Transthoracic Echo-Doppler Appearances of Perforation of a Bicuspid Aortic Valve by Bacterial Endocarditis

The echo-Doppler diagnosis of aortic valve perforation has seldom been made before. We describe a combination of findings in a patient with severe aortic regurgitation following endocarditis of a bicuspid aortic valve, which suggests the presence of aortic cusp perforation: (A) discontinuity of cusp contour in parasternal long-axis view; (B) emergence of aortic regurgitant jet through a cusp rather than between the two cusps; (C) fine flutter of a cusp, but not on the free apposed edges; (D) severe aortic regurgitation without flail cusp motion, following bacterial endocarditis.     

Cineaortography in the assessment of aortic regurgitation: a comparison of different catheter types

The accuracy in diagnosing aortic regurgitation was studiedin 170 consecutive cineaortograms. In 85 patients (group A) cineaortograms were undertaken withSones or Gensini catheters, which producea jet of contrast materialdirected towards the aortic valve. The other 85 patients (groupB) underwent cineaortography with pigtail catheters, which maycause more equal distribution of contrast material in the aorticroot. In group A, 31 of 71 patients (44%) without clinically knownaortic valve disease showed angiographic grade I–III/IVaortic regurgitation. In group B only 8 of 61 patients (13%)without clinical evidence of aortic valve disease had gradeI–II/IV aortic regurgitation on cineaortography. Thisdifference is statistically significant (P<0.001). We conclude that catheters which produce a jet of contrast mediumdirected straight at the aortic valve can cause artificial trivialto moderate aortic regurgitation. Angiographic evaluation of aortic regurgitation should be performedwith a catheter such as a pigtail or closed-end multiple sideholecatheter in which the contrast medium is not directed straightat the aortic valve.     

Massive aortic regurgitation following paravalvular balloon valvuloplasty of an edwards sapien valve treated by emergent corevalve implantation: Never cross a transcatheter aortic valve without a pigtail

A 72‐year‐old patient, with a history of coronary artery bypass and aorto‐bifemoral graft, was diagnosed with a symptomatic severe aortic valve stenosis in the presence of moderately decreased left ventricular function. The Heart team decision was to implant an Edwards SAPIEN XT 26 mm valve by transapical approach, therefore avoiding access through the aorto‐bifemoral graft. At the end of the procedure, grades 2–3 aortic regurgitation was observed. Since each run of rapid pacing ended in ventricular fibrillation, it was decided to treat the aortic regurgitation conservatively with the option of post‐dilation in a second procedure if hemodynamic deterioration was observed. Six days later balloon valvuloplasty was performed because of heart failure requiring endotracheal intubation. Despite transesophageal echocardiography guidance the balloon was inadvertently advanced through the paravalvular space. As a consequence, balloon valvuloplasty was complicated by massive aortic regurgitation and severe hemodynamic instability which was resolved after emergency transfemoral implantation of a CoreValve. Without any further complications, the patient was discharged eight days later. © 2013 Wiley Periodicals, Inc.     

Echocardiographic and hemodynamic features of severe aortic regurgitation with diastolic opening of the aortic valve

Severe aortic regurgitation may be associated with premature aortic valve opening. Several possible etiologies for this diastolic opening have been suggested. We present a patient with hemodynamic data, M-mode and 2-D echocardiography in the setting of severe aortic regurgitation and diastolic aortic valve opening. Our data lead us to conclude that aortic valve opening in this situation is neither from passive flotation nor dependent on atrial systole. We believe that active ventricular recoil mechanisms can facilitate increases in diastolic ventricular pressure which then can transiently exceed aortic pressure in the setting of severe aortic regurgitation. This hemodynamic observation suggests that the valve opening is an active process.     

Acute aortic regurgitation due to spontaneous rupture of a bicuspid aortic valve: detection by echocardiography

A 42-year-old man was admitted with acute severe aortic regurgitation. There were no signs of a systemic infection. M-mode and two-dimensional echocardiography revealed bicuspid aortic valve and echocardiographic features consistent with aortic leaflet rupture. The diagnosis was confirmed at surgery. This report illustrates that spontaneous rupture of a bicuspid aortic valve should be considered in acute aortic regurgitation without infective endocarditis.     

Quadricuspid aortic valve: a case report and review of the literature

Quadricuspid aortic valve (QAV) is a rare congenital anomaly that can present as aortic insufficiency later in life. We report a case of aortic regurgitation associated with a QAV, treated by aortic valve replacement. The patient presented with breathlessness, lethargy and peripheral oedema. Echocardiography and cardiac magnetic resonance revealed abnormal aortic valve morphology and coronary angiography was normal. The presence of a quadricuspid aortic valve was confirmed intra-operatively. This was excised and replaced with a bioprosthetic valve and the patient recovered well postoperatively. Importantly, the literature indicates that specific QAV morphology and associated structural abnormalities can lead to complications. Hence, early detection and diagnosis of QAV allows effective treatment. Aortic valve surgery is the definitive treatment strategy in patients with aortic valve regurgitation secondary to QAV. However, the long-term effects and complications of treatment of this condition remain largely unknown.     

A systolic murmur is a common presentation of aortic regurgitation detected by echocardiography

BACKGROUND: The finding of aortic regurgitation at a classical examination is a diastolic murmur. HYPOTHESIS: Aortic regurgitation is more likely to be associated with a systolic than with a diastolic murmur during routine screening by a noncardiologist physician. METHODS: In all, 243 asymptomatic patients (mean age 42 +/- 10 years) with no known cardiac disease but at risk for aortic valve disease due to prior mediastinal irradiation (> or = 35 Gy) underwent auscultation by a noncardiologist followed by echocardiography. A systolic murmur was considered benign if it was grade < or = II/VI, not holosystolic, was not heard at the apex, did not radiate to the carotids, and was not associated with a diastolic murmur. RESULTS: Of the patients included, 122 (49%) were male, and 86 (35%) had aortic regurgitation, which was trace in 20 (8%), mild in 52 (21%), and moderate in 14 (6%). A systolic murmur was common in patients with aortic regurgitation, occurring in 12 (86%) with moderate, 26 (50%) with mild, 6 (30%) with trace, and 27 (17%) with no aortic regurgitation (p < 0.0001). The systolic murmurs were classified as benign in 21 (78%) patients with mild and 8 (67%) with moderate aortic regurgitation. Diastolic murmurs were rare, occurring in two (14%) with moderate, two (4%) with mild, and three (2%) with no aortic regurgitation (p=0.15). CONCLUSIONS: An isolated systolic murmur is a common auscultatory finding by a noncardiologist in patients with moderate or milder aortic regurgitation. A systolic murmur in patients at risk for aortic valve disease should prompt a more thorough physical examination for aortic regurgitation.     

Mixed aortic valve disease treated with transcatheter aortic valve replacement in a high risk patient presenting with acute decompensated heart failure

Mixed aortic valve disease refers to the combination of aortic regurgitation (AR) and aortic stenosis (AS). Commonly etiologies include a bicuspid aortic valve, rheumatic heart disease, and endocarditis superimposed upon a stenotic aortic valve. Treatment depends upon the severity of disease, the presence of symptoms and the size and function of the left ventricle. We present a case of a young patient that presented with new onset acute decompensated heart failure with mixed aortic valve disease that was successful treated with transcatheter aortic valve replacement (TAVR). Invasive hemodynamics at baseline and following TAVR provide an insight into the characteristic features of mixed aortic valve disease. TAVR represents a new treatment option for critically ill patients deemed high risk or nonoperable for surgical aortic valve replacement.     

单纯主动脉瓣反流病因超声心动图与手术对照分析

目的探讨行手术治疗的单纯主动脉瓣反流病因分布。方法手术治疗的单纯主动脉瓣重度反流患者86例．通过超声心动图观察主动脉瓣反流、瓣膜形态及异常回声、升主动脉内径,综合超声心动图、手术所见、部分病理结果和临床资料确定最终病因。结果在手术治疗单纯主动脉瓣反流患者中,瓣膜松弛、感染性心内膜炎和升主动脉夹层分别排行前3位病因。风湿性心脏病、退行性变、白塞病排行并列第4位。其余病因为主动脉瓣二叶瓣和梅毒。结论本组行手术治疗的单纯主动脉瓣反流病人中,病因以瓣膜病为主．超声心动图在确定病因方面起重要作用。     

Aortic dilatation resulting in chronic aortic regurgitation and complicated by aortic dissection in a patient with Turner's syndrome

A patient with XO Turner's syndrome with a 12-year history of progressive aortic root dilatation resulting in chronic aortic regurgitation is presented. Her case is unique in that it occurred in the absence of coarctation of the aorta, bicuspid aortic valve, or hypertension. Idiopathic dilatation of the aorta may be an additional risk factor to the development of aortic dissection in the setting of Turner's syndrome.     

中-重度主动脉瓣反流患者的主动脉根部形态与冠状动脉血流速度的关系

目的:探讨中-重度主动脉瓣反流患者的冠状动脉血流速度变化,同时了解主动脉根部形态对冠状动脉血流速度的影响.方法:收集我院2018年8月至2019年5月期间中-重度主动脉瓣反流患者41例(反流组),术前行经食道三维超声心动图检查,通过半自动方法获得主动脉根部形态参数.同时选取20例主动脉瓣功能正常的院内就诊者作为对照组,...     

Severe aortic regurgitation: a rare presentation of giant cell arteritis

A 53-year-old patient with no past history of rheumatic fever or lues presented with severe aortic regurgitation, underwent hemodynamic evaluation, and subsequently, an uneventful aortic valve replacement. The initial pathological interpretation was nonspecific aortitis. Six months following surgery arthralgia, muscular pain, difficulty in mastication, and fatigue occurred. There was no fever, however, sedimentation rate was 100/130. Cardiac examination was normal. Review of the pathological specimens revealed granulomatous arteritis with giant cells, typical of giant cell arteritis. Though the association of aortic regurgitation and giant cell arteritis is well recognized, only two such cases of severe aortic regurgitation requiring valve replacements have yet been described, of them, one probably had Takayasu's arteritis. An accurate diagnosis is of importance since steroid treatment is effective, and if introduced early, the inflammatory process may be arrested.     

Severe aortic regurgitation with intimal intussusception secondary to Debakey type I aortic dissection

Aortic regurgitation (AR) with intimal intussusception, secondary to aortic dissection, is relatively rare and the images are interesting findings. We report a typical case of severe AR with intimal intussusception, secondary to DeBakey type I aortic dissection, detected by contrast-enhanced computed tomography (CECT) and transesophageal echocardiography (TEE). Since there are three types of aortic regurgitation with aortic dissection, it is imperative to consider the most appropriate intervention for AR. The combination of CECT, TEE, and surgical findings may play an important role in determining the optimum surgical procedure for AR with aortic dissection.     

单纯主动脉瓣反流病因超声心动图与手术对照分析

目的 探讨行手术治疗的单纯主动脉瓣反流病因分布.方法 手术治疗的单纯主动脉瓣重度反流患者86例,通过超声心动图观察主动脉瓣反流、瓣膜形态及异常回声、升主动脉内径,综合超声心动图、手术所见、部分病理结果和临床资料确定最终病因.结果 在手术治疗单纯主动脉瓣反流患者中,瓣膜松弛、感染性心内膜炎和升主动脉夹层分别排行前3位病因.风湿性心脏病、退行性变、白塞病排行并列第4位.其余病因为主动脉瓣二叶瓣和梅毒.结论 本组行手术治疗的单纯主动脉瓣反流病人中,病因以瓣膜病为主,超声心动图在确定病因方而起重要作用.     

Progression of valvar aortic stenosis: a long-term retrospective study

Aortic valve stenosis is a potentially serious condition. Progression from mild to severe aortic stenosis is well-recognized but there are few data as to the likely rate of progression. Clinical outcome and cardiac catheterization data were reviewed for 65 patients with valvar aortic stenosis. Each patient had been investigated by cardiac catheterization on at least two occasions, the interval between studies ranging between 1 and 17 years (mean 7 years). In 60 cases the aortic valve gradient had increased, from a median of 10 mmHg (range 0-60) to a median of 52 mmHg (range 15-120). The mean rate of increase of gradient was 6.5 mmHg per year, and was significantly faster in patients in whom there was aortic valve calcification or aortic regurgitation present at the first catheter study (P less than 0.02). This study shows that progression of aortic stenosis may be very rapid, and correlates with valve calcification and regurgitation. If cardiac surgery is proposed for co-existing coronary or mitral valve disease in patients with mild or moderate aortic valve gradients, then aortic valve replacement should be considered at that time.     

Transient acute severe aortic regurgitation complicating balloon aortic valvuloplasty

Transient, acute severe aortic regurgitation documented by hemodynamic and Dopplerechocardiographic assessment was observed in an elderly woman immediately following balloon aortic valvuloplasty for critical aortic stenosis. Aortic regurgitation responded to medical therapy and resolved within 24 hr. Potential mechanisms are discussed. We suspect that an oversized balloon to aortic ring area stretched the annulus, separating the valve cusps and resulting in severe regurgitation, which rapidly normalized.     

Aortic valve regurgitation due to cusp aneurysm: a case report.

Two-dimensional echocardiography is a valuable tool in visualizing and monitoring aortic valve and root abnormalities. We present a rare case of a patient with massive aortic regurgitation due to cusp aneurysm, which was accurately diagnosed by echocardiography and treated by valve replacement. A complicated course with recurrent aneurysms of the aortic wall after aortic valve replacement was remarkable in this case. Although different possible etiologies could not be determined, endocarditis and/or aortitis may be the most likely explanation of the complicated and finally fatal course of this patient.     

Prolapse of the "floppy" aortic valve as a cause of aortic regurgitation. A clinico-morphologic study

A clinico-pathologic study was performed in 25 patients undergoing aortic valve replacement because of regurgitation, caused by myxoid degeneration of the valve leaflets. Associated cardiac anomalies were floppy mitral valve (2 cases), floppy mitral valve and idiopathic hypertrophic subaortic stenosis (1), left atrial myxoma (1), and aortic coarctation at the isthmus (1). Three patients died (2 immediately and 1 on the 30th postoperative day). Pathological studies of the explanted valves showed deformities characterized by redundant thin leaflets which appeared soft and gelatinous. On histologic examination the fibrous layer of the leaflets was seen to be infiltrated by myxomatous tissue. Echocardiography showed the aortic root to be dilated in 13 patients and normal in the others. In those with normal aortic root, the histological examination of aortic wall disclosed minimal cystic medial necrosis in two cases. In contrast, more severe forms of cystic medial necrosis were evident in all patients having a dilated aortic root. Aortic valve replacement was performed in all cases. It was accompanied by a Bentall procedure (1 case), repair of ascending aorta dissection (2), replacement of the ascending aorta (1), mitral valve replacement (2), mitral valve replacement and apico-ascending aorta conduit (1) and excision of a left atrial myxoma (1). Our experience suggests that prolapse of the aortic valve due to floppy leaflets is a common degenerative disease which is generally associated with noninflammatory aortic root degeneration. This, together with aortic root dilatation, contributes to valve insufficiency. Nevertheless, the disease, when isolated (with normal aortic root), is liable in itself to produce aortic regurgitation. The need for early diagnosis is stressed, so as to be able to perform valve replacement.     

Pathology of aortic valve stenosis and pure aortic regurgitation a clinical morphologic assessment—part I

This two-part article examines the histologic and morphologic basis for stenotic and purely regurgitant aortic valves. Part I discusses stenotic aortic valves and Part II will discuss causes of purely regurgitant aortic valves. In over 95% of stenotic aortic valves, the etiology is one of three types: congenital (primarily bicuspid), degenerative, or rheumatic. Other rare causes of stenotic aortic valves include active infective endocarditis, homozygous type II hyperlipoproteinemia, and systemic lupus erythematosis. The causes of pure aortic regurgitation are multiple but can be separated into diseases affecting the valve (normal aorta) (infective endocarditis, congenital bicuspid, rheumatic, floppy), diseases affecting the walls of aorta (normal valve) (syphilis, Marfan's, dissection), disease affecting both aorta and valve (abnormal aorta, abnormal valve) (ankylosing spondylitis), and diseases affecting neither aorta nor valve (normal aorta, normal valve) (ventricular septal detect, systemic hypertension). Diseases affecting the aortic valve alone are the most common subgroup of conditions producing pure aortic valve regurgitation.     

A rare mechanism of aortic regurgitation in a young patient

A 19‐year‐old male patient was admitted to our institute with dyspnea. His medical history had no rheumatic fever or infective endocarditis. Physical examination revealed a diastolic murmur over the aortic area, rales of bilateral lungs. Bedside transthoracic echocardiography (TTE) revealed a severe aortic regurgitation (AR) without aortic valve stenosis and a moderately dilated left ventricle accompanied by an ejection fraction of 55%. The aortic valve could not be clearly demonstrated as either bicuspid or tricuspid. Congenital AR typically occurs in conjunction with an additional cardiac abnormality or aortic valve stenosis. Furthermore, bicuspid aortic valves are observed in the majority of patients. The aortic valve is created from the truncus ridge of the truncus arteriosus while the embryological development.