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@#Objective To evaluate the efficiency and safety of intraprocedural valve-in-valve deployment for treatment of aortic regurgitation following transcatheter aortic valve replacement (TAVR). Methods Consecutive patients (n=333) who diagnosed with severe aortic stenosis and underwent TAVR in Zhongshan Hospital affiliated to Fudan University from October 3rd, 2010 to April 21st, 2021 were included. There were 208 males and 125 females aged 76.0±7.0 years. There were 316 patients underwent simple TAVR (simple TAVR group) and 17 patients underwent intraprocedural valve-in-valve deployment following TAVR (valve-in-valve group). Their clinical and echocardiographic outcomes were evaluated and compared. Results There was no significant difference between the two groups of patients at postoperative 30 d and 1 year in all-cause mortality (4.4% vs. 0, P=1.000; 6.3% vs. 0, P=1.000), incidence of pacemaker implantation (10.4% vs. 17.6%, P=1.000; 11.8% vs. 17.6%, P=1.000), incidence of ischemic stroke (1.3% vs. 0, P=1.000; 1.3% vs. 0, P=1.000), mean trans-aortic pressure gradient (11.4±6.4 mm Hg vs. 8.9±4.9 mm Hg, P=0.099; 10.5±7.6 mm Hg vs. 11.2±5.2 mm Hg, P=0.432), left ventricular ejection fraction (62.0%±9.0% vs. 57.0%±12.0%, P=0.189; 63.0%±7.0% vs. 60.0%±8.0%, P=0.170), and incidence of mitral valve dysfunction (0.6% vs. 5.9%, P=1.000; 0.6% vs. 5.9%, P=1.000). Conclusion It is feasible to treat perivalvular leakage with valve-in-valve technology in the procedure of TAVR, and the short and medium-term effects are satisfied.
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<p><b>OBJECTIVE</b>To evaluate the accuracy of echocardiography in identifying aortic valve structures and determine the prevalence of bicuspid aortic valves (BAV) in severe aortic stenosis (AS) population to provide useful information for transcatheteraortic valve replacement (TAVR).</p><p><b>METHODS</b>A total of 300 AS patients undergoing surgical aortic valve replacement were included to determine the accuracy of transthoracic echocardiography in indentifying BAV from January 2009 to July 2013. The echocardiographic data of our hospital from 2004 to 2012 was retrospectively reviewed. 1 371 patients with isolated severe native aortic valves stenosis were consecutively enrolled.</p><p><b>RESULTS</b>The aortic valve structures could be defined by transthoracic echocardiography in 75.7% (227/300) patients with severe AS. With BAV diagnosis during operation as gold standard, the accuracy of transthoracic echocardiography in identifying BAV was 89.4% (203/227). Among 1 371 patients with severe AS, the percentage of BAV in patients aged <40 years, aged 40-59 years, aged 60-69 years, aged 70-79 years and aged ≥ 80 years was 60.0% (57/95), 57.5% (262/456), 42.7% (184/431), 43.2% (133/308) and 21.0% (17/81), respectively. Incidence of BAV in patients with degenerative calcific valve was significant higher than in those with rheumatic heart disease (44.3% (552/1 246) vs. 4.0% (3/76), P<0.01). Proportion of combined aortic regurgitation ≥ grade 2 was significantly lower, ascending aortic diameter was larger and left ventricular end-diastolic dimension was smaller in BAV patients compared to severe AS patients with tricuspid valves (all P<0.01), while aortic valve annuals diameter and accompanying cardiovascular diseases between BAV and tricuspid aortic valve groups were similar (all P>0.05).</p><p><b>CONCLUSIONS</b>Transthoracic echocardiography could accurately identify aortic valve structures in about 76% patients. BAV is common in severe AS patients across all ages. These results provide important information for the popularization of TVAR.</p>
Subject(s)
Humans , Aorta , Aortic Valve , Congenital Abnormalities , Aortic Valve Stenosis , Echocardiography , Heart Valve Diseases , Heart Valve Prosthesis , Incidence , Prevalence , Retrospective StudiesABSTRACT
10.3969/j.issn.2095-4344.2013.24.020
ABSTRACT
BACKGROUND:Surrounding structure of intracristal ventricular septal defects(IVSD) and membranous ventricular septal defects(MVSD)is complicated,and it is difficult to perform transcatheter closure treatment.Corresponding animal models should be established to define an optimal interventional therapy.OBJECTIVE:To prepare the animal models of IVSD and MVSD under echoeardiogram location.DESIGN:Animal modeling experiment.SETTING:Department of Cardiology,Zhongshan Hospital Affiliated to Fudan University.MATERIALS:Six healthy adult dogs,irrespective of gender,were purchased from Shanghai Experimental Animal Center.Aorta and great saphenous vein stapler-puncher(St.Jude corporation,USA)was used.The main improvement is to cut the plastic shell even,thin,or shorter in order to reduce the resistance when puncturing the"purse"in the fight ventficle and the interventficular septum.Sonos 5500 multifunction ultrasonoscope(Philips,USA)was used,and the frequency of the probe was between 2.5-3.5 MHz.METHODS:Experiments were performed at the Zhongshan Hospital Affiliated to Fudan University and Central Laboratory of Shanghai Institute of Cardiovascular Disease from April to July 2006(biosaflety level 2).After anaesthesia,6 adult dogs were fixed at decumbent position.The interventricular septum was punetured to make the preparation with the location of echocardiography(ECHO)by using the modified aorta and great saphenous vein proximal stapler-puncher.Animal intervention met the Animal Ethical Committee of Fudan University.MAIN OUTCOME MEASURES:One week after the surgery,transthoracic echocardiography examination was used to check the VSD site,the highest shunt flow rate,the pressure difference between both sides of the VSD,as well as pulmonary artenal pressure.RESULTS:The VSD models were successfully established in three survivals and included in the final result.Two models of IVSD and one model of MVSD were examined by ECHO one week after the surgery.The diameter of VSD ranges from 1.8 to 3.6 mm.The Peak Flow Rate of the VSD ranges between 1.8 and 4.0 m/s.The pressure difierence of both sides of the VSD ranges between 42 and 51 mm Hg.The pulmonary arterial systolic pressure ranges from 23 to 29 mm Hg.CoNCLUSION:Located by the ECHO,it is possible to establish animal models of the IVSD and MVSD with the modified aorta and great saphenous vein proximal stapler-puncher.