Degenerative Aortic Valve Disease Its Mechanism On Progression Its Effect On The Left Ventricle And The Postoperative Results
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| Author | : Wilhelm Peter Mistiaen |
| Publisher | : Bentham Science Publishers |
| Total Pages | : 332 |
| Release | : 2013-01-10 |
| Genre | : Medical |
| ISBN | : 1608052877 |
"Degenerative aortic valve disease is the most prominent cardiac valve disease in Western societies. This volume describes some of the more important issues and problems for this condition: its progressive character and the underlying mechanisms of this progression diagnostic difficulties 1) ascertainment of valvular origin of symptoms in elderly; 2) the challenge of the low output – low gradient syndrome; 3) moderate aortic valve calcification during CABG; 4) prediction of the rate of progression (who will need surgery on short term and who not). the burden on the left ventricle and its consequences (danger of postponement of surgery) the effect and the modalities (access, types of valves) of surgical treatment on survival (and QoL) the mode of registering postoperative complications determining predictors for valve related, non-valve related cardiac and non-cardiac postoperative complications. The e-book is a unique presentation, specific to degenerative aortic valve disease and its treatment including information about ways to deal with the progressive character of the disease (autophagy as a mode of cell death). Cardiologists still avoid or delay referring patients to the surgeon for the sake of age, left ventricular function or co-morbidity. Therefore, the e-book benefits readers by addressing the above issue and providing critical information for changing referral policy, which would ultimately enhance postoperative survival of patients suffering from heart valve disease."
| Author | : Henrik Hultkvist |
| Publisher | : Linköping University Electronic Press |
| Total Pages | : 101 |
| Release | : 2019-05-13 |
| Genre | : |
| ISBN | : 917685079X |
BACKGROUND Postoperative heart failure in the setting of aortic valve surgery results in poor long-term survival. We hypothesized that there could be a myocardial factor that is not addressed by risk scores currently available. We speculated that this myocardial factor could be diastolic dysfunction. By evaluating postoperative heart failure, the EuroSCORE, the NT-proBNP level, and diastolic function, we might achieve a deeper understanding of the outcome for individuals with postoperative heart failure. METHODS This research project was built upon four cohort studies. The first two studies (I and II) were retrospective in nature, and studies III and IV were prospective, observational, and longitudinal. All work was based on data from clinical and national databases. In Study I, we compared the outcome of patients with or without postoperative heart failure, evaluated according to the preoperative risk score. In Study II, we explored the effect of underlying heart disease on the preoperative level of NT-proBNP and the relationships between NT-proBNP and severe postoperative heart failure and short-term mortality. In Study III, we described the dynamics of NT-proBNP, from a preoperative evaluation to a six-month follow-up, in patients that underwent one of two different procedures: a surgical aortic valve replacement and a transcatheter implantation. We related both pre- and postprocedural NT-proBNP levels to one-year mortality. In Study IV, we evaluated diastolic function in patients that underwent surgical aortic valve replacement and its influence on outcome. We also evaluated NT-proBNP levels and postoperative heart failure as predictors of long-term mortality. RESULTS Study I This study included 397 patients that underwent isolated surgical aortic valve replacements. Of these, 45 patients (11%) were treated for postoperative heart failure. With an average follow-up of 8.1 years (range 5.2-11.2), among patients at low risk (EuroSCORE≤7), the crude five-year survival rates were 58% in patients with postoperative heart failure and 89% in those without postoperative heart failure (p<0.001). Among patients with postoperative heart failure, those classified as low risk had the same poor long-term prognosis as those classified as high risk (EuroSCORE>7). In the high risk group, survival rates were similar between patients with or without postoperative heart failure (57% vs. 64%; p=0.60). Study II This study included a cohort of 2978 patients with coronary artery disease, aortic stenosis, and mitral regurgitation. Preoperative NTproBNP levels were found to be 1.7-fold higher in patients with aortic stenosis than in patients with coronary artery disease and 1.4-fold higher in patients with mitral regurgitation than in patients with coronary disease. The power of preoperative NT-proBNP for predicting severe postoperative heart conditions was good among patients with coronary heart disease and patients with mitral regurgitation, but not as good among patients with aortic stenosis. NT-proBNP also showed good discriminating power for short-term mortality among patients with coronary artery disease. Moreover, NT-proBNP was found to be an independent predictor for both severe postoperative heart failure and short-term mortality in patients with coronary artery disease. Study III This study included 462 patients that underwent preoperative evaluations for aortic valve disease. Aortic valve interventions elicited a rise in NT-proBNP that was more pronounced in patients undergoing surgical aortic valve replacement compared to patients undergoing transcatheter valve implantation. No deterioration in NT-proBNP was observed during the waiting time before the intervention, despite a median duration of four months. At six months after the intervention, NT-proBNP levels had decreased to or below the preoperative levels in all groups. Among patients that received surgical aortic valve replacements, pre-and early postoperative NT-proBNP levels showed good discriminatory power for oneyear mortality. This discriminatory power was not observed among patients that had undergone a transcatheter procedure; those patients had higher levels of both pre- and postoperative NT-proBNP compared to patients that had undergone surgery. Study IV We evaluated 273 patients that underwent aortic valve surgery. High left ventricular filling pressure was present in 22% (n=54) of patients at the time of surgery. At six months after surgery, diastolic function deteriorated in 24/193 (12%) patients and improved in 27/54 (50%) patients. Diastolic dysfunction was not found to be associated with long-term mortality. However, both postoperative heart failure and preoperative NTproBNP levels were associated with increases in long-term mortality. In a multivariable Cox analysis, NT-proBNP remained predictive of long-term mortality. CONCLUSION Postoperative heart failure contributed to long-term mortality, even in patients considered to be at low risk preoperatively. Our results suggested that pressure overload, followed by a volume overload led to a NTproBNP response that was more pronounced than the ischemia response. Elevated levels of NT-proBNP were associated with both short- and long-term mortality. In these studies, we could not corroborate the notion that high left ventricular filling pressure was associated with long-term mortality.
| Author | : Cécile Oury |
| Publisher | : Frontiers Media SA |
| Total Pages | : 58 |
| Release | : 2020-03-04 |
| Genre | : |
| ISBN | : 2889633551 |
Calcific aortic valve stenosis is the most frequent valvular heart disease in Western countries, affecting up to 13% of individuals over 75 years. The disease is associated with considerable morbidity and mortality. It is characterized by fibro-calcification of aortic valve cusps and concomitant left ventricular remodelling due to chronic pressure overload, which can evolve into overt heart failure. It progresses very slowly until the onset of symptoms, the indication for aortic valve replacement. Today, about 300,000 aortic valve replacements are performed annually worldwide, either via surgery or transcatheter implantation. This is the only treatment shown to improve survival. There is no pharmacological treatment to prevent or slow disease progression. Major risk factors include older age, congenital anomalies of the aortic valve (bicuspid valve), male gender, hypertension, dyslipidaemia, smoking, and diabetes. However, how these factors contribute to the disease in unclear. Due to the disease itself, patients are at increased risk of both thrombosis and bleeding, which, in addition to advanced age and comorbidities, makes antithrombotic management of these patients difficult. Regarding valve prostheses, the ideal prosthesis either mechanical or biological still does not exist. Clinically available prostheses can lead to major complications, thrombosis or infection, which necessitate reoperation or cause death in 50-60% of patients within 10 years post-implantation. Hence, there are major unmet medical needs in CAVS and more basic and translational research is definitely required. Our Research Topic depicts major challenges and research paths that could be followed to address these major health needs.
| Author | : Saadullah Husayn Ahmed |
| Publisher | : |
| Total Pages | : 339 |
| Release | : 2019 |
| Genre | : |
| ISBN | : |
Aortic Valve Disease (AVD) is a progressive disease process of the aortic valve that affects an average of about 3-4 % of the world population and is the most common cause of cardiac valve disease in the Western World. Recent studies have shown that AVD is, not merely a degenerative process on its own, but instead there are genetic and developmental factors that contribute to disease initiation and its progression prior to the environmental factors that add to the disease development. The current management of AVD largely relies upon aortic valve replacement (AVR), and despite treating the disease, AVR comes with a lot of risks and delayed complications. This project was aimed at: identifying the genetic pathways that are involved in aortic valve development using Gene Ontology; bridging the gap in the understanding of the development of the disease process across age groups by performing a detailed morphological analyses of stenosed aortic valves in fetal, pediatric and adult specimens; and, examining tissues from a laboratory inbred strain of pigs, the Gottingen minipig to evaluate its feasibility for use as a source of bioprosthetic valves. In order to explore the genetic pathways involved in aortic valve development, I used Gene Ontology (GO) terms to capture the role of 28 proteins to aortic valve development, 25 of which had not been previously annotated to aortic valve development in GO, by creating over 300 new annotations. In addition, 6 other proteins were annotated to other cardiac developmental processes. Secondly, in the cardiac morphology section, 56 specimens and 11 scans were studied for gross examination and high definition imaging, respectively. Standard gross morphological examination showed that there was a significant correlation between; the age of sample and site of fusion to the nature of raphe present; the nature of raphe and area of interleaflet triangle; the site of fusion and progression of severity fibrosis/endocardial fibroelastosis (EFE); and left ventricle (LV) remodeling in relation to the fibrosis/EFE. Comparison of measurements acquired using gross examination to those obtained using a high definition novel imaging technique (micro-CT) showed that new imaging techniques allowed for the visualisation of greater detail, and more precise measurements. However, there were differences between the measurements of both techniques. Efforts to optimise technique for micro-CT imaging showed that: siliconization of the sample led to less distortion and thus, significant differences when measuring the cross-sectional area of the aorta in comparison to a non-siliconized sample; and, under- or over-iodination affected the quality of the images studied. Lastly, using a set of molecular biology techniques, tissues from two strains of pigs, were tested for the presence of xenogeneic antigens that have been shown to contribute towards the degeneration of current bioprosthetic devices. The tissues tested expressed Sda antigen and therefore, were not useful as a potential source of bioprosthetic heart valve development. Since all porcine tissues tested previously, and in this project, have xenogeneic glycans present on their surfaces, it is essential to have a standard uniform assay to measure antibody reactivity to all three xenogeneic glycans. I showed that a pig kidney cell line, PK15, expressed B4GALNT2, the gene responsible for the production of the Sda antigen. Since this cell also makes other xenogeneic antigens, Gal and Neu5Gc, this cell line could act as a uniform assay to assess antibody reactivity to all glycans. This will allow for monitoring the immune response after BHV replacement could help explore the development of long-lasting bioprosthetic devices. This thesis is the first to my knowledge that looks into aortic valve stenosis in a multi-faceted approach, therefore, providing an integrative platform for future research to be carried out in the development and treatment of this disease.
| Author | : Michael Y. Henein |
| Publisher | : Springer Science & Business Media |
| Total Pages | : 306 |
| Release | : 2010-02-25 |
| Genre | : Medical |
| ISBN | : 1848002750 |
Over the last three decades, major advances in the management of diseases of the valves have been seen. While cardiac catheterization was in the 1970s, the only means for con?rming the diagnosis, Doppler echocardiography has become the corner stone for accurate assessment of valve disease, even in fetuses. Now not only the disease can be identi?ed but also the rate of disease progression (e. g. lea?et calci?cation and stiffness) can be accurately measured and quanti?ed by echocardiography and multislice/electron beam CT imaging. Surgical treatment of valve disease has also w- nessed great advances, having moved from traditional valve replacement to sophisticated repair procedures and the use of extracorporeal pump support in some patients. Robotic valve surgery has also proved a great success, in well selected cases, and is expected to have a fruitful future. Furthermore, in special circumstances, conventional surgical valve excision has now been replaced by percutaneous catheter-based valve replacement for aortic and pulmonary disease. This approach reduces the risk from the surgery itself, avoids general ana- thesia and many potential post-operative complications. This book discusses the practicalities of the diagnosis and treatment of the various aspects of common heart valve d- eases, covering most clinical and surgical issues. It is designed to assist clinicians in the management of patients with valve disease and provide them with answers to many of the clinical questions that arise.
| Author | : Steven Droogmans |
| Publisher | : Nova Biomedical Books |
| Total Pages | : 0 |
| Release | : 2011 |
| Genre | : Drugs |
| ISBN | : 9781616689780 |
The notion that drugs can induce valvular heart disease (VHD) has occurred since the sixties and has received a lot of attention in recent years. Overstimulation of the serotonin 2B receptor (5-HT2B) leads to valvular fibroblast proliferation and thickening of the valvular leaflets with reduced mobility and regurgitation as a consequence. This new book focuses on different aspects of this distinct kind of valvulopathy including pathophysiology of drug-induced VHD, histopathological and echocardiographic characteristics, drugs associated with VHD, the influence of cumulative drug dose and risk factors and others.
| Author | : Koichiro Niwa |
| Publisher | : Springer |
| Total Pages | : 327 |
| Release | : 2017-02-09 |
| Genre | : Medical |
| ISBN | : 4431560718 |
This is the first textbook to focus on Aortopathy, a new clinical concept for a form of vasculopathy. The first section of the book starts from discussing general concept and history of Aortopathy, and then deals with its pathophysiology, manifestation, intrinsic factor, clinical implication, management and prevention. The second part closely looks at various disorders of the Aortopathy such as bicuspid aortic valve and coarctation of aorta. The book editors have published a lot of works on the topic and have been collecting relating data in the field of congenital heart disease for the past 20 years, thus present the book with confidence. The topic - an association of aortic pathophysiological abnormality, aortic dilation and aorto-left ventricular interaction - is getting more and more attention among cardiovascular physicians. This is the first book to refer for cardiologists, pediatric cardiologists, surgeons, ACHD specialists, etc. to acquire thorough knowledge on Aortopathy.
| Author | : A. John Camm |
| Publisher | : |
| Total Pages | : 3198 |
| Release | : 2019 |
| Genre | : Cardiology |
| ISBN | : 9780198824879 |
| Author | : Ramiah Rajeshkannan |
| Publisher | : Springer Nature |
| Total Pages | : 584 |
| Release | : 2020-12-18 |
| Genre | : Medical |
| ISBN | : 9811567557 |
This book covers the cross-sectional imaging of congenital heart diseases, and features a wealth of relevant CT and MRI images. Important details concerning anatomy, physiology, embryology and management options are discussed, and the key technical aspects of performing the imaging are explained step by step. Written by a team of respected authors, the book is richly illustrated and supplemented with access to a number of clinical videos. Intended to provide quick and reliable access to high-quality MRI and CT images of frequently encountered congenital and structural heart abnormalities, the book offers a go-to guide for imaging physicians, helping them overcome the steep learning curve for pediatric cardiac imaging.
| Author | : Elena Aikawa |
| Publisher | : BoD – Books on Demand |
| Total Pages | : 544 |
| Release | : 2013-06-12 |
| Genre | : Medical |
| ISBN | : 9535111507 |
Due to population aging, calcific aortic valve disease (CAVD) has become the most common heart valve disease in Western countries. No therapies exist to slow this disease progression, and surgical valve replacement is the only effective treatment. Calcific Aortic Valve Disease covers the contemporary understanding of basic valve biology and the mechanisms of CAVD, provides novel insights into the genetics, proteomics, and metabolomics of CAVD, depicts new strategies in heart valve tissue engineering and regenerative medicine, and explores current treatment approaches. As we are on the verge of understanding the mechanisms of CAVD, we hope that this book will enable readers to comprehend our current knowledge and focus on the possibility of preventing disease progression in the future.
