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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aortic dilation and dissection are well-recognized cardiac abnormalities in women with Turner syndrome (TS), although the underlying pathophysiology is not fully understood. We report on a 46-year-old Hispanic woman who was previously diagnosed with moyamoya disease on magnetic resonance imaging after a presentation with stroke-like symptoms. Her features were consistent with TS and chromosome analysis revealed mosaicism in which 17% of the cells showed a pseudoisodicentric Y chromosome: 45,X (25)/46,X psu idic (Y)(11.2) (5). A preceding screening transthoracic echocardiogram had shown a bicuspid aortic valve (BAV) with an aortic diameter of 3.2 cm; at the time of moyamoya diagnosis, the aorta was 3.5 cm with mild aortic stenosis and mild aortic regurgitation. Four years later, the patient had had an acute aortic dissection, Stanford type A, which was repaired successfully. This case report is the third individual with TS associated with moyamoya disease and the first associated with dissection. The small number of cases does not allow detailed analysis other than noting patient age (two older than 40 years), karyotype (two others associated with isochrome Xq), and associated cardiac risk factors (one with BAV). Although this may be a chance occurrence, we hypothesize that moyamoya disease could be a manifestation of the vasculopathy in TS.
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PMID:Aortic dissection and moyamoya disease in Turner syndrome. 2063 2

Bicuspid aortic valve (BAV) is a common condition but is only rarely associated with embolic complications. We describe a 42-year-old man with recurrent posterior circulatory ischemic strokes that resulted in ataxia and cognitive impairment. Transesophageal echocardiography demonstrated a BAV with mild stenosis, moderate calcification, and a dilated ascending aorta. The degree of calcification and the valve phenotype might be important factors implicating the BAV as a rare cause of ischemic stroke.
J Stroke Cerebrovasc Dis 2011 Nov
PMID:Recurrent posterior circulatory emboli from a mildly stenosed bicuspid aortic valve. 2083 85

Coarctation of the aorta (COA) is an obstruction of the aorta and is usually associated with bicuspid and tricuspid aortic valve stenosis (AS). When COA coexists with AS, the left ventricle (LV) is facing a double hemodynamic load: a valvular load plus a vascular load. The objective of this study was to develop a lumped parameter model, solely based on non-invasive data, allowing the description of the interaction between LV, COA, AS and the arterial system. First, a formulation describing the instantaneous net pressure gradient through the COA was introduced and the predictions were compared to in vitro results. The model was then used to determine LV work induced by coexisting AS and COA with different severities. The results show that LV stroke work varies from 0.98J (no-AS; no-COA) up to 2.15J (AS: 0.61cm(2)+COA: 90%). Our results also show that the proportion of the total flow rate that will cross the COA is significantly reduced with the increasing COA severity (from 85% to 40%, for a variation of COA severity from 0% to 90%, respectively). Finally, we introduced simple formulations capable of, non-invasively, estimating both LV peak systolic pressure and workload. As a conclusion, this study allowed the development of a lumped parameter model, based on non-invasive measurements, capable of accurately investigating the impact of coexisting AS and COA on LV workload. This model can be used to optimize the management of patients with COA and AS in terms of the sequence of lesion repair.
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PMID:Modeling the impact of concomitant aortic stenosis and coarctation of the aorta on left ventricular workload. 2195 30

We present a 30-year-old male patient who developed new-onset heart failure and stroke in the setting of myocardial noncompaction. He presented with shortness of breath that progressively worsened in the past 15 days. Chest X-ray showed diffuse bilateral infiltration with bilateral hilar fullness. Electrocardiography showed sinus rhythm, signs of left ventricular hypertrophy, and diffuse T-wave negativity. Transthoracic echocardiography demonstrated moderate systolic dysfunction of the left ventricle and trabeculations and intertrabecular recesses in the anterolateral and apical regions of the inferior wall. Dense spontaneous echo contrast was seen in the left ventricular cavity. He also had a bicuspid aortic valve. The patient developed stroke at the eighth hour of hospitalization. Heparin infusion and heart failure treatment were started. Transesophageal echocardiography showed no thrombus. Clinical and radiological findings improved significantly during the follow-up. Oral anticoagulant therapy was initiated and the patient was discharged with control recommendations. Myocardial noncompaction was also demonstrated by cardiac magnetic resonance imaging.
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PMID:[Development of heart failure and stroke in the setting of myocardial noncompaction]. 2239 77

Acute ischemic stroke may be the first clinical manifestation of the underlying cardioembolic source. We are reporting a 28-year-old man presenting with acute posterior circulation infarct due to underlying bicuspid aortic valve disease with vegetation detected by transesophageal echocardiography in the absence of clinical features of heart disease and infective endocarditis. The case report highlights the importance of routine evaluation of cardioembolic sources in all cases of ischemic stroke.
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PMID:Acute posterior circulation infarct due to bicuspid aortic valve vegetation: An uncommon stroke mechanism. 2366 75

We describe a 55-year-old man who presented with a stroke resulting from active infective endocarditis (IE) involving a heavily calcified bicuspid aortic valve. The case highlights the infrequency of IE involving a heavily calcified valve, the inability of the infection to penetrate the calcific deposits, and the ability of the infection to spread to the adjacent soft tissues, leading to ring abscess and its multiple complications.
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PMID:Infective endocarditis superimposed on a massively calcified severely stenotic congenitally bicuspid aortic valve. 2438 2

The records of 75 patients with the diagnosis of bicuspid aortic valve (BAV) confirmed at the time of valve replacement were reviewed retrospectively to assess the frequency of cerebrovascular events. There were four transient ischemic attacks, one stroke, and one retinal embolus; four of these could be explained by factors other than embolism from the aortic valve (infective endocarditis, two; carotid plaque, one; prolapsed mitral valve, one). Cerebrovascular complications occurred close in time (median, 2 months prior) to valve replacement. We conclude that BAV is a rare cause of cardioembolic stroke, which occurs only with severe valvular dysfunction. The risk of cerebrovascular events with a functionally normal BAV is probably very low.
J Stroke Cerebrovasc Dis 1991
PMID:Risk of stroke in patients with congenital bicuspid valve. 2648 95

Transcatheter aortic valve implantation (TAVI) has been increasingly utilized for the treatment of severe symptomatic aortic stenosis in inoperable and high surgical risk patients. Recent advances in valve technology include repositionable scaffolds and smaller delivery systems, as well as improvement in periprocedural imaging. These advances have resulted in reduction of vascular complications, rates of paravalvular aortic regurgitation and periprocedural stroke and improved overall outcomes. Increasingly, TAVI is the preferred treatment for high-risk surgical patients with severe aortic stenosis. Consequently, there is growing interest for the use of TAVI in lower surgical risk patients. Furthermore, the role of TAVI has expanded to include valve-in-valve procedures for the treatment of degenerative bioprosthetic valves and bicuspid aortic valves. Questions remain in regard to the optimal management of concurrent coronary artery disease, strategies to minimize valve leaflet restriction and treatment of conduction abnormalities as well as identifying newer indications for its use.
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PMID:Transcatheter aortic valve implantation: current trends and future directions. 2669 62

Because surgical repair for coarctation of the aorta has been performed since 1945, growing numbers of patients with repaired coarctation are reaching adulthood. Primary transcatheter intervention for coarctation emerged as an alternative to surgery after 1983, and it provides comparable relief of the aortic gradient with few complications at a cost of an increased need for reintervention and a higher risk of aneurysm after repair. Although short-term outcomes are good after coarctation repair, alterations of vascular form and function persist. Mortality is increased after coarctation repair compared with that in the general population, which is related to several predictable complications. Hypertension mediates much of the late morbidity with increased rates of stroke, coronary artery disease, and heart failure after coarctation repair. Prevalence of hypertension in patients with coarctation increases over time, with a majority of patients being affected by middle age. Other late complications include recoarctation, which can usually be addressed with percutaneous balloon dilation and stenting with covered stents. Aneurysms at the coarctation repair site and the ascending aorta require surveillance with imaging and timely treatment. Intracranial aneurysms occur 5 times more commonly in patients with coarctation than in the general population. Finally, bicuspid aortic valve disease, which is present in at least half of these patients, requires surveillance and ultimately becomes the most common reason for reoperation. Awareness, identification, and appropriate treatment of long-term complications after coarctation repair are paramount to reducing long-term morbidity and mortality.
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PMID:The Adult With Repaired Coarctation: Need for Lifelong Surveillance. 2708 76

The association of severe calcific aortic stenosis with clinically significant stroke has not been well established. This case vividly describes the relationship with clinical and pathological (gross and microscopic) findings in a 62-year-old man with a severely calcified bicuspid aortic valve. Eleven months prior to aortic valve surgery, the patient had stigmata of cerebral embolic events in the absence of any other embolic source. During the aortic valve replacement surgery for aortic stenosis, he was found to have a large atheroma on the aortic valve cusp with a crater containing friable debris in its center. These findings support the potential for embolic stroke in patients with severe calcific aortic stenosis. We recommend that the aortic valve be considered as an embolic source in patients with an otherwise cryptogenic cerebrovascular accident.
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PMID:Deep Crater in Heavily Calcified Aortic Valve Leaflet: A "Smoking Gun" for Embolic Stroke. 2717 68


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