Coronary ostial stenosis after aortic valvuloplasty (comprehensive aortic root and valve repair)

Han, S.W.,Kim, H.J.,Kim, S.,Ryu, K.H. Springer International ; Springer-Verlag New York 2009 European journal of cardio-thoracic surgery Vol.35 No.6

Comprehensive aortic root and valve repair (CARVAR) surgery using specially designed aortic rings was introduced as a new surgical technique for aortic valve disease. We present five consecutive cases of iatrogenic coronary ostial stenosis after CARVAR surgery in patients with aortic stenosis. The preoperative coronary angiography confirmed that all the patients had normal coronary arteries. They underwent aortic valvuloplasty by aortic leaflet extension and insertion of specially designed inner and outer rings at the level of the sinotubular junction. Within 6 months after surgery, all the patients complained of resting chest pain and dyspnea with changes of electrocardiography. Repeated coronary angiography demonstrated right coronary artery (RCA) ostial stenosis in one patient and left main (LM) ostial stenosis in the other four patients. Intravascular ultrasonography demonstrated severe ostial stenosis and extensive echogenic tissue in the extravascular area. Four patients with LM ostial disease successfully underwent coronary bypass graft surgery, and percutaneous coronary intervention with stenting was performed in one case of RCA ostial stenosis. Because the mechanism of this complication is not fully confirmed, more clinical study is required to confirm the safety issues of CARVAR surgery.

대동맥 판상부 협착증에 동반된 폐동맥 및 우심실 유출로 협착

김태우,김웅흠,고재곤 世宗醫學硏究所 1993 世宗醫學 Vol.10 No.2

전신성 홍반성 낭창에 동반된 대동맥 판막 협착증의 수술 1예

최주원,김우식,고행일,강윤경,김용인 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.7

Systemic lupus erythemotosus (SLE) is an autoimmune disorder with dermal, renal, and cardiac manifestations. It frequently has cardiovascular complications such as pericarditis, myocarditis, and valvular heart diseases. Valvular heart diseases in SLE comes mainly in the form of mitral or aortic insufficiencies. Report of aortic stenosis is extremely rare. Surgical treatments of valvular heart disease in SLE are not done frequently because of complications in other organs. Aortic stenosis developed in a 59 year-old woman with SLE, and aortic valve replacement was done successfully. 전신성 홍반성 낭창은 자가면역질환의 일종으로 피부, 신장 및 심장에 빈번히 침범하는 질환으로 알려져 있으며, 심장에서는 심외막염, 심근염 및 심장 판막 질환을 발생시킬 수 있다. 전신성 홍반성 낭창에서의 심장 판막 질환은 주로 승모판막 및 대동맥 판막 폐쇄부전증인 것으로 알려져 있으며, 대동맥 판막의 협착증이 보고는 극히 적었다. 또한, 판막성 심장 질환이 발생하여도 다른 장기의 손상으로 인하여 수술을 받는 경우는 매우 드물며 국내 보고도 확인되지 않았다. 저자들은 전신성 홍반성 낭창으로 받아오던 59세 여자 환자에게서 대동맥 판막 협착증이 발생하였으며 이를 수술 치험하였기에 보고하는 바이다.

Multimodality Imaging for the Assessment of Severe Aortic Stenosis

박성지,Marc R. Dweck 한국심초음파학회 2019 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.27 No.4

Aortic stenosis is the most common type of valvular heart disease. Aortic stenosis is characterized both by progressive valve narrowing and the left ventricular remodeling response that ensues. In aortic stenosis, therapeutic decision essentially depends on symptomatic status, stenosis severity, and status of left ventricular systolic function. Imaging is fundamental for the initial diagnostic work-up, follow-up, and selection of the optimal timing and type of intervention. Noninvasive imaging has played a pivotal role in enhancing our understanding of the complex pathophysiology underlying aortic stenosis, as well as disease progression in both the valve and myocardium. The present review provides the application of multimodality imaging in aortic stenosis.

퇴행성 대동맥판 협착증의 중증도 평가: 증례보고 3례

김성희,Kim, Sung-Hee 대한임상검사과학회 2019 대한임상검사과학회지(KJCLS) Vol.51 No.2

노령 인구의 기대 수명이 증가함에 따라 퇴행성 판막 질환이 많아지고 있다. 류마티스성 판막 질환인 승모판 협착증과 대동맥판 역류가 점차적으로 감소하고 석회화된 퇴행성 대동맥판 협착증, 승모판 탈출증 및 허혈성 심장 질환으로 인한 승모판막 폐쇄 부전의 빈도가 증가하고 있다. 심장초음파는 심장판막질환의 진단은 물론, 치료방법 및 수술 시기와 더불어 예후 평가에서도 매우 중요한 도구이며, 판막질환을 평가할 때 모든 판막을 자세하게 관찰하는 이면성 심장초음파가 우선해야 한다. 흔히 접하는 퇴행성 판막질환에 대한 이해와 함께 임상적 특성을 파악하여 심장초음파를 정확하게 시행하는 것이 가장 중요하다. 아울러 대동맥판 협착증의 중증도 평가가 수술적 적응증을 판단하는 데 꼭 필요한 검사인만큼 정확한 판단 기준에 따라 평가하여 환자의 정확한 진단 및 치료가 이루어지도록 해야 한다. 퇴행성 대동맥판 협착증 환자 3례를 통해 심장초음파 검사의 중증도 평가를 쉽게 이해할 수 있기를 바라며 퇴행성 판막 질환의 심초음파 소견을 숙지하는 것이 심장초음파검사를 정확하게 수행하는 것에 수반되어야할 것으로 사료된다. The incidence of degenerative valve disease also increasing with the increasing life expectancy of the elderly population. Rheumatic valve disease is decreasing gradually and the incidence of calcified degenerative aortic stenosis (AS) is growing. Echocardiography is a very important tool for evaluating the prognosis and treatment method as well as the time of operation and diagnosis of heart valve disease. When evaluating valvular heart disease, 2-dimensional echocardiography, which observes all heart valves in detail, should take precedence. Understanding the clinical findings of degenerative valve disease and performing precise echocardiography are extremely important. In addition, an assessment of the severity of aortic stenosis is necessary to determine the surgical indications. An assessment of the severity by echocardiography was explained with three cases of degenerative aortic stenosis. To perform echocardiography accurately, it is necessary to understand degenerative valve disease and its clinical findings accurately.

Antihypertensive Treatment in Severe Aortic Stenosis

강태수,박성하 한국심초음파학회 2018 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.26 No.2

Previously, antihypertensive treatment in severe aortic stenosis was considered a relativecontraindication. However, recent studies have shown that antihypertensive treatment maybe safe and even beneficial in terms of reducing the progression of left ventricular pressureoverload and even retarding the progression of valvular aortic stenosis. To date, no randomizedclinical trials have been performed and no definite treatment guideline exist for the properantihypertensive regimens. Antihypertensive treatment with β-blockers has generally beenavoided in patients with severe aortic stenosis (AS) due to the concerns for inducing leftventricular dysfunction and hemodynamic compromise in the presence of severe outflow tractobstruction. Although it remains unclear whether antihypertensive treatment with a β-blockeris associated with increased risk of cardiovascular events in patients with AS, recent studies haveshown that the use of β-blockers may be safe and may even be beneficial. Renin-angiotensinsystem (RAS) are upregulated in AS and have been shown to be involved in valve calcificationand progression in both experimental models and in human trials. As such, theoretically, RASinhibition would have benefit in retarding the progression of valvular stenosis as well as havebenefit in left ventricle remodeling. Recent clinical studies are indeed showing that use of RASinhibition may be beneficial in patients with AS. Future clinical trials to establish the ideal targetblood pressure and antihypertensive regimens in severe AS is essential.

The First Successful Transapical Aortic Valve Implant in Korea

정동섭,박표원,최민석,성기익,김욱성,이영탁,권현철,최승혁,박성지,이상민 대한의학회 2011 Journal of Korean medical science Vol.26 No.4

Transcatheter aortic valve implantation is an alternative to open heart surgery in high risk patients with severe aortic stenosis. High mortality and complications related to cardiopulmonary bypass for conventional open heart surgery can be avoided with this new less invasive technique. In case of concomitant severe arterial disease, the transapical approach is recommended rather than transfemoral access. An 80-yr-old man with symptomatic aortic stenosis and who had very high surgical risk factors such as diabetes mellitus, hypertension, a history of stroke, bronchial asthma including poor pulmonary function and hepatocellular carcinoma was treated with a transapical aortic valve replacement. The expected mortality in this patient was 25.4% by Euroscore if we performed the conventional aortic valve surgery. The patient was discharged and was well at the 45 follow-up days. We report the first case of successful transcatheter transapical aortic valve implantation which is available recently in Korea.

Evaluation of plasma N-terminal pro-brain natriuretic peptide and troponin I concentrations in dogs with congenital ventricular outflow tract stenosis

Kim, Gye-Dong,Suh, Sang-IL,Park, In-Chul,Hyun, Changbaig The Korean Society of Veterinary Science 2016 大韓獸醫學會誌 Vol.56 No.4

This study evaluated the levels of cardiac biomarkers in dogs with either pulmonic stenosis or aortic stenosis and the correlation between biomarkers and the severity of stenosis assessed by the echocardiography. To achieve this study goal, 38 dogs (10 healthy control dogs, 15 dogs with pulmonic stenosis and 13 dogs with aortic stenosis) were examined. The jet velocity and pressure gradient in this study population were measured by echocardiographic estimation, after which the study group was subdivided by the severity of stenosis. The plasma cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in this study group. The median concentrations of cTnI and NT-proBNP of the disease group were significantly higher than those of the control group, and these increased gradually as stenosis worsened. The severity of stenosis and the concentrations of cTnI and NT-porBNP were also found to be significantly correlated. Finally, the plasma cTnI and NT-proBNP tests were found to beneficial for differentiating clinical patients, predicting the progression of disease, and monitoring the outcome of interventional therapy for stenosis.

Aortic Valve Replacement for Aortic Stenosis and Concomitant Coronary Artery Bypass: Long-term Outcomes and Predictors of Mortality

Won-Chul Cho,유동곤,김준범,이재원,주석중,Sung-Ho Jung,정철현 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.2

Background: We evaluated the surgical results and predictors of long-term survival in patients who underwent coronary artery bypass grafting (CABG) at the time of an aortic valve replacement (AVR) due to aortic stenosis. Materials and Methods: Between January 1990 and December 2009, 183 consecutive patients underwent CABG and concomitant aortic valve replacement for aortic stenosis. The mean follow-up period was 59.8±3.3 months and follow-up was possible in 98.3% of cases. Predictors of mortality were determined by Cox regression analysis. Results: There were 5 (2.7%) in-hospital deaths. Follow-up of the in-hospital survivors documented late survival rates of 91.5%, 74.8%, and 59.6% at 1, 5, and 10 postoperative years, respectively. Age (p<0.001), a glomerular filtration rate (GFR) less than 60 mL/min (p=0.006), and left ventricular (LV) mass (p<0.001) were significant predictors of mortality in the multivariate analysis. Conclusion: The surgical results and long-term survival of aortic valve replacement with concomitant CABG in patients with aortic stenosis and coronary artery disease were acceptable. Age, a GFR less than 60 mL/min, and LV mass were significant predictors of mortality.

Mass Reduction and Functional Improvement of the Left Ventricle after Aortic Valve Replacement for Degenerative Aortic Stenosis

Sumin Shin,Pyo Won Park,Woo-Sik Han,Ki Ick Sung,Wook Sung Kim,Young Tak Lee 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.6

Left ventricular (LV) hypertrophy caused by aortic valve stenosis (AS) leads to cardiovascular morbidity and mortality. We sought to determine whether aortic valve replacement (AVR) decreases LV mass and improves LV function. Materials and Methods: Retrospective review for 358 consecutive patients, who underwent aortic valve replacement for degenerative AS between January 1995 and December 2008, was performed. There were 230 men and 128 women, and their age at operation was 63.2±10 years (30∼85 years). Results: There was no in-hospital mortality, and mean follow-up duration after discharge was 48.9 months (2∼167 months). Immediate postoperative echocardiography revealed that LV mass index and mean gradient across the aortic valve decreased significantly (p<0.001), and LV mass continued to decrease during the follow-up period (p<0.001). LV ejection fraction (EF) temporarily decreased postoperatively (p<0.001), but LV function recovered immediately and continued to improve with a significant difference between preoperative and postoperative EF (p<0.001). There were 15 late deaths during the follow-up period, and overall survival at 5 and 10 years were 94% and 90%, respectively. On multivariable analysis, age at operation (p=0.008), concomitant coronary bypass surgery (p<0.003), lower preoperative LVEF (<40%) (p=0.0018), and higher EUROScore (>7) (p=0.045) were risk factors for late death. Conclusion: After AVR for degenerative AS, reduction of left ventricular mass and improvement of left ventricular function continue late after operation.