Small Aortic Valve Research Articles

Small aortic valve prostheses; inferior clinical and echocardiographic results

Small aortic valve prostheses; inferior clinical and echocardiographic results

Actuarial survival and other events following valve surgery in octogenarians: comparison with an age-, sex-, and race-matched population

From January 1973 to December 1989, 54 patients over 80 years of age underwent an intracardiac repair which included a cardiac valve operation. There were 21 males and 33 females. Mean age at operation was 82 years, range 80-89 years. Fifty-two patients (96%) were in New York Heart Association functional class III or IV preoperatively. Six patients had undergone previous valve surgery (11%). There were eight hospital deaths (14.8%). Risk factors for hospital death included older age at repair (p = 0.008), increased total cardiopulmonary bypass time (p = 0.06), and, possibly, smaller aortic valve prosthesis (p = 0.10). All 46 hospital survivors were followed up at a mean of 28.8 months after hospital discharge. There were 11 late deaths (23.9%), occurring at a mean of 32.3 months postoperatively. Survival analysis indicated that increased age (p = 0.06) and increased pulmonary artery diastolic pressure preoperatively (p less than 0.07) were multivariate risk factors for overall mortality. Actuarial survival at 5 years was 44%, with no difference from survival in an age-, sex-, and race-matched population. We conclude that octogenarians in the modern era have good chance for survival following valvular surgery. As hazards for full anticoagulation were low in this series, if valve repair is not feasible, we presently recommend the use of mechanical valves in the elderly to reduce the requirement for late reoperation due to bioprosthesis degeneration.

Small aortic valve annulus in children with fixed subaortic stenosis

Twenty-one hearts with fixed subaortic stenosis (FSAS) were examined pathologically. Thirty children with no hemodynamically significant heart disease, 31 children with valvar aortic stenosis, and 25 children with FSAS were studied by echo- and angiocardiography. The following conclusions were drawn: (1) Patients with FSAS often have abnormal aortic valve leaflets as well as small aortic valve annulus. (2) A small aortic annulus/descending aorta ratio is probably present at birth, and may decrease with increasing age. (3) In some patients with FSAS the aortic valve annulus is too small for simple resection of the fibroelastic tissue. A Konno operation is needed for these patients. (4) M-mode echocardiography has not been useful in identifying abnormally small aortic valve annulus in FSAS patients.

Duration of ejection in aortic stenosis: Effect of stroke volume and pressure gradient

The theoretical effect of variable ventricular function on left ventricular ejection time in aortic stenosis was predicted by applying data measured in 52 patients with pure aortic stenosis to equations derived from the relations of Gorlin and Gorlin and Weissler et al. Ejection time and aortic valve area are not, of necessity, linearly related because (Formula: see text) where LVET is left ventricular ejection time, k is a constant, SV is stroke volume, PG is mean aortic pressure gradient and AVA is aortic valve area. When the patients were separated into performance groups on the basis of cardiac index (at 2.8 liters/min per m2), the linear regression relating the measured SV/square root PG with valve area in 18 patients with normal function (SV/square root PG = 11.1 AVA + 2.0, r = 0.969, p less than 0.001) predicted ejection time prolongation with decreasing valve area. In 34 patients with poor function, however, the decrease in SV/square root PG with decreasing valve area was more marked (SV/square root PG = 12.6 AVA + 0.4, r = 0.894, p less than 0.001), predicting a shorter ejection time at any given valve area in this group. As predicted by the effect of valve area on the equation, ejection time becomes most variable at a small aortic valve area. Independent ejection time measurement in these patients validated the predicted effect.

The Lillehei-Kaster valve prosthesis hemodynamic and mechanic features in vivo (author's transl)

29 patients with Lillehei-Kaster vale prostheses, 22 in aortic position and 7 in mitral position, were examined. With small aortic valves (A 14 - A 16) mean gradients averaged 32 mm Hg, valve area varied between 1 and 1.2 cm2. Only size A 20 and larger showed satisfying gradient and valve areas of 1.9 cm2 and greater. The mitral gradients averaged between 10 and 5 mm Hg according to size and valve areas were about 1.6 cm2. The maximal measured opening angle of the pivoting disk averaged 64degrees in the aortic valves and 61degrees in the mitral valves; complete opening (80degrees) was not observed.

Supravalvar aortic stenosis. Roentgen analysis of twenty-seven cases.

SUPRAVALVAR AORTIC STENOSIS ROENTGEN ANALYSIS OF TWENTY-SEVEN CASESGERALD J. KURLANDER, M.D., EUGENE L. PETRY, M.D., HOOSHANG TAYBI, M.D., PAUL R. LURIE, M.D. and JOHN A. CAMPBELL, M.D.Audio Available | Share