence of coronary artery disease by the CT coronary angiogram. Because of depressed LV function, it was decided to do the TAVR with ECMO (Extra Corporeal Membrane Oxygenation) support. Based on CT measurements, CoreValve29 was selected The native valve is pre dilated then CoreValve29 was advanced. Unfortunately valve was larger than the aortic annulus and during trial to valve deployment ( Fig A) ,valve jumped into proximal ascending aorta in opining position just few centimeters from coronary ostium ( Fig B). We advance balloon for maximum dilatation of core valve 29 to ensure fixation of valve in ascending aorta and complete opening of valve leaflets. A second smaller valve (coreValve26) was advanced through the dislodged valve and crossing through its leaflet of first core valve (which settled in aorta) and successfully reaches the aortic annulus and confirming proper positioning of the coreValve26 and then deployed safely The coreValve26 was deployed in acceptable position and coreValve29 was hooked and well-fixed to 26 valves in proximal ascending aorta (Fig C). Coronary flow was secured and confirmed by aortic root injection (Fig F). Patient kept supported on ECMO before and during the TAVR procedure. The patient tolerated the procedure and was stable hemodynamically throughout the procedure. Successful ECMO weaning and patient hemodynamically remained stable with Total bypass time on ECMO was 142 minutes. Post procedure chest X ray showed two corValves hooked together in aortic root and ascending aorta in (Fig D). Follow up TTE showed improved EF systolic LV function (EF 39 %). Normal functioning aortic valve prosthesis. Conclusion Up to our knowledge, this is the first case that valve dislodgment was treated percutaneously not required urgent surgical intervention. Although it is one case report, however it could open the ideas for new approach how to manage difficult cases with dislodged valve with percutaneous approach. Abstract 1644 Figure.

Aortic balloon valvuloplasty and mid-term results in newborns: a single center experience.

Aortic balloon valvuloplasty (ABV) has become the first-line treatment for critical aortic valve stenosis in infants. We aimed to evaluate the short- and mid-term results of patients who underwent ABV during neonatal period, the factors affecting the success and complications of the procedure. We retrospectively examined 65 patients who underwent ABV during the neonatal period between 1998 and 2017. All hospital records including cardiac catheterization reports, echocardiographic information, and angiographic views were reviewed. Forty five (69.2%) of the patients were male and mean follow-up was 6.2 ± 4.9 years (range: 6 months - 19 years). The mean age of the patients at the first ABV was 14.5 ± 10.6 days (range: 1-30 days) and body weight was 3.25 ± 0.6 kg (range: 1.5-4.8 kg). The peak systolic gradient measured during pre-valvuloplasty cardiac catheterization was 73.3 ± 22.7 mmHg (range: 30-142 mmHg), and it decreased to 29.2 ± 12.2 mmHg (range: 5-55 mm Hg) after the procedure. Valvuloplasty was successful in 59 (90.7%) patients. There was no more than mild aortic regurgitation in any patient before valvuloplasty. There was mild aortic regurgitation in 21 patients before the valvuloplasty. In the acute phase after valvuloplasty, 30 patients had mild, 15 had moderate and two had severe aortic regurgitation. There was a significant increase in the degree of aortic regurgitation related to valvuloplasty (p < 0.05). The most important complication of ABV was increased aortic regurgitation (26.2%). Another important complication was femoral artery occlusion; and was detected early after valvuloplasty (61.6%). There was no serious complication or death in the acute phase. In newborns with valvular aortic stenosis, balloon valvuloplasty has become the first choice in many centers due to its high success rate, low mortality and morbidity, and increased clinical experience. Aortic regurgitation and femoral artery occlusion were the most important complications. Although reintervention for residual or recurrent aortic valve stenosis is common during the first year after valvuloplasty, these patients are able to reach advanced ages without the need for surgical intervention. Surgical valvotomy is a good alternative treatment for a small number of patients in whom valvuloplasty fails.

Prosthetic Valve Endocarditis in Surgical vs. Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with critical aortic valve stenosis who are deemed too high risk

Acute therapy of newborns with critical congenital heart disease.

Critical congenital heart disease (cCHD) is the most common reason for acute cardiac failure in the neonatal period. cCHD, defined by systemic low cardiac output (LCO) and requiring surgery or catheter-based intervention in the first year of life, has an incidence of approximately 15% of CHD and is responsible for up to 25% fatalities of newborn infants. Clinical deterioration develops in most cases due to rapid closure of the ductus arteriosus (DA). Early diagnosis and immediate treatment determinate beneficial outcome. Critical CHD can be classified in duct-dependent systemic flow, duct-dependent pulmonary flow and transposition of the great arteries. The latter two manifest themselves in oxygen resistant cyanosis, whereas CHD with duct-dependent systemic flow may present itself with cardiogenic shock, which can be difficult to differentiate from other causes of shock such as sepsis. Besides prostaglandin therapy for reopening the arterial duct, a balanced parallel pulmonary and systemic circulation should be a therapeutic goal. In CHD with duct-dependent systemic flow a decrease of pulmonary resistance should be avoided; therefore inadequate oxygen therapy, hyperventilation and alkalosis due to excessive treatment of acidosis, should be averted. Volume therapy should be performed carefully. In CHD with duct-dependent pulmonary flow, pulmonary resistance can be decreased, in case of poor pulmonary flow systemic resistance should be increased, mild alkalosis is recommended. Intense volume therapy is in most cases necessary, except if a restrictive atrial communication is present. In addition to intensive care measures, an arsenal of catheter- and surgery-based procedures need to be hold available as back-up for emergency procedures. Transcatheter interventions are nowadays decisive. Atrial-septostomy was the first and still the most utilized high-urgency procedure; DA-stenting is used in prostaglandin-refractory duct stenosis. In the presence of critical aortic valve stenosis, palliation consists of balloon valvuloplasty. In critical aortic coarctation with myocardial failure and no response to prostaglandin, palliative balloon angioplasty may be the method of choice as bridging for corrective surgery.

ОТДАЛЕННЫЕ РЕЗУЛЬТАТЫ ИСПОЛЬЗОВАНИЯ БИОЛОГИЧЕСКИХ ПРОТЕЗОВ У ПАЦИЕНТОВ C ПОРОКАМИ АОРТАЛЬНОГО КЛАПАНА

Background: This article presents hospital and long-term (1 year after the intervention) results of aortic valve replacement with biological valves of different size in patients with critical aortic valve stenosis. Objective: To evaluate hemodynamic parameters on the implanted biological aortic valve prostheses depending on the size, as well as to study left ventricular (LV) remodeling after surgery for aortic valve stenosis in the early and late periods. Material and methods: The study included 171 patients who were performed isolated or combined with the correction of concomitant pathology (coronary bypass surgery, mitral valve plasty, tricuspid valve plasty) aortic valve replacement with biological prostheses with landing sizes of 19-25 mm. Carprotier-Edwards PERIMOUNT, Carpentier-Edwards PERIMOUNT MAGNA, Medtronic Mosaic, St.Jude Medical Epic and TLPB Labcor bioprostheses were used for prosthetics. Results: The prosthesis-patient mismatch (PPM) phenomenon of a moderate (effective hole area index (iEHA) less than 0.85 cm2/m2) and severe degree (iEHA less than 0.65 cm2/m2) was observed in patients with implanted bioprostheses size 19 and 21. When PPM occurred, the peak and average transprosthetic gradients were lower than on the affected valve prior to surgery. The occurrence of PPM did not lead to complete remodeling of the left ventricle in the long-term period. Conclusions: In patients with implanted biological prostheses size 23 and 25 the prosthesis-patient mismatch phenomenon was not observed in the hospital and long-term period; a reverse left ventricular remodeling was detected in the long-term. The analysis showed that when using biological prostheses of standard sizes 19 and 21 iEHA in most cases was less than 0.85 cm2/m2. In these groups, it can be argued about the presence of a patient-prosthesis mismatch of varying severity.

Хирургическое лечение критического аортального стеноза в сочетании с ишемической болезнью сердца у пациентки 80 лет с помощью гибридной методики: пятилетнее наблюдение, качество жизни

Хирургическое лечение критического аортального стеноза в сочетании с ишемической болезнью сердца у пациентки 80 лет с помощью гибридной методики: пятилетнее наблюдение, качество жизни

651 - Long-term functional and myocardial assessment in patients with critical aortic valve stenosis

651 - Long-term functional and myocardial assessment in patients with critical aortic valve stenosis

Transcarotid balloon valvuloplasty in neonates and small infants with critical aortic valve stenosis utilizing continuous transesophageal echocardiographic guidance: A 22 year single center experience from the cath lab to the bedside.

Utilization of continuous transesophageal echocardiographic guidance (cTEE) during transcarotid balloon valvuloplasty (TCBV) in neonates and small infants with critical aortic valve stenosis (AS) allows for continuous hemodynamic assessment and improved outcomes. Preferred method of intervention for critical AS remains controversial due to conflicting results. Since 1992, 30 neonates and small infants with critical AS and adequate left ventricular (LV) volumes underwent TCBV with cTEE. Critical AS was defined as ductal dependent systemic circulation, LV systolic dysfunction, or an echo gradient≥100 mm Hg with evidence of hypoperfusion. The median age at intervention was 4 days (range 1-54 days). Nineteen (63%) patients required PGE1 and 25 (85%) had LV dysfunction. All procedures were performed with cTEE guidance. The initial 15 patients were performed in the cath lab whereas the subsequent 15 patients were performed at the bedside without fluoroscopy. The peak systolic gradient decreased from 70 to 24 mm Hg (P<0.001). Four (13%) early deaths were secondary to associated cardiac anomalies although one patient developed severe aortic valve insufficiency (AI) immediately post intervention. At discharge, two patients (8%) had ≥moderate AI. At a mean follow-up of 9 years (range: 2.2-20 years), there were 15 additional aortic valve interventions. Freedom from aortic valve reintervention at 10 years was 55% and actuarial survival rate at 10 and 15 years was 82%. Bedsides TCBV with cTEE guidance is effective palliation for neonates and small infants with critical AS and allows for continuous hemodynamic assessment without the use of ionizing radiation. Our early and late results appear comparable to surgical valvotomy.

0535: Percutaneous valvuloplasty versus surgical valvulotomy in neonates with critical aortic stenosis

This study was to compare outcomes and prognosis of newborns with critical aortic valve stenosis (AVS) who underwent either percutaneous or surgical intervention as first therapeutic option. Neonates with diagnosis of critical AVS (defined as aortic flow dependent on ductus arteriosus patency) were included in the study, and divided in group I (percutaneous valvuloplasty) and group II (surgical valvulotomy). From 2000 to 2013, 23 cases (19 males) were analyzed: 9 in group I and 14 in II, aged 0 to 28 days at diagnosis (< 7 days of age: 78% of group I vs 50% in II, p= NS). Weight was > 2.5 kg in 100% of group II and 78% of group I. Symptoms of heart failure were more frequent in group I. Echocardiography showed: LVSF < 28% in 67% of group I vs 43% group II (NS), LV fibroelastosis in 88% of group I and 21% group II (p< 0.05), mitral regurgitation in 77% of group I and 7% group II (p< 0.05). Aortic valve anatomy included bicuspidia in 52% of cases, aortic tricuspide valve dysplasia in 43.5%. Analysis of events occurring within 36 months after first intervention showed: significant restenosis in 6 cases (26%= 55.5% in group I and 7% in group II), aortic valve regurgitation >grade2 in 11 cases (47.8%= 44% of group I and 50% of group II), Ross procedure performed in 5 cases (21.7%= 22.2% of group I and 21.4% of group II). Prognosis factors for reintervention were: aortic valve dysplasia, LV fibroelastosis and aortic annulus diameter <6 mm in group I (reintervention frequency respectively= 100%, 75% and 83%), and bicuspidia, aortic valve annulus <6 mm in group II (reintervention frequency respectively= 33% and 50%). Results of percutaneous valvuloplasty compared to surgical valvulotomy in neonates with AVS showed higher rates of reintervention in the percutaneous group and more severe AR in the surgical group. Aortic annulus diameter < 6 mm was related to reintervention risk.