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Query: UMLS:C0232605 (regurgitation)
 8,217 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Among the initial 492 patients who underwent balloon aortic valvuloplasty as part of the Mansfield Investigational Device Exemption Protocol, 31 (6.3%) had acute catastrophic complications. These included ventricular perforation in nine (1.8%), seven women and two men; six cases (67%) involved serial balloon inflations and seven (78%) also involved dual balloon inflations. In six (67%) of the nine patients perforation was fatal. In four patients studied at necropsy, the perforation involved the base of the lateral left ventricular free wall. Pericardiocentesis was performed in five patients, three of whom survived with (one patient) or without (two patients) operative repair. Acute, severe aortic regurgitation developed in four patients (0.8%), all women. None had significant regurgitation before valvuloplasty; dual balloons were used in two of the four. All three patients who underwent emergency valve replacement survived. A fourth patient died 2 days after valvuloplasty without operative intervention. Fatal cardiac arrest complicated balloon aortic valvuloplasty in 13 patients (2.6%), including 7 with cardiogenic shock and 4 with refractory ventricular arrhythmias. Of the seven with shock, four had been treated with serial balloon inflations; dual balloons were used in three. In two of three patients studied at necropsy, the aortic valve was observed to be congenitally bicuspid. A fatal cerebrovascular accident occurred in two patients (0.4%); it was hemorrhagic in one, embolic in another. Both patients were treated with serial (including one dual) balloon inflations. Limb amputation was required in three patients (0.6%), two women and one man; in two patients amputation was above the knee, in the third patient it was limited to two toes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Acute catastrophic complications of balloon aortic valvuloplasty. The Mansfield Scientific Aortic Valvuloplasty Registry Investigators. 201 64

A consecutive series of 602 surgically excised aortic valves was evaluated by means of macroscopic and histological study. Pure aortic stenosis was diagnosed in 140 patients, pure incompetence in 254 and combined dysfunction in 208. Of the cases with pure aortic stenosis, 38% were rheumatic, 34% were calcified bicuspid valves and 23% showed dystrophic calcification. Half the patients with pure aortic regurgitation showed aortic root dilatation. Most cases of combined aortic stenosis and regurgitation were the sequelae of rheumatic fever. A male prevalence was detectable in each group (mean male: female ratio = 2.6), and was highest in infective endocarditis and aortic root dilatation. Infective endocarditis was a frequent complication of congenitally bicuspid valves. In conclusion, rheumatic disease is still a frequent cause for surgical replacement of the aortic valve. At least half the explanted aortic valves have degenerative or congenital diseases which are often the site of a superimposed infective endocarditis.
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PMID:Surgical pathology of aortic valve disease. A study based on 602 specimens. 224 50

The congenital bicuspid aortic valves usually become stenotic with severe calcification or regurgitant due to infective endocarditis (IE). However, pure aortic valve regurgitation without calcification or IE may be occurred. We report seven these cases out of 30 bicuspid valved patients who underwent aortic valve replacements. Pathological findings of these resected valves revealed neither calcium deposit nor findings of infection, but commonly showed myxoid degeneration. They were operated on at the mean age of 39, while those with calcified bicuspid aortic valves had an average age of 56. Two rare cases in whom an anomalous fibrous band on the larger cusp attached to the aortic wall were also reported.
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PMID:[Pure aortic valve regurgitation due to congenital bicuspid valve--analysis of 7 cases and a report of 2 rare cases]. 229 50

A group of 22 adults with Turner's syndrome, mean age 29.6 years, was subjected to a careful examination by one-dimensional, two-dimensional, pulsed and coloured Doppler echocardiography. The purpose was to assess the incidence and character of congenital and acquired abnormalities of the cardiovascular system which occur within the framework of this defined genetic syndrome. A quite normal echocardiographic finding was recorded in 13 patients, i. e. in 59.1%. In the remainder a wide spectrum of abnormalities was found such as prolapse of the mitral valve (in 13.6%), bicuspid aortal valve with a medium regurgitation (4.5%), hypoplasia of the coronary cusp of the aortal valve (4.5%), dilatation of the ascending aorta with a residual significant stenosis at the site after operation of coarctation of the thoracic aorta (4.5%), subaortal defect of the interventricular septum (4.5%) and slight left ventricular hypertrophy in patients with arterial hypertension (9.1%). Echocardiographic examination in Turner's syndrome makes early diagnosis of abnormalities of the cardiovascular system possible, incl. quantification of the haemodynamic impact. Some of these pathological changes (bicuspid aortal valve, dilatation of the root of the aorta) are for a long time clinically silent but may be nevertheless associated with serious complications. An echographic diagnosis made in time may be of decisive importance for the prevention of complications.
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PMID:[Disorders of the cardiovascular system in Turner's syndrome]. 239 89

Percutaneous balloon dilation of the aortic valve has recently been proposed as a palliative procedure for treating nonsurgical candidates with calcific aortic stenosis. To assess the safety, efficacy and mechanisms of successful balloon valvuloplasty, postmortem (n = 33) and intraoperative (n = 6) balloon aortic valvuloplasty was performed in the hearts of 39 elderly patients with calcific aortic stenosis. The cause of aortic stenosis was degenerative nodular calcification in 28 cases, calcific bicuspid aortic stenosis in 8 cases and rheumatic heart disease in 3 cases. Balloon dilation was performed with 15 to 25 mm balloons in the postmortem specimens, and with 18 to 20 mm balloons in the operating room immediately before aortic valve replacement. After balloon dilation, valve orifice dimensions and leaflet mobility increased in all patients. The mechanisms of successful dilation included fracture of calcified nodules in 16 aortic valves, separation of fused commissures in 5 valves, both in 6 valves and grossly inapparent microfractures in 12 valves. Valve leaflet avulsion occurred in one heart after inflation with a clearly oversized balloon. Liberation of calcific debris, valve ring disruption or midleaflet tears did not occur in any heart. In conclusion, there are at least three mechanisms of successful aortic valvuloplasty, depending on the origin of valvular stenosis. Embolic phenomena and acute valvular regurgitation do not appear to be likely events associated with this procedure.
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PMID:Postmortem and intraoperative balloon valvuloplasty of calcific aortic stenosis in elderly patients: mechanisms of successful dilation. 295 Jan 56

Anatomical data obtained from 64 patients aged from 70 to 86 years with calcified and tight aortic orifice stenosis (functional area less than 1 cm2) were divided into three types according to the macroscopic appearance of the aortic valve: (1) tricuspid valve without commissural fusion: 44 cases (18 men, 26 women, mean age 76 years); (2) tricuspid valve with commissural fusion: 12 cases (8 men, 4 women, mean age 72 years); (3) calcified congenital bicuspid valve: 8 cases (6 men, 2 women, mean age 73 years). Thus, the distribution of patients by sex became the same starting from the eighth decade of life. Calcified aortic orifice stenosis (CAOS) of degenerative origin was the most common lesion (69 p. 100), with a strong female predominance. There were several differences between degenerative CAOS and bicuspid valve stenosis on the one hand and aortic orifice stenosis with commissural fusion on the other hand. In the first group, calcification did not involve the free edge of the aortic cusps, large calcifications of the mitral ring were extremely frequent, and there was little or no aortic regurgitation. Moreover, the aortic ring clearly was wider in cases with bicuspid valve. In patients with degenerative CAOS and bicuspid valve, attempts at digital dilatation by the left ventricular route succeeded in most cases in obtaining a fairly important widening of the aortic orifice by compression and/or disruption of the valvular calcium deposits, without causing significant regurgitation of injuring the valve; the cusps recovered some mobility.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Narrow and calcified aortic valve stenosis in subjects in their 8th and 9th decades. An anatomic study of 64 cases]. 314 87

Twenty nine patients (19 male, mean (SD) age 6.25 (0.5) years (range 0.16-15 years] with typical pulmonary valve stenosis were treated by balloon dilatation of the pulmonary valve. They were studied by echocardiography before the procedure, immediately after it, and at follow up (mean (SD) 10.2 (5.6) months, n = 18). The morphology of the pulmonary valve, the right ventricular-pulmonary artery gradient, and ratio of the systolic to diastolic endocardial dimensions (infundibular ratio) were examined. No patient had pulmonary regurgitation before the study. The valve gradient was significantly reduced (47%) from a mean (SD) of 72 (31) to 37 (23) mm Hg with no short term change in cardiac index after dilatation with a balloon with a mean (SD) diameter that was 118 (10.8)% of the valve annulus. The infundibular ratio was unchanged by the procedure (0.49 (0.11) (n = 21) before dilatation and 0.47 (0.14) (n = 16) after dilatation). In twenty seven patients the commissure of the pulmonary valve was seen to be torn after dilatation. Two patients with bicuspid valves had flail leaflets. Doppler examination at follow up showed mild pulmonary insufficiency in all 29 patients; the mean (SD) valve gradient (31 (+/- 21) mm Hg) at follow up was no different from the gradient found immediately after the procedure and infundibular ratio (0.58 (0.15) was not abnormal. These data indicate that commissural tears are the primary mechanism of valve disruption and demonstrate that the dynamic right ventricular outflow tract obstruction relaxes and gradient reduction persists at follow up.
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PMID:The morphology of the right ventricular outflow tract after percutaneous pulmonary valvotomy: long term follow up. 366 23

To establish the etiology of isolated aortic valvular regurgitation, histologic examination was carried out on 27 consecutive surgically removed aortic valves from patients with aortic regurgitation. In 12 patients, the regurgitation was due to rheumatic or syphilitic valvular disease or a congenital bicuspid aortic valve. In the remaining 15, no etiology was apparent. In the latter group, seven aortic valves were identified by the surgeon as redundant and eight as thickened and retracted. Despite these gross differences, the histologic features of the 15 valves were similar and consisted of increased and disorganized elastic and collagen fibers, with variable quantities of acid mucopolysaccharide and calcium. Although small foci of myxomatous stroma were present, they did not differ substantially from those observed in age-matched competent aortic valves removed at necropsy, nor were they as extensive as described in reports of floppy aortic valves. Idiopathic degeneration was the most common cause of aortic regurgitation, occurring in more than half of the surgically treated patients. An underlying defect in the synthesis of collagen or elastic fibers, similar to that described in mitral valve prolapse, may be an important feature in aortic valve degeneration.
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PMID:Idiopathic degeneration of the aortic valve: a common cause of isolated aortic regurgitation. 396 18

In 11 adult patients with isolated valvular aortic stenosis, the progression of the disease was assessed by two heart catheterisations without intervening aortic valve surgery. Four patients had bicuspid valves, whereas the remaining seven were considered to have acquired aortic stenosis. Significant differences between the two catheterisations were found for left ventricular peak systolic pressure (LVPSP), left ventricular aortic mean pressure gradient (LV-AO gradient), and for aortic valve area (OA). The rate of progression varied considerably. In one case the pressure gradient increased 43 mm Hg in 68 months, whereas in another case it remained almost unchanged for 103 months. One patient developed aortic valve regurgitation. ECG, chest X-ray and phonocardiography gave only poor estimates of the degree of progression. Thus having established a mild aortic stenosis at heart catheterisation, recatheterisation usually remains necessary to give the final indication for operation.
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PMID:Spontaneous progression of valvular aortic stenosis. 398 53

The prevalence and clinical significance of aortic valve prolapse were determined prospectively in 2000 consecutive patients undergoing routine clinical cross sectional echocardiography. Two hundred and twelve patients were excluded because the aortic cusps were not adequately visualised. Aortic valve prolapse was defined as downward displacement of cuspal material below a line joining the points of attachment of the aortic valve leaflets. Twenty four cases of aortic valve prolapse (1.2%) were identified. The patients were aged 12-64 years and nine were women. All had underlying valvar heart disease and the commonest lesion (in 11 cases) was prolapse of the larger cusp in bicuspid valves. Aortic valve prolapse was seen in four patients with mitral valve prolapse (two with severe regurgitation), one of whom had marfanoid aortic root dilatation. The remaining examples of aortic prolapse were seen in patients with various disorders including one with pulmonary atresia, two with aortic root disease (one with dissection and one with idiopathic dilatation), and one case of severe mitral regurgitation. Valves destroyed by infective endocarditis were seen in two cases. Aortic valve prolapse may be detected in various cardiac disorders and does not imply the presence of aortic regurgitation, but when bicuspid aortic valves are present it may well be important in producing such regurgitation. Although aortic valve prolapse may be associated with severe forms of mitral valve prolapse, these patients rarely have aortic regurgitation.
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PMID:Prevalence and clinical significance of aortic valve prolapse. 401 27


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