Signs Of Aortic Regurgitation Research Articles

Papillary fibroelastoma of the aortic valve: occlusion of the left main coronary artery.

A 53-year-old woman with palpitations and respiratory distress as her main symptoms, which had resulted in a cardiac arrest, was referred to the emergency room. Coronary angiography (CAG) with percutaneous cardiopulmonary support (PCPS) was performed, but no severe stenosis was found. The patient was diagnosed with vasospastic angina, treated medically, and discharged to her home. Six months later, however, during hospitalization for sick sinus syndrome, she suddenly developed runs of ventricular tachycardia. Therefore, CAG with PCPS was again carried out and revealed an occlusion of the left main trunk (LMT) of the coronary artery (Panel A, arrow). Intravascular ultrasound imaging was also performed (Panel B), and a plausible thrombus formation associated with coronary spasm was diagnosed. An emergency surgical intervention was therefore carried out. Intraoperative transoesophageal echocardiography imaging showed both a large mass at the aortic valve that may have occluded the LMT (Panel C, Supplementary data online, Video S1), and a previously undiagnosed severe aortic valve regurgitation caused by the mass. Aortic cross-clamping and a cardiac arrest were conducted; a huge mass originating from the right coronary cusp (RCC) of the valve was found (Panels D and E, arrowheads) and resected. No thrombus formation in the coronary artery was observed. Post-operatively, the patient's angina resolved without any sign of aortic regurgitation. The pathology report revealed a papillary fibroelastoma (PFE). This series of symptoms was caused by embolization within the coronary artery and the presence of a huge PFE, which together caused this rare condition.

Clinical Cases: Valvular heart disease142A sub-aortic valve mass in a rheumatoid arthritis patient: an unconventional mechanism of aortic regurgitation143Symptomatic severe aortic regurgitation with coronary obstruction due to chronic type a dissection144Mitral valve prolapse and ventricular tachycardia: a long-lasting love story

Clinical Cases: Valvular heart disease142A sub-aortic valve mass in a rheumatoid arthritis patient: an unconventional mechanism of aortic regurgitation143Symptomatic severe aortic regurgitation with coronary obstruction due to chronic type a dissection144Mitral valve prolapse and ventricular tachycardia: a long-lasting love story

138 * TRANSAPICAL AORTIC VALVE IMPLANTATION IN PATIENTS WITH AND WITHOUT SEVERE CALCIFICATION OF THE ASCENDING AORTA: DIFFERENT PREOPERATIVE CHARACTERISTICS BUT NO DIFFERENCE IN OUTCOME

Objectives: Severe calcification of the ascending aorta represents a risk factor for outcome after conventional aortic valve replacement. This study evaluated differences in baseline characteristics and postoperative outcome between patients with and without severe calcification of the ascending aorta who underwent transcatheter aortic valve implantation (TAVI) using the transapical approach. Methods: Calcification of the aorta was analysed by preoperative CT scan in 682 patients who underwent transapical TAVI. There were 94 (13.7%) patients with severe calcification of the ascending aorta (34 porcelain aorta and 60 semicircular calcification), 132 (19.3%) patients with moderate calcification and 456 (66.8%) patients without calcification. Results: In comparison to patients without calcification, patients with severe calcification of the aorta more frequently had preoperative renal failure (32.9% vs 22.6%, P = 0.035), peripheral arterial disease (75.5% vs 62%, P = 0.017), neurological deficit (29.8% vs 18.2%, P = 0.015), pulmonary hypertension (45.7% vs 33%, P = 0.024), and previous cardiac surgery (35% vs 20%, P = 0.004). The 30-day mortality was similar in both groups (4.5% vs 4.4%, P = 1.0). Postoperatively, the rate of aortic regurgitation did not differ between the groups (no sign of aortic regurgitation, 57% vs 56%, P = 0.872). Univariate analysis showed that severe calcification was not a predictor for long-term mortality (P = 0.173) or for postoperative stroke (1.0% vs 1.9%, P = 1.0). Survival at 1, 3 and 5 years was 77%, 54% and 51% in patients with severe calcification and 82%, 64% and 55% in patients without calcification (P = 0.171). Conclusions: In contrast to conventional aortic valve replacement, severe calcification of the ascending aorta has no negative influence on perioperative outcome and long-term survival after transapical TAVI.

Acute Aortic Regurgitation Due to Necrotizing Granulomatous Inflammation of the Aortic Valve in a Patient With Rheumatoid Arthritis

A 62-year-old woman with severe rheumatoid arthritis was admitted to our hospital with a 1-month history of increasing breathlessness. She had undergone pericardectomy for pericardial constriction 2 years previously. The histology of pericardium showed chronic nonspecific inflammation. On examination she was found to be in congestive cardiac failure with signs of aortic regurgitation. An echocardiogram showed severe aortic regurgitation with a dilated left ventricle with a diameter …

Rupture of the ascending aorta caused by blunt trauma

Background. Rupture of the ascending aorta caused by blunt trauma rarely has been diagnosed and treated. As a result, the clinical manifestations and management of this injury have not been clearly defined. Methods. We describe the clinical presentation, diagnosis, and management of 3 consecutive patients with ascending aortic rupture treated during the last 3 years. We also review the cases with this injury reported in the English-language literature until 1996. Results. The predominant clinical manifestations of all patients, including reviewed case reports, were those of other organ injuries, and 5 had signs of aortic regurgitation and 1 of cardiac tamponade. The mediastinal silhouette was normal in 6 and widened in 14 patients, 1 of whom had also rupture of the subclavian artery. The aortic tears were managed with primary repair or with graft interposition and the valve injury with replacement or repair. Three of 20 patients died, for an overall mortality of 15%. Conclusions. Ascending aortic rupture should be considered in any patient with severe blunt trauma who has widened mediastinum or cardiac tamponade, as well as in patients with associated major thoracic injuries. Absence of a widened mediastinal silhouette does not exclude the diagnosis. The repair is relatively straightforward, but survival depends primarily on the severity of associated injuries.

Flutter of left ventricular structures in patients with aortic regurgitation, with special reference to patients with associated mitral stenosis

Echocardiography was performed in 45 patients with aortic regurgitation. Forty showed a high frequency diastolic flutter of the mitral valve, which was holodiastolic in all but the patients with associated mitral stenosis. Of four patients with coexisting mitral stenosis, mitral flutter was absent in two; in the other two, in atrial fibrillation, mitral flutter occurred, but only during a fixed interval after mitral valve opening, irrespective of cycle length. A fine flutter of similar frequency was observed on the left ventricular aspect of the ventricular septum in 12 patients. In six of these it was of slight degree and restricted to early diastole and the high septum; in four others (three of whom had associated mitral stenosis), the septal flutter was more marked, holodiastolic, and present over all parts of the septum scanned; in two, it was holodiastolic over the high septum but early diastolic at lower septal levels. Aortography performed in 19 patients showed that septal flutter was present in seven of 12 patients in whom the regurgitant aortic jet was directed forward to the ventricular septum, whereas in the other seven patients with no septal flutter, the jet was directed away from the septum. Septal flutter is useful as an echocardiographic sign of aortic regurgitation, especially in the presence of mitral stenosis when mitral flutter may be absent or exceeded by septal flutter in both amplitude and duration, and when the mitral valve has been replaced by a prosthetic valve. Vibration of the septum appears to be attributable to the regurgitant aortic jet impinging on it and may contribute to the production and radiation of the characteristic diastolic murmur of aortic regurgitation.