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

Two rare patients are reported with tetralogy of Fallot and congenital aortic valvar stenosis. The anatomic and developmental interrelationship between tetralogy of Fallot and truncus arteriosus is summarized. A study of 100 randomly selected postmortem cases of tetralogy revealed aortic valve pathology in 8%, myxomatous aortic valve leaflets without stenosis in 4%, bicuspid aortic valves without stenosis in 3%, and congenital aortic valvar stenosis in 1%. The frequency of systemic semilunar valve pathology in truncus was much higher (66%): moderate to marked myxomatous change in 44%, mild myxomatous change in 22%, truncal valvar stenosis in 11%, and truncal valvar regurgitation in 15%. Being aware of the tetralogy-truncus interrelationship and knowing that myxomatous aortic valves are prone to premature calcific aortic stenosis and/or regurgitation, physicians should follow the aortic valves of surgically repaired patients with tetralogy of Fallot and truncus arteriosus long term with great care. Timely aortic valvuloplasty or replacement may well prove life-saving in such patients.
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PMID:Tetralogy of Fallot with congenital aortic valvar stenosis: the tetralogy-truncus interrelationship. 1656 7

Dilation of the ascending aorta (AA), which is disproportionate to associated valvular lesions, is a relatively well-recognized phenomenon in patients with a bicuspid aortic valve (BAV). The aim of this study was to evaluate the rate of changes in the AA dimensions and the outcome in patients with AA dilation and BAVs compared with patients with AA dilation and tricuspid aortic valves (TAVs). Serial transesophageal echocardiograms (>12 months apart) were performed in 113 consecutive patients (BAV, n=27 and TAV, n=86) with AA diameters of >or=40 and <or=60 mm, respectively, without associated significant aortic valve stenosis or regurgitation. Baseline diameters at the sinuses of Valsalva (SV), the sinotubular junction (STJ), and the tubular tract (TT) were similar in both groups (41.3+/-5.3 vs 42.3+/-6.3 mm, p=NS, 37.8+/-5.2 vs 38.7+/-5.5 mm, p=NS, and 47.3+/-5.3 vs 45.9+/-5.1, p=NS, respectively). During an average 3-year follow-up, the rate of AA diameter progression was similar for the BAV and TAV groups (0.86+/-0.81 vs 0.82+/-1.1 mm/year, p=NS for the SV; 1.06+/-1.6 vs 0.63+/-1.1 mm/year, p=NS for the STJ; and 0.81+/-1.1 vs 0.75+/-1.1 mm/year, p=NS for the TT, respectively). Three patients in the TAV group experienced cardiac death (2 died suddenly and 1 after emergency surgery for AA dissection); there was no occurrence of cardiac death in the BAV group. In conclusion, the rate of progression of AA aneurysms was similar in patients with BAVs and in those with TAVs. Furthermore, patients with BAVs did not have increased rates of AA related complications compared with patients with TAVs.
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PMID:Progression rate of ascending aortic dilation in patients with normally functioning bicuspid and tricuspid aortic valves. 1682 2

This study sought to determine the morphology and function of bicuspid aortic valves (BAVs) with and without coarctation of the aorta (CoA) in a young population. The transthoracic echocardiograms of 117 patients with BAVs and 62 patients with CoA were retrospectively reviewed and compared with normal transthoracic echocardiographic results. In each patient, the area subtended by the aortic cusps and valve and the diameters of the aortic root at different levels were measured, and additionally in each BAV, the type of cusp fusion and the presence and degree of aortic stenosis and/or regurgitation were evaluated. The median age of patients with BAVs was 4 years (range 0 days to 34 years), and the median age of patients with CoA was 1.9 years (range 0 days to 16.5 years). BAVs with right and left coronary cusp fusion were significantly associated with CoA (p <0.0001) and cardiac anomalies (p <0.0001), whereas BAVs with noncoronary and right coronary cusp fusion were affected by valvar dysfunction (p <0.001). Compared with normal tricuspid aortic valves, BAVs had aortic root dilation, even in patients with no hemodynamic disturbance, particularly at the level of the ascending aorta (p <0.0001); the difference was still significant comparing BAVs and CoA with tricuspid aortic valves and CoA (p <0.0001). In conclusion, different morphologies of BAVs are associated with different cardiac abnormalities, valvar function, and aortic root dilation. Although detectable early in life, valvar dysfunction and aortic root dilation progress with age.
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PMID:Morphology and function of the bicuspid aortic valve with and without coarctation of the aorta in the young. 1702 79

Aortic valve replacement is the standard procedure in patients with aortic valve regurgitation (AR). Although long-term results for both biological and mechanical heart valves could be improved, a valve-sparing operation has several advantages especially in young patients. Alterations in the geometry of the aortic root, especially dilatation of the sinutubular junction, are the primary cause of AR in patients with aneurysms of the ascending aorta. In patients with a bicuspid aortic valve, AR is usually caused by a prolapse; with appropriate surgical experience, the prolapse can be corrected and the valve reconstructed. Isolated reconstruction of a tricuspid aortic valve such as decalcification, commissurotomy or plication of ring or leaflets are seldom indicated. The recontstructive techniques for aortic root aneurysms or type A dissection described by David and Yacoub have become routine procedures over the last decade. The long-term clinical results are excellent, and revision and thromboembolism rates are very low. A maximal diameter of the aortic root > 5 cm is indicative for performing the above procedures. This technique has been used in the own clinic since 1996 with excellent clinical and echocardiographic results. Only four of 101 patients operated had a moderate AR during the follow-up period. The reconstruction of a prolapse in a bicuspid aortic valve is possible by using an autologous, fixed pericardial patch, with very good long-term results. By using this surgical technique, two geometrically correct pockets with a broad coaptation zone can be constructed. In 36 of the patients operated in the own clinic, only four patients showed grade I AR. No patient had to undergo reoperation. An aortic valve reconstruction for an isolated leaflet perforation following a healed endocarditis is seldom indicated.In the authors' opinion, valve-sparing reconstruction in cases of aneurysms of the ascending aorta, and for bicuspid valves, represents a promising alternative to prosthetic valve replacement. With low surgical mortality and morbidity, excellent clinical and functional long-term results can be achieved. Furthermore, the lack of the necessity of anticoagulation as well as positive hemodynamic factors argue for a valve-sparing surgical technique. A final evaluation of the method is not possible, however, until long-term follow-up of up to 20 years is available and the positive results have been confirmed.
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PMID:[Indication, technique, and results of aortic valve and ascending aorta reconstruction]. 1707 82

An interrupted aortic arch was diagnosed in a 10-day-old girl weighing 3.3 kg, as was perimembranous ventricular septal defect (VSD) and severe tricuspid valve regurgitation (TR). The subaortic diameter was 3.6 mm and the aortic valve (3.7 mm in diameter) was bicuspid. We chose definitive repair, modified Yasui procedure, because of severe TR and no straddling of mitral valve. In primary biventricular repair, we undertook extended aortic arch anastomosis. Left ventricular outflow tract reconstruction consisted of intracardiac rerouting from the VSD to the pulmonary artery by using expanded-polytetrafluoroethylene (ePTFE) and Damus-Kaye-Stansel (DKS) anastomosis. Right ventricular outflow tract reconstruction was performed by the Rastelli procedure with an ePTFE valved conduit. Moreover, we carried out semicircular annuloplasty for severe TR.
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PMID:[Primary biventricular repair for interrupted aortic arch with left ventricular outflow tract obstruction and tricuspid valve regurgitation; report of a case]. 1709 51

We present a novel case of a hematoma involving a congenitally bicuspid aortic valve. The patient was a 47-year-old woman with polycythemia vera and antiphospholipid antibody syndrome. She was treated with anagrelide for thrombocytosis. The patient developed a valvular hematoma which caused clinically significant aortic stenosis and regurgitation. Consequently, the patient underwent surgery with insertion of a porcine bioprosthesis. Eighteen months postoperatively the patient developed a large prosthetic thrombus with severe aortic stenosis requiring reoperation.
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PMID:Hematoma of a congenitally bicuspid aortic valve in a patient with polycythemia vera and the antiphospholipid antibody syndrome. 1713 43

A 44-year-old woman underwent a Ross procedure for severe aortic regurgitation at the age of 32 years. She had been diagnosed in childhood with spondyloepiphyseal dysplasia and a bicuspid aortic valve. At surgery, a tricuspid aortic valve with chondroid metaplasia and fibrosis was reported. Biochemical and genetic evaluation in this patient confirmed the diagnosis of mucopolysaccharidosis IV type B (MPS IV), otherwise known as Morquio's syndrome. This autosomal-recessive inherited syndrome is characterized by the accumulation of keratin sulfate in connective tissue and various other organs. Cardiac (notably valvular) involvement has been well described in the literature. To the authors' knowledge, this is the first reported case of valve replacement or Ross procedure for this condition. This woman presented 12 years after her initial valve surgery with progressive dyspnea. Echocardiographic examination revealed severe pulmonic autograft regurgitation without a dilated aortic root, together with severe stenosis of the pulmonary homograft. It is postulated that the underlying metabolic abnormality may have led to progressive pulmonary autograft failure and to accelerated dysfunction and stenosis of the pulmonary homograft. It is likely that a mechanical prosthesis would have been a better therapeutic option if the preoperative diagnosis of MPS IV had been made.
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PMID:Morquio's syndrome: severe aortic regurgitation and late pulmonary autograft failure. 1715 95

Rupture of a sinus of Valsalva aneurysm is a rare, but life-threatening cardiac abnormality that requires surgical correction when diagnosed, and is frequently associated with other congenital defects, particularly with ventricular septal defect, aortic valve regurgitation, and bicuspid aortic valve. We present the case of a 21-year-old man who had a ruptured aneurysm of the noncoronary sinus into the right atrium, a ventricular septal defect, a persistent left superior vena cava and a noncompaction of the ventricular myocardium diagnosed by two-dimensional echocardiography. Surgical repair was carried out and the patient made an uneventful recovery.
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PMID:Ruptured sinus of Valsalva aneurysm associated with noncompaction of the ventricular myocardium. 1722 88

Although the Ross procedure is a well-established approach to aortic valve disease in pediatric patients and young adults, there still is no ideal method of right ventricular outflow tract (RVOT) reconstruction, especially in children. To achieve improved RVOT reconstruction with long-term valve function and growth potential, we have developed a hybrid valve which combines the autologous aortic valve and expanded polytetrafluoroethylene (ePTFE) valves. The posterior wall of RVOT was reconstructed using the autologous aortic wall with a noncoronary cusp, and the anterior wall was reconstructed using a patch made of bovine pericardium or ePTFE with bicuspid ePTFE valves. We implanted hybrid valves in 14 patients (age 5-18 years). During the follow-up period (2.4-8.8 years), there were no mortalities or morbidities, and no patients required reoperation. Echocardiography showed no significant stenosis and regurgitation, and preserved valve motion in all patients. The z-value of the diameters of the pulmonary annulus in early and late follow-up was -1.4 and -1.8, respectively, the difference not being significant. Creation of a hybrid valve was associated with excellent mid- to long-term results. Given its theoretical growth potential, we speculate that this valve could be a good choice for RVOT reconstruction in the Ross procedure, especially for young children.
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PMID:An expanded polytetrafluoroethylene-autologous aortic hybrid valve for right ventricular outflow tract reconstruction in the Ross procedure. 1766 99

Extracellular matrix degradation and increased proteolytic enzyme (matrix metalloproteinase (MMP)) activity characterise abdominal aortic aneurysm formation. Post-stenotic dilatation of ascending aorta is associated with aortic stenosis and regurgitation, haemodynamically normal bicuspid aortic valve (BAV) and following AV replacement. We aimed to determine an association between ascending aortic pathology and abnormal AV, with particular reference to MMPs, and ascertain differences between BAV and tricuspid (TAV) AV. Subset of the study population (n=19) with a preoperative ascending aorta of >4 cm was analysed. Samples of ascending aorta and AV were obtained from 82 patients (TAV, n=54, BAV, n=28) undergoing surgery. Gene expression of MMP-1, -2, -9 and tissue inhibitor of metalloproteinase (TIMP)-1 and -2 was quantified by real-time RT-PCR. No significant difference was seen in gene expression level of MMPs, TIMPs and ratio of MMPs/TIMPs in ascending aorta and AV between patients with BAV and TAV. MMP-2/TIMP-1 in ascending aorta was greater in BAV, in the subset of patients with preoperative aortic dilatation (P<0.05). No difference exists in gene expression of MMPs in ascending aorta and AV between patients with BAV and TAV. However, patients with larger aortic diameters have increased MMP-2/TIMP-1. Modifying MMP expression may have a role in development of aneurysms.
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PMID:Matrix metalloproteinase expression in the ascending aorta and aortic valve. 1823 68


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