Stenosis In Adult Patients Research Articles

Subaortic Stenosis in Adult Patients With Atrioventricular Septal Defect

BackgroundPatients with atrioventricular septal defects (AVSD) are at risk for development of subaortic stenosis throughout their lifetime. The early and midterm outcomes of adults with AVSD undergoing primary operation or reoperation for subaortic stenosis remain unknown. MethodsAll patients aged 18 years or more with partial or complete AVSD who underwent operation for subaortic stenosis at our institution from 1992 to 2020 were retrospectively reviewed. ResultsNineteen patients were identified: 15 patients with partial AVSD (79%); 3 (16%) with complete AVSD; and 1 (5%) with transitional AVSD. Fifteen patients (79%) had previously corrected AVSD (median 8 years; interquartile range, 3.6-23.1) and 7 (37%) had previous repair of subaortic stenosis. The mechanism for obstruction included subaortic membrane (n = 19, 100%); septal hypertrophy (n = 11, 58%); anomalous papillary muscle, chordae, or left atrioventricular valve tissue (n = 9, 47%); and tunnel obstruction (n = 5, 26%). All patients underwent transaortic membrane resection, and septal myectomy was done in 18 patients (95%). There was no early mortality. During follow-up (median 8.3 years, maximum 28), survival was 100% at 5 years and 95% at 10 years. One patient required reintervention for subaortic stenosis 15 years after the operation at our institution. ConclusionsSurgical correction of subaortic obstruction in adult patients with AVSD can be accomplished with low morbidity and mortality. Subaortic stenosis can appear late after the initial repair of AVSD, and these patients remain at risk for recurrence after resection.

Computed Tomography-Derived Fractional Flow Reserve for the Diagnosis of Coronary Artery Disease


 Computed tomography-derived fractional flow reserve (CT-FFR) may predict coronary artery disease or flow-limiting stenosis in adult patients with stable chest pain better than coronary CT angiography alone, based on the relevant studies in 2 systematic reviews.
 CT-FFR is associated with a decreased need for invasive coronary angiography and revascularization in adult patients with stable chest pain, based on findings from 1 systematic review.
 In the US settings, CT-FFR was dominant (i.e., less costly and more effective) compared to stress testing for the evaluation of low-risk stable chest pain, based on findings from 1 cost-effectiveness study.

Incidence of Primary Punctal Stenosis in Adult Patients with Epiphora

Abstract Background Punctal stenosis is one of the etiologies of epiphora, which is caused by an anatomical narrowing or occlusion of the external opening of the lacrimal canaliculi. Punctal stenosis is graded according to punctal sizes examined under slit-lamp biomicroscopy into grade 0 (could not find papilla and punctum), grade 1: Papilla is covered by a membrane (exudative or true membrane), grade 2: Smaller than normal size but recognizable, grade 3: normal, grade 4: Small slit (<2 mm) and grade 5: Large slit (>2 mm). Objective To assess the incidence of punctal stenosis in adult patients with epiphora attending outpatient’s ophthalmology clinic at Ain Shams University Hospital during the months of January and February 2020. Patients and Methods This is an observational study, conducted at the Ophthalmology Outpatient Clinic, Ophthalmology Department, Ain Shams University, using non-probability (convenience) sample. It included all patients above 18 years old who presented to the Ophthalmology Outpatient Clinic during the months of January and February 2020 with tearing, proved to be epiphora on clinical examination. Results Thirty one patients, out of 1800 patients attending the Outpatient Ophthalmology Clinic during the study period had epiphora with incidence of 1.6 %. Incidence of punctal stenosis was reported to be 68.4%. Other reported causes of epiphora were: Canaliculitis (3.5%), chronic dacrocystitis (5.3%), lacrimal sac mucocele (1.8%) and lower lid laxity (21.1%). Punctal stenosis was more common in females (61.5%) with mean age 58.55 years ± 11.67 SD. Punctal stenosis usually presented as bilateral (93.3%). Regarding ocular history 41% of cases were on topical anti glaucoma treatments. Most patients were medically free (54%). Conclusion Incidence of epiphora was 1.6% out of patients attending ASU Ophthalmology Outpatient Clinic. Punctal stenosis incidence was reported to be 68.4%. Most of the cases were females, above 63 years, grade one was the most common, with significant association with the long term use of topical anti-glaucoma medications.

Diagnostic accuracy of prospectively gated, 128-slice or greater CTCA at high heart rates: a systematic review and meta-analysis.

IntroductionProspectively gated 64‐slice CT coronary angiography (CTCA) may be contraindicated for heart rates (HRs) over 65 beats per minute (bpm) due to reduced diagnostic sensitivity. Newer CT scanners typically provide 128 or more slices and superior temporal resolution compared with older models; consequently, diagnostic accuracy for current technology prospectively gated CTCA may be adequate at HRs above 65 bpm. The aim of this systematic review was to investigate the diagnostic accuracy of CTCA using 128‐slice or greater CT technology when compared with conventional coronary angiography for patients with HRs >65 bpm.MethodsA systematic search of PubMed, CINAHL, EMBASE and Scopus was performed as well as unpublished databases, sources and reference lists. Titles and abstracts were screened by two independent reviewers. Full‐text screening was then performed. Studies that determined diagnostic accuracy of coronary artery stenosis in adult patients with high heart rates utilising prospectively gated 128 detector or greater scanners were included. Studies that were included in the review underwent critical appraisal using the QUADAS‐2 tool.ResultsTen studies were included in the systematic review, with nine of these included in a diagnostic test accuracy meta‐analysis, including six of which reported data at the patient level. Meta‐analysis indicated very high pooled sensitivity 100% (95% CI 0.99, 1.00); however, pooled specificity was less at 79% (95% CI 0.69, 0.88).ConclusionsProspectively gated CT coronary angiography may be justifiable at heart rates above 65 bpm if performed on a 128‐slice or greater CT unit. Caution regarding the implication of a positive result is recommended due to reduced specificity. Further evidence is required before consideration of a new higher heart threshold.

Screening for Asymptomatic Carotid Artery Stenosis in Adult Patients

Screening for Asymptomatic Carotid Artery Stenosis in Adult Patients

Application of transcatheter valves for aortic valve replacement in pediatric patients: A case series.

To describe our initial experience with pediatric transcatheter aortic valve replacement. Transcatheter aortic valve replacement (TAVR) has been approved and used to treat calcific aortic stenosis in adult patients. Select pediatric patients with congenital heart disease (CHD) who are poor candidates for conventional surgical aortic valve replacement can benefit from TAVR. A retrospective review was performed to identify and describe pediatric patients with CHD who underwent transcatheter or hybrid aortic valve replacement using a Melody Valve (Medtronic, Minneapolis, MN), or Sapien S3/XT valve (Edwards Life sciences LLC, Irvine, CA). Patients in whom transcatheter valves were implanted on cardiopulmonary bypass were included. Imaging data, procedural elements, and clinical follow-up data were collected to evaluate acute and short-term results. A total of eight pediatric patients underwent treatment of aortic valvular disease using balloon expandable valves and delivery systems. Two patients had Melody valve implantation and six received a Sapien valve (one XT/five S3). In one patient, a Melody valve was placed surgically, failed, and was replaced with a Sapien valve 2 years later. Two patients were treated using a standard transfemoral route, four had the valve delivered on cardiopulmonary bypass via a median sternotomy, one was placed with a transapical approach, and one via a carotid cut down. Patients were followed for an average 16 months (range 1-208 weeks). There were no early or late deaths in this cohort. There were no embolic events, and all valves worked well in the immediate postoperative period. Both Melody implants developed moderate to severe regurgitation at 2 years and 4 years, respectively, and both required replacement at that time. One Sapien 3 valve developed a paravalvular leak that required reintervention within 6 months of implantation. Transcatheter valves offer a reasonable alternative to traditional surgical aortic valve replacement in certain pediatric patients who are suboptimal surgical candidates. Hybrid approaches and valve delivery on cardiopulmonary bypass has been used in smaller patients. Long-term performance of these valves in young patients has not been studied.

Percutaneous treatment of congenitally pulmonary vein stenosis in adult patient: A case report

Congenital pulmonary vein stenosis (PVs) is an infrequent and poor prognosis anomaly due to associated cardiac anomaly and progressive pulmonary hypertension. In this report we described congenitally PVs without associated anomaly in adult patient that successfully treated percutaneously.

Management of embedded metallic stents used in the treatment of grades III and IV subglottic, and upper tracheal stenosis in adults.

The aim of this study was to evaluate the post-operative complications of using balloon-expandable metallic stents in treatment of benign, major subglottic and tracheal stenosis in adult patients whom conventional therapy has failed and to demonstrate how to deal with these complications in the long run. A retrospective review of five cases; adlut patiets with benign, major subglottic and upper tracheal stenosis whom were treated with balloon expandable metallic stents at King Abdulaziz University Hospital, in the years between 2008 and 2013. Granulation tissue formed in five of the four cases and restenosis occurred. Other complications encountered were stent infection and dislodgment. The complications were managed by removing the stents surgically via a laryngofissure incision and required the placement of a Montgomery T-tube. Managing the restenosis due to granulation tissue formation around the metallic stents is best achieved by removing the embedded metallic stents surgically via open technique and then by placement of a Montgomery T-tube as a bridging option to successful decannulation. Open surgical procedures remain the mainstay treatment for advanced airway stenosis.

Three‐Dimensional Echocardiographic Features of Unicuspid Aortic Valve Stenosis Correlate with Surgical Findings

A unicuspid aortic valve (UAV) is a rare congenital defect that may manifest clinically as severe aortic stenosis or regurgitation in the third to fifth decade of life. This report describes two cases of UAV stenosis in adult patients diagnosed by transesophageal echocardiography (TEE). The utility of three-dimensional TEE in confirming valve morphology and its relevance to transcatheter valve replacement are discussed.

Effects of Rosuvastatin on Progression of Stenosis in Adult Patients With Congenital Aortic Stenosis (PROCAS Trial)

Recent trials have failed to show that statin therapy halts the progression of calcific aortic stenosis (AS). We hypothesized that statin therapy in younger patients with congenital AS would be more beneficial, because the valve is less calcified. In the present double-blind, placebo-controlled trial, 63 patients with congenital AS (age 18 to 45 years) were randomly assigned to receive either 10 mg of rosuvastatin daily (n = 30) or matched placebo (n = 33). The primary end point was the progression of peak aortic valve velocity. The secondary end points were temporal changes in the left ventricular mass, ascending aortic diameter, and N-terminal pro-brain natriuretic peptide (NT-proBNP). The median follow-up was 2.4 years (interquartile range 1.9 to 3.0). The mean increase in peak velocity was 0.05 ± 0.21 m/s annually in the rosuvastatin group and 0.09 ± 0.24 m/s annually in the placebo group (p = 0.435). The annualized change in the ascending aorta diameter (0.4 ± 1.7 mm with rosuvastatin vs 0.5 ± 1.6 mm with placebo; p = 0.826) and left ventricular mass (1.1 ± 15.8 g with rosuvastatin vs -3.7 ± 30.9 g with placebo; p = 0.476) were not significantly different between the 2 groups. Within the statin group, the NT-proBNP level was 50 pg/ml (range 19 to 98) at baseline and 21 pg/ml (interquartile range 12 to 65) at follow-up (p = 0.638). NT-proBNP increased from 40 pg/ml (interquartile range 20 to 92) to 56 pg/ml (range 26 to 130) within the placebo group (p = 0.008). In conclusion, lipid-lowering therapy with rosuvastatin 10 mg did not reduce the progression of congenital AS in asymptomatic young adult patients. Interestingly, statins halted the increase in NT-proBNP, suggesting a potential positive effect of statins on cardiac function in young patients with congenital AS.

The analysis of the factors affecting lumbar spinal stenosis in adult patients

In this study 67 lumbar spinal stenosis in adult patients operated in our clinic in 3 years are aimed to be analysed in terms of clinical and surgical techniques. Diagnoses were made on the basis of patients' histories and their clinical examinations. Average age was 52.16 +/- 8.9 (33-64). 70.1% (47) of patients were females and 29.9% (20) were males. The most frequent neurological symptoms were 71.1% lasque (+) and 56.7% sensory loss. The anterior-posterior diameter was below 11.5 mm in 56.7% of the cases. Partial recovery was observed in the early term of 71.6% the cases. 56.7% of the cases were applied total laminectomy. Decompressive laminectomy can be performed safely and effectively in patients of with lumbar stenosis.

Combined percutaneous treatment of atrial septal defect and pulmonic or aortic stenosis in adult patients

Combined atrial septal defect and pulmonic or aortic stenosis are relatively uncommon conditions in adult patients, with few reported cases of percutaneous treatment. We present two patients with secundum type atrial septal defect and concomitant pulmonic or aortic stenosis and their treatment by transcatheter techniques.

Ultrasound dilution evaluation of pediatric hemodialysis vascular access

Hemodialysis access thrombosis is a significant cause of morbidity for hemodialysis patients and results from decreased access flow caused by venous outflow tract stenosis. Ultrasound dilution (UD) is a practical, noninvasive, and reliable indicator of access flow and is effective in predicting venous stenosis in adult patients receiving hemodialysis. The current study is the first to our knowledge to evaluate the accuracy of UD in predicting hemodialysis access stenosis in a pediatric hemodialysis population. Thirteen pediatric patients receiving hemodialysis via permanent access (4 AVF and 9 AVG) received 73 UD measurements over three months. Mean raw access flow (QA) was 720 +/- 428 mL/min, and mean corrected access flow (QAcorr) was 886 +/- 537 mL/min/1.73 m(2). QAcorr was significantly lower in accesses with stenosis (401 +/- 176 mL/min/1.73 m(2)) versus accesses without stenosis (1158 +/- 330 mL/min/1.73 m(2), P < 0.0001). Unlike flow values reported by raw QA, there was no overlap in flow values reported by QAcorr in accesses with stenosis (174 to 579 mL/min/1.73 m(2)) versus accesses without stenosis (709 to 1711 mL/min/1.73 m(2)). Two patients with an AVG who had QAcorr less than 600 mL/min/1.73 m(2) developed an access thrombosis within one week after UD measurement. No patients with QAcorr greater than 700 mL/min/1.73 m(2) developed access thrombosis in the 30 days following UD measurement. : The current study supports the use of monthly UD measurement to prevent access thrombosis in children receiving hemodialysis.

Transluminal Balloon Valvotomy for Pulmonic Stenosis in an Adult

Transluminal balloon valvotomy has become a widely used nonsurgical approach to treatment of certain valvular lesions in children. In adults, however, experience with this technique is limited. We performed balloon valvotomy in a 61-year-old woman who had pulmonic stenosis. Four months after the procedure, her exercise tolerance had increased and she no longer had exertional dyspnea. Among the few reported cases of balloon valvotomy in adult patients with pulmonary stenosis, the systolic pressure gradient and the peak systolic ventricular pressure have been considerably reduced. Possible mechanisms by which transluminal balloon valvotomy relieves obstruction are tearing or deformation of the valve cusps, separation of fused commissures, fracture of valvular calcification, dilation of the annulus, or some combination of these factors. Balloon valvotomy seems to be an appropriate therapeutic choice for pulmonic stenosis in adult patients.

Balloon dilation of mitral stenosis in adult patients: Postmortem and percutaneous mitral valvuloplasty studies

Preliminary reports have documented the utility of percutaneous balloon valvuloplasty of the mitral valve in adult patients with mitral stenosis, but the mechanism of successful valve dilation and the effect of mitral valvuloplasty on cardiac performance have not been studied in detail. Accordingly, mitral valvuloplasty was performed in five postmortem specimens and in 18 adult patients with rheumatic mitral stenosis, using either one (25 mm) or two (18 and 20 mm) dilation balloons. Postmortem balloon dilation resulted in increased valve orifice area in all five postmortem specimens, secondary to separation of fused commissures and fracture of nodular calcium within the mitral leaflets. In no case did balloon dilation result in tearing of valve leaflets, disruption of the mitral ring or liberation of potentially embolic debris. Percutaneous mitral valvuloplasty in 18 patients with severe mitral stenosis (including 9 with a heavily calcified valve) resulted in an increase in cardiac output (4.3 +/- 1.1 to 5.1 +/- 1.5 liters/min, p less than 0.01) and mitral valve area (0.9 +/- 0.2 to 1.6 +/- 0.4 cm2, p less than 0.0001), and a decrease in mean mitral pressure gradient (15 +/- 5 to 9 +/- 4 mm Hg, p less than 0.0001), pulmonary capillary wedge pressure (23 +/- 7 to 18 +/- 7 mm Hg, p less than 0.0001) and mean pulmonary artery pressure (36 +/- 12 to 33 +/- 12 mm Hg, p less than 0.01). Left ventriculography before and after valvuloplasty in 14 of the 18 patients showed a mild (less than or equal to 1+) increase in mitral regurgitation in five patients and no change in the remainder.(ABSTRACT TRUNCATED AT 250 WORDS)

Noninvasive evaluation of the severity of aortic stenosis in adult patients

To determine if a combination of noninvasive variables would be useful in the prediction of the severity of isolated aortic stenosis (AS), 53 patients (mean age 63.4 = 11 years) were evaluated by the following criteria: (1) aortic valve calcification in the plain chest x-ray film; (2) left ventricular hypertrophy by ECG and M-mode echocardiography; (3) faint or absent aortic closure sound; (4) timing of the peak of the systolic murmur; (5) half rise time (T time) of the carotid pulse; and (6) ejection time index. A numeric scoring system and a logistic regression model employing these variables were developed. The total maximum score was 16 points. Sensitivity and specificity for each variable were determined. Patients with clinically evident coronary artery disease (CAD) and significant aortic regurgitation were excluded. All patients underwent hemodynamic studies and coronary arteriography. Thirty-two patients had severe AS (aortic valve area <0.75 cm 2) and 21 had mild to moderate AS (aortic valve area >0.75 cm 2). Significant CAD (≥50% reduction in luminal diameter) was present in 55% of patients. A total score of ≥5 occurred in 59% (19 of 32) of patients with severe AS compared to 5% (1 of 21) of patients with mild AS. The presence of subclinical CAD moderately reduced the accuracy of the scoring system principally by its effect upon the timing of the systolic murmur and the ejection time. Combining the scoring system with the presence or absence of symptoms improved the identification of severe AS in patients with a low score. It is concluded that a point scoring system and a logistic regression model employing six noninvasive variables combined with the clinical evaluation of symptoms provides a useful method of assessing the severity of isolated AS in an older age population.

Reliable estimation of peak left ventricular systolic pressure by M-mode echographic-determined end-diastolic relative wall thickness: Identification of severe valvular aortic stenosis in adult patients

In compensated hearts, left ventricular systolic pressure (LVSP) can be estimated from the ratio of LV wall thickness to chamber radius (RWT). To determine the clinical value of such estimates, we examined echocardiographic RWT in an unscreened series of 81 individuals with aortic valve disease, hypertension, or normal hearts. Despite the presence, in many subjects, of symptoms of congestive heart failure, reduced ejection fraction, or coronary disease, end-diastolic RWT (RWT D) correlated well with peak LVSP ( r = 0.77); 45 of 55 patients with LVSP ≥ 140 mm Hg had RWT D ≥ 0.45, while 26 of 26 with LVSP < 140 mm Hg had lower values ( p < 0.005). RWT D was ≥ 0.50 in 30 of 34 patients with LVSP ≥ 180 mm Hg and in 6 of 21 with LVSP 140 to 180 mm Hg. RWT D correctly estimated LVSP range in 26 of 27 severe aortic stenosis (AS) patients and, combined with echocardiographic aortic valve calcification, correctly recognized the presence or absence of severe AS in 99% of the series. The RWT D for any given LVSP was higher in patients on antihypertensive treatment and lower in patients with severe aortic regurgitation. In contrast to series based on patients with normal LV function, end-systolic RWT correlated poorly with LVSP.

Hypertrophic pyloric stenosis in adult patients: a plea for a simple method of operative correction.

Hypertrophic pyloric stenosis in adult patients: a plea for a simple method of operative correction.