ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committeeto Develop Guidelines for the Management of Patients With Valvular Heart Disease)

Journal of the American College of Cardiology (Impact Factor: 16.5). 10/2008; 52(13):e1-142. DOI: 10.1016/j.jacc.2008.05.007
Source: PubMed
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    • "Aortic stenosis disease (AS) is a common native valve disease found in up to 5% of the elderly population.1 Surgical aortic valve replacement (AVR) is the standard treatment for patients with symptomatic severe AS.2 However, despite the accepted results of conventional surgery, surgical risk is markedly increased in elderly patients with comorbidities. "
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    ABSTRACT: Purpose We sought to evaluate the clinical usefulness of decision making by a multidisciplinary heart team for identifying potential candidates for transcatheter aortic valve implantation (TAVI) in patients with symptomatic severe aortic stenosis. Materials and Methods The multidisciplinary team consisted of two interventional cardiologists, two cardiovascular surgeons, one cardiac imaging specialist, and two cardiac anesthesiologists. Results Out of 60 patients who were screened as potential TAVI candidates, 31 patients were initially recommended as appropriate for TAVI, and 20 of these 31 eventually underwent TAVI. Twenty-two patients underwent surgical aortic valve replacement (AVR), and 17 patients received only medical treatment. Patients who underwent TAVI and medical therapy were older than those who underwent surgical AVR (p<0.001). The logistic Euroscore was significantly highest in the TAVI group and lowest in the surgical AVR group (p=0.012). Most patients in the TAVI group (90%) and the surgical AVR group (91%) had severe cardiac symptoms, but only 47% in the medical therapy group had severe symptoms. The cumulative percentages of survival without re-hospitalization or all-cause death at 6 months for the surgical AVR, TAVI, and medical therapy groups were 84%, 75%, and 28%, respectively (p=0.007, by log-rank). Conclusion TAVI was recommended in half of the potential candidates following a multidisciplinary team approach and was eventually performed in one-third of these patients. One-third of the patients who were initially considered potential candidates received surgical AVR with favorable clinical outcomes.
    Full-text · Article · Sep 2014 · Yonsei Medical Journal
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    • "Surgical correction is recommended in cases of severe mitral regurgitation in symptomatic patients with or without left ventricular dysfunction, and for asymptomatic patients with left ventricular dilatation and/or left ventricular ejection fraction <50% (Bonow et al., 2008). Because of the asymptomatic status of the twins in our case and the lack of significant regurgitation, regular clinical follow-up and periodical echocardiographic examination were suggested. "
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    ABSTRACT: Valvular heart disease is a multifactorial disorder. Twin studies may help to better understand both genetic and environmental determinants contributing to the development of valve lesions. We describe the case of a 45-year-old female asymptomatic triplet with multiple valvular heart lesions, with a somewhat different pattern between the dizygotic twin pairs compared with the monozygotic twin pair. After thorough assessment of medical history and physical examination, the triplet underwent two- and three-dimensional transthoracic and transesophageal echocardiographic examinations to assess the pathomechanism and severity of their heart valve lesions. The monozygotic twin pair (second-born twin B and third-born twin C) showed the same pattern of valvular lesions: mild mitral, tricuspidal, and aortic regurgitation of the same pathomechanism (posterior mitral valve cleft and aortosclerosis). Interestingly, the examination of first-born twin (twin A), who was dizygotic to twins B and C, revealed mild protosystolic mitral and mild tricuspidal regurgitation, but neither aortic insufficiency nor mitral cleft or indentation could be detected. Beyond the genetic effect, we presume that the intrauterine twinning process might also play a role in the development of congenital valvular heart disease. In order to verify this, further investigation should be performed on larger twin populations. Nevertheless, when one twin is affected, the other asymptomatic twin should also be examined for valvular heart disease.
    Full-text · Article · Aug 2014 · Twin Research and Human Genetics
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    • "The ejection fraction, stroke volume, and the cardiac output for both ventricles were derived. Severity of aortic stenosis was estimated using 3 methods: -The Calc-PG: inverse Hakki's formula [15] [21], which is a simplification of Gorlin's [14] formula; DP = (cardiac output/ aortic valve area) [2]. -The aortic valve planimetry. "
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    ABSTRACT: Aim Cardiovascular magnetic resonance (CMR) has been increasingly used as an alternative method to evaluate the severity of aortic stenosis. The aim of our study was to evaluate whether the indirect measurement of the aortic gradient (Calc-PG), derived from Gorlin's formula, is a reproducible parameter for gradient assessment. Then, we evaluated if this parameter is correlated with left ventricular hypertrophy, considered as a marker of severity of aortic stenosis, better than phase-contrast sequences-derived pressure gradient (PC-PG) and aortic valve area. Methods Forty-one patients with isolated aortic stenosis underwent CMR. Calc-PG was obtained from the formula (cardiac output/aortic valve area)2, and it was compared to PC-PG. Results We found that the Calc-PG has higher correlation with left ventricle mass than PC-PG (r2 0.44, p < 0.001 vs. r2 0.26, p < 0.01), also after multivariate analysis adjusting for age, gender and hypertension (p < 0.001). Furthermore, Calc-PG was more reproducible than PC-PG. The receiver operating characteristic comparison curve analysis showed that Calc-PG has a significantly higher ability to describe the presence of left ventricular hypertrophy than PC-PG (area under the curve 0.85, 95% CI 0.70–0.94, p < 0.0001 vs. 0.74, 95% CI 0.58–0.87, p = 0.03). Conclusions We propose that transaortic gradient indirectly calculated by using the simplified Gorlin's equation could be an alternative method to assess the severity of aortic stenosis.
    Full-text · Article · Aug 2014 · Journal of Cardiology
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